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My tolerance for suffering fools has reached full capacity


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Apologies: I seem to be mentioning our new health secretary in my opening paragraph for the third column in a row. But the thing is, Matt Handapp and his digital cock (I might have that wrong) does us a big favour when he points out that GP At Hand frees up capacity by ‘taking pressure off the NHS’.

Not because he’s making sense because, obviously, he isn’t. But because he reminds us that someone, somehow, has to get hold of the issue of our capacity to handle spiralling workload.

And winter’s just around the corner, right? Which means the return of doctor dyscopia, the NHS in crisis and headlines predicting medical Armageddon. So as our shimmery summer memories dissolve, these perennial issues come back into focus. What happened to the BMA’s grand plan of appointment caps? Or the idea of primary care issuing black alerts just like they do in hospitals? The Bawa-Garba case has now demonstrated that, even as we try to force down the lid on the workload jack-in-the-box, an overwhelmed system won’t mitigate our trial for manslaughter.

Weren’t we supposed to be doing something about all this? In fact, in our practice, in our own little way, we just have. Or, at least, we’ve tried. We’ve had what I believe is known as a ‘dialogue’ with our local NHS team. This was prompted by a recent unseasonal crisis when, on a Monday morning, a mixture of illnesses reduced us from our usual seven docs plus one ANP to three docs and no ANP. By 10am, we were waving the white flag. But the NHS’s response to our request to divert urgents to 111 for a few hours while we caught our breath was – and I’m not making this up: No, you can’t do that, have you considered getting the GPs to work through their lunch hour?

Where will patients go when 111, A&E and local overflow hubs all cry ‘full’ too?

Anyhow, post dialogue, I now know that it’s fine for in-hours patients to opt for 111 first themselves, but not for them to be directed there by our switchboard (not even when we’re on our knees). It may, though, be okay for the various AI and e-consult iterations now lodged between patient and practice to direct patients to 111, as these new platforms are blurring where practice responsibility kicks in. And as for practices saying, ‘Sorry, we’re full, try later, try A&E or try 111’, that’s sort of okay, so long as we pretend it’s not happening, even though it is.

Confused? Me too. Plus, there’s still the underlying conundrum: if we are given the mechanism to contain workload, then what happens when 111, A&E and local overflow hubs cry ‘full’ too? Where is the service with infinite capacity where the buck, and the patient, stops?

A good start would be clarity over – and maybe revision of – our contractual obligations, and some radical thinking over reducing or containing demand. I don’t have a solution, but I do know a digital wonderland is not the answer, or even part of the answer, and may become part of the problem.

And as for those who insist otherwise, well, you just have to wonder about their capacity.

Dr Tony Copperfield is a GP in Essex


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Readers' comments (16)

  • Tony, there has been a simple solution that has been known for decades, and is currently working well in most places globally. Let the customer be fully responsible for the demand. And I mean fully, inclusive of financial costs. And the provider to be fully autonomous in deciding what services they want to provide and charging for it accordingly. I.e. free market.

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  • I agree Christopher. Free at the point of delivery is a major problem with the NHS.

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  • Free at the point of delivery is not that bad an issue. Lots of other countries send the bill later, or send it to the insurance companies. Its the bulk contract, that can be changed unilaterally by the state, that is one of the prime causes of all this. Throw in heavy state intervention/bureaucracy, resultant decreasing GDP per capita, end result - nobody is happy. One clearly wonders, how our union ever negotiated a contract like this ever. Who needs enemies eh, when you have friends like them

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  • I agree Christopher. It’s simple economics ( not just in a financial sense ). People have zero incentive to try any kind of self management or disease promotion. Secondary care have zero incentive not to dump on GPs. Patients have zero incentive to turn up, be on time, or try to fit their problems in to 10 minutes. And, so, we are screwed.

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  • Christopher is right. A lot of our problems are caused by this "free" system. Today on radio 4 there was talk about containing demand for the 1st time but with the usual tried and tested useless solutions of 111, chemist etc. No one is brave or smart enough to say the obvious. Charges.

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  • I too agree - even a fee of £10 would solve it.
    Alas none of the political parties have the courage to alter
    the status quo because of fear of annihilation at the

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  • Charging patients, say, £10 to £15 for a consultation would reduce our workload by 50% and I don't think anyone would suffer.

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  • Except the reigning politicians ?

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  • Tantalus

    5p on plastic bags
    Use goes down 85%
    Just sayin’

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  • £1 deposit on a supermarket trolley - haven’t seen one in the canal in years?

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