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GP leaders need to say ‘no’ to Little Miss Snotty



An important part of a GP consultation is creating a ‘shared management plan’ – we know this, because we are taught it.  Even if Mr Reasonable, says, ‘I’ll do whatever you think best, doctor’, we must not become paternalistic, we are still supposed to engage in a negotiation, I know, I passed my CSA.

When the DH start to consult with you, think, are they bullying?

So when I hear the word ‘negotiations’ mentioned in discussion of our annual contract, I think of consultations. I imagine our glorious leaders in a fruitful discussion with the Department of Health. They discuss how to best meet the needs of doctors and patients, despite a climate of dwindling resources, and the exodus of the workforce. I think back to my MRCGP learning and I hope they come up with a shared management plan that suits both parties.

But then reality hits. The DH is not Mr Reasonable, I worry that, in fact, they are a different patient altogether: Little Miss Snotty.

You all know Little Miss Snotty. She always attends late for her appointment. She’s told the front desk once again that she won’t rebook, because it’s an emergency, and she NEEDS to be seen today. She barges in to your consultation room, sits down and brings out ‘The List’. ‘The List’ bares no resemblance to the actual problems that need sorting. She refuses discussion on any point: it’s her agenda, and it’s not to be messed with. And nothing, not even your very best consultation skills, are going to distract her from her singular mission of leaving your room with something unreasonable (imagine a four month prescription of zomorph, diazepam and zopiclone for a questionable condition). You know the threats will come: if you don’t comply, she’ll complain or ‘report you to the GMC’. Negotiation is futile. She intends to bully you.

But in many ways, for me, these are quite straightforward negotiations.  For the sake of the patient, the doctor, and the NHS the answer is ‘no’. Some discussion is warranted; a clear explanation of the current dire situation and reasons why their solution is inappropriate, nay harmful. And if that discussion isn’t accepted, there is sometimes only one solution – you leave or they do.

Negotiations on the ‘rescue package’ for general practice are looming. So please respected leaders, when the DH start to consult with you, think, are they bullying? Does their list and agenda really address the awful situation in primary care? Are they taking the Little Miss Snotty role? And if they are, on behalf of those of us on the front line, the answer to their unreasonable demands should be ‘no’. If they refuse to accept your explanation of the current state of general practice and the need to act immediately, please just walk away.

Dr Susie Bayley is a GP in Derby and chair of GP Survival