This site is intended for health professionals only

Open or shut, it’s what’s inside that counts

Open or shut, it’s what’s inside that counts

Back in the days when a clip round the ear was pragmatic child discipline rather than a safeguarding issue, my old mum used to quell noisy disputes between me and my brother by threatening to bang our heads together. And that, frankly, is what I’d like to do to patients and GPs to curtail the endless, pointless and brainless bickering about whether or not general practice is ‘open’.

So consider the following a severe finger wag to you both.

Patients: GP surgeries have been open throughout the pandemic, though we’ve been limiting F2F to those who need it because, apparently, there’s been some sort of virus going around, so if another of you – while sitting in my actual consulting room, literally, there, with me as a physical presence, taking your pulse in reality – asks when we are going to re-open, I’ll say it doesn’t matter, because I’m going to kill you.

And GPs: drop the reflex unappreciated indignation, will you, it’s tedious and grating, and it’s really not hard to understand that, while we know we’re ‘open’ to patients, kind of, on our terms, that bolted front door could well be taken by the public to symbolise the opposite.

There, can we move on now and play nicely?

We certainly need to, because this spat is a distraction from the real issue. Which is not whether the doors are open, it’s what you’ll find once you get through them. Or, rather, who you’ll find.

Because, as we move through the gears trying to fend off the pandemic and deal with the backlog, we’re reminded the dwindling GP workforce is being replaced by those who are known, for the sake of brevity or contempt, as noctors. Or mocktors. Or phoctors. Whatever. We’re getting close to the point where, as a patient, you’re as likely see one as you are to see a GP, whether you like it or not.

That works if the nocmockphoctor is good and working within their capabilities. And that’s where there’s a problem. Just as there are good and bad GPs, there are good and bad nocmockphoctors. But, as their name would suggest, they are not trained to GP level, so their competence spectrum must result in an overall lowering of the standard of care. Especially when, as often seems to be the case, they are expected to deal with all-comers.

Their resulting bewilderment has all sorts of potential consequences including, but not restricted to, over-investigation, over-treatment, and over-referral (an example in the last category being a 22-year-old woman with bilateral breast pain for a fortnight referred under the two-week rule).

My nurses and pharmacists are exempt, of course, being brilliantly trained and carefully contained. But overall the situation is insane, and it’s one we’ve colluded with because, in the absence of the oft-promised GP cavalry, we have no choice.

Addressing that elephant in the room actually requires a new room. Meaning we need to overhaul what general practice is for and what it can reasonably be expected to achieve. So thanks, Pulse, for convening a panel to radically rethink practice. And for asking my mum to chair it. 

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

John Graham Munro 26 July, 2021 3:36 pm

Plenty of staff around at ubiquitous practice meetings——–cucumber sandwiches see

Patrufini Duffy 26 July, 2021 8:02 pm

The NHS permits DNAs – and at the same time complaints to a free service. You cannot win. It is patient vs. patient – but has been made out into patient vs. doctor.
“Turn down their symptoms” says the Seretide advert.
“Turn down their access, and then their mind” says common sense.
But this is big business. And demand creates dissatisfaction, which creates private solutions.

David Mummery 27 July, 2021 10:16 am

All GPs should be paid *just* for clinical , patient-facing work (not for attending meetings, or ‘management’ etc). Of course
GPs can do other outside remunerated work outside of this for which they can be paid directly by whoever they are doing it for. If GPs were *only* paid for the clinical work at GP practices , they would be much less likely to be short of GP sessions..

John Graham Munro 28 July, 2021 1:23 am

David Mummery——–wait until you start getting vitriolic responses——don’t be daunted—— many are slowly coming on my side