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Another zombie policy to cap it all off



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I know it seemed like a good idea at the time. But one of the (many) arguments I could make against the concept of GP workload capping is this. If I was a casualty consultant observing our efforts to somehow coax a bung into the volcano, I’d be thinking, with a mixture of bemusement and indignation, hang on, what’s so special about you guys – OK, general practice may be about to topple over, but A&E is on the brink, too, where do you think your patient overflow will end up and, when push comes to shove, where does the ‘dangerous when overworked’ argument stack up most effectively, A&E or general practice?

But I won’t. Because the point I really want to make is that it was ironic having, at the BMA ARM, that motion about capping patient workload to preserve our ‘sanity’  juxtaposed with another motion suggesting we should charge patients for appointments

The latter is an idea that has been kicking around for years, which rears its ugly head every so often and which gets voted down every time. Whereas the former is a new idea which everyone is very excited about and which has just been given the voting thumbs up. So, chalk and cheese? Nope. In fact, both send exactly the same message: the NHS in general, and GPs in particular, would be fine if it wasn’t for those pesky patients booking appointments and spoiling it for everyone else, especially us. They also have in common the fact that they are both superficially attractive yet completely unworkable.

In our practice, total annual appointments wasted by DNAs equated to roughly a FTE doctor

So why doesn’t the BMA learn from the one (appointment charges, which never gets off the ground) and therefore stop wasting energy on the other (workload caps, which never will either)? Or are we to face, as we do with the appointment charges concept, intermittent zombie-like reappearances of the workload cap idea which we can blast to smithereens but not, it seems to oblivion?

Alternatively, how about combining both concepts into something workable? In our practice, some back-of-the-envelope maths shows that the total number of annual appointments wasted by DNAs equated to roughly a FTE doctor. So, how about we charge for DNAs rather than charging attendees? That’ll satisfy those punitive urges and significantly ease workload by cutting appointment wastage in the future. Job done. And we’d still be able to look our casualty colleagues in the eye – probably quite useful when you pitch up with your workload-induced infarct.

Dr Tony Copperfield is a jobbing GP in Essex