A&G gaslights the way to GP hell

Copperfield argues that behind the semantics of A&G reform lies an attempt to make GPs doubt their clinical judgment and accept more work as ‘control’

It’s a strange time to be gaslighting someone, considering the current cost of fuel. But given that external forces seem to be manipulating GPs into questioning our own reality/memory/sanity, that appears to be exactly what’s happening.

It all started with the new contractual A&G obligation leading to some semantic confusion over the word ‘refer’. On the one hand, we were reassured that ‘New A&G pathways do not impact a GP’s decision to refer’. On the other, it was announced that GPs will ‘refer’ via a single point of access, with consultant-led triage deciding the outcome.

Er, so we can refer but it might not be a referral? This paradox is explained as follows: We GPs traditionally mean, by ‘refer’, devolving a specific part of the patient’s management to secondary care, usually via a F2F and follow up. Whereas NHSE now interpret a ‘referral’ as a message sent by us through a single point of access resulting in a ‘GP-to-do’ bounce-back under the cloak of A&G.

Just some innocent confusion, then. Until, that is, you read further justification for the new system. Such as: ‘It also means the onus is not on the GP to decide whether a referral should be for advice and guidance or an outpatient appointment’. Uh? So that’s been our problem, has it? Being overburdened by an inability to decide what we want for our patients as opposed to our complete inability to procure for them what they really need?

I’m feeling woozy already, but there’s more. The new system avoids us having to submit a separate claim for each request for A&G, while we still receive a full share of the funding via the global sum. Ah yes, I see now. The main arse-ache with A&G was the financial admin – not the doom-loop for patients, the workload dump for us, and the complete undermining of the profession’s authority. Fewer forms! They’re doing us a favour!

Are they inside your head yet? If not, here’s the coup-de-grace. The new model for planned care commits to ‘ending outpatient care as we know it’. And get this: ‘The NHS will put GPs in control when it’s unclear whether a patient needs specialist care.’ Yes, indeed, that’s outpatient care, but not as we know it: its outpatient care delegated to us, for free.

That’s a good thing, isn’t it? We always banging on about wanting autonomy and loathing interference. And this way, we’re, quote, ‘in control’. Though not of our minds.

Dr Tony Copperfield is a GP in Essex