‘It is time for GPs to get a little bit naughty’

Dr David Turner argues that online access requirements, endless triage and political gimmicks are pushing GPs to breaking point – and it’s time to stop being so polite about it

Let’s face it. As a profession, GPs are too nice. We always want to help and go the extra mile with our patients. That instinct – to be helpful – is also why we keep giving each new political administration the benefit of the doubt. Even when it is long after they have shown they do not deserve it.

Well, I for one have had enough. Can we please all stop saying ‘yes’ to every hideous new initiative and contract change? The type of ‘enough ‘ where we stop tugging our forelocks to each new health secretary like village idiots to the country squire.

There is a great line in ‘Matilda the Musical’: ‘Nobody but me is going to change my story. Sometimes you have to be a little bit naughty’.

Wise words indeed.

Where to start? Firstly, let’s accept the reality that Wes & Co are never going to back down on unlimited patient access. So, channelling our inner Matildas, maybe we show DHSC exactly what responding to every last patient request looks like. In practice, it means no appointments for the last two hours of the day while we deal with every last patient email about crumbly nails and itchy teeth.

Yes Wes, less appointments is what you will get – not more. GP time is finite; the pie is only so big. If a bigger slice is forcibly allocated to triage, then the slice for F2F appointments naturally must get smaller.

And if, as many of us already suspect, these new access rules push us into unsafe territory, then theoretically we’d have to start wondering whether we’re supposed to report ourselves to the CQC and GMC for operating under impossible conditions. There’s no official guidance saying that, of course, but it’s the kind of absurd conclusion you reach when a system demands unlimited access without unlimited clinicians.

I would love to see how these organisations manage to investigate every practice and every individual GP at the same time. One could imagine that it might be a bit like having to see all our usual patients and deal with dozens more extra emails a day…

Next, we might as well use Jess’s rule to our advantage. Now I don’t think there is anything particularly new about the ‘three strikes and rethink’ rule. I seem to be remember being taught that on day one as a GP trainee. But if policymakers insist on these rules, then fine! Let’s apply them consistently across the system. Secondary care being arsey about referrals?

Dear consultant, under Jess’s rule you are obliged to see this patient who has presented three times with the same symptoms….

All of this is to underline a simple point: We simply cannot carry on with business as usual. I don’t claim to have all the answers, but just mindlessly ploughing on, blinkered and blindly hoping the next contractual change will improve things is not going to get us anywhere. And continuing to ‘work under protest’ is about as threatening to the Government as Paddington Bear in a fright mask.

Please colleagues, stand up and take some action. Whether you are at the beginning of your career or the end; if you care about general practice, support your profession and our representatives in the GPCE and let’s follow through with the proposed actions voted for at the recent LMC England conference in November. We voted overwhelmingly to support undated resignations from GMS contracts. If and when we are asked to do this by the GPCE, to give them more ammunition in their negotiations with DHSC, then I implore you to support this action. The time to play nice is over.

Wes could massively improve our situation overnight, by simply shifting a tiny percentage of secondary care funding to primary care. It would not cost them a penny; and in the long term would save them several in fact.

If all else fails though, we could just put some glue inside his hat please, à la Matilda.

Dr David Turner is a GP in Hertfordshire