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GPs buried under trusts' workload dump

Obsolete? Of course not, GPs are the bedrock of the NHS

Copperfield

 

copperfield duo 1500x1000px

copperfield duo 1500x1000px

I really think they’re out to get us. Which could be GP protectionism or GP paranoia. Whatever – I’m certainly feeling glassy eyed, having just read the long-term plan, which I hadn’t planned to do, and which is long. Read right through it and, I think, seen right through it.

It starts OK, pointing out that the NHS is well designed, efficient and scores high on satisfaction – this last point illustrated (honest) with the example that diabetics are twice as likely to get a leg amputated in Germany, and not just because the waiting lists are so long over here. My mate Jürgen is hopping mad about this.

Then it talks about us being mandated to work in primary care networks, which is fine because a) this comes with loads of cash, and b) we’ve already been huddled together in federations, collaborations, joint ventures, alliances and various other thesaurus entries for ‘network’ for ages, because everyone keeps saying that’s the only way to survive. So, just like when QOF started, we’ll be paid new money for doing something we’re doing already.

So where’s the problem? Read on, and a common thread slowly emerges through the euphoria.

At face value, it sounds great that there will be new teams looking after care home residents, community crisis services delivering NICE-approved management within two hours, urgent treatment centres in every locality, 111 directing patients to pharmacies, ‘population health management and predictive prevention’ and screening services so cutting edge that illness is all but banned. Less work for us GPs, hurrah!

But then there’s the emphasis on ‘digital’, ie algorithms and docbots. And the lowering of threshold for cancer referrals, which I predict will make our gatekeeper role redundant – especially alongside the aspiration that patients with red-flag symptoms will be able to self-refer to ‘rapid diagnostic centres’.

And it’s at this point that you catch yourself laughingly saying, ‘It’s almost as if they don’t need GPs at all!’ Then you stop laughing. And you realise, they don’t need GPs at all. Suddenly, it all makes sense. GPs – that is you and I – are now seen as dispensable. True, buried deep within the document there is the statement: ‘We still believe we need a net increase of 5,000 GPs as soon as possible and are committed to this.’ But, with the sudden disappearance of the 2020 deadline, this is the clearest backtrack yet on that promise. And it certainly doesn’t stop the protectionist/paranoid concluding that only a little more backpedalling might result in a new target somewhere in the region of minus 33,000 GPs.

I can only draw two possible conclusions. One, that Matt Hancock et al have absolutely no idea what GPs actually do. Or, two, that they know exactly what GPs do, but think it worthless. Neither is a comfortable notion. Because, either way, GPs are dead and buried. We are decomposed, compressed and fossilised. We are the sediment that now provides the foundation to a shiny, digital future. We are the bedrock of the NHS.

Dr Tony Copperfield is a GP in Essex

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Readers' comments (14)

  • When we are gone they will look back and remember the good old days as they pay for the service.

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  • Unfortunately I think you are right. The days of GP are numbered. Its private specialism is the holy grail for our government. No idea what we do.......

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  • Curious, you have no idea what we do? I wonder how the vast majority of the rest of the world survives.... open your eyes, get woke lol

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  • Hi Chris! I meant the government has no idea what we do.....and certainly no appreciation..... my eyes were always open which is why I emigrated to Australia.....I only ever locumed in the Uk as a GP....

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  • Ahh, my mistake. glad you've escaped. I haven't given up hope yet, and I can't leave due to family. Just have to keep fighting the good fight lol

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  • Good luck! I have survivors guilt! :-) its like escaping a hostage situation and feeling bad for those left behind. It is a bit naff that on balance being a GP in the UK is no longer a sensible option for talented young folk...... not for the time, cost, effort etc involved in getting there, then the responsibility / blame / indemnity costs/ stress/ lack of family time when you arrive etc, better off either as a specialist or engineer...... I wonder how HSL can stand there and say theres never been a better time to be a GP? Has she just stepped off the tardis or is it the emperors new clothes?...like seriously! Young doctors should avoid the career like the plague (Ebola these days) or if they have a clear plan to use it as a stepping stone to something else then fair enough....

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  • Have faith - Haven't the government delivered on Brexit, Universal Credit and pulling out of Afghanistan and Iraq?

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  • I really hope this is not the case... in an era where hospital specialisation happens way too early without registrars cutting their teeth in every speciality, there is a dearth of good General Physicians - this is where general practice needs to sit. We all see specialists look at their tiny blinkered area, find nothing and refer to another blinkered narrow focus speciality and so on ad infinitum - GPs need to step up to the mark to become the respected general physicians of the future, leaving the minor illness and low level pathology to ANP/EMP roles, care home reviews to dedicated teams and (in my utopian world) free up GPs to deal with the ill, the complex and the confusing whilst maintaining a sense of family/community knowledge. One can but hope...

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  • good luck to them. just look to OOH to see how much this will cost.

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  • Most of our work is too nebulous to easily categorise and keep tabs on, so considered worthless. The only way to prove our worth is mass strike or resignation, which would quickly lead to complete capitulation from the goverment. Go private and tell the governemnt to refund the amount they pay us to the taxpayer who can then seek private GP healthcare and then reflect on what a good deal general practice was.

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