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A tale of two surgeries

Picture two surgeries. In Surgery A, you see patients to discuss cardiovascular risk, manage chronic disease, tweak statins or antihypertensives, screen for dementia, assess risk of diabetes, dispense lifestyle advice, plan admissions avoidance strategies and so on.

In Surgery B, you see patients with coughs, cystitis, abdominal pain, headache or a combination of all these; patients with symptoms that make no sense or defy description, patients worried about cancer when they shouldn’t be and not worried about cancer when they should be, and so on.

Increasingly, we’re expected to run Surgery A, which was not in my original job description. Problem is, we’re still running a teeming Surgery B, which was. So we’re running two surgeries at the same time. If you feel you’re twice as busy and ageing twice as fast as before, that’s because you are.

No worries, say the movers and shakers. The direction of travel, to use the current vernacular, is away from Surgery B towards Surgery A. Apparently, Surgery B can be deconstructed, then delegated or diverted – to pharmacists, physician associates, open-access cancer investigations and so on. That frees us GPs to get on with the complex/chronic cases in Surgery A, which, according to the mantra, requires skills only we possess.

There’s just one problem with this: it’s bollocks. They’ve got it completely about-face. The truth is, we’re a far better fit for Surgery B – and not just because the alternative is so unremittingly tedious that, within half an hour, any reasonable GP would be chewing their CQC-approved floor covering. 

Screening, chronic disease management, lifestyle advice, diabetes prevention and all the other public health crud being tipped relentlessly into our laps at least has the benefit of a skipload of guidance to steer, flowchart-style, whoever ends up doing it. So Surgery A, far from requiring GP superpowers, could actually be handed to just about anyone who doesn’t currently need half-hourly neuro obs.

Conversely, dealing with people who are, or think they are, ill cannot be done by protocol. It requires knowledge, reasoning, judgment and gonads of steel. True, it involves wading through trivia but that’s not an indictment of the system, it’s a description of the territory. Try farming Surgery B out elsewhere, and you end up with an expensive, ineffective and dangerous mess. Any dissenters to this argument should just try dialling the numbers one, one and one.

So I have a message for the newly reinstated health secretary who, apparently, is on a ‘mission’ to improve GP services. First, Jezza, you’ve got find a few thousand GPs, but until you remember where you put them, you could sort out recruitment and retention if you stop turning us into public health lackeys. Give us space and time to breathe and to get on with being GPs, because we could do it brilliantly if you’d just bloody well let us.

A ‘step change’ in GP services? Sure: as long as it means putting that direction of travel into reverse.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.