Get me some adrenaline, I feel a petition coming on...
For reasons I won’t bore you with, I’m allergic to petitions. So, to avoid anaphylaxis, adrenaline etc, I usually avoid them. Still, a petition for safe working hours in general practice? Surely a no-brainer?
Sure. Except some might say that a petition about controlling GP workload generated by an NHS GP who also runs a private home visiting service employing other NHS GPs has a certain irony – and that ‘some’ might include tabloid editors who aren’t that familiar with the nuances of the GP contract or how general practice works.
Plus, the petition’s demand for 15-minute appointments will, yawn, invite the predictable NHS England response that GPs can set whatever appointment lengths we damn well like, requiring us to have to respond, double yawn, that yeah, but we can only extend appointment times when workload is cut enough to give us the slack to do so.
And as for a General Practice Working Time Directive to introduce a maximum working week per month: fine in principle, but, in practice, come on, we’re not just going to down tools when the clock ticks past six, are we?
We should get the acute stuff siphoned off elsewhere, leaving us time to deal with the patients who really need it
We need ideas to match the resolve, but appointment and time caps are too fraught with problems to do the job. So how about a different approach? Such as: define and limit our responsibilities alongside the type of work rather than the hours endured or the number of appointments seen.
Sound complicated? It doesn’t need to be. Simply let patients self-define ‘urgent’ as something that has to be seen on the day – because of discomfort, distress or genuine disease. Then divert them to a local urgent care centre which would use the infrastructure and funds already available thanks to the existing various efforts which faff around the edges of our problems rather than solve them. Whereas the subacute/chronic are retained within standard general practice where continuity and wisdom count.
Result? General practice is no longer doing two jobs at the same time: the acute stuff gets siphoned off elsewhere, leaving us with the time to deal with the patients who really need it.
Yes, there are problems. Your acute care ANPs might need retraining as chronic care nurses. And general practice might become even less attractive as it turns into a multimorbidity dump – so we’d just emphasise the portfolio angle to those who’d like to maintain their acute skills with stints at the local urgent care centre.
And I probably don’t need to emphasise, except perhaps to the politicians, that the splitting off of acute care shouldn’t come with a commensurate cut in money. Remember, chaps, the idea is to fund the two roles properly rather than cram both into a single under-resourced one.
It almost makes me want to start a petition. Not easy when your tongue’s swelling.
Dr Tony Copperfield is a GP in Essex