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Copperfield at Pulse Live: Defaulting to world-weary cynicism



17.05 Hmm, that got me thinking, That being the way, according to a speaker in the an early afternoon session, one particular GP resigned from his practice: by text. I think when my time comes I’ll spray a grafitti’d ‘I’m going, HA HA HA’ in my own blood over the main entrance of the health centre.

Not quite there yet, though, so onto the new contract session. Some of it we knew – we’re operating within a grossly underfunded NHS. And some of it we didn’t, or at least I didn’t – there are more hospital contract changes coming, such as a requirement for them to provide a liaison service for patients which doesn’t involve the phrase, ‘See your GP’.

And finally to the Big Interview with Prof Ian Cumming, chief exec Health Education England, aka the man with 5,000 GP stuffed down the back of his sofa. There was a lot of debate about statistics from our special guest until it was pointed out that the latest recruitment figures don’t look to promising, prompting the comment, ‘I don’t want to get into a debate about statistics’.

The answer, apparently, is to convince young people that, despite the stress and despite the demand, general practice can be rewarding life. Not according to one member of the audience who pointed that that the greater problem is at the other end of GP careers with that stress and demand pushing experienced and wise GPs over the edge. This – predictably but appropriately – drew the biggest round of applause of the day. Assuming you don’t go over that edge tonight, see you tomorrow.

13.30 Disaster. In fact, double disaster. Such are the crowds at this year’s Pulse Live that queues are forming outside many of the workshop sessions. And some of those sessions are very popular indeed, including my chosen next destination of ‘Recognising common paediatric emergencies’, which I think I can, but would like to have confirmed.

No such luck. I’m enthusiastic about education, especially when it fulfils a PDP requirement with barely a few weeks to go until my appraisal, but I draw the line at getting involved in an unseemly melee. But that was what we had outside ‘Recognising common paediatric emergencies’. There were people literally fighting to get in and I personally witnessed one of the placards advertising the session come crashing down, in the sense that it fell on me. Incredible scenes. Anyway, I didn’t get in. The only other viable option was ‘Scrotal lumps’ but I’d just eaten a satsuma so…nah. Besides, it’s not on my PDP.

As for disaster two. Thought my caffeine-based prayers were answered when I strolled into an empty speaker’s room with a vast tureen of coffee. Joy! But no mugs. Not one. Opposite of joy. I am officially in withdrawal.

12.24 So I’m not trying to bite the hand that feeds. But there is a big issue at break time. After all, what’s a break for? Coffee, right? So there isn’t any. At least, there is, but the one outlet I can find has a queue longer than the one snaking its way out of my surgery every Monday morning. Possible salvation, though. Someone whispers to me that there’s a special speakers’ room where there’s a swimming pool literally filled with coffee. True, I’m not actually a speaker. But it’s a fine line. In that I can speak.

Can’t find it, though. But I do stumble across the prayer room, and that’s a start. Anyway, while I’m waiting for my chosen deity to respond – I was 38th in the queue so I assume I’m on hold – it’s off to, ‘Top tips to practically and sustainably manage workload’, cos that’s exactly what I want to do. 

Great to hear that all the problems I have with the much vaunted ‘contractual levers’ – bounce-back of referrals, DNAs being discharged etc – are being experienced, with similar molar-cracking exasperation, by loads of us. And that many GP workload-dump dissenters, like me, have been told by riled hospital consultants, ‘You’re the only GP who won’t do this’ – who, therefore, are wrong. So tell them next time they try that one.

10.32 ‘Sick notes are a waste of time’. That’s the opening Great GP Debate. But why stop there? It’s not just sick notes that are a waste of time. Patients with TATT, hospital letters, DESs, LESs, CQRS, chasing up money we’re owed, CQC, appraisal, revalidation etc etc etc etc are too. What else? Time wasters. They’re a waste of time.

The session isn’t, though. Dr Rory McCrea points out that the main purpose of fit notes is to end perplexing and annoying consultations. So, although arguing they’re a waste of time, he declares he loves them. Almost as much as DNAs, which he loves, too, and about which he says, ‘I never find it a wasted resource when I’m in my own company’, an early contender for quote of the conference.

Tricky to follow that, though Dr Rob Hampton does, pointing out that GPs are trusted by patients (aaaaah) and can use the fit note to influence patient behaviour and expectation – hard thought that is to believe on a wet Monday morning with packed waiting room and a patient using all necessary verbal and non-verbal cues short of an actual crowbar to get a sickie out of you.

Results? The big majority agreeing they’re a waste time was unchanged by the end. So that was a waste of time. Or not. Let’s debate that.

9.25 I was looking back atlast year’s Pulse Live blog and it was suffused with a real air of optimism. Then again, we were younger and a bit naiver then, and it was a glorious Spring day. One year on, we’ve had Brexit, Trump and my testicles freezing while I waited for the train this morning. So I’m guessing that we’ll probably be defaulting back to world-weary cynicism today, which obviously suits me fine. After all, never mind the macro-politics. On a micro level we’ve had the Forward View, the Urgent Prescription for General Practice and the new contract. Yet back at the coalface, everything seems much the same as we firefight our way through dysfunctional days with too much work and too few doctors.

Mind you, the sessions I’m attending at today’s Pulse Live offer some hope. By the end of the day, I should be able to manage my workload, hire new partners, address ‘challenging’ conversations, inject joints and dermatoscope the moley. Oh, and achieve a state of mental Nirvana by going to the mindfulness seminar. Although I’ll probably sit there wondering what the sick child session’s like.