I’m writing this as A-bomb dropped today. That’s ‘A’ as in, ‘Access’: NHSE’s bulletined and bulleted list requiring us to throw open our surgery doors and offer F2Fs on request.
In other words, they’ve chosen to blow-up our Covid-based version of general practice in the hope that the wreckage will fall roughly in the shape of the Old Normal.
We should have seen this coming. Society’s opening up, and we’re already getting a thrashing in the media, so maybe the idea was to head off the inevitable: ‘I can see my hairdresser yet I can’t see my family doctor’ GP-hate columns.
On the other hand, it’s sudden, draconian and sits uneasily with NHSE’s mantra of thanks for our efforts and protestations that they know we’re open, it’s just the public and media who are too stupid to get it.
Whatever. It would appear that the current ‘ask’ of general practice is something along these lines: continue with the Covid vaccination programme, expand the flu jab campaign, reboot chronic disease management, resurrect enhanced services, jump raised QOF hurdles, move the mountain of mental illness, seek and destroy the pathology backlog and, now, return to business-as-normal access. Doubtless we’re responsible for mopping up our own blood, sweat and tears, too.
Well, OK, we’ll do that. But something’s got to give. We need more than grateful platitudes and hollow support to survive this particular mushroom cloud. We’ll give you access-as-usual, or a version of something close to it, as long as it’s just that. Which means, of course: scrap online consulting.
This was last year’s contractual aspiration and has become this year’s living hell. We knew it would be, but hell has turned out to be far worse than we’d imagined. Whoever said that online consulting would dilute or divert work was malicious or mad because, of course, it achieves the exact opposite. It opens the floodgates to the neurotic, impatient, whimsical, intolerant, obsessive, angry, entitled, manipulative and vexatious. Now these people can torment their GP repeatedly, at all hours, from the comfort of their own caves, rather than just in contracted hours like they used do.
One significant reason for this is something the Government would like to pretend isn’t true: the fact that a small built-in delay for accessing health care is a good thing. Most symptoms resolve given some time, and if they don’t, then at least they evolve into something meaningful. Remove the barriers to consulting and you just end up with perplexed doctors, over-medicalised patients and yet more work, and if you don’t believe me, check out the Monday morning e-consultation list. And no, frankly, I’m not worried about the urgent or seriously ill, as there are already enough portals available to sort them out.
So, NHSE, while you’re opening one door, encouraging patients to see their GP, how about quietly locking another? Without fuss or fanfare, just contractually unplug e-consultations. An A for an E.
Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield