Government magic trick has vanishing chance of success

Columnist Dr Copperfield looks at the Government’s cancer target revamp and sees yet more unfunded work for GPs

Oh, that’s clever. The Government can say it’s no longer missing two-week cancer targets, because there are no longer two-week cancer targets to miss. Neat sleight of hand, but it’s nothing compared with the grand illusion they’re conjuring around general practice. No, I don’t mean they’re going to double GP numbers by sawing us in half. Let me explain.

A blindingly obvious consequence of the cancer target revamp is that just about everyone we refer on the new ‘eight-week-to-diagnosis/all-clear’ target will default to straight-to-test. And we all know what that means – another pathway for the patient, starting immediately after those eight weeks, leading straight back to us. Cue consultations starting with, ‘I’ve received this letter from the hospital which is written in Greek, I’ve been told I’m discharged, which I don’t understand because I’ve not even seen anyone and I’ve still got diarrhoea/weight loss/a cough/bleeding, etc’. 

This is a little bit like setting off on your holiday, only to spend your entire time at the airport before being returned home with no explanation, without your luggage. And we GPs find ourselves staffing the complaints desk. Which means the significant role of reassuring, explaining and placating, followed by the even more significant role of pursuing the patient’s non-cancer diagnosis, is dumped on us. In other words, we are left to do the consultant’s job.

And that’s becoming a familiar feeling. The complete farce of the routine NHS referral system means that those who cannot afford private care – and, let’s face it, there are very few high street banks left to rob – are stuck in limbo. By default, we’re left carrying the clinical and medicolegal can that previously would have passed to the specialist. And we’re obliged to kick this can down the road until the patient spontaneously improves, deteriorates to the point of needing urgent admission or expires.

And if we do bother trying to refer, what then? Either a bounceback for using the wrong colour pen, or an unsolicited A&G response telling us that, actually, it’s pretty easy repairing an aortic aneurysm on a kitchen table with a plastic spoon, why not give it a go and get in touch if you’re having problems?

So we’re trapped. Every route to secondary care ends in road closures diverting patients back to their GP. We are on our own. If you feel like you’re running the NHS, that’s because you are. After all, for years now the ‘kindly do’ shopping lists on discharge letters have treated us like community housemen and women. These latest changes simply promote us up the hospital food chain, whether we like it or not.

And that’s the Government’s spellbinding new trick. Ministers have drawn some curtains around our consulting rooms, said abracadabra and hey presto. Pull back those curtains and you’ll find a GP
magicked into a community consultant: primary care physicians who are doing a secondary care job.

Which would be fine except that I’m not trained for it, funded for it, or up for it – not least because I already have an important day job to do and my sanity to protect. But don’t worry. On any theatre stage, there’s a trap door, and this one leads to retirement, or fewer hours, or Australia. So just find the right lever and do a disappearing act.

Dr Copperfield is a GP in Essex. Read more of his blogs here