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At the heart of general practice since 1960

We need a service that stops GPs head-butting the walls

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I don’t usually do dedications, but, this time, for reasons that should become apparent, I’m making an exception. So, switchboard operator at my local DGH, this one’s for you.

I won’t bore you with the clinical details. Besides, you’ll recognise the general scenario: my patient is non-cancerous but genuinely urgent, so you can imagine his and my delight when the outpatient appointment I arrange for him turns out to be in December.

There then follows the standard ‘Let’s try ringing the consultant to speed things up’ procedure, aka how to give yourself a subdural using the nearest brick wall. I go through the whole gamut of telephonic torture: switchboard not replying, then replying but cutting me off, then putting me through to a secretary whose phone simply rings forever, then putting me through to another who is on voicemail, then putting me through to yet another who does pick up but is the wrong one and who, when transferring me to the right one who she assures me is there and will pick up the phone, cuts me off.

So, having spent 15 minutes achieving literally nothing, other than temporomandibular spasm, I do the only rational thing a person can do in this circumstance, which is to have a biscuit.

Then I try again. And this time, there must be something in my voice – a slightly cracked, desperate, on-the-edge tone, perhaps – that, to her credit, the switchboard operator picks up. Or maybe it was the stream of industrial-strength swearing.

Anyway, to paraphrase, what she says is this: ‘I can see you’ve been messed about. I’m sorry. I will keep you on the line while I phone the relevant secretaries one by one until I get a response. I will not cut you off and I will keep coming back to you. Don’t worry, I will sort this out.’

Incredible. I’m slack-jawed with a combination of gratitude and defused tension. Two minutes later, all my problems have been resolved.

And suddenly I’m struck by a blindingly obvious idea. What we need, desperately, is GPALS. That is, a GP version of PALS, the Patient Advice and Liaison Service which, down my way, is pretty effective at butt-kicking when patients get stuck in the Kafkan nightmare of secondary care.

GPALS: staffed by real humans who actually pick up a phone and do stuff, a single point of contact I can go to before I give that wall one head-butt to many. And I want this switchboard operator to run it.

‘By the way,’ I say, down the phone. ‘I’ve just had a really intriguing thought. Would you be at all interested in…er…hello? Hello? Hello?’

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield 

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Readers' comments (9)

  • With CQC inspection due next week I was in desperate need of a laugh and you have not disappointed me.........I have spent half my lifetime making calls like this.......

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  • My clinical assistant does all that for me, bliss

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  • We spend so much of our precious time doing this sort of utter rubbish, because of poor secondary care provision. Refer, re-refer,phone calls, repeat and multiple consultations, OOH contacts, A+E attendances - all because of untimely, long waits to see a Consultant
    Analysing our A+E attendances, in an attempt to reduce them; we came across this phenomenon time and again.
    One patient, waiting for months and months for an appointment just to be seen for Gallbladder colic, attended A+E 21 times, but had over 250 contacts with us in Primary care in the same period.
    She got pancreatitis, pseudocyst,obstructive jaundice and spend weeks in hospital.
    We GPs are doing our job, more than our job, our consultations have increased 100% in 15 years, compared to a 30% increase in A+E, without any increase in GP numbers, but almost 100% increase in A+E Consultants.
    We do 92% of consultations for 8% of the budget. Yet, it is us GPs that are supposed to do more. The ONLY reason we are the dumping ground for everyone is because there is no extra pay for all the extra work.
    As long as we GPs cling to average list sizes that do not take into account consultation rates or appointments, we will be forced to do more.
    An analysis of our A+E figures clearly show our increasing workloads.
    We are doing our jobs, but the Trusts are not.

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  • I'm glad there's somewhere in the universe that PALS are worth the air they breathe. My local one is known to patients as the 'Pointless Arse-covering and Lame-excuse Screw-up' which may give you an indication of just how mch we'd prefer a chocolate teapot.

    Although, reading this and multiply my own referral problems by the size of my GP's patient list, I have a lot more understanding of why I'm left to chase up my own appointments. I still don't like it, especially when the answer is 'if you need to be seen earlier you'll have to get your GP to ring us' and tends to leave me the one banging my head on the wall, but at least I get it.

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  • GPs are falsely penalised by National health and GMC is not helping.They are given very poor support to cope with tremendous tasks asked to perform. The The Law Commission reports has reported quoted in BMJ editorial of 27 september 2014that present regulatory system are inflexible,bureaucratic and outdated.
    GPs deserve better support.

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  • Dominique Dock

    Tony does not do praises easily, so this one in the disguise of a rant about secondary care, is a beautiful one. One to keep at hand and read when things heat up again ! Which shouldn't take too long...

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  • My very last patient ever, on the day of my retirement, needed to be admitted (to the Royal Lancaster Infirmary).I phoned the Emergency Admissions number...and got an ansafone message!!!Kafka in his wildest dreams could not make it up.Worse still, this nonsense was a frequent occurrence, and the CCG had formally complained on more than one occasion. I put my patient in my car and drove him to A&E. My "robust" e mail to the CEO of the Trust received the reply not of "How awful, how could we possibly permit the emergency admissions point of contact to be a machine, I will rectify this today", but along the lines of: "oh, sorry about that,That is not every GPs' experience". There are still some who believe the dysfunctional and dangerous shambles that is the NHS is a "jewel in the crown". On a positive note, at the CCG we developed software (Datix) to sit on GPs computers, which took about 30 secs to fill in a note on such concerns, and was reviewed by the CCG weekly.Presenting the Trust with hard evidence of worrying trends at least made them aware.

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  • Eh, it's not so bad for you guys (relatively-speaking) - try being a GP on the Isle of Man....over 3 years for a Dermatology appt, Pain Clinic 2 years, 18 months Endocrinology and 12 months for Orthopaedics! Oh yes, the govt there make the UK govt look remarkable!! That's what living in a ''Tax Haven'' gets you...a falsely low tax rate and subsequently a 3rd world secondary care health service!!

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  • Stuart Calder

    Brilliant! I've been there, done that and felt every emotion in the process on many occasions. But, once I got to know the telephone operators at the local hospital better with a bit of idle banter, it is impressive the lengths that they'll go to find you the right person.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder