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A faulty production line

Get some (extra dilute) saline quick... we're on black alert!


If you dilute anything to the nth degree, you end up with something that’s useless, or even worse than that. And if you don’t believe me, check out homeopathy.

I say this because it looks like liberal amounts of very cold water have been added to that good idea that’s been knocking around for a while about putting a cap on the number of appointments that a GP can reasonably see per day. Perhaps in recognition of its seismic nature and the fact that it would require major contractual rewrites, it seems to have been doused to the point of being a mere echo of itself.

What we end up with, as a result, is the notion that, hey, maybe GPs should be able declare a hospital-style black alert when ‘maximum safe capacity has been reached’ - a notion that became a motion, and has now been passed, albeit with some grunting and straining.

Apparently, this will stop people pushing us around and might act as a defence should it all go pear-shaped and the GMC get involved. Which surely begs the response, uh? Or rather, uhhhhhhh????!!!!

A black alert in hospital is based on an objective measure and leads to a specific response, as in, a) the hospital is full and b) patients are diverted elsewhere. In general practice, we have no definition of ‘full’ and we are contractually obliged to see all-comers, so the concept falls at the first hurdle. This could only be rectified by contractually clarifying and agreeing how many patients we should see per day, and where we can send the overspill, which takes us full circle back to the good but evidently non-viable idea we started with.

The alternative is to be entirely subjective about what constitutes a general practice black alert. Which, given that some practices rise to a challenge whereas other sink at the whiff of a crisis, would create enough inconsistency to render the whole concept a joke.

Besides, volunteering that we can’t cope, but being obliged to plough on regardless, is in effect a medicolegal suicide note, and one that might have an interesting effect on defence premiums. So if you really believe this Bright Idea will keep the GMC at bay, then all I can say is, here’s some essence of natrum muriaticum. Awfully good for gullibility, apparently.



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Readers' comments (2)

  • I agree. Who wants to pain a (black) target on themselves for the CQC and NHSE to choose you next for 'Improvement'?

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  • I don't thinks this idea is quite as silly as it sounds. CQC inspections tell little about what problems a practice is really having and it seems reasonable that we should flag up issues before they become mission critical. In the ideal world, being down a GP for example might attract extra resources to make up the deficit (I know pigs might fly). Black alert status could allocate more appointments at the local hub for a practices use. I appreciate there is considerable risk of moral hazard but any system can be abused and sadly the risk of extra CQC scrutiny is real. However, if we have no mechanism to quantify the extent of the GP crisis we can hardly blame the government for ignoring us. I suppose it depends if you believe earlier treatment of a problem leads to a better outcome.

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