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GPs go forth

We need to tell the time wasters to bugger off

Dr Katie Musgrave

Legend has it that once upon a time, a GP in South Devon got so frustrated with his patients that he stormed into the waiting room bellowing ‘If you’re not seriously ill, I want you to leave my surgery immediately!'

You can imagine the response in the present day. Smartphones would be seized. Teenagers would be weeping in the corner. The footage would go viral. All over the country, we’d hear horrified commentators lambasting the doctor’s insensitivity, like ‘How could he ask the poor, innocent patients to leave him alone?’

But, don’t we, in our heart of hearts, regularly share this doctor’s frustration? I’ve been a GP trainee for a few years now. Among many presentations of unwell patients, I regularly see a plethora of totally insignificant problems, that should never get anywhere near a doctor. I’d hazard a guess that on a given day, fewer than half of my patients will have a genuine medical need. 

The others present with a range of minutiae, fairly implausible-sounding health anxieties, or social problems (which I’m ill-placed to help with).

Sorting through these patients, and establishing that they don’t actually need to see a doctor, is a tiring and complicated business, especially as amongst them will occasionally lie an unexpected cancer diagnosis, or a heart attack you didn’t see coming.

Recent examples include the patient who came in worried that her toenails were stained yellow after she removed her nail varnish, and another who asked if I could offer advice on hair dye to cover her greys.

A particular highlight was a 30-something-year-old man who asked if I would mind squeezing a spot on his back that he couldn’t reach. He didn’t know who else to ask… We all have examples of such consultations.

I fear I’ll find that little old lady dead in the corner

These stories might be amusing, if it wasn’t also true that many genuinely ill people now struggle to get a GP appointment

Waiting times are so long in many places that patients are undoubtedly coming to harm, or inappropriately using A&E services

I remember a day when, running behind in my surgery, I had a delightful older lady wander in, clutching her chest. She’d been quietly having a myocardial infarction in the waiting room, while I was busy dealing with a teenager who’d been having tantrums over his PlayStation. This isn’t a joke. Those who need our help are left suffering for our lack of action.

The founding principle of the NHS of being free at the point of access has been so abused that we desperately need to address the situation.

Too many now believe that the NHS is worthless - on hand to jump at their every whim. A very small fee, for taxpayers who could afford it, might go some way in encouraging people to think twice before consulting their doctor.

Perhaps this fee would be charged at both GP surgeries and A&E departments. It wouldn’t be the end of the world - we don’t view prescription charges as threatening Nye Bevan’s principles in founding the NHS.

Likewise, a small financial disincentive to working age adults might encourage them to appropriately value their GP’s time. If patients sought advice from a family member or read NHS Choices instead of booking an unnecessary GP appointment, we might regain the capacity to manage those patients who are in genuine need of medical care. 

After all, free at the point of use is worthless if those who need the service can’t access it.

I genuinely fear that if someone doesn’t go into the waiting room and have a stern word with the patients, before long, I’ll find that little old lady dead in the corner.

Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West

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Readers' comments (72)

  • I am left wondering:

    1. Why you are blaming patients for your poor access system?

    2. Why you think a nominal fee won't have the same exemptions as prescription charges?

    3. Whether you are in the right job?

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  • Populist is an interesting term of abuse used by some when the disagree.
    populist -strive to appeal to ordinary people who feel their CONCERNS are disregarded by the established elite groups.

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  • Katie it is refreshing to see someone young have such a mature view of the state of affairs. of course if it is free you ain't going to value it and you are not going to bother to learn the skills of dealing with minor illness. eg . Why are people advised to ask pharmacists for medical advice ? Just do home remedies like your grand parents used to. eg. Now I feel happy when a child sees me for an urti with symptoms since one week which was the norm about 20 yrs ago because now it is usually cough since one day and that is after seeing OOH the previous night. Everyone is so anxious now , thanks to the media and the NHS is free , so why wait?

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  • Dear Shaba
    Are any of us in the right job in the UK? Katie is not blaming patients as such, merely pointing out the fact that our role as filters and gatekeepers has become increasingly difficult due to society's much lower thresholds for presenting than previous generations.... In terms of nominal fee, have you any suggestions for how to improve funding since we are purely reliant on HMG who only release relatively small pots with lots of strings attached? Then take the money away (Not the work) leaving us with more work for less money. In the Uk there is a monopoly employer who keeps dictating the terms unilaterally... that is an abusive relationship Shaba - if you make comparisons to Domestic violence- so how are you going to attract people into this job? Colouring books, wellness journals and chocolate coins' a-la' RCGP are a complete joke to young professionals. Do you think my nephew who's starting off on 150k in his 20's is thinking...."oh I wish Id done general practice?' I think very rationally Katie is trying to address the huge problems we face.... asking her if she is in the right profession is more likely to encourage her to leave..... once she has taken time to reflect and realise she is being 'done over' compared to other specialities. Rather than criticise her, like Ivan, perhaps you would both do well to ponder why young trainees are feeling like this? Shaba if General practice is such a good job and Katie has it so wrong how come we have the highest burnout rates? Most doctors agree they can't do General practice full time compared to other specialities (Hence the rise of the portfolio GP so they can get out of the trenches and away from the coalface...not exactly what the public needs is it?), we have the lowest remuneration and the poorest public image in the press. Katie is merely asking the questions that society needs to answer if they want a free at point of use NHS to continue. Doctor blaming is NOT going to resolve the issues of relentless demand and blame. I can see that Katie has insight into the problem.... I concur with her observations, my solution was to move to Australia as I could see the UK leaders were quite frankly incapable or unwilling to tackle the decreasing thresholds for presentation. I have a much more interesting and well paid job now..... so Shaba why should anyone in my situation come back to the UK? Someone like Katie who is young, bright and intelligent and obviously wanting to problem solve would be welcomed here...... perhaps she should leave, in fact I think she should, I dont think she should be abused by the current system, I dont think she should be expected to sacrifice her life to keep others who want everything for nothing happy, she should have a rewarding career and be properly remunerated. So I do agree with you Shaba, but not in the way you intended. Finish your training Katie and come to a country where you are valued.... or perhaps look at Canada. Actually I have a colleague here who works between OZ and Canada and he is having the time of his life, his life is a mix of ski fields and scuba between clinical sessions...... or you can wait around in the UK for your next NHS/RCGP bonus........

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  • Dear Shaba
    You’re very welcome to my chocolate coins, colouring books etc

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  • Curious excellent response to the portfolio 2-3 session brigade of cardies.GP in th UK is dead and is beyond resuscitation.Its just making the jerking motion of a caught mackerel now.Even if it was put back in the sea to late its dead.Our senior commentators are just giving of the gaseous emissions of a decomposing corpse.The last 10 years have done too much.Good look in Aus and any young buck who can get out of the UK needs to get out asap its toxic for medics.

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  • To everyone asking if Dr Musgrave is in the correct profeddion.

    You do realise almost every junior doctor I've met regrets their career choice.

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  • Doesn`t everyone do this?

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  • More time is wasted by the rest of the NHS ‘family’ than patients themselves.

    Bounced referrals, crap discharges, work dumping etc is endless.

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  • Cobblers

    Katie I can't let this go without giving you my support and saying you are in the majority in terms of your views.

    A GPs job can be wonderful but just not in the UK, for now.

    I see even Shaba decides to have a poke. You kick puppies for fun Shaba?

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