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A steaming pile of…

Copperfield knows exactly what to make of this year's GP contract agreement – if only he could find the right words to express it.

I've never been very good at analogies. It's like, when God handed analogies out, everyone else got a box set, beautifully wrapped, with a nice decorative bow on top, and I got… er… I'll come back to that.

Anyway, general practice. Remember the days when we could just get on with our job? No, me neither. I'm suffering chronic change fatigue, role vertigo and BMA motion sickness. Which means I'm feeling knackered, dizzy and sick. And so are you.

Let's pop some Stemetil, step back and take stock of where we are: smack bang between a rock and a hard place. The rock represents crushing constraints and pressures – on outpatient referrals, emergency admissions, prescribing and so on. And the hard place is crowded with unachievable NICE guidance, new or revised DESs, promises about patient choice, an unforgiving, litigious public and the baying media.

This is not a comfy place to be. For example, soon I'll have to explain to limping, stick-wielding arthritics that, because the commissioning budget's as knackered as their hips, I can't send them for a joint replacement. But I can at least offer them a choice of hospitals not to be referred to.

All of which means, as if we didn't know already, that the Government's Bright New Idea – a patient participation DES – is simply a PR stunt to give us all a painful PR.

Imagine: evenings listening to dumb-ass suggestions which haven't a hope of being implemented, a) because they're dumb-ass, and b) because, even if they're not, there's no money/energy/willpower left to implement them with. That's not rewarding on any level.

And certainly not on a financial one. This new DES forces me to re-earn money originally paid for extended hours, which had forced me to re-earn money originally paid for QOF points.

Which is just one example of many financial sleights of hand in the new deal. Another is the new prescribing QOF, designed to scrutinise our prowess with the FP10. So say goodbye to local prescribing incentive schemes – stolen by the new QOF PIS-take.

A clear case of robbing Peter to pay Peter, except Peter's too busy running patient participation groups to notice.

And while we're wedged, helpless, between rocks and hard places, we're being given a good kicking, too. Because the implicit message behind these changes is that we GPs are currently underemployed.

How else could we find the time to pursue commissioning, patient participation, care pathway initiatives, scrutiny of referrals and so on, ad nauseam? Jeez. Just what have we been doing all this time?

It's not all bad, though. There's much to look forward to. The loss of practice boundaries, for example. And resuming responsibility for out-of-hours. And, most chilling of all, ‘Quality and Productivity Indicators'. Oh, so hang on, actually it is all bad.

Put simply, general practice is a big plate of cack, and the current revamp is simply going to stick it in the microwave, so we end up with a big steaming plate of cack. And that, come to think of it, is what God gave me when he was handing out analogies.

Click here for more Copperfield Copperfield knows exactly what to make of this year's GP contract agreement – if only he could find the right words to express it