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CAMHS won't see you now

GPs are doomed to lose the only game in town


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By the time you read this, it will be too late. And if that reads a little like the beginning of a suicide note, then how apt.

Because, unless you’re a raving refusenik, a resident of Planet Zorg, or part of the escape committee tunnelling your way out of general practice, then, in the past few weeks, you will have signed up to the latest abbreviation created to crush our souls: the PCN.

Hence it being too late. And this great sign-up to the primary care networks occurred even before the blanket of brown caused by Pulse’s workload survey shitstorm had been fully mopped away. That’s the survey, you’ll recall, that revealed we are battered, bruised and desperate for help. We knew that already. But now the public does too, and they’re actually bothered by it. They don’t really care about us, of course, because overpaid stereotypes die hard, but they do now understand that if all that batter, bruising and desperation compromises their safety, then the story’s suddenly about them, not us. And if that story’s a coachload of patients driven off a cliff because the exhausted GP driver is asleep at the wheel, then that’s quite a headline.

So we create this perfect storm of professional despair, public concern and political urgency and what happens? A mass PCN sign-up, performed with a passivity that perhaps can only be explained by the irony that we’re so burned out we’re beyond noticing, caring, or both.

By now, you’ll have signed up to the latest abbreviation created to crush our souls: the PCN

Wow. What a missed opportunity to achieve meaningful change. And what a far cry from the 2016 ‘Urgent prescription for general practice’, in which the BMA suggested, among other things, a cap on consultations, 15-minute appointments, overspill hubs, a reduction in regulation and bureaucracy, an expanded workforce and an end to workload dump.

Instead, we find ourselves corralled into reluctant groups, with tiny carrots of indemnity, DES money and subsidised noctors we definitely didn’t ask for and probably don’t want, and a big stick just itching to rap our network knuckles if, despite all this ‘largesse’, we fail to deliver the NHS long-term plan.

So, three years ago, we couldn’t cope with our own jobs. Now, not only are we expected to continue as before, but we also find ourselves responsible for developing and integrating the future NHS by designing, training, staffing and running our own mini-health ecosystems. That’s in addition, of course, to finding the time to get our heads round impenetrable and hastily cobbled together VAT guidance for PCNs – which is absolutely what I spent nine years training for.

Seriously, is this what any of us really wanted? Does anyone believe it will improve the lives of GPs or patients? We’re repeatedly told: ‘It’s the only game in town.’ But it’s one we feel doomed to lose, because what else do you suppose we might ultimately have signed away as we scrawled on the PCN dotted line? Continuity of care? Independent contractor status? The traditional role of the GP? Too late. It’s no longer an urgent prescription we need. As in any case of bleak, teetering-on-the-edge, insightless despair, it’s sectioning.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield

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Readers' comments (10)

  • Goodness Coppers - I've had this low level melancholy for last few months and you have articulated why in this excellent column

    I am no longer a Partner but wild horses wouldn't get me back to doing it now - and I was really hoping there would be something in the partnership review or a new contract that would attract me back again.

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  • What did you expect Tony? Do I really have to say again what I've been saying all along?

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  • JFDI
    (or bail-out like everyone else).

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  • Have you signed up or joined the refuseniks?

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  • Sadly unless we refuse en masse, declining to opt in only risks isolating practices from any support and not all of us feel that robust at the moment.

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  • We are doomed from the word go in a health system that is not sustainable. I had someone complaining that I have not read ALL her letters....all 328 letters. So I asked her if I give her a book that is a 1/3 less, eg. 100 page long and she has to finish it in 10 min if she can do that, it has enlightened her.

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  • oh, you mean you don't have faith in our leaders?
    Im still waiting to hear from anyone (not a 'leader') who both works clinically full time and who actually thinks PCNs will make a difference to the front line.....the only ones who tell me it will be great are those who are portfolio GPs and dont really see more than a token number of patients......

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  • come to locumland, where you don't have to put up with this shit ! you can also decide what you are paid, when and where you will work, how much hols you have etc etc etc.

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  • This reminds of "ngms" that Chisholm et Al sold the government agenda of the break up of the truly GP led 24 hr contract with the slogan
    No more work without resources
    The ability to say no
    No out of hours work
    In England I see 8 to 8 7 days a week-albeit in bigger towns and cities and no individual GP responsibility but corporate liability as a member of a PCN
    If GPS think that pharmacists paramedics PAs etc want to help us they are deluded
    The end point will be less take home pay for GPs to take on responsibility for more complex cases and the actions of others
    In my experience the best work life balence I had was under the 24 hr contract working with other GPS in cooperatives
    We were in more or less total control and did not have 111 paramedics pharmacists and others dump work back to us the next day having heightened patient anxiety and expectations
    So I am with Tony
    More emperors new clothes me thinks dressed up as
    Indemnity solution
    Ashok Rayani

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  • Simon Stevens has a plan; PCNs are merely a step along the way and won't last long -CCGs will disappear too.

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