Columnist Dr Tony Copperfield has some advice for the new health secretary ahead of the winter months
Forty-nine days is a long time in politics, as I’m sure Thérèse Coffey would agree. This has to be the shortest ever stint in office for a health secretary. Indeed, once Liz Truss was in iceberg-lettuce time, it did look like Ms Coffey’s tenure would last no longer than a course of the amoxicillin she’s allegedly happy to dish out to friends and family. And so it proved.
What a legacy, though. She highlighted a primary care fronted by chiropractors, insisted that GP numbers are stable and created an expectation that patients will get an appointment within two weeks. All this while maintaining a laser-like focus on the first four letters of the alphabet.
To be honest, she never seemed a great fit. That much circulated cigar-toting, booze-necking picture portrayed her as secretary of state for anti-health and social don’t care. And some of her pronouncements have certainly seemed health illiterate, nihilistic or both.
So welcome back Steve Barclay, holder of the record for the second shortest ever stint as health secretary. As the old cliché goes, he’s got a lot in his in-tray, assuming he can find it through the smoke-fug and fag-ash. Before he gets immersed in the endless and apparently insoluble NHS crises, I’d like to offer him a quick primary care win requiring just a tiny tweak of wording.
Among the requirements and expectations of the recently published Winter Resilience Plan was the idea that ICSs should ‘actively consider establishing’ respiratory hubs for the winter, to take pressure off GPs and ambulance services. As a GP who spent two long emergency surgeries yesterday dealing solely with children and adults with cough – none needing admission and barely any needing any specific treatment – I was frustrated, bored and exhausted in equal measure.
And it’s not even November. Changing that ‘active consideration’ to a ‘mandate’ would divert all that winter drudge elsewhere, meaning I could get on with the more relevant, complex day job. So, bring back – and fund – the Respiratory Hub. That’s ‘R’ and ‘H’, Steve – you’ll find them in the bits of the alphabet your predecessor didn’t get to.
Dr Copperfield is a GP in Essex. Read more of Copperfield’s blogs here
Funny that!
My day was exactly the same albeit in Hertfordshire – everyone with a cough and nobody with a chest sign to keep it interesting.
However, if I worked in the Respiratory Hub being suggested, then every day would be like that, and my second retirement wouldn’t so much beckon as become irresistible unless there was nurse triage, in which case I could sit and do the crossword all day.
Hi Doc, do we really need respiratory hubs or instead better patient education on cough and when to see the doctor?
We are trialling something to reduce the need for individual reassurance with the magical movements of the stethoscope. We encourage our patients to watch our health advice videos:
https://www.kingsnorthmedicalpractice.co.uk/cough—myth-busting
Using the media to send out these type of messages would potentially reduce our workload. What do you think?
You can email me on zkomlosi@nhs.net
Regards, Zsuzsa Komlosi GP
Yes. Go to a respiratory Hub, then the pub, hug some trendy dogs, then have a few cigarettes, and stand in the cold singing Barmy Army chants and Three Lions whatevers. Can’t wait for winter. Everyone with a cough and chest pain should be illict drug tested. See what that shows.
Patrufini Duffy – could you please, please give it a rest…..
What I want to see is a triage algorithm for cough / pneumonia in adults analogous to Centor for sore throat.
NICE says no antibiotic required unless pneumonia suspected, but there are no diagnostic guidelines for diagnosing pneumonia in primary care. Not from NICE, not anywhere that I’ve been able to discover: all the diagnostic criteria I can find refer to CXR findings.
It seems amazing that an antibiotic prescribing decision that a clinician may end up making a dozen times a day is left to clinical intuition. If we had a tickbox score chart we could head off many of these consultations at triage stage.
(Interestingly, this “gap” in the literature only refers to adults. There is a really useful algorithm for GP remote triage of cough in children on the what0-18 website)
Interestingly I’ve been seeing very little of the usual coughs and colds. The one I saw yesterday had a Sign, so got antibiotics.
I sort of assumed people had got used to dealing with these things better without us.
Or getting antibiotics over the phone which I won’t do.
Yen quid to see the doctor would have a miraculous effect on consultation rates for minor illness.
“Abnormal findings on auscultation in patients with LRTI strongly predict antibiotic prescribing and this is probably inappropriate for most patients. These results should prompt GPs to consider the extent to which finding ‘crackles/rhonchi on auscultation’ influences their decisions to prescribe antibiotics for their patients with LRTI, and to consider the predictive value of individual clinical signs in reaching evidence-based prescribing decisions.”