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Independents' Day

We are everyone’s house dogs

Dr Shaba Nabi

Red was a significant colour for me as a junior house officer (F1 if you qualified after 2005).

It was the colour of the pen I used to diligently transcribe abnormal results from bits of yellow and pink paper into a patient’s medical notes, beautifully tabulated and ready for the consultant ward round.

It was also the colour of my lipstick, which I purposefully re-applied before heading down to the dungeons of the radiology department to beg for my patient’s ultrasound to happen this side of Christmas.

As I passed through both psychiatric and medical specialist training programmes, I was able to delegate some of my work to more eager puppies, all trying to outdo each other with their tricks.

But once I joined the world of general practice, I realised consultants still viewed me as their community house officer, existing only to support their very important work.

A patient who comes in to the surgery because ‘the consultant said to see you for my results’ is not only irritating, but is also in downright danger, when said results happen to be abnormal tumour markers.

In the world of primary care networks and multiprofessional working, it seems my emasculation is only getting worse.

My inbox is now filled with demands from a spectrum of healthcare professionals including podiatrists, physiotherapists, paramedics and specialist nurses.

The majority of the time, often through no fault of their own, they are unable to complete the patient pathway, so requests for X-rays, fit notes and blood tests inevitably find their way back to us.

Unlike my consultant colleagues, I still have a full day of patients and telephone callbacks

This would be less of an issue if I were swanning around my network with an entourage of my own faithful dogsbodies behind me, barking out orders for all the tests that are needed.

But, unlike my consultant colleagues, I am still seeing at least 30 face-to-face patients each day and managing a mushrooming list of telephone callbacks solo, so all this extra work is squeezed into an already bulging day.

Setting aside my personal gripes, this situation also results in a poor experience for patients. They are navigating their way around a Monopoly board, often landing on a chance card that sends them back to ‘Go’.

This isn’t too much of a problem if it’s just waiting for medication that should have been issued by the hospital, but if mismanagement means they go back to the bottom of a waiting list, they may feel as though they have been sent to jail. We are all patients and we deserve holistic, joined-up care.

I’m cautiously optimistic that these pathway glitches will be ironed out in time. After all, we’re still in the early days of having first-contact musculoskeletal specialists and paramedics relieving us of some of our work.

But what I am not optimistic about is the level of medical risk and uncertainty that will still be passed to us. In spite of the NHS’s new general practice indemnity scheme, we will still potentially face the emotional turmoil of being sued. And no amount of red lipstick is going to help me get through that.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of Dr Nabi’s blogs online at

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Readers' comments (12)

  • Cobblers

    OK I'll bite.

    Can a woman be emasculated?

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  • Cobblers

    Not sure if the current problem is as black and white as you say Shaba.

    Some time back it was normal for a person to see the consultant, who then ordered various tests and they were then followed up by the team for consideration of those investigations, diagnosis, treatment and discharge, letters taking 3-4 days to get to the GP.

    But, guess what, pressure came from Primary Care (PCG, PCT, HA, CCG), to reduce the follow ups (thereby saving money) and people ended up with a half arsed job and sent back to their GP. It got so far as the CCG stipulating what percentage follow ups would be paid for and above that number could not be charged. Woe betide a consultant with a higher FU ratio!!

    Add to that the recently reported schism in terms of communications between secondary and primary care. The inability of the medical software to talk to each other.

    And all this malodorous ordure comes gently filtering down the the place of last resort. Primary Care.

    Thank God I am out of it.

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  • Ivan Benett

    At the risk of ending up in the dog house, you shouldn’t let the tail wag the dog. Your work load sounds a bitch. Perhaps pack in some of the longer hours.
    Back in the day of course we would see 30 patients a surgery, two surgeries a day. 9-10 surgeries a week. Plus home visits, about 5 usually, but up to 10. Night calls to the house on a rota plus weekend surgeries and on call. Siriusly, every dog has his day.

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  • the hospital should give the patient a med3 to cover "expected time off work", not just to cover their time in hospital. all hospital have been told this, several times. explain to the patient they have been misinformed by the hospital/consultant/ward/sho/hospital porter/whoever looked after them. send them back to the ward, with a snotogram from you reminding those responsible of their responsibility. explain, carefully, to the patient that you CANNOT give them a med3, because the hospital haven't told YOU the details of what THEY have done. when those at the other end phone the surgery to have it out with you, explain to receptionist (beforehand) that you cannot talk to them - you are too busy. i had one stroppy hospital doctor who simply wouldn't cooperate - until i asked for his gmc number and threatened him with the gmc, when he rolled over. all rather unpleasant and unnecessary - rather like a lot of the donkey work that is dumped on us !

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  • I'll accept a moan if it is followed by a solution.

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  • One solution is to signpost the patient to the, previously under-utilised, Patient and Advice Liaison Service (PALS), who can then deal with the inappropriate secondary care requests....

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  • I agree with the workload issues and in the view of so called debated safety issues- it’s only getting worse day by day!

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  • Where's Optimus?

    Ivan I suspect it is easy to see 60 patients a day
    when there is minimal documentation in Lloyd George records
    no computers to help keeps tabs on the complexity
    not as severe medicolegal climate
    etc etc
    i suspect the notes kept must have been minimal

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  • DrRubbishBin

    I totally agree with you, I'm a little confused why anyone wouldn't. But then again trading comments like "Back in the day of course we would see 30 patients a surgery, two surgeries a day" like this ISNT pretty much on the low side of today's standard.

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  • DrRubbishBin

    'reading' not 'trading' - no idea why you can't edit or delete your comments within a reasonable time window on PULSE.

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