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Continuity of despair


So, we’ve just had two big ideas tossed out there: one is unworkable but right, and the other is workable but wrong.

In the first category, we have Jezza’s suggestion of personalised lists.

I think we’d all agree that personalised lists lead to continuity of care, and that continuity of care is a good thing. That said, a bit of discontinuity can bring the odd startling insight (as when a senior partner said to me about one of my inexplicably tired regulars, ‘He’s got Parkinson’s, you moron’), and it’s not great to be compelled to stick with a crap GP, although at least you get consistent crap.

Overall, though, no question: continuity is better for doc, patient and NHS. The only problem with personalised lists is, of course, that it’s not 1970. Just about every policy in living memory has moved in the opposite direction to personalised care: an all-U-can eat NHS, the bigger is better mantra, the obsession with access, the digital revolution and so on.

Add to that the complete Governmental failure to address the workload issue with anything but a random number generator and vacuous promises, and you just end up with continuity of despair. If you don’t believe me, ask any of those paragons of personal lists: a single hander. Except you can’t, obviously, and there’s no going back now.

Then we have Saja’s suggestion of a national vaccination service. Now you’re talking, almost. At least this is about easing workload by taking a big lump of work away from us. Except, of course, the job will be done less well, it will cost more (remember out-of-hours?), and they’ll cut our pay. And – whisper it quietly – while we fret over vaccination targets and chasing unpaid invoices, it’s actually the nurses who do all the real jab-work.

Of course, a true and sustained reduction in workload for GPs would be a cause for manic celebration, but would require stripping something really significant from the job description (again, remember out-of-hours?) – such as the obligation to provide the completely disruptive and soul-destroying on-the-day dross clinics masquerading as ‘emergencies’. Drag that old banger out of the garage and we might just be able to provide the Rolls Royce service everyone’s always wanted.

So forgive me for tossing those ideas back, Jezza and Saja. But one little tip: the combo you’re looking for is workable and right.


Patrufini Duffy 2 February, 2022 3:17 pm

Excited to see Babylon, LIVI, GP at Hand and Doctorcareanywheres lists. Continuity is their dirty word, used at whim – a bit like transparency and candour, to basically say, you shoulder it, we can’t be bothered. And we’ll crucify you, not the broken system. The patient will crucify you actually, and you’ll be a lonely sheep, the named GP. Makes one cringe. How about more named hospital, ICS and social care coordinators? A named rogue health visitor, or psychologist perhaps? Maybe a named physiotherapist. No, that’s ludicrous. Dump it. I’d like the “continuous” name of the hospital central booking person who casually discharges patients inappropriately. This is just you being a scapegoated social and blame-game worker. There is no tariff on continuity and shouldering burnout. The CQC shut single handers and small lists, remember? Is that “working at scale” drive suddenly inneffective, wasteful and unsafe? Who would’ve known. They disrespect GPs, then want them shackled to their desks 8-8, 7 days sorting out ever individual with an individual plan. Ideal, cheap world. The NHS is a “souless, grey, standard operating procedure, bullet pointed, intimidating monitoring and persecutory juggernaut”, pushing you on to the high street for a scalding as “their” doctor.