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The SAS can’t save us

The SAS can’t save us

Staff and associate doctors are not Noctors, but might not be much more useful, argues Copperfield

I suppose the reflex response to Charlie Massey’s reiterated and radical proposal to fill the GP workforce void with specialty and specialist grade doctors was predictable: facepalms all round. SAS doctors can no more do my work than I can do theirs. We’ve already diluted out the general practice landscape with Noctors and Phoctors and, while the SAS cavalry at least comprises actual doctors, they are not actual GPs. Besides, I defy anyone to come up with a suitable epithet. Specialists with a special interest in general practice? General spectitioners? It doesn’t work, and nor would they.

Having heard Charlie Massey expand on his plans at Pulse Live, though the penny may not have fully dropped, but I have to admit it shifted a bit. Because it seems the idea is not that the SAS act as quasi GPs, but as primary cared based mini-specialists, siphoning work appropriate to their specialty – paediatrics, elderly, acute care et al – away from us.

Which might actually work. Until, that is, you think for a moment and realise that, whatever way you dice and splice it, it won’t. If SAS’s are embedded in-house, with us, we’d have to triage relevant patients to them and, presumably, supervise what they do – which at best would be work neutral. And if they function as a PCN-level quasi-specialist service, they’d only be seeing the patients we’d have been sending to them when they worked in secondary care, just in a different location, with a workload saving of precisely zilch.

Besides, this all works on the assumption that a) They want to leap from the frying pan of hospital to the fire of general practice and b) That we GPs are perfectly happy to reinforce the burgeoning perception among public, politicians and media that, in fact, any Tom, Dick or Harriet can ‘do’ general practice. Frankly, I think neither apply.

Put simply: the lack of GPs cannot be rectified by people who aren’t, no matter well meaning the idea and diligent the staff. Only GPs can replace GPs and, as we know that is going to take forever, the cure for our woes has to lie elsewhere: specifically, in taking a massive and definable lump of workload away from us and making it entirely someone else’s responsibility. That, too, would be radical. But also workable.

Dr Copperfield is a GP in Essex. Read more of his blogs here



Please note, only GPs are permitted to add comments to articles

David Mummery 27 March, 2023 6:10 pm

Agree it won’t work , but maybe can we now re-direct patients to Tesco ?

RAMAN PRABU 27 March, 2023 6:26 pm

But I think it will be better than some Locum GP’s holding us to Ransom.

Dr No 27 March, 2023 6:32 pm

And what would that massive and definable lump be exactly ? MENTAL HEALTH. Welcome the National Mental Health Service. They could start by adequately funding Talking Therapies.

Patrick Young 27 March, 2023 6:54 pm

I was a GP for 30 years until i got fed up with it. I seem to remember so much management time (ducking & diving) being spent on coming up with ways to farm out our work to someone/somewhere else without losing income. Claiming only GP’s can do what GP’s do in that context seems a little absurd.

David Church 27 March, 2023 11:11 pm

Oh, I thought even the Special Armed Services had a few GPs as well as hospital specialists on their medical team, but perhaps that was not what Dr Massey was thinking if , then.

Decorum Est 28 March, 2023 12:18 am

Just the same shite repeatedly. Why even bother engaging???

Finola ONeill 28 March, 2023 9:19 am

Locums aren’t holding you to ransom. The govt are. And until GPs decide to stand up to them they will continue. Observe the junior doctors. And follow suit. Seems like the BMA have finally found their gonads. GPs to follow. There is a shit load of well paid locum work. I suggest salaried and partners, drop a day and work to rule. 8.30-6pm. Safe workloads. Triage out the same day urgent stuff and whatever you can do on top do it. Work to rule. It’s not breach of contract like striking for a day. And a more long term solution. Once you have reached capacity redirect to 111 and A&E. Again. Not in breach of contract. Not unsafe. Pick up the extra day locuming; GP in A&E, loads of private online stuff they want people for.
Stop trying to compensate for the govt massively underfunding us and dumping secondary care on us.
Refer everything back to secondary care. If they decline or try and get you to do the investigations etc under Advice and Guidance, decline and refer back again.
Again not in breach of contract.
Like an abusive coercive relationship GPs are enabling the govt and NHSE to continue shafting them.
As above, decline the shafting.

John Graham Munro 28 March, 2023 12:11 pm

? Locums holding G.P.s to ransom——-that’s irony for you——-most locums used to be G.P.s

Lise Hertel 28 March, 2023 12:33 pm

what Finola ONeill said !
Only way to save General Practice and the people who rely on us.

Thomas Kelly 28 March, 2023 12:59 pm

I agree. I think the main way that we could be helped is by putting in place capped work loads. This will be difficult as due to the nature of our work there are some things that we can’t and should not say no to for patient safety reasons. It seems that duty GP lists are getting longer and I think this is something that could be capped. After the list reaches a certain size then patients could be redirected to 111 or another service. Other non urgent patient requests could be capped or redirected if possible. It is challenging to organise this for patient safety and where the clinical responsibility will lie if and when something slips through the net. The ever increasing work load does need to at least stop increasing as we all can’t continue to work beyond our capacity. I can see colleagues reducing their sessions or leaving for other roles within the NHS and out of it and I don’t really blame them. There will reach a point probably in the next 5 years where the amount of GPs both partners and salaried leaving will have such an impact that it will force a big change as the system collapses. I think the exodus of GPs will lead to UK general practice natural conclusion which I can see being a two tiered system. There will be an NHS GP service that will offer basic GP services and then a large privately operated general practice service working like private UK dentistry. Possibly after training you will be obliged to work in the NHS service for your first 3 to 5 years and then be eligible to work withing the private sector. This would mean the NHS service would be staffed. Who knows but the current state for general practice cannot last for us or our patients.

paul cundy 28 March, 2023 2:58 pm

We could call them GASPs?

Paul C

William John Lockley 28 March, 2023 4:21 pm

There is a simple truth here that has to be appreciated by everyone trying to sort out primary care: nothing at all is going to improve until those making the rules and managing the NHS are *forced* to have skin in the game: to take *personal* and continuing responsibility for *all* the decisions they make which don’t deliver, perhaps by being *personally and individually* fined, sacked or demoted if their plans don’t work.

Darren Tymens 28 March, 2023 6:42 pm

You don’t understand, Copperfield. They aren’t supposed to *save* us, they are supposed to *replace* us.

No more holistic patient-centred clinical care, just Pathways.

As for names, we are General Practitioners, so how about Partial Practitioners?

Thomas, I don’t agree that ‘due to the nature of our work there are some things that we can’t and should not say no to for patient safety reasons’ – except in very limited circumstances, like someone collapsing in front of me. It is the SoS’s responsibility to commission a comprehensive health service, it is not my responsibility to deliver it without proper resources. There are other parts of the system, generally much better funded parts, that can deliver the care I am not funded to. Until we change our mindset we will continue to be treated abusively and exploited by the NHS.

Kirsty Cole 2 April, 2023 6:46 am

Except, this is what was tried in Scotland and it hasn’t worked. By now, every GP Practice in Scotland is meant to have a fully operations pharmacotherapy service, FPOC Physio and Mental health services, treatment room services and link workers all siphoning work away from GPs to more apropriate professions and all provided by the “new” Scottish GP Contract. It has utterly failed.