This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

I've a shortage of patience


The Pulse pages are sometimes criticised for being lopsidedly bleak and negative. So, for the sake of balance, let’s consider the positives of a typical Monday.

Good. So, moving onto the negatives. I’m duty doctor and I’m triaging to vacant or emergency slots. All of which are filled shortly after 9am. I am now triaging to slots which don’t exist, which is tricky.

Onto some routine consultations and phone calls. I hear the usual litany of patients unable to book outpatients appointments after referral to secondary care. The situation has become so bad locally that we are, in effect, running without a neurology or dermatology service.

Then there are the justifiable patient complaints about quasi-services – local ‘resources’ set up to give a semblance of service provision, but in reality a faceless body effective only at rejecting our referrals for not fulfilling arbitrary and ever-changing criteria (CAMHS, adult mental health etc).

We can’t even survive by self-medicating, because the sodding fluoxetine has run out

And, finally, an angry call from a patient because the ‘nursing assessment’ I had arranged for his disabled, dependent and acutely unwell wife has not materialised – apparently because we are stuck in a loop with the community nurses insisting on knowing exactly what her needs are first and me stating that she needs an nursing assessment by them to answer that question.

In desperation, to try to help someone, somewhere, I prescribe some drugs. The prescriptions return to me about half an hour later with a scribbled message from the pharmacist stating: ‘Medication shortage, please provide alternative’.

This, by midday on a typical Monday, is the state of general practice. There’s no way to put a gloss on this. We are now working in a system where there are no appointments, no means of referral, no functional local services and not even any f***ng drugs. Nonetheless, being the final common pathway with responsibility for my list, it is for the ‘GP to sort’.

How? How can we possibly work in this system? We can’t even survive by self-medicating any more, because the sodding fluoxetine has run out.

So Mr Hancock, a scribbled note for you: ‘NHS shortage, please provide alternative’.

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

Rate this article  (4.96 average user rating)

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Readers' comments (12)

  • Its OK because colouring book HSL has now been allocated £5 million of desperately needed funds for her social prescribing experiment to continue..... like who needs fluoxetine when you can just sing la-la-la-la-la under a tree with a crayon in hand? Which is where half the GPs will be if no-one sorts out the mess anytime soon. I think everyone should print out the social prescribing experiment information and put it on the wall, and when patients ask why they can't get what they need just point to the poster and say because of 'experts' like this with below average practice scores who insist you need a pair of himalayan cymbals and the opportunity to make a dream catcher more than you need your clopidogrel and access to a cardiac surgeon.

    Unsuitable or offensive? Report this comment

  • @ Curious | Locum GP25 Oct 2019 12:44pm

    You beat me to it!

    And, Tony is just being his usual ‘lopsidedly bleak and negative’ self in the face of the incontrovertible progress with social prescribing (we shall all be frolicking in the sweet meadows of Shangri La before we know it / awaken).

    Unsuitable or offensive? Report this comment

  • Hey doc my heads fu$%^£d and my usual gabbas and jellies arent working have you got anything stronger or I'm gonna lose it.......

    Yes Mr Knuckles, have you considered self referring for reiki and taking a walk at your local National trust?

    Unsuitable or offensive? Report this comment

  • Agree social prescribing should be 'why don't you either do it yourself or alternatively go to the citizens advice bureau?'

    Unsuitable or offensive? Report this comment

  • Ahhh the alternative to the NHS - the grand Tory master plan and there they are not even having to face the splatter of the shit hitting the fan with focus elsewhere!

    Unsuitable or offensive? Report this comment

  • Yes, this is exactly the grim (un)reality of general practice now.

    Unsuitable or offensive? Report this comment

  • You can’t even run off to Australia Tony, as the drawbridge is being raised as we speak. Bloody lucky to escape when I did.

    Unsuitable or offensive? Report this comment

  • It would help to control our workload if every NHS appointment had a £5 or £10 charge to pay; children under 10 years and people on Benefits should get free treatment but not for "minor illnesses"; Our Patient Forum Group(PFG) feel that people who Do Not Attend (DNA) should pay the full cost of the appointment - about £70 in one includes the cost of the building. I think the totally free NHS with unlimited demand and workload is nor realistic or sustainable.

    Unsuitable or offensive? Report this comment

  • Spot on Tony.However you have understandably gone back to the bleak old negative assessment. The positive spin would be delusional hope. Hope for "online consultations" (obviously massive numbers of GPs waiting to take that all important call). You can still see a GP! (Even though their hands are tied with referrals bounced, prescriptions rejected and they are expected to give world class care). There is still a "local" surgery to get to (for now). Patients can now get their hands on their notes with GDPR (They could always ask for it without GDPR)!
    Now how positive is that! Sadly the Australia drawbridge is gone but here are other bridges.

    Unsuitable or offensive? Report this comment

  • Clearly no need to visit your Practice as its the same as mine.
    Same old same old pouring money into unproven treatments and medicalising life.
    Only thing different is that Tony didn't mention the daily argument of patients that Google/Goop/Steroid users Forum/the Daily Mail said your GP should do this for you!

    Unsuitable or offensive? Report this comment

View results 10 results per page20 results per page

Have your say