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Dear consultants, we are not your lackeys

Dr david turner duo 3x2

I’ve ranted about this before and I’ll rant about it until I’m blue in the face: GPs are not consultants’ junior doctors.

I’ll say it again: GPs are not there to do the job of your juniors and support staff.

Despite all the promises that GPs are no longer to be ‘dumped on’ by hospitals, like poverty and inept governments, it never stops.

If anything, the extent of hospital work dumping has grown. It ranges from the oblique reference, such as, ‘it would be helpful it this patient were to have some physiotherapy’, to the overt, in your face, unapologetic crapping of work on our desks – for instance, ‘GP to do bloods in three weeks , titrate up analgesia, refer to physio and if no improvement refer to pain clinic’. Perhaps you’d like me to paint the patient’s garden fence while I’m at it?

Some of this behaviour is downright dangerous

If it weren’t such an absolute salt irrigation of an anal fissure, some of the dumping would be funny.

Like when a specialist in the local hospital sees a patient, decides the problem is too complex for him/her and that it needs a referral to a tertiary centre to see a sub-specialist – and that the person best suited to referring to this sub- specialist is, you guessed it, the GP.

Some of this behaviour is down to arrogance, some laziness and some (although less than claimed) is due to budgetary constraints.

Whatever the reasons, however, some of it is just downright dangerous.

I attended a meeting recently where a consultant thought it entirely reasonable to ask GPs to prescribe unlicensed medications to children.

I raised this with the consultant, and asked if they realised we take full clinical responsibility for prescribing even if the drug has been recommended by a specialist. The reply was that it is cheaper for GPs to prescribe. To which the chair of the meeting, to his credit, pointed out an FP10 costs the same whether issued by hospital or general practice. That some consultants need this spelled out to them is worrying.

I have tried every tactic in the book to deal with secondary care dumping: ignoring it, getting angry, trying to reason with the consultants and becoming utterly miserable, until all that is left is acceptance. Well, that, and an angry blog.

Dr David Turner is a GP in north-west London


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