Last month’s column – in which I predicted that we’ve been so effective at flushing our USPs down the grimy bog of general practice history that we’ll be hard pushed to attract new recruits – drew criticism for being too gloomy.
So I took a good look at myself, and my colleagues, and our work, and concluded that, yes, I’m wrong. It’s actually far worse than that. General practice has not only lost its USPs, it’s in danger of losing itself. Because, having tried for years to convince everyone that general practice is a specialty, it’s now arguable whether it’s even an entity.
I concluded this on hearing that our patients suddenly have ‘open access’ to a mental health practitioner. Yippee, you’d think, no more patients whose ‘bipolar is playing up’, or who ‘feel a bit suicidal’, or who want signing off work with stress because ‘work is stressful’.
And yes, superficially, this is a cause for celebration. It’s the bigger picture that concerns me. What once were novelties of delegation are becoming a frighteningly accessible norm. After all, this new ‘service’ came hot on the heels of the local introduction of open-access ‘physiotherapy practitioners’ for musculoskeletal problems. So patients depressed about their osteoarthritis can now be diverted to two separate independent practitioners, without troubling their ‘general’ one, aka me. Hurrah!
Then I hear the contraceptive pill is going OTC. So patients languishing in bed depressed about their osteoarthritis can avoid simultaneously falling pregnant merely by seeing three different health professionals, none of whom is their GP, etc etc.
And so it goes on. I’m trained in every facet of primary care, but no longer seem actually to provide any of them. It’s like I’m in an NHS version of the Monty Python cheese shop sketch. Medication review? Sorry, in-house pharmacist. Acute triage? Nurse practitioner. Chronic disease check? Practice nurse. Minor ailment? Community pharmacist. Alzheimer’s exacerbation? Dementia crisis team. Pregnancy issue? Call the midwife. Non-acute query? Online doctor-bot. Feeling like death? Palliative care service. We wanted our workload reduced, via appointment caps, enforceable agreements with secondary care, or whatever. Instead, workload has stayed the same, but been diverted by a deconstruction and delegation of our day job.
So why do we still feel overwhelmed? Because we still have the tasks of a) Covid-jabbing all and sundry, and b) being a community PALS officer sorting out the mess created when this uncoordinated dystopia fails to function to the punters’ satisfaction – which is just about always.
When these are sorted, what then? Once, we were general practitioners. We’re certainly not ‘general’ any more and it’s arguable whether we’re ‘practitioners’. If I was on the outside looking in, I’d say we were plain redundant, and maybe that was the idea all along. Careful what you wish for.
On the plus side, I can offer you some Venezuelan Beaver Cheese.
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield