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At the heart of general practice since 1960

Bah! We’re all completely scrooged

Copperfield

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I’ll admit I have been Scrooge-like lately, displaying general grouchiness, badwill to all men and women, and a grudging acceptance of the need to see the less fortunate such as the learning disabled or the mentally ill purely because of their QOF/DES potential. But still, I wasn’t expecting a visitation from the Ghost of General Practice Future.

That’s exactly what I’ve had, though. And this vision has been brought into sharp focus by the proposed new Scottish GP contract, which finally gives general practice’s current direction of travel a clear sense of destination. Apparently, we GPs are to become ‘expert medical generalists’.

True, the Scots are taking the high road of what looks like a salaried contract and the English are taking the low one of devolved power. But we’ll end up in the same place, with general agreement that the role of the modern GP is to specialise in complex cases and undifferentiated presentations.

And that’s what the Ghost of Christmas Future showed me. A Monday morning, and me dragging myself out of bed to face my daily multimorbidity clinic. My first patient has T2DM, CCF, AF, COPD, RA and CKD, which I get half an hour to wade through. All the other patients have a similar permutation, giving me a Scrabble hand of abbreviated morbidities which, if it spells anything at all, spells a morning of utter misery.

There's nothing to discuss because, while all our cases are difficult, none is interesting

At lunchtime, we have our weekly difficult/interesting case discussion. But there’s nothing to discuss because, while all our cases are difficult, none is interesting. Then we troop off to our undifferentiated illness clinics, which entail sifting through whatever our multidisciplinary team has not been able to sort out: the vague, the polysymptomatic, the unexplained and the dissatisfied. It’s like running a pain clinic where the pain is all ours.

Then the ghost shows me a grave.

Now, I do appreciate GPs like me could be accused of constant moaning. And, yes, this might be a salutary lesson in being careful what you wish for. But I guarantee a single day in this new role will have even the most expert of expert medical generalists gagging for the unpredictability, entertainment and spice of our old day job, warts and all.

Besides, this inexorable progress towards a new role makes four whopping assumptions. First, that we really will find pushing water uphill for the rest of our professional lives a sustainable option. Second, that we’ll be able to sell this to potential recruits as a viable career. Third, that the bits hived off to nurses, pharmacists et al can be done safely and cost effectively. And fourth, that our current USP of being able to do multiple things in double-quick time without bankrupting the NHS or killing too many patients is genuinely less valuable than the new USP they are trying to create.

So its a giant leap of faith to which I say, ‘Bah, humbug.’ It’s not what I trained for, not what I’m looking for and not what will make me wake up on Christmas morning a changed man.

And the words on that tombstone the ghost showed me? ‘General practitioner’.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

 

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Readers' comments (9)

  • Hyperlipidaemia, CKD and mild to moderate hypertension, 3 risk factors for disease, have now become illnesses in their own right. They are symptomless states for the most part, except for the anxiety and side effects their investigation and treatment generate, and we now have freely available NNT data to show how much time we devote to these conditions for so little return.

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  • The place I work at - I am already living the dream.

    I can vouch it is unsustainable. It will finish off the last of us who didn't mind seeing patients. We will all endeavour to be portfolio GPs that don't involve having to do clinics.

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  • We have also become geriatricians par excellence
    When I was an shot we had consultant geriatricians who looked after vast swathes if elderly complex morbidity stuff, then these consultants became stroke physicians thrombolysing every one they could get their hands on, dumped all the oldies in private nursing homes, closed the respite and instant geriatric beds and we were informed we had become the community geriatricians instead!
    No one asked me if I would like to do this and as for the funding, well you get capitation and very little else,
    Now my days centre around multiple nursing homes with highly complex patients all vying for
    My expertise and my input at a discount price to the nhs,
    Can we please have some geriatricians again and the occasional secondary care geriatric bed for the occasional patient? Please?

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  • AlanAlmond

    Yes the future is as the community geriatrician and worried well advisor/complaint handler. Spent my morning assessing a string of 89-94 year olds accompanied by their concerned pensioner child, each taking approx 50% of the allotted 10 min consultation just rising from the waiting room chair and walking super slow motion stylie into my room. Once sat down mostly concerned about being dizzy, ‘not well’ or forgetful, often living alone and needing some kind of additional social care. Everyone witj more than three chronic health conditions none of which with any prospect of resolution. Pure joy

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  • 'Not well' -have you ever given in to frustration and said, 'not being well is a pre-requisite for seeing a doctor. How about some detail?'

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  • Really looks forward to the elderly coming in and saying Im tired all the time.welcome to the club apart from I wont be getting to your grand old age.

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  • CCG offices and the DoH Whitehall office should put aside some of their grand meeting room space for these patients to drop by and spend the day having a chat with them instead. It would be more cost effective and if given tea and scones and some card table would accommodate several hundred high satisfied patients. A rota basis could be assigned if too many show up without appointments.

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  • So these guys are increasingly coming to us now anyway.

    I would rather have the minor stuff removed, see just this bunch and go home, as opposed to seeing both groups like we do now...

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  • Not the job I signed up for or wanted.We are not geriatricians.
    Glad I am leaving soon.

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