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GP-to-do-everything is the road to madness

Collaboration and ‘working at scale’ is clearly going to be a contested topic on these pages in 2017. The general consensus seems to be that we wish this fad would just disappear and leave us unmolested, as so many have over the years. The problem is that this time the landscape is changing beneath us, and if we aren’t agile on our feet we may find ourselves lost without a map. We can no longer stick our fingers in our ears and hope that STP stands for sticky toffee pudding.

 Why not work together to try to strike out the nonsense?

For the powers that be are patently not interested in the values and benefits of the corner-shop model, and small surgeries are being deliberately snuffed out. GPs are miserable, overworked, resentful, absent. Even faced with the prospect of a sick, bleak existence in the toxic wasteland of the junior doctor contract fallout, foundation trainees still give the VTS wide berth. We should have young doctors beating down the door, instead a pervading fog of negativity jaundices their interest as much as the wallpaper of our crumbling estate.

The challenge, then, is to save ourselves. The plans – grandiose, imposing, with hidden critical weaknesses – are real. The lasers are being calibrated. We are our only hope, Obi-Wan, lest we want stupid and unpleasant futures to befall us. What’s more, unless we ask specifically to see the blueprints, they sure as heck ain’t gonna show us.

But let’s look at the positives. We’re in a meritorious position, having run the most efficient part of the entire health system since its inception. We are skilled communicators and expert problem solvers. In the absence of anything changing for the better from above we must realise our gift to change from within. We must think differently about how to approach these common problems as a way of maintaining sanity and independence, and if that means working in more collaborative ways then so be it.

Many patients (and doctors) will mourn the loss of continuity, but, for better or worse, society insists on convenience at all costs. We can’t put the genie back in the bottle and shouldn’t try to pacify public nor policy by trying to offer everyone unlimited wishes. What we can do is provide some of the things they want in exchange for others, and ask for some of the things we want in return for our own measured concessions.

GPs are usually unsettled by this idea, fearing that we may hasten our own obsolescence. Copperfield is, as usual, on the money with his note of caution that we should not be too quick to hand over too much responsibility. After all we’re pretty good at most of this, and in particular we’re good shouldering the uncertainty and saving patients from themselves, from falling foul of unnecessary investigation and treatment.

However, although I agree wholeheartedly that only doctors should be doctors, the truth is that our job is choked out with garbage and tedious ephemera, flab and flotsam that’s washed up over the years and silently become entirely our problem. Off the top of our heads I’m sure we could all reel off a dozen daily bores that we’d gladly see the back of. Surely it’s time draw up a list and strike out some of the nonsense that is, quite frankly, beneath us?

So why not work together more closely to try to facilitate this? GPs have spent years – decades – laboriously trying to change patient behaviour in the consultation room, painstakingly eking out narrow attritional wins one by one. It hasn’t worked and isn’t ever likely to given the pressures under which we currently reside. We cannot continue to plough lonely furrows, doing the same things differently in a thousand un-coordinated and archaic ways and must find ways of making life easier for ourselves and each other. We can work in the peripheries, offer ad-hoc bereavement counselling and medicines management and lifestyle advice, sure, but there might be other multi-disciplinary team members better placed to help us.

Similarly, there will be doctors out there who love doing the jobs you hate; shiny happy Mr Muscle GPs who just can’t get enough of medically unexplained symptoms, occupational assessments and nursing home ward rounds. Why not share clinical expertise and resources, back-room staff, appointments, IT support; why not delegate some of the daily dross? It has to be a better model that than GP-to-do-everything, if, of course we can ensure that the work isn’t just bounced around revisited on us in a different way.

Of course, I may regret beckoning the tide, drowned by my own foolish naïveté, a belly full of film-wrapped biscuits and bobbing head full of idealistic guff, my famous last words expelled loudly from my back passage like the ghost of Christmas Dinner past.  But we all know what the definition of madness is and – lest we be nimble – madness yonder lies.

Dr Karim Adab is a GP in Manchester