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A faulty production line

Watch and learn, Lord Darzi

Copperfield kindly requests the company of the changer-in-chief to spend a morning with him in general practice

Copperfield kindly requests the company of the changer-in-chief to spend a morning with him in general practice

Put down that scalpel, Lord Darzi. Take off your theatre gear and come with me. I'm going to show you what goes on in general practice. Because the last time you were exposed to it was either years ago, when you spent a week on attachment as a student, or never. Probably the latter, if you seriously believe - as I've heard this week - that there should be three nurses to every GP in your nice shiny polyclinics.

So nurses are to inherit primary care? OK. Sit there in the corner. Look, listen and learn. Gasp as I unravel the complexities of the patient's TATT. Thrill to me checking a chest and neatly declining a request for antibiotics. Gulp as I treat an infected ingrowing toenail and discuss surgery - which I can perform next week in this un-polyclinic-shaped building.

Swoon as I inquire about an elderly relative and suggest measures that will avert both an admission and the carer going bonkers. Be amazed as I point out that a case of dyspepsia is caused by an unnecessary NSAID prescribed by an unnecessary casualty officer resulting from an unnecessary A&E attendance.

Smile as I remind the patient that her smear is due and her mammogram isn't. Shudder as I fend of an inappropriate request for a CT scan for a headache. Jiggle with excitement as I correctly diagnose a mole as a mole rather than a melanoma, thereby saving the hospital an appointment and the patient anxiety.

Rub your hands with glee as I offer anti-smoking advice and prescribe NRT. Cheer as I say, Yes, I can sort out your travel vaccinations, No, that isn't arthritis and hmmmm, maybe those other symptoms you've mentioned are IBS, let's run some tests to check it out.

And now collapse in a heap. Because you're exhausted. But no, your lordship, surgery's not over. It's only just begun. I realise we've covered the entire spectrum of medical practice and reached the point of sheer knackeredness in the process… but that was just the first patient.

They always come with multiple issues and we always manage the lot in about 10 minutes. Nurses can't do this, I guarantee, on account of not being GPs. Then there's another 15 patients where she came from. And this afternoon, we start all over again. And no, you can't have a lie down in between. Because there are prescriptions, visits, paperwork and teaching to sort.

The point is, I want you to understand what we GPs do, and how efficiently we do it. Because I've had the distinct feeling that you're as qualified to comment on general practice as I am to repair your aortic aneurysm.

It can be hard to articulate what goes on in primary care, given the enormity of the task. You just have to be there.

Still determined to pursue policies which undermine general practice, which erode its core values and which fragment its myriad components? Then you'll have patients with head spinning, GPs with morale plummeting, an NHS with costs spiralling and me with ears steaming.

Now you have a little insight, I'll allow you to go back to what you do best - garbing up in green and excising things. And the thing we'd really like you to cut out? Change.

Dr Tony Copperfield is a GP in Essex. You can email him at tony


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