Columnist Dr Copperfield shares a radical proposal with the health secretary: take urgent, on-the-day appointments away from GPs to free up time for more complex patients
Although GP appointment access is a hot agenda item for the new PM, the new health secretary Thérèse Coffey has declared a ‘lack of a plan’. Not to worry, her predecessors had no idea either.
Something she is clear on, though, is punctuation. She’s especially hot on commas, apparently. Hopefully, this punctuation obsession won’t cloud her NHS work, otherwise she’s going to be very confused about colon screening. But perhaps she will, at least, sort GP access problems – simply by putting a full-stop to them.
After all, the fundamental problem is simple: it’s the mismatch between GPs and workload. This is more about figures than commas, but coming from Work and Pensions, I’d imagine she’s encountered numbers before. So let’s put it in terms she’ll understand. GP workload: big number. Actual GPs: little number.
As the workforce shortage is insoluble in the short term, she has to reduce workload. This can’t be done by the usual reflex response of throwing random initiatives at us, such as mad, time-limited, non-recurring, tickbox-dependent funding streams. Or chiropractors.
Instead, she needs a blockbuster idea that will transform general practice overnight in the way dropping out-of-hours responsibilities did in 2004. Believe me, I was there and it was transformative.
So here’s a suggestion. General practice has evolved into two jobs in one. An ‘on-the-day’ acute care service and a subacute/chronic/preventive/complex care service, the latter increasingly driven by outside forces such as NICE, QOF, IIF, hospital dumping, et al. Two jobs into one don’t go, and this invites the obvious seismic idea: relieve us of responsibility for all those disruptive and time-consuming urgent/on-the-day problems.
Instantly, the appointment crisis is resolved. In our practice alone, we’d free up around 40 appointments per day currently reserved for ‘urgents’. Cue happy patients, and happy GPs, too – so long as there’s no concurrent financial clawback. After all, we deserve to get paid the same for doing one difficult job well as we do for doing two impossible jobs reasonably. So NHSE should find funds from somewhere, perhaps by diverting all those resources currently frittered away on back-of-envelope initiatives, IIF, ARRS, etc etc.
Besides, it’ll be cheap. Most on-the-day work involves the usual acute suspects (cough, D&V, cystitis, etc), which really could be handled by noctors or even AI, given a sane and pragmatic protocol/algorithm.
There might be grumblings around ‘the death of continuity’. But the only continuity most acute issues require is the consistent message that these ailments simply need self-care. Besides, freeing up routine appointments will actually enhance continuity for long-term complex issues that really need it but that currently get the opposite because their only way into the system is to pretend they’re urgent.
Will it make the job boring? Maybe. But frankly I’d rather die slowly of boredom than quickly of stress. And any worry about defining ‘on the day’, and ensuring follow-up for those acutes that need it, is just a matter of dotting Is and crossing Ts.
So, Thérèse, release us from those urgent-care shackles and you would instantly make general practice a saner, happier place where we’d have the headspace to do our job properly and enthusiastically – which, in turn, would encourage new recruits.
It’s just comma sense, really.
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs here