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A faulty production line

What I really need is some *enhanced* enhanced additional roles


It’s a Monday morning day duty at the coalface, and I glance down the first few on my triage list. It makes for ominous reading:

  • ‘Foot hurts’
  • ‘Not sure where his life is going’
  • ‘Thinks toilet is too low’
  • ‘Believes that no one cares’
  • ‘Feels hungry’

Sigh. Or so you’d think. But no! Thanks to the enhanced additional roles reimbursement scheme, I can unleash my new PCN superhero team of podiatrist, life-coach, OT, care-coordinator and dietitian, respectively!! It may be manic Monday, but my patients, and my day, are saved!!!

Yes, I know I’ve done a post-contract-update-blog. But that was a measured response and sometimes you just need a cathartic rant, so that’s what’s coming (this blog’s for my benefit, not yours, don’t you know that yet?).

Because the more I think about the additional roles nonsense, the more I genuinely think, what the f**k is going on? As in, WHAT THE F**K IS GOING ON?

The roles include something I literally didn't know existed

The roles include something I literally did not know existed and have had to look up. So apparently, a pharmacy technician is some kind of pretend pharmacist. Ta da! The first ever nocnoctor. What’s all this about? Did I sleep through the PCN taking over pharmacy services? Or do all clinical directors belong to dispensing practices?

And why do I need PCNs to take on OTs, podiatrists and dietitians, when the CCG already commissions these services for me? And where will they come from? (Actually, let me guess: they’ll resign from their CCG posts so they can take up PCN posts. Duh.)

Or is this all based on the idea which underpinned the original additional roles reimbursement scheme? By which I mean the Concept of Surplus: we’ll subsidise these staff for you GPs not because you want or need them, but because they’re available. That, at least, explains the life coaches.

On that basis, I’d suggest an enhanced enhanced additional roles reimbursement scheme to incorporate anyone with a qualification who’s at a loose end. Starting with 150% reimbursement for event managers: there are going to be quite a few retirement parties to organise.

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 (6)

  • I had a sh*te life coach, yeah my dad didn't bother much with me growing up, nor did he lead much by way of example. Yet self-learning/reading, and a propensity to rationality helped.

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  • It’s almost like there aren’t enough GPs and they’re unwilling to adequately remunerate those that do exist

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  • Enhanced means better. The in-house psychologist at a CIA black site based in Morocco told me so.

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  • Now thats an idea IDGAF! Perhaps your friend in Morocco could pay a visit to the NHS leadership with a large cloth and a jug of water, and using 'enhanced' methods could find out what the hell they've been thinking about... is it malevolence or incompetence? Id really love to know....

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  • Once again transfusion without tying off the artery. The PCN is like menopause treatment without HRT. Some kind of works in a placebo way but nothing beats actual replacement because that is what is needed.
    They should improve working conditions and not distract GPs from seeing patients with more regulation, SARs photocopying, managing HR, taking on more business and clinical risks. All prettybad for health.

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  • i love saying 'tada'. usually comes after a patient complaint for waiting times and i reply 'what do you expect - the NHS is bankrupt and the staff are all leaving for better pay and working conditions abroad'. tada!

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