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The risks of noctors, phoctors & mocktors

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Lying on a beach sipping an ice cold mocktail seems a distant memory to me now, with summer well and truly over. Don’t you just love the term mocktail? It’s a cocktail but without any of the alcohol. It’s a bit like ‘noctor’ – a word I’ve never been entirely sure about. Is it anyone who is not a doctor? Is it a nurse acting as a doctor? Is a ‘phoctor’ a pharmacist performing our role or an orthopaedic physiotherapist running a spinal clinic? And what of the newest addition to this lexicon – a physician associate? 

What all these professionals have in common is this – they are not medical doctors. They are highly trained and skilled professionals in their own right, and know their subject area in greater depth than us. But they are not generalists and they were never trained to manage risk and uncertainty.

We all know the impossible balancing act that is happening in primary care right now. Patient demand is escalating and GP numbers are dwindling. We can do one of two things to put this right: manage demand or increase GP numbers. As the former is political suicide and the latter entails cloning, the Government (supported by our college) has decided to increase the numbers of noctors, phoctors and mocktors (mock doctors).

If you carry the medicolegal risk of six other individuals as well as yourself, what do you do?

Just to be clear – I fully support multidisciplinary working. Our practice was one of the first in the area to employ a nurse practitioner and we also have a practice nurse partner who is worth her weight in gold (and more). My concerns lie mainly around the medicolegal risks of delegation. At the moment, the medical defence organisations are happy to cover the indemnity of the odd one or two nurses, within a group premium. However, if there are more non-doctors than doctors to cover within the group, they are certain to be less generous. And these indemnity fees are likely to be even greater than the current astronomical costs of GP indemnity because the risks will be perceived as higher. The real question is, who will pay for it? I have a sneaking suspicion it will fall on the shoulders of the partnership, unless we make a stand as a profession about indemnity fees.

So in this brave new world of general practice, we will have large super-practices run by a handful of GP partners (or more likely by Virgin) with a large salaried payroll consisting of GPs and various mocktors. As a salaried GP, you will be consulting, as usual, at 10-minute intervals. In addition, you will be answering dozens of messages flashing up on your screen as you will be supervising two trainees, two nurse practitioners, a pharmacist and a physiotherapist. Then at the end of morning surgery, you will be debriefing six other professionals before starting to wade through the blood tests and letters diverted to you as the only one who can fully interpret them.

If you carry the medicolegal risk of six other individuals as well as yourself, what do you do? Well, it’s obvious isn’t it? You go shopping for some shorts and suntan cream and buy a one-way ticket to Australia. And GP numbers will dwindle further…

 Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (76)

  • @ anonymous partner 17 October 03:25 am.
    Strange post at a strange time. I feel very sorry about the unfulfilled nature of your work. I'm a new GP and my set of specialist General skills are second to no other technical skill of a surgeon or a highly specific area skill of a Psychiatrist. It became very clear, when I recently treated a Rheumatologist.
    And I'm afraid I can't afford a horse. Not a high one, nor a little pony.

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  • And don't forget 'psychoctors', most younger clinical psychologists now have convenient 'Dr' appellations, which many insist upon using, because the previous masters degree primary accreditation course has been inflated to that of a Doctorate (ClinPsyD) without any commensurate increase in academic rigour. So be careful if you wish to refer to a 'proper doctor' in mental health services, actually win the lottery and get a positive response, you may be exposing your patients to a psychologist instead, the actual practical utility of which being immensely variable.

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  • I love this article.Like so many things that are amusing it actually says something really crucial. 'We can do one of two things to put this right: manage demand or increase GP numbers.' is the most important point, or as the CE of the Chelsea and Westminster said this week 'Reduce the menu'
    We underestimate people's ability to deal with simple medical problems with the backup of a good GP....by telephone or email. @DrMortons we aim to empower them to do this. It could reduce the burden on GPs and leave them to do the amazing job they do best which is complex detective work and continuity of care for those who need it

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  • @ 3.25am

    Have you actually read the article before posting? You appear to have completely missed the main thrust the article. I wonder if you are indeed a doctor or another GP hating troll? The article is also about GPs being medicolegally responsible for a lot of other people who are not medically qualified. Many GPs are understandably unhappy about this.

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  • Totally agree with this. As a nurse for over 30yrs it saddens me greatly to see the way 'we' are all being treated. This article brings to mind how also there are going to be more and more 'narers' being responsible for nurses duties. Whilst I totally respect carers and the work they do, we could not be without them.

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  • Absolutely agreed with a lot of the comments above . I do firmly believe that an experienced Advanced Nurse practitioner ( trained to the correct level ) can adequately and competently manage risk and uncertainty . I do find the ' worth their weight in gold ' a little condescending . Many ANPs have also stuided to very high levels , possibly equating to more than 10 years and are still developing as we all have to .
    It is about complementing each other not replacing each other and surely we need to stand together . ANPs are not doctors . I am baffled to know how pharmacists can replace GPs ? One of the above comments mentions PAs checking BPs , this made me LOL , HCAs do this .
    I am not a Noctor and resent being referred to as one ! If I had wanted to be a Doctor I would of studied medicine .
    We need more Doctors , we cannot plug the holes with these other allied professionals and believing that we can is short sighted and will eventually be shown to be unsafe and unsustainable .

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  • It is a fact of life that once you breach a principal a line in the sand then you have to endure the consequences
    We abandoned our whole patient role and started fobbing off our patients to nurses when they got chronic illnesses and all for money money money
    Goodbye our rule as whole patient Doctors and hello MANGERS !! of the patient with nurses doing the work
    Nurses are not Doctors and we have fallen hook line and sinker to the politicians ploy to have a cheap service
    Why in Gods name would any bright young Doctor want to be a GP ?

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  • I absolutely agree with this. Do not under any circumstances supervise the work of these people. They are practitioners in their own right and they can take their own responsibility.
    One of the factors that absolutely defines a doctor is taking responsibility and being accountable for their actions.
    With the MDO's taking a more detailed look of risk profiling you would have to be mad to accept the medicolegal risk for other allied health professionals

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  • OMG old fashioned territorial views are still rife..no wonder the nhs is in a shambles....work together not pull apart is the way forward

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  • Spot on Shaba s you always are. GPs are shooting themselves in the foot by agreeing to supervise a half dozen PAs..not for the money of course. Greed will make all kinds of excuses possible. This will be one of the big nails in the GPs coffin

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