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Independents' Day

Home truths from Chesterfield

Copperfield

There will be a new and unlikely name to add to Pulse’s annual Villains of the Year list. Among the Johnsons, the Hancocks and the coronaviral pangolins, there will be the Suzannes from Chesterfields. Because, the other day, during a Government briefing, Suzanne from Chesterfield appeared to shaft we GPs. Specifically, she stated: ‘We are seeing large numbers of patients referred to the emergency department because their GP or dentist are refusing face to face consultations.’

Subsequently, Suzanne from Chesterfield was apparently unmasked as a Professor of emergency medicine at the University of Sheffield, or at least she would have been if she actually had any PPE. Cue reflex GP uproar and equally predictable ‘GPs are doing an absolutely fantastic job’ from that lovely Chris Whitty, showing that Profs can be nice, too.

And yes, Suzanne of Chesterfield, on the face of it this does appear anecdotal, lopsided and underhand, with perhaps a naive acceptance that patients might twist a lack of F2F into a surfeit of TTFO. But, like most things that induce apoplectic GP splutterings, it also contains a germ of truth.

The truth hurts, though not so much that we’d take it to A&E

Consider this. We GPs work along a spectrum. For all I know, some have coped with the Covid crisis by erecting ‘business as usual’ signs. Whereas, at the other extreme, yes, I have heard of some who really are refusing F2F – either because of ‘no PPE/no see’ or simply because that’s the way they have decided to cope.

Most of us sit somewhere between these polarities and that’s where I reckon you’d locate me. But even as a ‘moderate’, I’m aware that my opening remote consultation line is: ‘Sorry we’re having to do this by remote, but I’m sure you understand the situation.’

In other words, while I do occasionally see punters F2F, that may not be the impression I give them. And that’s the problem. Their perception is that we’re closed, or more specifically, virtually closed. Those who do ‘consult’ may not be happy with the remote outcome, and you can guess where they might end up. And if we’re honest, we’d probably admit that our new way of working will inevitably lower our threshold for bouncing people in the direction of A&E.

So the Prof has a point. A tiny part of the problem is that the remote consulting pendulum may have swung too far. And a huge part of is the public’s confusion about the current status of general practice and some dissatisfaction with its new modus operandi.

Time and tweaks will fix those – plus we have a duty to let the public know that we’re dealing with everything, as per usual, but we’re dealing with it in a different way, so make sure your phone’s charged and don’t go to the loo when I’m trying to call.

In the meantime, let’s go easy on a doubtless knackered and stressed emergency medicine prof. And admit that, hey, the truth hurts, though not so much that we’d take it to A&E.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield

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Readers' comments (20)

  • WHAT DOES A PROFESSOR OF EMERGENCY MEDICINE ACTUALLY DO-----NEVER HAD ONE WHEN I WAS A JUNIOR

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  • Sorry, rubbish article.

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  • I don’t agree either. GPs have been working hard to meet demand and yes a lot of it has been done remotely but this has been for safety reasons. Do you seriously want to have waiting rooms full of people during a pandemic? Especially since we didn’t even receive any so called PPE till quite late on in many cases. This is a virus about which we know very little and the more we learn about it the less reassured I am. And yet we still have very flippant attitudes about “getting back to normal” when we still have an average of 4000 new cases a day (recent ONS figures). They have been taking precautions (quite rightly) in AEs with PPE etc and virtually all hospital appts are being done remotely (also have they not been saying that the numbers visiting AE depts are down compared to previous years?) yet in primary care we are expected to just carry on as normal? The only reason the NHS “coped” is that everything else has been paused to deal with coronavirus.
    As you know GPs have been bringing patients in that need F2F reviews and doing home visits too. Our access to diagnostics etc is severely limited so apologies that we can’t perform MRIs and endoscopes and carry out appendicectomies etc ourselves in primary care but perhaps this could all be included in future contracts??!!
    I have to say though that so far throughout all this I have felt that secondary care colleagues have been working well with us and they have been giving advice and organising reviews via telephone and kinesis etc that has really helped with managing patients. So there are some positives (albeit not many) to come out of this.
    However, the question that was so innocently posed by S from Chesterfield was feeding into the distorted view that GPs and our dental colleagues are lazy and don’t want to see patients. This is simply not true and is an insult to all colleagues who have been working flat out during these difficult months. As a bunch we GPs are terrible at defending ourselves against such attacks and just get on with things but sometimes enough is enough!
    I would suggest you focus on how primary and secondary care can work better together through technology and other means. This pandemic is far from over and sadly with the messaging coming out of govt that has resulted in the scenes of overcrowded beaches etc (am not looking forward to seeing what happens on 4th July) that is likely to result in a rise of cases again.

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  • Agree with Tony. There are no "we" or "they" and there are bad apples, tired disillusioned doctors and burnt out working bees amongst all of us, GPs, ED staff, patients. Some tell the truth, some don't, some manipulate situations for a multitude of reasons. We all should stop whining and be afraid of complaints and be couragious in saying NO. Whose fault it all is is also equally spread between Gov patients relatives friends and doctors who don't work as one and not consistently. And let's not forget, the NHS is still comparatively good value for money for patients and they can pay extra if they are unhappy. The fear to upset and confront is a cultural two-faced concubine

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  • The A&Es have been very quiet over the past 2 months.
    Still I'm sure things will pick up on the 4th of July

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  • Try being a patient in my surgery now I've retired. My branch surgery is totally closed, apparently due to Covid, the main surgery it is attached to is 7 miles away and the phone is constantly engaged. They don't do online appointment booking either.
    As a patient I feel lost.

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  • I agree with Tony. In the last month I have had four very necessary GP contacts as a patient. All phone on the tray for telephone appointments and all with different doctors. Three related to two unconnected possible cancers. So no continuity and and a very definite impression that there could be no face to face. This flowed today by a telephone consultation with a specialist when I was informed that trust policy Re cancer investigation had changed because of Covid and against NICE guidance. That is as a retired GP. God knows what service the general public get !?

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  • I wonder if this question was her own? Did the decisive nature of the question have a political aim? At a time when general practice has massively adapted in a short space of time, managing covid and everything else while the gates to secondary care closed, her comments are harmful and ill thought out. While a minority may not be seeing anyone f2f (not that I am personally aware of anyone doing this) throughout we have seen and assessed ANYONE and everyone, covid or otherwise who needed to see a GP. If they had a stroke or cardiac sounding chest pain, they would have been sent to ED appropriately. Masking her identify like this was unprofessional and I fear she has brought our profession into disrepute.

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  • There's a limit to how "knackered" a part time professor can get though, isn't there? One or two shifts per week? month? who knows, whatever they are they will be much less "knackering" once back at home - sorry, home office - reading articles on how to manage long term conditions to avoid attendance at casualty ( see research interests:"Current studies include CLAHRC 2: avoiding admissions and attendance in patients with long term conditions")

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  • Only 1 star this week, Tony must have Covid-induced brain fog.
    NHS has been telling us to send more patient to A&E - they even have half-page adverts in the local newspaper telling patient sto go there because staff are bored with nothing to do!

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  • As a GPWSI in head,neck & facial pain I would point out that all my hospital F2F clinics are cancelled, as are all the other regional pain intervention (injection) sessions in the Pain Clinic & Rheumatology.
    A significant number of these 'high end of need' pain patients must certainly also add to the A&E figures.

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  • Having volunteered to spend a day a week that I’m not working in GP land to provide senior cover in the hospital for Covid / medical inpatients, I spoke with lots of docs of various grades including SHOs who’d stopped doing A&E Locum shifts as they were too dull with no patients to see! I’ve seen patients F2F in GP land throughout this for anyone who phone /video was suboptimal and referred as needed. Paeds consultant friend told me most of the patients weren’t examined by them - they put them in a aside room given fluid challenges and observation only and went by the GPs examination findings rather than “risk another exam”.... A&E are far from full through this pandemic and if GPs are advising people to go, it’s probably appropriate and still less than normal. Very sad that some hospital colleagues still stick a wedge in our working relationship.

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  • There are without doubt some bad apples - I’ve seen a few cases in out of hours who clearly needed an examination which their own GP declined. However the majority are doing a good job.

    There are more appropriate ways the professor could have shared her concerns - eg a phone call to the practice or discussing with the local ccg, lmc, federation etc to have a professional dialogue rather than a rant on national TV. Plenty of GPs have been working in 111 which unlike a&e has at times been busier than ever whilst dispatching fewer ambulances - the stats are clear

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  • Suzanne might have been attempting to shaft US GPs. That’s the sort of grammar that sends I mad.

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  • A&E cost top nhs per visit £200
    GP cost £25
    AED had received huge amounts of funding and has been relatively quiet. They are tooled up to deal with COVID we aren't.

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  • Dear All,
    The evidence is against her, as is the behaviour, she should apologise or resign.
    If she does not do this in equal measure to her indiscretion, i.e. on national radio, then she should be reported to the GMC and her employers.

    Regards
    Dr Paul Cundy
    GMC 2582641

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  • I wonder how many sessions in A+E the Professor does? A+E footfall has dropped by more than half. Only fools generalize. I have not sent anyone I would not usually send and has seen people F2F if needed. Most of my colleagues are the same. The telephones actually takes longer.

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  • Contacts have gone up. Telephone appts take longer than f2f in many instances. The initial "not wanting to bother us" is well and truly over. Trivia up, actual pathology up (and often worse as some patients have held on). Secondary care dumping worse. More patients needing to be seen f2f. It's a worsening nightmare, so I'd suggest the esteemed Professor sticks to doing (presumably) very few shifts in A&E and keeps her ill-informed opinions to herself.

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  • I for one will not be paying much attention to the ill informed “Suzanne from Chesterfield”. Imagine my surprise to learn on social media that Suzanne regards the Prime Minister as a “hero” and has described criticism against him as “vitriol”. How could such a champion of the Prime Minister be so lucky to be randomly selected to pose an independent question/statement to the Prime Minster on a Downing Street coronavirus briefing? I wonder?

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  • A stage managed career builder, standing on the shoulders of her colleagues and scampering up the media ladder. Tony unfortunately has given her a helping hand by offering his sympathy - are you OK tony?

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