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GPs go forth

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)

  • Good article Nabi.
    NHSE and GMC are a bunch of invertebrates who have completely lost sight of their function in order to satisfy their political masters.
    If your Irresponsible Officer is reading this then I'd be quite interested to know what they can take issue with.

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  • Good idea! Lets do it.

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  • National Hopeless Service

    Totally agree Shaba. I dont have a single session now which isnt obstructed by some non medical utter nonsense. But our profession is herding cats.

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  • Ivan Benett

    I agree that prescribing homeopathic remedies should be promoted. They are inexpensive and will not cause physical harm. If used properly and holistically can help people with their symptom of ‘shit life syndrome’. There is a risk of over dependence, as with conventional medication and doctor patient interaction, but this has to be managed.
    It isn’t just the dillusiI n and succession that gives homeopathy its healing powers. Indeed some say that this is bolony or worse. It is the power of the human interaction and therapeutic relationship that does the trick.
    Surprisingly I think you’re on to something Shabi

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  • Ivan Benett


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  • NHS England and GMC are not run by medical professionals. This is the root of the problem

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  • And why bother with homeopathic? Just relabel tic tacos and it’s a valid positive placebo effect.

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  • This is what you get with socialised comprehensive healthcare provision. Ivan, prescribing water and placebos should be promoted??? God forbid you get the reins of power. Industrial action? There's no need to play games. Just say no. I will not be prescribing anything without a strong evidence base, I've already stopped prescribing just about anything you can get over the counter, and my patients know it. I won't prescribe anything outwith my competencies, and gender dysphoria would be one of them. Sod anyone's feelings lol

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  • Cobblers

    Shaba: "I have already received a written warning from my Responsible Officer about a previous offering."

    Care to share?

    My personal experience of these people is that they may have a Dr in front of their name but the rest that follows is pure unadulterated gong chasing admindroid.

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  • Hear, hear

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