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16 things that are wrong with that 16-page open letter

16 things that are wrong with that 16-page open letter

So you’ve read it – the 16-page open letter to patients from a practice in Derbyshire. And you’ll have your own opinion. I do. Here are 16 things I think are wrong with it.

1. It’s way too soft on the bastards.

2. Just kidding! That was simply my way of grabbing your attention, and getting the comments-cohort onside.

3. It’s too long. I mean, really. 16 pages. Jeez. I have a vested interest, and I sympathise with a lot of this stuff. But I’ve tried to digest it three times and I still find myself speed-scroll-reading about two thirds of the way through.

4. That’s ironic, given that many of the points made relate to patients not reading/following advice/instructions. How can the solution to this be a 7,500 word+ manifesto?

5. Yes, I know there’s a one-page summary, but still.

6. Conclusion over length and tone: this is catharsis. This I understand – you only need to look at the pic heading up this blog for proof. But primal scream therapy is for the screamer. So this isn’t really for the benefit of patients at all.

7. The stuff about online consulting leaves you vertiginous. It’s imposed by the Government. But it can stop patients bothering the GP. But patients are too feckless to use it properly. But they should make the effort to do so. But then they manipulate it. Etc.

8. Its tone is overly aggressive and anti-patient, and I speak as a GP who wants to punch each and every punter in the face by the end of Monday morning surgery.

9. It’s not just the overall feel that achieves this, it’s the specific examples given when the rant after-burners are turned to max, about halfway through. Such as:

10. Patients should sort themselves out.

11. They shouldn’t present lists.

12. They pretend problems are urgent when they aren’t.

13. The mildly mentally ill ignore the support available (what are they like?!).

14. Medical advice from clever professionals – who deserve better – is ignored.

15. All of which may be true. But it’s also true that this comes over as a massive, doctor-centred, finger-wag-fest, which will certainly make the job of anti-GP media columnists so much easier, this week’s angle being that GPs seem to think the system should be built around their needs rather than the patients’.

16. By emphasising online consulting, signposting, open access and self-reliance in the manner of a lupine howl, and by failing to acknowledge the possible value to the NHS and patient of gatekeeping, continuity and the therapeutic value of human contact with a health professional, this could well be the longest general practice suicide note ever.

I don’t know. I’m conflicted. Because I like and can relate to Munch’s ‘The Scream’. But I also like and can relate to ‘Fildes’ ‘The Doctor’. And, one of these days, we’ll be patients, too.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at



Please note, only GPs are permitted to add comments to articles

John Graham Munro 4 May, 2021 9:13 pm


David Church 5 May, 2021 10:10 am

There is a need, and it is time for some BALANCE in the Doctor-patient relationship :
For too long, medicine has been patient-centred to the exclusion of the Doctor – it is about time for some Doctor-centredness, to restore balance, before we find Doctors excluded altogether and only Nurses and (assistant)-Practitioners available to doctor us in our surgeries in our old age.

John Ashcroft 5 May, 2021 10:52 am

The letter maybe too long for some.
The main issue is at risk of getting lost; eConsult was dramatically increasing workload, and it was “worried well”, rather than those in clinical need.
The central issue is that if the government wants to increase access it needs to put more in.
And that means a new contract.
Under the present system trying to deliver more just means higher workload, and if you try to meet the workload by working harder then you burn out; or if you do it by employing more and more staff you take home less and less money for delivering more and more.
Deliver less, you earn more especially as patients with high wants and needs go elsewhere.
You would have thought a conservative government would have a better understand basic economics.

John Ashcroft 5 May, 2021 11:48 am

The practice statement. It sounds like feed back from patients, and other doctors has been quite positive.
They have moved back to a more traditional model.
It sounds like eConsult should have been better trialled.
Another NHS App fiasco.

Dave Haddock 5 May, 2021 1:44 pm

Many problems would diminish with charges for consulting.

Patrufini Duffy 5 May, 2021 8:46 pm

Well, at least we’re not running IBS clinic, proctology, GUM or IAPT for a GAD score of 3. Well…maybe we actually are?

David Mummery 8 May, 2021 11:01 am

It’s a ‘cri de coeur’ from the heart and soul, almost in a stream of consciousness ( I suspect it was written in one sitting ) and should be taken as such..

Anthony Gould 8 May, 2021 5:44 pm

The basic issue is supply and demand
Demand rises and supply diminishes as there are fewer GPs, they are made to do more things and attend meetings of limited value
There needs to either be a huge rise in the number of GPs and other primary care physicians or we need to have a charge at the point of usage where the contact is initiated by the patient (so not for reviews and repeat prescribing )
I see no other way forward except GPs becoming salaried so primary care can go into the red like hospital trusts to buy extra resources as the shortage of clinicians will immediately be very apparent
Perhaps much more funding of deprived practice areas might help to stabilise the areas of most need
I have been a doctor since 1978 and have come to these views especially over the last 7 years as QOF has become a millstone and GPs have been made to do penance for the 2004 contract Plus the CQC has not helped .
I used to be sceptical about burnout but the government have caused a great number of good GPs really burning out
I still work albeit less hours but I do feel I almost collapsed under the pressures of general practice before resigning and working as a Locum