I’m getting paranoid about para-help
Copperfield on how extra clinical staff are hindering rather than helping with reducing general practice workload
I am notoriously bad at noticing what is staring me in the face, as my wife and her new haircuts will tell you. So I’m guessing that this week’s lightbulb moment may be a statement of the bleedin’ obvious. Whatever. It took three cases in quick succession for the penny to drop.
Case 1: A patient with prolonged and severe sciatica – who therefore comes into the rarefied category of actually needing a scan and, maybe, surgical intervention. For some reason, he was unimpressed by the physio phone call and leaflet he was triaged to after I referred him, so after two months of exasperation, he looped back to me to start over.
Case 2: A patient with significant mental illness is referred back to me by the mental health practitioner because he ‘needs to see GP?’ Why? Long story short: he has chronic MH issues, serious and increasing impairment, no clear diagnosis and an accumulation of industrial strength psychotropics with no psychiatric follow up for years. So I refer him to the mental health team. They bounce back with: ‘To see MHP first.’ I rebounce back with: ‘No offence to MHPs, but they have zilch to contribute here. Still no offence mental health practitioners, but they don’t seem to diagnose, can’t prescribe and water-tread through treatment reviews. Not sure where “practitioner” fits in, tbh.’ Despite this, MHT diverts him to MHP, MHP says needs GP input as per above. Back to square one, so he needs anger management now too, on top of all that.
Case 3: This happened to my colleague. He tried to admit an elderly man with vomiting and off-legs, only to be phoned by a ‘consultant paramedic’, who says the patient doesn’t require transport to hospital; he just requires antibiotics, an anti-emetic and some bloods. I have to be honest, I’d have said, ‘Well, you may be a “consultant paramedic”, but I don’t care if you’re Santa Claus. If you are, though, stick the patient in your sleigh, set Rudolph’s nose to “blue/flashing” and get him to hospital’. The patient was admitted the next day. After all, even with a ‘consultant paramedic’, there’s still that tell-tale ‘para’ in the title, isn’t there?
So that’s how I suddenly realised why our role is so sodding impossible these days. All these extra, wonderful, highly qualified staff who are supposed to help with our workload as the pressures rise and our numbers diminish? It’s all bollocks, isn’t it? Their purpose is the exact opposite: to get in the way of us doing our day job, because the perception is that all we do is over-refer and over-admit.
The whole system is conspiring against us. These three cases are just examples of a whole anti-cavalry of para-help. They represent a covert and dangerous cut in our autonomy and, as cuts go, that’s a really ugly one. Unlike my wife’s of course.
Dr Tony Copperfield is a GP in Essex
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READERS' COMMENTS [13]
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It’s what you get when you have the smartest professionals forced to work in an increasingly stupid system….sounds like a shitty week….but I’ve had…
Case 4. Fat red-nosed character with alcohol issues and a tendency to pathological laughter…
Case 5. Three confused swarthy fellas with a shared delusion that they were following a star…
Case 6. A young lass who wanted “another pregnancy test cos the chemist said I was pregnant, but I can’t be…I’m a virgin”…
What’s going on? What IS going on?? Ohhhh…it’s that time of year – happy Christmas, Coppers 🎅
Pay peanuts and you wind up with monkeys.
The system is trying to get away with using the cheapest available options instead of properly paying properly trained professionals to do the job properly.
Glad we’re all in the same boat.
exactly same for arrange x-rays for podiatrist arrange bloods but not listed which bloods or timescale on discharge…..
we dug our own hole, and have been digging for several decades, and what a massive ugly hole we have dug for ourselves and watched our profession and careers slide into it, but nice you woke up for Christmas Dr Rip van Winkle. Good article, made me chuckle. Para is the future if you keep hiring paras.
I had all the cases in the article and more: unstable vertebral fractures (yes several) not even looked at in AE, patient with Hb of 50 unable to stay awake for more than couple of hours a day, discharged with oral iron she can’t tolerate, patient admitted with sepsis- family sent to GP so ask for methotrexate (ward don’t stock it and obviously don’t know what it is). All recent, current.
I now routinely start my discussion of management plan with: ideally this is what should happen, but in reality here you will be lucky to get zilch
Specialities like rheumatology, paediatrics, cardio- nearly impossible to get to. Pain management, gastro, MH- moved from almost impossible to reach to either impossible or completely useless. In case of MH (AWP) it’s deliberate, what is their PCLS for? Can’t diagnose, can’t prescribe, can’t forward on to anyone within the “service” who can.
Every flow chart ends with review by GP. I think more so now as no-one ever sees an GENERAL Physician,Surgeon, Psychiatrist, Urologist etc- if slightly out of their remit patients are bounce back
💯
Can’t believe it has taken so long for the penny to drop. This has been an obvious barrier to safe mental healthcare for a number of years. Front door of secondary care is entirely staffed by non doctors. Patients pushed around for years ( literally sometimes) without a diagnosis and guess what- they don’t get better!! In fact often, they get worse. A few recent headlines regarding community murders of strangers is the worse outcome. The new MHA is just going to make things worse. Until everyone realises that actually, only doctors are trained and capable of making diagnoses and coming up with sensible holistic plans, this will continue. Doctors have been complicit in enabling non doctors to think they can.
And just for info, myself and two other consultant colleagues wanted to set up privately online so that we can (try our best given circumstances) to provide expert mental healthcare to fill the increasing primary/ secondary care interface gap. After 9 months of pushing CQC, 60 page online forms, writing policies etc, they have turned us down and we have to resubmit at back of queue again. Wrong advice from them, obstructive irrelevant and outdated rules which are variously and badly applied; a veritable omnishambles. So in summary, the government really don’t want competent doctors seeing the public.
I had an elderly demented couple, chap fell down the stairs, hit head more confused, taken in by ambulance, no ct head-too long on trolley; left again, refusing to go back, me trying to manage his acute on chronic confusion not presented to any medical services-hermits-bloods taken, antibiotics tried-urgent referral to OT and social care by me-snotty son-in-law comes onto speaker phone (single phone slot for both patients) telling me he’s not just a paramedic he’s an emergency paramedic adn starting to give me his CV, I cut n and ask what is your question for me. He supercilliously asks me why I haven’t done a frailty score of the pair. I said I prefer to have action points than scoring systems that don’t offer any actual management plan, I say I have to go, waiting room full of patients, the 2 for 1 phone call has got us quite behind. He says I don’t want to know about how busy you are. Well I don’t want to know what his CV is. He’s recommending a scoring system as an action plan and he is wasting my valuable time.
Essentially anyone who tries to convince you how great they are is useless. Anyone who adds consultant to their title apart from a doctor after 20 years of training who may actually be useful, needs to go to medical school if they want to be doctor or if not accept they are not a doctor and not advise us what they think is needed.
At least PAs have been renamed assistants and are being slowly phased out through the penny having dropped.
Now we need to put ARRS funding back in to core funding, phase out any ARRS that are not proving useful and conspicuously call everyone exactly what they are; doctor, nurse, paramedic, pharmacist, physio.
And then get everyone to do the job they are trained in.
GPs are more expensive than the allied HCP roles, but we are more efficient, so actually good value for money.