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If you want my advice…

If you want my advice…

The Pulse editor referred me to many topical stories other than ‘Advice and Guidance’ this month in the hope that I’d write about something else. But those stories rejected the referral on the grounds that they remain less interesting than A&G. Which, let’s face it, as a concept, a constraint and a colossal work dump, remains end-of-civilisation-as-we-know-it huge. 

Its sudden transformation from an optional and occasionally useful service to ubiquitous and (as predicted here last month) mandated referral hurdle is something we maybe should have seen coming. After all, quite apart from the obvious need for radical solutions to relieve NHS pinchpoints, there’s the fact we GPs have been softened up into a mindset of what we request not necessarily being what we receive. Referrals for a hip replacement switch to endless and pointless physio, computer pop-ups nudge us towards a different treatment to the one we thought we were prescribing, and ambulance requests morph into us providing an ad-hoc advisory service to paramedics.

So now there’s the Advice and Guidance monster. It’s become such a dominant feature that I’m fully expecting it to spill out into my social and personal life. Invitations to friends to come round for dinner being rejected on the basis that they actually hate me and advise I eat alone; and the desire to have a dump denied on the basis that I could first try controlling the urge with CBT and Imodium.

The only solution is to try fighting fire with fire. If only we could demand-control our own patients and their insatiable demand for consultations using the A&G concept. Well, we can, and do. Every day, our receptionists advise patients that they don’t need the GP and instead guide them towards, say, the pharmacist for minor ailments, the social prescriber for psychosocial angst and the respiratory hub for the management of actual and possible Covid.

 And signposting is great, except for the fact it doesn’t work. Even if patients accept the diversion – and many don’t, or only do after giving the receptionist a volley of abuse – then the pharmacist can’t manage the problem or gives advice the patient doesn’t trust, the social prescriber is off sick with stress, and the respiratory hub has croaked its last but no one told us.

So the patient comes back to us. And that’s the problem: GPs are the final common pathway for everything. We always have been and always will be.

And now, with the advent of Advice and Guidance, our major escape route has been road-blocked. This ruins my working life in ways so profound that I find it hard to articulate. I used to know my limitations in terms of knowledge, competence and capacity but, apparently, not any more. Secondary care is now defining this for me in a manner that suits them but certainly doesn’t suit me.

So if you’re considering a career in general practice, you might want to take some free advice and guidance. I’d suggest you think again and consider doing something to get it out of your system. Such as a good dump.

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 3 December, 2021 3:03 pm

Today’s anxieties and an inability to cope, is tomorrows constant cycle of waste of time, trivial explanation and normal tests. Well done. We achieved nothing. And clogged up everything. The new human has an inept attitude to physiology, self care and resolution and that is soul and system destroying. A blah attitude to responsibility and maximum blame and persecution of front-line staff, explaining made up symptoms because the mind itself needs some proper advice and guidance. They’ve built a second gate for the gatekeeper, and thrown that key away. This is unsolvable. The lawyers remain happy, well done – a perverse climate to practice a pure science.

Reply moderated
Patrufini Duffy 3 December, 2021 7:29 pm

Solution: Maybe the patient should directly just ask the hospital for advice and guidance. That’d be efficient and be a conversation we’d like to sit in on. Like to hear what the Gastroenterologist has to say about that weekend of bloating and offensive takeaway stool and want for urgent allergy tests to donor kebabs. Take the publics call directly, it’s humourous.

David Mummery 4 December, 2021 9:37 pm

It’s called ‘integrated care’ Tony 😂

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James Weems 4 December, 2021 9:44 pm

Quite often I can get a long winded tirade mainly aimed towards secondary care coming in via AMGP.
It’s nice to be able to ask as Sec to cut and paste amd send to secondary care as an A&G. Ticks the box. ‘Prevents’ a referral (they are already under they speciality but patient been trying unsuccessfully for days to get through to them).
Raw uncensored emails from the patient. They can share in the fun for once!

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