The collective action escalator is going down

As collective action escalates, Copperfield wonders whether GP enthusiasm is already fading

So how’s collective action going in your patch? You remember? Collective action? The action we’re taking, er, collectively? That’s why we’re all editing, and then forwarding, that letter to our ICBs thumbing our collective nose at their data sharing requests, an action that, the GPC reassured us, even the wussiest practice would take.

Truth is, our very unwussy practice hasn’t done it, and nor has any other practice I know of. Perhaps I just work in a sinkhole of apathy. But I think the real explanation is the action seems both vague and confusing, and frankly doesn’t light the fuse of militancy. So GPC email and attachment ends up in that file of guilt we all have which contains items that require attention they’ll never receive.

Well, it’s too late now anyway, because it’s time to escalate. Admittedly, from a low base. Next up is the rejection of medicines optimisation. Woo-hoo! We can turn off those pesky pop-ups!! Especially the one reminding me to co-prescribe a PPI, even though I’ve only prescribed the patient an NSAID cream!!! That’ll reduce our stress levels by, oooh, up to 0.1%. Then again, it’s not for us, is it? It’s to shout slightly louder in the Government’s face until they listen.

And yes, we could prescribe profligately, pretending that we’re just maintaining our precious clinical freedom. It might actually be enough to put a tiny dent in ICB budgets even if it is at the cost of some professional self-respect and with the knowledge that, ultimately, wilfully wasting NHS money does impact patient care somewhere down the line.

But will anyone actually do it? As a cranking up of pressure, it still feels a bit meh. What’s next? An agreement to collectively sigh out loud whenever we sign a fit note?

Who knows where this is going. But what does seem likely is that, month by month, the escalation in action may be paralled by a de-escalation in on-the-ground militancy. Because collective action fatigue will set in. Plus the sense that, as time goes by, we’ve already adapted to whatever it that triggered this in the first place, assuming we can still remember.        

The GPC is trying it’s best to achieve a difficult thing, but it’s slow turn of the screw feels too slow and not screwy enough. Bigger and faster would help, and maybe if we knew the nuclear option, once escalation peaks, we might remain primed and ready for action. But they probably want to keep their powder dry. Trouble is, when the time comes, there may be no flame to ignite it.

Dr Tony Copperfield is a GP in Essex