Columnist Dr Copperfield criticises the rejection of a motion at the England LMC Conference that proposed to separate acute on-the-day care from planned general practice care
I’m furious. Partly because as a blogger that’s a contractual obligation, and partly because Pompey finally relinquished their extraordinary unbeaten run thanks to dodgy refereeing decisions (oh, and four goals conceded). But mainly because the LMCs have voted against the motion/notion that GPs should dump acute care.
This, IMHO, is the best idea ever. Or, at least, the best idea since deciding to opt out of the nightmare that was OOH, which this new initiative has been compared to. And rightly so: ditching OOH was a radical attempt to shed workload at a time when general practice was on its knees – sound familiar? And it was transformative. I was pinning my future on this, and I’ve thought it all through. Here is my working:
- To solve workload issues, you have three options: divert, contain or shed work. Divert? All roads lead back to us. Contain? Limiting hours or appointments are unworkable. Shed? Yes, that works (see OOH as above). So instead of piddling around the periphery of the problem, we have to be big and bold.
- If you’re queasy about the definition of ‘acute’, it’s easy: it’s whatever a patient insists needs dealing with on the day. See first, educate later.
- Would it make the job tedious? Well, I’d rather be bored than stressed to distraction. And you can always do sessional work in the acute hub if seeing sore throats and cystitis floats your boat. Continuity concerns are fatuous. Genuinely acute issues don’t need continuity. And if they do – recurrence/underlying concerns – then they can be referred on to the usual GP for that. Who will do it? Won’t this use up more GPs? On-the-day stuff really can be sorted via Idiot Guide protocols. Which means pharmacists, paramedics, ANPs, AI et al could sort them. No disrespect intended etc. I don’t want to start offending people.
- Money. Ah, yes. Ideally, we make the argument that we’re already doing two jobs (acute and chronic/complex) while being paid for one. If that doesn’t cut the mustard, then we have to decide how serious we are about cutting workload. With OOH, we agreed to a tiny cut in income and a few months later absolutely no one was arguing it wasn’t worth it.
See? Simple. But not according to the England LMC Conference, which still seems to believe that workload can be solved by concerted hand-wringing. My football season and professional future were wrecked in one weekend. Thanks, ref. Thanks, LMCs. And time to bring in VAR at the annual conference.
Dr Copperfield is a GP in Essex. Read more of his blogs here
READERS' COMMENTS [8]
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Copperfield has nailed it as always. OOH was dropped by GPs because demand outstripped capacity..In hours demand for same day attention has outstripped capacity. Accept that our public wants a service that is not deliverable So, provide continuity except in a very urgent situation and if you want to then work a few sessions to maintain your ‘urgent’ assessment skills. We cannot do both at the same time in todays NHS.
I would suggest that limiting hours AND appointments are workable and many practices are already taking steps towards this by implementing the BMAs Safe Working Guidance
OOH was dropped by Practices, NOT GPs.
If you think in hours General Practice is poorly funded, you should try working for an Urgent Care Service.
That said, we already handle most of the acute stuff as patients are told they can’t have an appt with their own GP for nearly a month. Give us the money, and we’ll make this work.
Giving up acute care would play into the hands of those who wish to bring an end to general practice and replace it with something ostensibly cheaper and far inferior. This isn’t in our interests, nor those of our patients.
It is entirely possible to limit contacts to safe levels and redirect patients elsewhere once we are full. We just have to learn to say ‘no’ when appropriate. IMHO this is the approach we should be taking, along with a move towards linking pay with activity, and pushing for acceptable levels of funding. But to do that we need to be prepared to back the GPC.
Sorry, Copperfield, but the LMC Conference got this one right.
Copperfield is correct. He has spelled it out clearly. The LMC got this completely wrong. There is no arguing it. If you want to carry unlimited workload for no increase in pay with the stress, complaints and everything else that goes with it, then conti ue your hand but STOP MOANING about workload because you have voted against the thing that can help reduce it.
“I’d rather be bored…” you lost me after that.
Well put Darren. Dr C, some of us haven’t got retirement just around the corner, who is shortsighted here?
Julius Parker nailed it: if you haven’t figured out how to limit/ cap workload yet then perhaps take more than just a cursory glance at the conference outputs or maybe even attend it in person.
Dear Coppers
As a fellow blogger, I love the fact that being furious is a contractual obligation!
As the recently retired Chair of England LMC Conference, I wanted to share the detail that went into debating this motion.
Prior to the binary debate, all LMC reps participated in x3 one hour break-out discussions, and one of the topics was the separation of acute and planned care. Within this break-out groups, they were asked to reflect on the strengths, weaknesses, opportunities, and threats of this model. The feedback received was that this was useful for them to consider all factors, even if it wasn’t something they agreed with.
The debate that followed took around 40 mins and a range of views were heard from both partners and sessional GPs.
I feel confident that LMC reps were voting based on all the nuanced discussions that were had over the day.
For me personally, for the first time in my life, I am on the fence on this one as I can see both sides of it. But if we do planned care really, really well, then there is unlikely to be much cause for acute care.
Take care
Shaba
I think the greatest risk is that shedding acute care is a means to merge to superpractice salary model throughout. Who else has the capacity to manage the urgent care other than us? Does superpractice salaried model improve outcomes, GP or patient satisfaction. We could shed mental health, or a number of other areas before urgent care. GP input provides more value in urgent care than mental health appts, and this wouldn’t lead to partnership model being dismantled (at enormous long term costs).