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Checking more urinalyses, expanding IVF provision and Making Every Contact Count: we would if we could



Another few days endured on Planet Primary Care. Which means another few days feeling as though someone has been hitting us in the face with a plank. Or, in this case, three planks.

Plank 1: a BMJ paper suggesting that we should be checking more urinalyses in kids with fever. You GPs aren’t taking the piss, they imply, though they may be. Have you ever tried getting a wee specimen you can trust out of a grumpy febrile toddler? Cue a whole load of false positives – or even creatively accounted ‘Nitrite +ve/leucocyte +ve’ results. After all, this works in the local A&E where, as soon as the dipstick turns up anything even remotely positive in that old lady who’s ‘off her legs’ , the case officer is effectively given permission to diagnose a UTI and stop thinking – thereby overlooking, say, the axe buried in the back of the patient’s skull.

Plank 2: new NICE guidance suggesting we should expand IVF provision at precisely the same time that we are under unprecedented pressure to save money. Why would CCGs bust budgets on luxuries to expand the population when we haven’t got the dosh to fund the basics for the existing one? A good question, but not one likely to trouble headline and negative-pregnancy-test wielding patients who’ll see us as the ones behind rationing decisions. Because we will be.

Plank 3: the DH’s proposed plan to include a statutory duty in the NHS Constitution for GPs to ‘make every contact count’ by routinely and opportunistically badgering our patients into leading healthier lives. Frankly, I can’t even be bothered to dignify this with a response, but if you’d care to, here are the sort of words you might need: ‘risible’, ‘lamebrains’, ‘utter’, ‘pillocks’, ‘insane’, ‘impositions’, ‘pile’, ‘cack’, ‘of’, ‘f****ng’, ‘horsewhipped’, ‘can’t’, ‘wait’, ‘until’, ‘I’, and ‘retire’.

So, whether it’s a paper in a journal, a NICE guideline or an entire philosophy of practice, we routinely and painfully get it in the neck. Remember, that’s only the last three days. And our pleas that we have no time, no funds and no energy to take these ideas seriously simply aren’t heard – it’s hard to articulate them when we’re in a plank-induced coma.

Dr Tony Copperfield is a GP in Essex. You can email him at tonycopperfield@hotmail.com and follow him on Twitter @DocCopperfield.