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A faulty production line

'Sharing the load' seems to mean dumping work on GPs

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They say that the evacuated waste products of life rotate towards the place where gravity can exert its force, or words to that effect.

And thus, fresh from a teaching evening by a secondary care colleague, I sleep soundly having heard them wax lyrical about working together, working efficiently, sharing the load.

We cannot say no

Fast forward one week. Hidden amongst my many emails and offers of 'hot mums' (I subscribe to a menopause newsletter) is a small notice to GPs from the said colleague.

'Dear comrades,' it reads, 'We have reviewed our policy in line with the CCG's recommendation and will no longer be monitoring or prescribing this specialist drug. We would kindly ask you to do it. We know it will result in increased workload for you but frankly my dear, I don't give a damn' (paraphrased for clarity).

A few murmurs are heard the next day over coffee and someone mentions the LMC, but deep down we all know what's going to happen. If secondary care, or a dentist, or social services or any and many other services don't or won't do something, the silent expectation is that general practice will.

Given that we are named and responsible for our patients, and we are the most accessible form of comprehensive health care despite what the headlines say, the buck inevitably stops with us. Other services are fortunate that if they say no, there are GPs to pick up the work. Other services know if they don't do something, the onus of responsibility appears to fall back on the GP to figure out what to do next.

We cannot say no - properly - because if we say no patients have nowhere else to go. Say no to prescribing the specialist medication? Sorry mate, your condition is going to have to get a lot worse whilst we sort out this ridiculous situation. And seeing as my patients really are my priority, I'm probably going to add this prescription to my dentist-cum-social worker-cum-occupational therapist hat.

We are therefore not bearing the load, we are the foundation. And if the foundation fails, the house tumbles. 

Dr Danny Chapman is a locum GP in east and south Devon 

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Readers' comments (5)

  • I'm sorry Danny.
    But you are a specialist too- in general practice.
    As much as I sympathise with the patients on this, you have to say no.
    And tell them exactly why you are not prescribing specialist medication that a specialist/dentist etc should be prescribing.
    Let them answer why they are not caring for them.

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  • National Hopeless Service

    It is this sort of attitude that has partly got us into this mess. One of our hospitals is now insisting for 2 week wait referrals we email a referral letter AND fill in a pro forma form which does nothing more than duplicate work and hence increase work. I have steadfastly refused and had some heated discussions with hospital managers but guess what... all other GPs have 'agreed' to it. Keep self flagellating.

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  • With respect you are completely wrong.

    We have a contract. This falls outside of that contract therefore we should say no. Then it is up to the CCG to commission the service.

    Why would you do it for free ? It would detriment your existing ability to care for patients and affect the viability of your business. It is a new world I am afraid and we have to think as a business to be able to survive.

    Also are you an expert in this drug, you can imagine that if there was a problem the wolves would go for you. Therefore it also increases you clinical risk.

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  • We can only prescribe within our knowledge and safety. What is specialist [ it is simple, I just cannot know every specialty completely ] prescription is just that.
    I would not, not ever take a chance, damage a patient and land up before the GMC and loose my right to practice.

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  • AlanAlmond

    The point being made is that secondary care is becoming expert in managing their work load by refusing to see people or placing onerous conditions on potential referrals. We cant do that. The only part of secondary care that cant control who books to see them is a&e and look what a mess that is in. Anyone can book an appointment to see a GP for anything and we basically have to see them. Secondary care? ...ummmm 'i'm sorry but you don fulfil the current criteria and we don't have funding to deal with that particular kind of issue anymore, and anyway you haven't filled in our new form...besides which I'm really a little too busy anyhow , why don't you go and see ....a GP?'
    Cut backs in secondary care = work dumped into primary care. simple. issues don't magically disappear when a hospital stops providing a service...people just have to make do with a GP instead, even if the GP cant do diddly squat they still come in to talk about it and tell you how unhappy they are you cant do anything for them.

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