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Choosing our battles wisely



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Don’t get me wrong. Just like any other sane GP, I love being paid properly and I loathe having workload dumped on me.

But I do think we have to know when the pendulum has swung too far.

Such as, to give a local and recent example, the suggestion from movers and shakers that we should refuse the occasional request from urology for long-term monitoring of men they’re discharging with borderline PSAs – unless this comes as a fully-fledged, enhanced and remunerated service.

After all, it’s not core, is it?

Nit-picking over trivial stuff risks making us look ridiculous – not only to secondary care, but also to potential new recruits

Hmmm. The problem with the ‘core’ argument is that it implies the definition of our fundamental job is frozen in time – but it’s not, it’s fluid and dynamic. There are ebbs and flows. As medicine and the organisations within it evolve, so will our job description and, to a reasonable degree, we have to accept that.

And, to really grow horns and a forked tail, I’d add this: if I was a health service manager, I’d point out that GPs can’t have it both ways. If we really want bolt-on money every time we reckon we’re put-upon, then the reverse should apply: now that I have a dementia intensive support team resolving crises, an acute visiting service sorting home visits and open access to IAPT rendering referral unnecessary then, for each, maybe I should have a Local Reduced Service sum subtracted.

So careful what you wish for. Maybe we should start trying to distinguish between reasonable resilience and sheer bloody-mindedness.

We should keep our powder dry and our energy up for the battles that really matter (think DMARDS not PSA). Besides, nit-picking over the likes of something as trivial as PSA monitoring risks making us look ridiculous, workshy and money-grubbing – not only to secondary care, but also to potential new recruits. And if we alienate them, it doesn’t matter how you define core – there won’t be anyone left to do it.

Dr Tony Copperfield is a GP in Essex