This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

Another zombie policy to cap it all off


copperfield duo 1500x1000px

I know it seemed like a good idea at the time. But one of the (many) arguments I could make against the concept of GP workload capping is this. If I was a casualty consultant observing our efforts to somehow coax a bung into the volcano, I’d be thinking, with a mixture of bemusement and indignation, hang on, what’s so special about you guys – OK, general practice may be about to topple over, but A&E is on the brink, too, where do you think your patient overflow will end up and, when push comes to shove, where does the ‘dangerous when overworked’ argument stack up most effectively, A&E or general practice?

But I won’t. Because the point I really want to make is that it was ironic having, at the BMA ARM, that motion about capping patient workload to preserve our ‘sanity’  juxtaposed with another motion suggesting we should charge patients for appointments

The latter is an idea that has been kicking around for years, which rears its ugly head every so often and which gets voted down every time. Whereas the former is a new idea which everyone is very excited about and which has just been given the voting thumbs up. So, chalk and cheese? Nope. In fact, both send exactly the same message: the NHS in general, and GPs in particular, would be fine if it wasn’t for those pesky patients booking appointments and spoiling it for everyone else, especially us. They also have in common the fact that they are both superficially attractive yet completely unworkable.

In our practice, total annual appointments wasted by DNAs equated to roughly a FTE doctor

So why doesn’t the BMA learn from the one (appointment charges, which never gets off the ground) and therefore stop wasting energy on the other (workload caps, which never will either)? Or are we to face, as we do with the appointment charges concept, intermittent zombie-like reappearances of the workload cap idea which we can blast to smithereens but not, it seems to oblivion?

Alternatively, how about combining both concepts into something workable? In our practice, some back-of-the-envelope maths shows that the total number of annual appointments wasted by DNAs equated to roughly a FTE doctor. So, how about we charge for DNAs rather than charging attendees? That’ll satisfy those punitive urges and significantly ease workload by cutting appointment wastage in the future. Job done. And we’d still be able to look our casualty colleagues in the eye – probably quite useful when you pitch up with your workload-induced infarct.

Dr Tony Copperfield is a jobbing GP in Essex


Related images

  • copperfield duo 1500x1000px

Rate this article  (4.27 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (10)

  • This just hits the nail on the head...

    Unsuitable or offensive? Report this comment

  • But charging for DNAs might reduce the number of DNAs.

    And then when would I do my paperwork?

    Unsuitable or offensive? Report this comment

  • Why should EVERY other person in the nhs get their workload capped except us? At least in ED, miserable as it is, they are shift based. If you said “you’re responsible for everyone who chooses to attend between 8:00 to 18:30 by phone, face to face or needing a visit even if you finish at 10pm” they’d laugh at you. Demand is now excessive, so the workload needs capping, or primary care fails because potential recruits see it for the hell hole it is.

    Unsuitable or offensive? Report this comment

  • I don't mind any DNAs. It gives me a chance to do one of the umpteen telephone consults that are added to the end of the list. Who are these people that are getting bothered about dna's? We do not get paid per consult you know.

    Unsuitable or offensive? Report this comment

  • But we can’t accept unlimited workload on limited (actually meagre) resources. Something has to give, and it shouldn’t be the health and sanity of the GPs.
    At the moment they give us too little resource then blame us publicly when we can’t see everyone and everything. To avoid that we and our staff work far beyond reasonable levels. I have on average 40+ patient contacts a day. Does anyone know what an a and E consultant or junior sees? Or a consultant psychiatrist? I do (I am a VTS PD as well and my trainees tell me) - and our workload doesn’t really compare favourably.
    If the patient attends A and E, the hospital is paid for it, and can use the money to employ staff. It wouldn’t be a good or cost-effective use of NHS resources, but if the government want good and cost effective care they should instead invest the money in general practice.

    Unsuitable or offensive? Report this comment

  • As mentioned above charging for DNAs will only ensure they turn up however wasteful for both GP and patient. However the 'while I'm here Dr' banal questions will increase. In terms of increasing efficiency I think the DNAs are already factored in for most of us - still don't get a coffee break and these allow for the inevitable overruns. So charge to make an appointment, return fee if they turn up or cancel more than 24 hours before. Otherwise keep the £s! Not as ludicrous as it sounds as it would put the ball very much more in the patients court.

    Unsuitable or offensive? Report this comment

  • I look at it this way; the five-year forward view was the death knell for individual practices.
    To do this they will only give extra resources to a locality approach and individual practice.
    We have to develop a bunker mentality if we want to preserve our practices. At least for now we are protected by the national contract.
    Therefore setting a limit to how many patients we can see makes perfect sense because they are setting a limit to our growth, while not allowing us to shut our lists.
    Ironically this will only work if we cooperate with other practices within the locality.
    Let's hope the extra funding comes from outside our national contract.

    Unsuitable or offensive? Report this comment

  • My dentist tells me that dentists are allowed to charge non-attenders but guess what? Those who DNA also don't pay their non-attendance fee and it simply isn't worth the hassle chasing it up.

    Unsuitable or offensive? Report this comment

  • Macaque

    You have wasted your time writing this Dr Copperfield!

    Unsuitable or offensive? Report this comment

  • Why is it unworkable to charge for services? Water company, petrol station, architects, solicitors, food vendors, dentists, butchers, bakers etc etc etc etc all manage to do this.

    Is the UK medical profession completely ignorant of where charges occur in Europe and the better outcomes (hard outcomes such as not dying from cancer) compared to the UK?

    Unsuitable or offensive? Report this comment

Have your say