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At the heart of general practice since 1960

Do we really need GPs at all?

Copperfield

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I’m staring at myself in the mirror. Never a good idea at my age, particularly when you have the metaphorical grime and grind of years at the coalface to aggravate the sags and wrinkles. But I’ve come over all introspective about the GP’s role, and there’s no better way to reflect than to take a long, hard look at yourself. And what I see is shocking.

This bout of soul-searching has been prompted by a couple of local innovations. One is the enthusiastic embrace of ‘signposting’. Apparently, this means our telephonists will grill patients wanting an appointment to see if they can be directed elsewhere – to pharmacist, to podiatrist, to priest – to anywhere, in fact, except to us hard-pressed GPs.

The other is the announcement that our CCG is setting up an acute visiting service, to relieve us of that particularly stressful, time-consuming and disruptive responsibility.

Naturally, this has led to an outbreak of back slapping, high fives and jumping for joy. So why, amid the popping of champagne corks, do I feel a weird and rising nausea?

The more I ponder, the more I realise this is a classic case of ‘careful what you wish for’

Consider this. Over the years, many other areas of our work have been deconstructed and hived off, by default or design. Out-of-hours went long ago and certainly no regrets there. Palliative care leaves me redundant given that terminally ill patients can’t move for end-of-life services, Macmillan nurses and rapid-response teams. Even my gatekeeper role is diminishing: patients can self-refer to psychological therapies and CAMHS, our musculoskeletal triage service has led to an all-you-can-treat approach and the cancer referral hurdles are now set so low as to verge on open access.

Acute illness? That’s seen by advanced nurse practitioners and pharmacists. Chronic disease and multimorbidity? Nurse-run chronic disease clinics or the community nurse specialists. Maternity? Direct access to the midwives. Dementia meltdown? Phone the dementia intensive support team. Problems making sense of hospital appointments/tests/consultant? Go directly to PALS. And so on ad infinitum.

And the more I ponder, the more I realise this is a classic case of ‘careful what you wish for’. We thought we were pitching for heaven and we may have ended up in hell. Because, for the first time ever, you could look out over the vast primary care landscape and ask, with some justification, do we really need GPs at all?

The obvious answer is to point out that, despite all this dilution and disintegration of our role, our surgeries remain full to bursting. Then again, work always expands to fill the space available.

So maybe it’s better to highlight that the reconstructed, aka traditional, GP would do all of the above, brilliantly, knowledgeably and with continuity, in a fraction of the time and at a fraction of the cost of this fragmented new world. That was always our USP and incontrovertible justification for our existence. But it’s too late now: the direction of travel is clear and irreversible.

Which explains the shocking thing I see when I look in the mirror: absolutely nothing.

Dr Tony Copperfield is a GP in Essex 

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Readers' comments (10)

  • Cobblers

    No 'reflection' in the mirror? You're done my son! Failed appraisal. One of the GP Undead doomed to wander the dark NHS corridors for eternity.

    On the plus side Buffy might take an interest in you in sharing a stake.

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  • Whilst it is true that GP does all, cheaper, faster etc, the truth is that we are swamped by the stuff that we actually don't need to see.

    Even if you take all the stuff that we don't need to see away from us, there is still plenty more stuff to be getting on with being a GP.

    So, I do welcome all these initiatives. However, I have yet to see any evidence of any of them working, because it is still too deeply ingrained in society, and indeed other NHS workers, that everyone needs to 'see the GP' (often urgently).

    So, don't worry Copperfield, not much chance yet of disappearing up our own proverbials in a whiff of smoke...

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  • They still need us to write fit notes and write those letters to support rehousing

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  • My indemnity bill tells me I’m doing something that requires high levels of medical rigour.

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  • Don't worry, the acute visiting service won't last long. Our local CCG trialled it for 2 years and then decommissioned it as it was not cost-effective. The CCG also pointed out that "GPs are already paid to do visits in their core contract". I personally loved the visiting service and did not miss the "stressful, time-consuming and disruptive" acute visits.

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  • No, no need at all

    If you want to escalate costs and complaints, needlessly investigate the worried well, refuse to see/supporting patients who aren't cost-effective and tip them into other expensive services such as social care etc etc

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  • Touch screen ATM-like machines outside the front door of the surgery would print sick lines of the patient's choice, and next to them would be antibiotic dispensers. GPs would then be relieved of their duties and would take up more useful hospital work. Meantime in the surgery a power struggle would erupt between the nurses, pharmacists, physios, social workers, counsellors, podiatrists et al as to who was to drive the ship. The managers would divide and rule and multiply as never before.

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  • Agree totally, we can do without GPs, but only at a massive increase in money costs AND the cost to those who do not get good health care when GPs are gone.

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  • sorry to disagree.... GPs are the part of primary care that are still going strong and massively valued by patients. Everyone else comes and goes at great expense and little effect. CCGs role is to change things around endlessly till we arrive back where we started.
    Do you know anyone in the community or management that lasts a decade let alone 30 years??
    Community services are becoming so fractionated into different groups with their 'silo working' that the poor patient desperately needs a personal GP to give continuity and reassurance.
    I personally think 'noctors' are not the answer. Instead we need GPs who can rattle through the dross quickly to give more time for those who really need it.

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  • " rattle through the dross"
    Oh dear...sometimes I despair of my GP colleagues and have to side with the Daily Mail.
    Ranks alongside Hillary's "deplorables" comment.

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