Copperfield channels his inner Sir Humphrey to explain general practice to Lord Bethell in uncomplex language that he might understand
Contrary to the thoughts of a former Conservative health minister, general practice can be so complex, technical and exhaustive that a determined GP can actually reach the tonsils of former Conservative health ministers during a rectal exam, which admittedly is an unconventional way of dealing with a sore throat, though I’d be happy to oblige.
Is what I wanted to say. But I won’t, because I can rely on the below-the-liners to do that for me. Besides, every ill-timed, ill-judged and medically illiterate rant does contain a grain of truth, even if coming from an ex health minister.
Just listen to many of the medical students on attachment at our practice. Their perception of GP land is a bunch of bored, burnt-out doctors sitting on their arses through an interminable surgery of coughs and colds (that’s a direct quote). And that’s what a winter’s day-duty surgery does feel like, largely because that’s what it is. The joys and nuances of spotting the lung cancer among the dross, trying to change illness behaviours or fighting to the death over amoxicillin are lost on them – they want to save lives, not scrutinise snot.
Which is another argument for hiving off ‘acute’ care from core general practice. The current backlash against the idea not only underestimates the effect on easing workload but ignores the fact that diverting trivia elsewhere would improve the image of our work no end.
By which I don’t mean we’d spend our hours wading through the treacle of chronic disease management – I’d rather spend the day punching myself in the face and, besides, that’s what protocols and practice nurses are for. I’m saying we could at last focus on the forgotten and significant cohort of subacute and evolving illness: the bowel disturbance that might be IBD or cancer, the numbness that could be MS, the joint aches perhaps pointing to SLE, the weight loss, the tiredness and the dizziness that could be one of a hundred things. And so on.
These presentations need assessing with judgement, experience and skill, all of which we have in abundance. What we don’t have is time and slack: time to explore and slack to arrange a reasonable follow-up.
Give us that and the job will be better for us and patients – and it will look a fitter prospect for potential future GPs. Better still, former Conservative health ministers can take their minor ills to practitioners with minor qualifications. Just save that sore throat for me, will you?
Dr Copperfield is a GP in Essex. Read more of his blogs here
READERS' COMMENTS [3]
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This Govt’s been dismembering primary care (ARRS, same day acute access, Pharmacy First).
It’s hard to see anything funny about it…
Unless you take it in the spirit of the Black Knight – “tis but a scratch, come back and I’ll bite your legs off, you yellow b*stards”
The thing is, general practice is, by its very nature, complex, because people are complicated.
– The person presenting with back pain who turns out to have myeloma.
– The person with a sore throat who has unexplained bruising.
– The old man with earache who looks more dishevelled and frail than when you saw him last.
– The woman who looks scared and unhappy when she attends with her husband, who does all the talking…
General practice has evolved to identify and manage this complexity safely. The new roles do not have the skill or training to deliver this, so the new system will inevitably lead to many more adverse health outcomes and some deaths. But ironically there is nothing to suggest it will be cheaper, or in any way better.
So why are we being pushed to do it?
And at what cost?
Unless of course you are lordy lord bethel private gp where back pains go to see private orthopod next week, tummy pains get to see private gastroenterologist, headaches the private neurologist and skin rashes the private dermatologist etv. All resources unavailable on the NHS without a 1 to 2 year wait and if the referral does not get rejected.
All need to be resolved and managed by an NHS GP.