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Rage against the migraine


A friend of mine phones her surgery. She knows a thing or two about migraines, having suffered from them for years, and just wants an appointment to discuss restarting prophylaxis.

No chance. Not for the foreseeable future. Oh. OK then, how about a telephone call from the GP as it could be sorted with a quick chat? No, the GPs don’t provide that service. Oh. Email? Skype? Turn up and beg? No, no, no.

Big deal. We GPs are under pressure, aren’t we, and simply can’t cope with patient demand. Sure. But here’s the big reveal: my migrainous friend is, herself, a GP. Despite this, she could not get anything even resembling help – she couldn’t even negotiate the receptionist.

Now, I’m not saying that GPs deserve preferential treatment. OK, actually, I am saying that GPs deserve preferential treatment: there are very few perks available for NHS staff, but you’d have thought that looking after our own might be one of them. Apparently not. My partner quickly found that playing the ‘I’m a GP’ trump card – which, in desperation, she did – was still met with immovable resistance, though she was told, helpfully, that she could of course go to A&E. Yes. For ongoing migraine.

Discussing this over our daily post-surgery caffeinated catharsis, it quickly became apparent that the migraine debacle was not an isolated incident. All of my colleagues had a similar recent frustrated tale to tell, about themselves, or about GP friends.

Perhaps we should get our house in some sort of order, before we become a complete parody of ourselves

Which makes me wonder quite how we GPs – who, remember, are repeatedly told not to neglect our own physical or psychological health – are meant to access primary care? Maybe we’re being forced to go privately. Or maybe we end up flouting GMC self-prescribing guidance simply because there is no realistic alternative.

It also made me think the following, which I realise doesn’t sit comfortably with my usual GP-against-the-rest-of-the-world schtick. Perhaps it’s time we took a look at ourselves. Yes, for as long as we can remember, we’ve been overworked and suffering change-fatigue.

But because we always assume we’re under siege, perhaps we’ve developed the mentality that goes with it, battening down the hatches and no longer listening to the clamour outside.

Perhaps the media acknowledgement of nationwide GP appointment delays has normalised long waits to the point that we’re no longer bothered about trying to resolve them.

And perhaps those signposting techniques our admin staff have been force-fed have resulted in triage so rigid that something as inappropriate as, say, routine migraine care is being diverted to A&E.

Which, if you put yourself in the position of the receiving A&E consultant, would result in a justified slagging off of GPs and which, if you put yourself in the position of his attending medical students, would not sell you general practice as a career.

In other words, perhaps we should uncover our eyes, unblock our ears and get our house in some sort of order, while we still have some professional self-respect and before we become a complete parody of ourselves.

In the meantime, has anyone got any spare topiramate lying around? I know someone who could use it.

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 (21)

  • V.G.!!!
    Just maybe, GPs should realise the shambles the service is?

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  • If she is happy to fly to Brisbane I can squeeze her in into my appointments schedule this Friday morning. Australia has reciprocal healthcare arrangements with the UK. She just needs to pop into the Medicare office for a visitors Medicare card when she arrives. For a GP colleague I always bulk bill. So just the cost of the fares then.

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  • Cobblers

    DecorumEst 27 Nov 2019 0:47am. GPs already know the system is a shambles (and I think you are being kind). It's the politicians who feel "It's the envy of the world!"

    What amazes me is the punter. It's almost like the slowly boiled frog. These long waits for routine GP care are accepted! I see no push yet for private GP provision. I wonder what it will take.

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  • |Cobblers | Locum GP | Kent|27 Nov 2019 11:01am
    I wonder what it will take.

    - It will take education of the public about the benefits of free market capitalism, libertarianism, limited government, and conversely, the adverse effects of socialism, leftism, Marxism. We've neglected the indoctrination of the public by the power-hungry left for too long. A hard road to traverse, but its either that, or leave.

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  • TC you going a bit ITV3 on us? This is a shameless repeat!

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  • Hi, this piece is from the October print issue of Pulse

  • Denplan works for dentists and their patients. Why are the BMA so hostile to private practice when it would make life better for doctors and their patients?

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  • Stelvio
    Working in an area where food banks are the only thing thriving and most of my punters haven’t a pot to piss in, I think this would only amplify health inequalities. A cursory look at their not very pearly whites would suggest they do not subscribe to Denplan either.

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  • This was d | GP Partner/Principal|27 Nov 2019 3:12pm

    You don't know your history or economics. The smaller the govt, the bigger the private sector/wealth creators/economy. The better the economy, the greater the opportunity for social mobility.

    Sure, cover emergency treatment and maybe access to primary care. Why should optional/non-evidence based treatments/non-medical treatments be covered by the taxpayer? The access to healthcare here is above what exists on average globally. Focusing on 'inequality', whether health or economic, whilst bankrupting the country, is ignoring the forest for a tree. Sure, you are free to help the 'less equal', and we all should, but surely it should be voluntary/for humanitarian reasons and not compelled by the inefficient state.

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  • It is sad that a plumber can fix his own tap, a plasterer doing his own plaster and patients can buy medication to self medicate but a doctor is unable to self prescribe non addictive medication. Ordinary people will laugh at the ridiculous situation the doctors have allowed themselves to be in.

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  • My daughter had croup- fairly bad and I thought she should be assessed for possible steroid therapy. I started phoning my GP, repeatedly, at 07:55 and phone 56 times between then and 8:40. No appointments, advised ED. I suggested this was inappropriate, but no sway. Thought of prescribing myself, but reconsidered. Paid Babylon, done in 15 mins.

    The NHS was a great idea, but as it’s mandate has increased, along with the availability of expensive treatments and demand from moronic self entitled patients, it cannot continue.

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  • An occupational health service is available for all GPs, provided by the CCG/LHB : she should contact the local Deanery for contact details.

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  • "..discussing this over our daily post-surgery caffeinated catharsis".

    Don't let Mr Hancock know you have such spare time. He would say that your friend could have been seen as an extra whilst you instead worked on developing a DVT.

    Maybe your friend just needs as much caffeine as you partake of? (/s).

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  • I love the way that some GPs still think they have any semblance of control over the system. You don’t. You are told what to do. If you don’t like it ( and you shouldn’t because you are told a load of balloney) you should get out.

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  • DrRubbishBin

    often as a locum all day everyday i see people booked into 'emergency same day appointments' many with trivial self limiting illnesses that developed within the last day or so and definitely didn't need a Dr. If you want to see a GP these days it's about how to work the 'emergency appointment' system. Some patients are absolute experts some are too honest. Want an appointment with your GP today? -- book the day off, sit on the phone and learn how to bull shit and lie. Works for the folks round me

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  • Dear Dr Christoper Ho
    It would be lovely if just one of your posts evidenced that you had a shred of humanity or empathy with those less able/fortunate than yourself.

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  • Sorry d
    Dr Ho comments (correctly, iconoclastically) about the passive acceptance of bureaucratic state control ("boot stamping on a human face forever")
    Why should he say " PS everyone, I love the poor and huddled masses and wish for world peace"
    Try to address the points he makes instead those you imagine he doesn't hold

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  • This was d | GP Partner/Principal|28 Nov 2019 4:16pm

    - The assumption here being that just because I don't advocate for compelled state 'compassion', that I don't have a shred of empathy at all.... Let me qualify that I simply think doing it through the state is the worst possible way to do it.

    1. Psychology shows that compulsion results in less of a desire to carry out an action (show empathy for e.g)
    2. The free market/capitalism/libertarianism is the best system we have come up with for giving the less fortunate the best opportunity to be socially mobile. Therefore, in championing this system, in treating people like adults and not children, in giving them individual responsibility, I believe I show the MOST compassion, to MOST of the population (those who want to partake in this system).

    I certainly think that there is utility to generosity e.g. human solidarity, but that it should be targeted, voluntary, and its certainly more efficiently done by the private sector

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  • We will just have to disagree then, how ‘socially mobile’ are the intellectually impaired?. I suppose the USA’s free market, with pathological over investigation and treatment of the insured well and the abandonment of the uninsured sick is a shining example of your brave new world.

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  • The intellectually impaired are definitely less socially mobile, as IQ is the primary predictor of lifetime success, as I'm sure you know.

    How is that an argument for implementing socialist policies compelled via the inefficient state though?

    You've betrayed an ignorance of the US healthcare system. It is not a completely free market as the mainstream media would want you to believe but combines the worst of both worlds. It has both a highly regulated, and therefore un-free private sector, with the American Medical Association acting as regulator and a union, as well as a costly subsidised public sector. Yet it still manages to be at the forefront in cancer treatments, laser eye surgery, etc. The benefits of which we enjoy, lest you forget.

    I also never said the free market is perfect. It can be subject to corruption and exploitation of the ignorant. That surely incentivises trying not to be ignorant, as well as encouraging transparency. Abandonment of the uninsured sick? How is Obamacare doing? And you leave no room at all for family bonds/charity/altruism/humanism? My brave new world is certainly more optimistic than yours.

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  • By no means an optimist dear boy

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  • By no means is my 'brave new world' anything new either. It existed prior to our increasing socialism over the last few decades, and exists currently in plenty of global/developed nations today. How is the 'uninsured sick' doing in places like Singapore, or even the US? They're not dying on the streets seemingly. In fact, most in these places enjoy BETTER healthcare than we do. Do they wait 2-3 weeks for a routine GP appointment? Or 6 months for an elective hip replacement?

    If all you have is an attempt at trying to paint my rationality as 'lack of empathy', then I see why you're posting as a pseudonym, and I implore you to do your homework about the facts, rather than trying to appeal to the readers' emotions unjustifiably.

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