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Copperfield at Pulse Live: Lessons on gambling disorder

Copperfield at Pulse Live: Lessons on gambling disorder

Monday 25th April:

Unbelievable scenes yesterday at Day One of Pulse Live London. Admittedly, I missed the relevant session. My other half had commanded me to snaffle as many free samples as possible from a skincare-product sponsor. And while I was furtively stuffing my Pulse Live tote bag with tubes of cream and lotion like an eczematous kleptomaniac, an eminent speaker was allegedly alleging that GPs are contractually obliged to provide ten-minute appointments.

This had us frantically checking our mental versions of the GP contract and coming up perplexed. And this was compounded by closing keynote speaker, RCGP chair Martin Marshall, saying that future GP appointments should last half an hour.

Combining these figures into a sort of Q-risk appointment/workload calculator I’ve just made up, I think I’m right in saying that the average GP day will last 33 hours. Add into the mix the fact that LMC representatives are going to vote on reducing GP core hours to 9am to 5pm and it’s clear that Pulse Live London Day One was the day that physics broke.

Fortunately, the keynote speech today is by a certain Rt Hon Jeremy Hunt – a man who can do amazing things with numbers, such as effortlessly convert +5,000 GPs into -1,000. Maybe his vision of the future and maths wizardry will save us.

I could certainly do with some good news. When I presented my wife with her carefully selected skincare collection, it was revealed to be perimenopausal skin-wrinkle cream and anti-dandruff shampoo. You may recognise me today, I’m the one with the limp.

Tuesday 26th:


Blimey. Today’s opening session on ‘Covid and the brain – what do we know?’ kicked off with the personal harrowing Covid story of speaker Dr Peter Bagshaw. He suffered first wave infection and stared out the Grim Reaper with sats of 55% (that’s fifty five per cent). Even when he went back to work, his sats were at levels where, according to guidance, he should have been dialling 999. This really puts the effects of my infection – going off Sauvignon Blanc a bit – into some kind of perspective.

Really interesting talk, even if the answer to the question posed in the title is: ‘Not much yet’. Bit concerned, though, to hear that there have been suggestions Covid infection might bring forward dementia onset by ten years. Did I mention that already?

Onto Transforming Digital Delivery at Scale which actually finished very early – if that’s a reflection of what at-scale-digital delivery can do for our surgery running times, then bring it on. But I did catch all of the Q&A session which almost made me well up given how genuinely GPs seem to want to improve access for their patients – where are those Daily Mail journalists when you want them?

And an interesting mini-debate about demand – by improving access can you ever reach a point where demand is satisfied? No official vote but the audience murmur was a very definite ‘nope’.


So I went to Dr Deen Mirza’s provocatively titled talk: ‘Working as a GP in secondary care’ for a number of reasons, including:

1) I’ve always been a bit sniffy about GPsWIs (‘I’m a GP with special interest in general practice’, ‘Why make working as something other than a GP one of the USPs of becoming a GP?’ etc, etc) so I thought this might be blog-fodder.

2) The blurb described the speaker as an ‘extensivist’ and I had no idea what this is.

3) Dr Mirza is an excellent speaker.

In fact, it turned out the original title was even more extreme (‘GP – an exit plan’), but was vetoed by the organisers. And, predictably, I became far less sniffy as the excellent talk seduced me into a surreal acceptance of what fun it might be to work in secondary care, even as it dawned on me that this would exacerbate our workforce issue.

It did leave me wondering whether, in a parallel universe, there might be a consultant talking about working as a specialist in primary care. Answer: there isn’t. But I do now know what an extensivist is: a GP given the time needed to what a GP can do really well. So that’s what I want to be.

And onto the final session of the morning: the neatly titled ‘Lost in transition’ (about transitioning from adolescent to adult services, not, you know, that other thing). This presented some really startling facts and insights into adolescent and young adult life. They comprise 20% of medical in-patients! They spend nine hours online every day!! They do want sex education from their parents but reserve the right to cross-reference with their peers and social media!!! And they do need more sleep that adult-adults and are hard-wired not to wake until 10am!!!! If you’re reading this – sorry, boys.


I want to make it clear that I excitedly went to the session on ‘Inducible laryngeal obstruction’ simply because I’d never heard of it before, NOT because it was something I thought, from the title, I might be able to induce in patients myself. Not even slightly, not even maybe to just shut them up a little bit for a moment to, say get a word in. That thought never entered my head.

Anyhow, turns out that this syndrome is the choking rather than swallowing version of globus. Probably a type of dysfunctional breathing and quite possibly, as the excellent speaker pointed out, the origin of the phrase, ‘to choke’ in sport.

And it’s a short hop from sport to gambling, of course, which led me seamlessly to the next session, on Gambling Disorder. And yes, the speaker was bang on: I don’t ask about it, I don’t recognise it and I don’t know how to help. But I do now.

Also, apparently, about a quarter of those with Parkinson’s Disease have a history of Gambling Disorder that preceded the PD diagnosis. Bet you didn’t know that.

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

Patrufini Duffy 26 April, 2022 8:30 pm

I thought Matt Hancock was a Key note: How to siphon NHS money and get away with it. Or a Kanani-Waller Key note on How to Disappear and Reappear in a timely fashion and Lessons learnt in Retrospection and How to Talk with colleagues. Or a GMC Chair talk, and you watching the final episode of This is Going to Hurt, with sweet popcorn.
For 2023 can suggest future talks of:
– solving racism and bullying in the NHS
– the cover-up and sell off
– how to be a private GP and flourish
– how to move to Australia and Canada
– who works in the DoH and who advises them
Next time there’ll be loperamide samples or Movicol lucky dips. And some foghorns and woopy cushions.