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GPs buried under trusts' workload dump

Welcome to Planet Advanced Nurse Practitioner

Copperfield 

A patient upends a bag of medication on my desk to reveal penicillin, co-codamol and benzydamine spray.

Another patient later upends another bag of medication on my desk to reveal oral rehydration sachets, metoclopramide and loperamide.

Yet another patient even later upends yet another bag of medication on my desk to reveal an antihistamine, a nasal decongestant and ibuprofen.

The diagnoses are, respectively, viral pharyngitis, gastroenteritis and a cold. I know what you’re thinking. The common thread here is that each patient has just returned for a post-holiday-illness review, the clues being the tan and the hilarious foreign polypharmacy. Wrong, though they have recently been to a far-flung place – Planet Advanced Nurse Practitioner, which I’m realising really is a very alien environment.

We all know that continuity is Cheyne-Stoking its way to oblivion, especially for acute and sub-acute illness. But something else is dying on its feet, too – rational treatment of minor illness.

Welcome to the trenches, pharmacists. Bring some bags, will you?

Unlike the ANP approach, I was trained to manage the illness, not the symptoms. Minor, self-limiting ailments are just that, and, most of the time, require nothing more than reassurance (that it’s not meningitis, sepsis, necrotising fasciitis etc), explanation (of how to self-manage) and redirection (so we don’t waste each other’s time with this stuff in future, OK?).

That sore throat, gastroenteritis and a cold would have got precisely nothing from me, because that’s precisely what it needs. I’ve worked 30+ years convincing patients that I don’t have a pill for every ill; I certainly don’t have one for every symptom. The way not to manage minor illness is to inflate its importance and confuse its resolution by seeking-and-destroying each individual symptom with a pharmaceutical goody-bag, unless, that is, you’re trying to undermine the NHS by creating work and destroying the drugs budget.

And as GP workload and recruitment dictate that acute care is delegated further down the road, things are not going to get any better. Who worse to introduce to the frontline than health professionals whose very existence has traditionally depended on monetising symptoms? Welcome to the trenches, pharmacists. Bring some bags, will you?

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield

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Readers' comments (12)

  • Dr Copperfield, I have worked in Essex for only 26 years and I still haven't worked out who you are but when I do I would like to shake your hand.

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  • ‘continuity is Cheyne-Stoking’??? - hilarious oxymoron?

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  • So true.
    And encouraging, really.
    And depressing.
    Brilliant (nearly) every time!

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  • brilliant observation. Noctors are bringing a host of issues, and you simply cannot replace the role of GPs on the cheap.

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  • Absolutely spot on. We all must have seen this. However only fellow doctors understand.

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  • Noted but our advanced nurse practitioner is brilliant

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  • Agree brilliant, and totally spot on! Often though driven by the patient who think they 'need something' for their symptoms..

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  • Dear All,
    How very true. Unfortunately its not just the noctors. A long term bug bear of mine is the many colleagues who advise Dioralyte for that less than perfectly formed stool. the number of times i've been consulted by patients not getting better after their gastroenteritis evolves into dioralyte maintained diarrhoea.
    Regards
    Paul C

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  • I normally agree with pretty much everything you write Dr C but in this case I disagree. I find the ANPs much less likely to prescribe unnecessary medications than the doctors (often jaded and close to retirement) who work in the OOH settings. They are more protocol driven it is true - but I find this results in their being far more happy to advise otc medications or nothing at all.

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  • Spot on and brilliant!

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