The charge of the online brigade

Copperfield on how online access will affect capacity and eventually lead to the collapse of general practice

I’m trying to work out whether the current state of the NHS represents industrial-strength stupidity or evil genius.

At first glance, it’s no contest. For the Government to contractually mandate all-day online access betrays ignorance of a chilling fact. Which is that, out there, every day, thousands of people have thousands of symptoms, most of which are minor, self-limiting and need no intervention.

General practice has always been protected from this tsunami of trivia by reasonable obstacles such as the minor inconveniences of getting through, waiting for an appointment etc etc, which put off those who would otherwise instantly gratify.

If you lower that threshold to access, you then usher in a deluge of irrelevance, based on want rather than need. Which is why, yesterday, I triaged online requests such as: ‘For two hours I’ve been sneezing, my nose is blocked and I think I’m getting a sore throat. Advice please.’ True, it was probably unprofessional to triage her to assisted dying, but she could obviously take a joke. Besides, that headed off the follow-up query of ‘No one has responded to me yet’ which would have arrived half an hour later.

Also pretty barking is the GPC’s response. They’ve warned Wes that we will continue to divert to A&E when we are ‘at capacity’. Hang on, though: despite years of toying with the concept, we still have no definition of capacity – other than a mental limit which, frankly, I’ve reached on a Monday morning day duty before I’ve even got to work.

Besides, it’s unprofessional and insane to overload A&E who, after all, could play the same game. If I was an A&E consultant, I’d deliberately set up a hostage-swap situation whereby, for every sore throat and cough pitching up in my department, I’d offload to a local GP a fractured hip and leaking aneurysm.

Which is when I saw the potential genius. This is, of course, a plot. The Government doesn’t want to define capacity, because doing so would demonstrate that we’re already working way beyond it. So they’re engineering unsustainable NHS chaos to create an environment where the most effective but unpalatable barrier to demand would be taken seriously.

After all, we already have escalating prescription charges. And punitive hospital parking fees. It’s not that much of a leap to charging patients for A&E and GP attendance, is it?

Bring it on. Charge baby, charge. Demand halved. NHS coffers boosted. Sanity restored, It’s a no brainer, so it suits the Government perfectly.

Dr Tony Copperfield is a GP in Essex