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The waiting game

Covid-19, NHS diktats 20


If you’ve had the feeling that general practice is driving down route Covid-19 without a clear sense of direction, relax. Because this week’s events should help us get our bearings.

To remind you: last Wednesday, we were told that the key elements of the Enhanced Health in Care Homes PCN DES were being brought forward from October to May.

The next day, that was corrected along the lines that, actually, this wasn’t the PCN DES at all, but ‘clinical guidance’.

And the day after that came an official communication stating that, while this guidance might not be the PCN DES per se, it would be better delivered as if it was, and it’s expected to morph into it anyway. Oh, and you’ve got two weeks to sort it out.

So I hope that’s clear now. What’s also clear is it’s not only Covid that comes in waves, it’s also government policy. Last week it was virus testing. This week it has been care homes. Next week, it’ll be something else (I’m guessing, ‘mental health’). These obsessions seem less driven by facts and strategy than by whimsy, public opinion and, latterly, opportunism (care homes don’t look good -> PCNs are taking them over in six months aren’t they? -> bring this forward to now -> care homes, tick -> now, what shall we do about everyone going mental?).

I’m getting fed up with the implication that general practice must be twiddling its thumbs

And while government might seem ultra-focused on this week’s task for general practice, it seems confused about how to implement it – or, at least, is implementing it in a confusing way, blurring (possibly deliberately) the lines between moral duty, contract and DES.

I have so far been pretty sympathetic about the government’s handling of the pandemic, and still am, to be honest – it’s trying to do the impossible with the inconceivable. But I am getting fed up not just with the deluge of guidelines and deadlines, but also with the implication that general practice must be twiddling its thumbs, and so needs micromanaging into delivering the political agenda of the day. As we’ve seen with shielding lists and 111 direct booking, this leads to repeated diktats, impossible demands and infuriating backpedalling.

The fact is, we GPs are busy – with Covid, with the rest of primary care and with reinventing our entire modus operandi. Plus we need the flexibility to fill in when our staff are ill or self isolating, and the resilience to cope with the tsunami of work which will follow when Covid backs off.

We’re good at this. And we’re also good at spotting and solving the local pinch points caused by the current crisis. So nag us from the back seat if you must. But please take your hands off the steering wheel.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at

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Readers' comments (5)

  • A perfect analysis of NHSE thought processes!

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  • If only we could gaffer tape them and put them in the boot instead.....

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  • We don't need these dictats. The most successful changes occur due to need and are driven by the front-line as a response to this. I am not doing video calls because I was told too - in fact when we were told we may have to I felt resistance to this.

    Ask practices how they can best help nursing homes and let them get on with doing this the best they can. If they need PCN support then let the PCNs decide how to do this and scrap all the nonsense in the DES that tbh is just there to pad it out and make sure that NHSE gets 'value for money'

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  • "So nag us from the back seat if you must. But please take your hands off the steering wheel."

    Keep begging Cops, you know it won't happen when the money comes from them...

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  • The 'boss' should consider loperamide before overflowing beige emails are sent.

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