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Primary care, your community-based panacea!

Dr David Turner

‘Instructions to GP: Please monitor haemoglobin and provide top-up transfusions in the community to maintain Hb above 80 as advised by gastroenterology since the patient is not suitable for invasive interventions.’

This is verbatim from a discharge report from a patient who had been in hospital for several days with severe anaemia. An ‘Instructions to GP ’note, not a polite request.

‘Please could you refer to local stroke services for assessment of possible TIA and ophthalmic services to exclude a retinal issue.’

This particular workload dump was inscribed at the end of a letter from a cardiologist who had assessed a patient and, clearly concluding that the cause of the patient’s symptoms was not cardiological, decided to ask us to take a shotgun approach to referring onwards. I just wondered why the cardiologist hadn’t suggested a psychiatric referral to exclude a psychogenic cause and a dental review while they were at it.

In the same day a private rheumatologist asked us to perform 18 different blood tests on a patient they’d seen, as the patient couldn’t afford to pay for them privately.

I’m reporting these very specific examples of secondary care dump not merely because they all occurred in the same day and not an untypical day at that, nor do I do it to have a go at our hardworking colleagues in secondary care. I do it because when we moan about being busy, there are no film crews wandering around our corridors filming patients lying on trolleys.

We have no lines of ambulances outside our doors, the footage of which can be shown on the evening news. However, when we say that we’re barely coping, it’s a fact and it’s unnecessary work deposited on us from the hospitals that are making the problem far worse than it need be.


The first example I brought to the attention of the LMC.

The second I wrote to the consultant concerned, explaining why we’re not their junior doctors.

Third example: I sent an NHS paper blood request form to the private doctor concerned and asked them to fill in what bloods they’d like and arrange to get the form to the patient.

Non-violent and direct action – give it a try.

Dr David Turner is a GP in Hertfordshire


David Mummery 9 August, 2021 8:22 pm

David, it’s called ‘integrated care’!
The role of the GP has morphed into ‘community house officer’ for secondary care….terrible really

Patrufini Duffy 9 August, 2021 10:58 pm

Today: patient attended AE with 1 week absolute constipation. Admitted under medics for 1 day. Discussed with surgeons.
Plan: GP to refer 2ww with FiT test.
Makes sense NHS.

Thomas Robinson 10 August, 2021 10:46 am

Excellent responses, now I am guessing David is not one of Clare Gerada nervous breakdown GP’s
So what if Prof set the same questions to those she is seeing.
Would they simply try to do as they are told.

Where does it say in the RCGP, documents that this is the right approach, endorsed by the college, supported by the GMC, and advised by the MDU.
How many training schemes can honestly say they have taught these responses.When has the RCGP exam ever covered this.

It is the training that is no good, because the people running it are no good, because they are too divorced from, and protected from reality.

Decorum Est 10 August, 2021 11:23 am

‘It is the training that is no good, because the people running it are no good, because they are too divorced from, and protected from reality.’
Exactly. The GP profession should reflect on its own failures (over the decades).

James Cuthbertson 11 August, 2021 1:46 pm

A golden rule in business is that if someone asks you to do anything, ask them to do three things beforehand. GP’s have made access to themselves too easy!!!!!! Other services in the NHS don’t allow you to dump on them like this. Perhaps a standard pro forma for any consultant requests to the GP…

Patrufini Duffy 11 August, 2021 2:34 pm

Imagine if your surgery could incur a locum debt of £100,000-£1,000,000. Then have that debt wiped off. Funny you can’t.
But they can.

A non 11 August, 2021 6:32 pm

The existence and need for locums is a symptom of the deteriorating illness within the NHS. Locums and locum fees are not the cause of that illness, they are a product of it. Just as you can not cure sepsis by getting the patient’s temperature down, giving paracetamol and putting them in an ice bath whilst furiously cursing the thermometer you wont cure the (terminal) decline of the NHS by forcing down locum fees and cursing the existence of locums. I make this point just for the sake of clarification and do not take issue with anything posted above. Maybe it’s because I left the utter misery of a series of salaried positions several years ago to take back control of my professional life several years ago, but I often read post about ‘locum fees’ in the comments on pulse and feel it’s important to restate these trues occasionally for the benefit of a wider audience who might be lacking a wider understanding of whats going on in our beloved NHS and come to some pretty stupid some of our administrative colleagues in wales, who I read recently (in the comments section of this publication) have banned the use of locums all together.

John Graham Munro 11 August, 2021 10:17 pm

Medics are shackled by altruism——to which the G.M.C. have the keys

David jenkins 14 August, 2021 11:11 am

a non

the same surgery i referred to in another post – yes, the one that won’t employ me “because i haven’t worked for them regularly over the past few months” (actually, couldn’t, because i hadn’t been jabbed), that same surgery posted an advert for locum cover on the welsh nhs website up to next march !! google “locum hub wales” or if you think i’m making it up !!!