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Independents' Day

I’m sick of being the fall guy

Dr Shaba Nabi

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I know this column will make me unpopular with certain patient groups (think homeopathy and gluten-free lobby) and get me into trouble at work. I have already received a written warning from my Responsible Officer about a previous offering.

But I feel strongly that this needs to be said, so I’ll write it anyway.

I am drained and exhausted by the hidden factor in every consultation – rationing. I am sick of my profession being made to feel like the ‘bad guy’. Don’t get me wrong, I am all for the judicious use of precious NHS resources and I strongly believe I should not be prescribing a box of paracetamol that can be purchased for 30p.

But if NHS England wants me to stop prescribing over-the-counter items, it should blacklist them. However, that is political suicide for its policy-makers and instead we are forced to have repetitive dialogues with patients in an already squeezed consultation window.

I am exhausted by the hidden factor in each consultation – rationing

This little rant comes on the back of NHS England’s most recent iteration of items that should not be prescribed routinely in primary care. This guidance states that there are no exceptions to the use of items such as bath emollients and silk garments yet does not stop these being prescribed on an FP10. It is entirely farcical that NHS England is expecting CCGs to be the arbiters of this set-up when they have no direct commissioning powers over an individual GP’s prescribing. As a result, there are still pockets of GPs who continue to prescribe diluted ignatia or mistletoe.

Even more challenging is the pressure placed on GPs by inadequately commissioned pathways, such as eating disorders and gender dysphoria.

These patients are some of most physically and psychologically vulnerable, yet they fall between the cracks of primary, secondary and specialised commissioning. And NHS England, in its wisdom, has exploited the GMC’s incompetent guidance, which instructs GPs to prescribe outside their competencies in certain situations. This has led to an army of private, online transgender providers advertising the guidance issued by both the GMC and NHS England, placing huge pressure on GPs to prescribe and monitor complex medication regimes without any additional training or funding. And when GPs try to explain their reluctance to patients, they are faced with understandable acrimony from a group desperate for timely access to a specialist NHS clinic.

So, I have an idea that might force the Government to sit up and face its own hypocrisy. What if every GP in the land started dishing out homeopathy by the bucketful to all patients with shit life syndrome? We would only need to do this for a month to blow our collective prescribing budgets and force NHS England to think twice about issuing guidance instead of blacklisting placebo medication.

With my CCG and BMA GP Committee roles, I’ll probably get into trouble for inciting industrial action, but quite frankly, I’m well past the point of caring.

Dr Shaba Nabi is a GP trainer in Bristol




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Readers' comments (26)

  • David Banner

    Bang on, Shaba, keep speaking out for our profession.
    -homeopathy? Just say no, next please
    - freely prescribe anything not blacklisted, you are duty bound to deal with the patient in front of you. If NHSE lack the sphericals to ban them from FP10, prescribe without fear until they do.
    -bounce transgender requests to secondary care, far too complex for GP dabbling.

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  • Freely prescribing otc meds and homeopathy will just make a rod for your own back as people keep coming back for more. It is similar to the more access you provide the more demand you generate. So the more free medicine you provide the more no-need demand you generate.

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  • I agree with Mark. David, you might be able to prescribe otc or poorly-evidenced meds without fear, but that's not good for the patient, for yourself, for everyone else is it?

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  • Nhsfatcat

    You are a very naughty girl ;)

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  • I quite agree with you Dr Nabi. We carry out the wishes of our 'superiors' and are totally unsupported when the punters complain. How about when we were supposed to tell patients they are fat. Good grief. And their children too - I know who would be grovelingly offering an apology for saying such a thing and it wouldn't be the ivory tower occupants who advised it.

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  • Bravo, Shabi, bravo. One of surely many growing frustrations of being a GP.
    PS. I way of apology for not being as brave as you Shaba, I hide behind a silly pseudonym because if I don't the more trouble-making ones come up on a google search of my real name, and I fear I might be sacked for whistle blowing.

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  • sell said dr nabi. you expressed what most of think only.
    well done

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  • Dear Dr Ho

    "I will not be prescribing anything without a strong evidence base"

    Are you being tongue in cheek or just a bit pompous? I have to admit to prescribing the following

    "Atenolol, cerivastatin, sibutramine, quinine, rosiglitazone, diclofenac, celecoxib, aspirin (for AF), and many many other medications where the "evidence base" was not as robust as previously thought. I have learnt that the BNF and NICE are very often proven wrong. Please don't believe everything that Pharma tell you! We don't even know the correct dose of amoxicillin anymore. The longer you practice the more you will realise that the "facts" are not always true.

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  • Time for a United front. There's no point 4/5 doctors politely asking people to buy OTC stuff themselves, when the 1/5 cardie_wearer happy to prescribe absolutely everything without comment, muttering "it's not worth the argument". Well yes, it is with it, and I've found a lot of patients quite happy to do so
    I had abuse hurled at me recently, for not prescribing a few day's worth of paracetamol tablets. Patient was happier to drive to WIC (petrol and parking costs involved) instead of paying with 20p. But I didn't give in, and sent a strongly worded letter about their behaviours.

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  • The biggest fiddlers are NICE and interests within. Has your RO seriously got nothing better to do, suggest he pop off and get a proper job rather than taking up arms as a footsoldier for Mordor and hurting his ex colleagues.

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