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All roads lead to the GP

All roads lead to the GP

Columnist Dr David Turner says it’s no wonder Labour has changed its stance on the partnership model when practices deal with workload dump from every direction without additional remuneration

No matter how hard we kick back, it seems like the medical buck always starts and stops with the GP.

A couple of recent examples sit on my desk. One is a letter from the adult eating disorder service, outlining their diagnosis of an eating disorder and asking the GP to undertake blood tests, ECG, blood pressure and weight monitoring on a regular basis, and then forward the results to the weight management service (in short: do their job for them).

The second letter is from a patient outlining her frustration with the tier 3 weight management service. After a 12 month wait, she was finally seen and rightly expected to be prescribed weight-loss medication. Instead, she was told there is a national shortage of weight-loss drugs, and she should – you guessed it – go back to her GP to ask them to prescribe. In the interim, the patient was advised to try dietary changes and exercise, which of course had never occurred to her (irony detector needle in the red here).

Words – well, publishable ones – fail me with the latter example. If the tier 3 weight management service, whose only real job is to dish out medicines to help patients with weight loss, does not have access to these medications, why would they think I would? Do they think I’m running some sort of Breaking Bad-style cottage industry manufacturing weight-loss drugs in our notes storage room?

So, it would seem like we are expected to be experts in helping patients with complex psychosocial issues gain and lose weight – and we do it all for our capitation fee of £102.28p per year.

On a not unrelated note, we have just learned that the private income we receive from completing cremation certificates will be diverted to fund the medical examiner service that is due to be rolled out in spring next year. In return, the service will complete cremation forms for us. Now, this will result in a loss of income, but surely less paperwork? Wrong. We will still have to complete all the paperwork for the medical examiner but – you guessed it – for free.

The thing is, no matter how much we gripe and groan and go for the jugulars of the idiots who come up with this nonsense (and believe me I have gone for more jugulars of ivory-tower-dwelling-out-of-touch-with-the-real-world-utterly-pointless-rule-devising-idiots than an XL Bully on anabolic steroids), they and we know that we will end up doing the work. Because at heart, most of us are soft-touch cardigan wearers who want the best for our patients.

On a completely unrelated matter, I see shadow health secretary Wes Streeting has just done a screeching U-turn on scrapping the GP partnership model. I can’t say I’m surprised – who else would do this job?

Dr David Turner is a GP in Hertfordshire. Read more of his blogs here



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

David Church 23 October, 2023 6:43 pm

How on earth would it help a national shortage of weight loss drugs if a non-expert prescribes them inexpertly, so that thye are likely to be used less efficiently and waste quantities of these, apparently nationally scare, drugs.
That is a specialist who has lost the plot completely, and is unfit to practice medicine due to cerebral malfunction.
I hope the GMC detects them and ensures replacement with a more functional model – perhaps a bully-XL patient chaser??

Karen Potterton 23 October, 2023 9:58 pm

GLP-1 RAs are forbidden fruit now anyway, even for diabetics, let alone non diabetic fatties. That’s an easy ‘No’. Sad to see crem money going though. Well chosen target because any resistance on our part will impact bereaved relatives.

Angus Ross 24 October, 2023 7:14 am

Ironic that when politicians want patient centred are, we are increasingly getting GP centred care.

Monica Stevens 25 October, 2023 2:56 pm

GP centred care is what the GP can manage to fit into his 12+ hour day. It certainly is not helpful to GPs who are run ragged trying to manage all the requests from secondary care, and increasingly complex GP patients, all in the elastic ten minute consultations.

R B 25 October, 2023 6:47 pm

I wonder why the requests keep coming when we continually moan but acquiesce? A soft touch is completely correct, but ultimately this inability to say’No’ has been to the detriment of our patients and the care we are able to provide. A total lack of gumption from a profession that still prizes keeping people happy above sound clinical and non clinical decision making. Only ourselves to blame I’m afraid!

The Locum 26 October, 2023 12:53 am

Stop doing cremation forms. Non contractual. Let the examiner do them. Why on earth would you do these if not paid?

Decorum Est 26 October, 2023 10:33 pm

Agree with R B
Be a good GP and say ‘NO’ to everything else. Hard to do but etc…

David Jarvis 27 October, 2023 11:38 am

For the cremation stuff I increasingly feel minded to say I am just not happy to opine on the cause of death. Over to you.

a S 27 October, 2023 8:39 pm

with regard to cremation form. Fine I’ll fill it for free but then it’s your responsibilty to get the form to me. No i wount be taking time out of my busy day unpaid to drive to you, use up my expensive petrol , fill in the form then drive back to surgery so I end up finishing way past 6pm time I am paid till. You can eather post it to me and we’ll post it back with 1 week turn around or do it yourself.