How annoying. There I was, all ready to go with this blog about how, despite UK GPs having 60% more patient contacts each day than the number considered safe, we should forget about the idea of a cap on consultations because it’s an unworkable waste of time, effort and hot air.
I had all the arguments mapped out.
How, if you cap the number of consultations, we’d just work quickly then put our feet up, or if you cap surgery length we’d see a single patient for a very long appointment, or if you hybrid the two we’d game the system by bringing back unnecessary low-stress follow-ups.
How a consultation would defy definition because of telephone, Skype and email interactions. How the post-cap patient overflow would need seeing somewhere and how that overflow would need a cap and therefore its own overflow, and so on ad nauseam.
It’s Dr Bawa-Garba’s horrific and by now well-documented scapegoating that had led me to this realisation
How, if there’s a ceiling, there might be a floor, too, with the concept of a minimum daily number of consultations coming as a nasty shock to some.
And most of all, how, if we’re honest, some GPs don’t want to debate this openly because they are already quietly putting up the ‘full’ sign each day and would rather continue covertly than have any troublesome contractual clarification.
But I can’t do any of that, because I’m wrong. We do have to put a cap on workload, so my column is redundant. Hence me being annoyed. Though probably not as annoyed as Dr Bawa-Garba. And it’s Dr Bawa-Garba’s horrific and by now well-documented scapegoating that had led me to this realisation.
We all know the story and probably, by now, the issues, too: clinical misjudgements become gross negligence manslaughter depending on which way the wind blows, and system/contextual factors are irrelevant. All of which is not conducive to any sort of REM sleep in the foreseeable future.
According to the National Patient Safety Agency, each year, around 10,000 incidents lead to patients dying or experiencing serious harm. And that’s just the ones they know about. Frankly, given how crazy busy it is every Monday, I reckon most of those episodes could be generated by our practice alone. But, of course, it’s the same nationwide, with all of us cutting corners and crossing our fingers just to get through the day and the workload.
Well, now you know. You are just a rotten slice of luck away from being slaughtered in the courts and executed by the GMC. We might as well all turn ourselves in now. And if we don’t, and we soldier on to the point of exhausted dysfunction? The GMC’s view is, apparently, that it’s the duty of doctors not put themselves in a dangerous position in relation to competence and skills. Which is kind of tricky when you’re self employed and you can’t batten down the hatches of safety against a perfect storm of demand.
Which means something has to give, and if it can’t be standards then it has to be workload. Hence a cap. Hence a useless column. Thanks Dr Bawa-Garba. No, really. I mean that.
Dr Tony Copperfield is a GP in Essex