To boldly practice, just split the infinite workload
Copperfield argues that dividing care by complexity isn’t the end of continuity; it might actually be the workload solution general practice is looking for
I’m so torn. On the one hand, the new model of practice being piloted by Northamptonshire ICB – where patients are ‘split by complexity’ – could be a complete nightmare.
While the ICB promises that the same day/one-off symptom patients will be seen by proper clinicians, it’s a slippery slope which could end up with acutes demoted to a noctor/AI stream, aka ‘The ChatNoc will misdiagnose you now.’ And what about nurturing continuity? And spotting the significant needle in the drossy haystack? And realising that recurrent minor illness might be the tip of some pathological iceberg?
Meanwhile, in the Brave New World’s ‘complex’ stream, we have us GPs dealing with the multimorbid, multimedicated, multisymptomatic multitudes. Just one day of that and you’ll be weeping for a sore throat or pill check.
But on the other hand… I’m not torn at all! I was just kidding!! I think it’s a bloody brilliant idea!!! In fact, it’s something I’ve been banging on about for years, so clever me. The potential pitfalls are real, but surmountable. For example, you don’t have to opt between being an ‘on the day’ or a ‘complex’ doc; you could split your week between the two. But at any given time, you’d be doing just one or the other – not both.
Because that’s the point. We GPs have become the victims of our own success. Our ability to manage everything, soak up workload and compensate for shortcomings elsewhere in the system means we are everything, everywhere, all at once. Until, of course, we burn out. Or boil out, like slowly simmered frogs.
Salvation does not lie in the usual suspects of half-baked initiatives, random staff bolt-ons and pathetic financial micro-carrots. As per previous rants ad nauseam, it needs something far more radical: a large chunk of work being stripped out.
Think back, if you’re ancient enough, to when we dumped out-of-hours. Our working lives were transformed overnight – that, specifically, being the first night in living memory without the stress of ongoing 24-hour responsibility for our patients. Fears and protests about the end of continuity, the family doctor etc etc – echoing current concerns around this new system – quickly evaporated, also pretty much overnight.
So imagine a future where ‘on the day’ is happening down the road. And you have time to manage, among the complex chronic, the evolving subacute – where follow up and continuity really counts. It’s not a nightmare, it’s a dream. Bring it on. General practice is dead. Long live the GP.
Dr Tony Copperfield is a GP in Essex
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READERS' COMMENTS [5]
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By complexity, you fools, split patients by complexity…🪓🪓🪓…. Not by axe 🪓🪓🪓
(overheard at Northants ICB)
‘Think back, ‘if you are ancient enough, to when we dumped out of hours’…
I must fall into your ‘ancient ‘ category, probably eligible a ‘very ‘prefix.
We did have better sleep on those nights when previously we would have been on call.
It did seem to make everyone in the practice happier – for a while at least.
Reducing hours per week followed with other measures such as employing ancillary staff followed.
Despite these advances, GPs now seem , for want of a better term, ‘less happy’ than 15-20 years ago.
Why is this ?
Have some of the best bits of the job been jettisoned?
‘ On -call ‘ and home visits, though onerous were two of the best parts of the job, for me.
‘ Very Ancient ‘…
I didn’t always enjoy being on call, but overall it was very interesting and satisfying.
How ridiculous.
The GPs and practice staff I meet these days seem
The patients are very clever at figuring out systems, and they know which car is mine. If I’m parked in the duty doctor space, then their problem is a new single symptom problem “urgent for today”. If they see my car parked down the road, they know it’s a problem with complexity that only I can deal with, as I know them best, and it wouldn’t be fair to burden the duty doctor. I imagine the patients in Northamptonshire are not considerably different to my own to be unable to suss this system out for what it is and enjoy the next round of “the great game of general practice”.
Fears and protests about the end of continuity, the family doctor etc etc – echoing current concerns around this new system – quickly evaporated, also pretty much overnight.
But, here we are in 2025 with continuity essentially lost, the family doctor virtually an extinct species … I’d say the concerns at that time were extremely well-founded and have been borne out by the passage of time!
It was brilliant when we ditched out of hours! Replaced by Co-operatives run by local GP’s who all knew each other and how they worked with drivers to ferry us around and work shifts. Still had to do some work but I think Co-ops were good for doctors and extremely good for patients who got a first rate service, unlike what replaced it with Nurse practitioners and Noctors. Our local co-op started with us having to do a Red Eye shift-nightmare when you had to work the next day but that was soon replaced with retainers to do the overnights. Bliss! Shifts were a doddle. I’ve been retired now since 2017, so a bit out of the loop but I feel General Practice is not functioning properly at the moment. I rang my Practice recently and was given a message that I was 35th in the queue! Worrying that with my increasing years I will rely on the GP’s more and more. Private Health Insurance is no longer a luxury (if you can afford it)