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I’m sick of being the fall guy



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I know this column will make me unpopular with certain patient groups (think homeopathy and gluten-free lobby) and get me into trouble at work. I have already received a written warning from my Responsible Officer about a previous offering.

But I feel strongly that this needs to be said, so I’ll write it anyway.

I am drained and exhausted by the hidden factor in every consultation – rationing. I am sick of my profession being made to feel like the ‘bad guy’. Don’t get me wrong, I am all for the judicious use of precious NHS resources and I strongly believe I should not be prescribing a box of paracetamol that can be purchased for 30p.

But if NHS England wants me to stop prescribing over-the-counter items, it should blacklist them. However, that is political suicide for its policy-makers and instead we are forced to have repetitive dialogues with patients in an already squeezed consultation window.

I am exhausted by the hidden factor in each consultation – rationing

This little rant comes on the back of NHS England’s most recent iteration of items that should not be prescribed routinely in primary care. This guidance states that there are no exceptions to the use of items such as bath emollients and silk garments yet does not stop these being prescribed on an FP10. It is entirely farcical that NHS England is expecting CCGs to be the arbiters of this set-up when they have no direct commissioning powers over an individual GP’s prescribing. As a result, there are still pockets of GPs who continue to prescribe diluted ignatia or mistletoe.

Even more challenging is the pressure placed on GPs by inadequately commissioned pathways, such as eating disorders and gender dysphoria.

These patients are some of most physically and psychologically vulnerable, yet they fall between the cracks of primary, secondary and specialised commissioning. And NHS England, in its wisdom, has exploited the GMC’s incompetent guidance, which instructs GPs to prescribe outside their competencies in certain situations. This has led to an army of private, online transgender providers advertising the guidance issued by both the GMC and NHS England, placing huge pressure on GPs to prescribe and monitor complex medication regimes without any additional training or funding. And when GPs try to explain their reluctance to patients, they are faced with understandable acrimony from a group desperate for timely access to a specialist NHS clinic.

So, I have an idea that might force the Government to sit up and face its own hypocrisy. What if every GP in the land started dishing out homeopathy by the bucketful to all patients with shit life syndrome? We would only need to do this for a month to blow our collective prescribing budgets and force NHS England to think twice about issuing guidance instead of blacklisting placebo medication.

With my CCG and BMA GP Committee roles, I’ll probably get into trouble for inciting industrial action, but quite frankly, I’m well past the point of caring.

Dr Shaba Nabi is a GP trainer in Bristol