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GPs are doomed to lose the only game in town

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By the time you read this, it will be too late. And if that reads a little like the beginning of a suicide note, then how apt.

Because, unless you’re a raving refusenik, a resident of Planet Zorg, or part of the escape committee tunnelling your way out of general practice, then, in the past few weeks, you will have signed up to the latest abbreviation created to crush our souls: the PCN.

Hence it being too late. And this great sign-up to the primary care networks occurred even before the blanket of brown caused by Pulse’s workload survey shitstorm had been fully mopped away. That’s the survey, you’ll recall, that revealed we are battered, bruised and desperate for help. We knew that already. But now the public does too, and they’re actually bothered by it. They don’t really care about us, of course, because overpaid stereotypes die hard, but they do now understand that if all that batter, bruising and desperation compromises their safety, then the story’s suddenly about them, not us. And if that story’s a coachload of patients driven off a cliff because the exhausted GP driver is asleep at the wheel, then that’s quite a headline.

So we create this perfect storm of professional despair, public concern and political urgency and what happens? A mass PCN sign-up, performed with a passivity that perhaps can only be explained by the irony that we’re so burned out we’re beyond noticing, caring, or both.

By now, you’ll have signed up to the latest abbreviation created to crush our souls: the PCN

Wow. What a missed opportunity to achieve meaningful change. And what a far cry from the 2016 ‘Urgent prescription for general practice’, in which the BMA suggested, among other things, a cap on consultations, 15-minute appointments, overspill hubs, a reduction in regulation and bureaucracy, an expanded workforce and an end to workload dump.

Instead, we find ourselves corralled into reluctant groups, with tiny carrots of indemnity, DES money and subsidised noctors we definitely didn’t ask for and probably don’t want, and a big stick just itching to rap our network knuckles if, despite all this ‘largesse’, we fail to deliver the NHS long-term plan.

So, three years ago, we couldn’t cope with our own jobs. Now, not only are we expected to continue as before, but we also find ourselves responsible for developing and integrating the future NHS by designing, training, staffing and running our own mini-health ecosystems. That’s in addition, of course, to finding the time to get our heads round impenetrable and hastily cobbled together VAT guidance for PCNs – which is absolutely what I spent nine years training for.

Seriously, is this what any of us really wanted? Does anyone believe it will improve the lives of GPs or patients? We’re repeatedly told: ‘It’s the only game in town.’ But it’s one we feel doomed to lose, because what else do you suppose we might ultimately have signed away as we scrawled on the PCN dotted line? Continuity of care? Independent contractor status? The traditional role of the GP? Too late. It’s no longer an urgent prescription we need. As in any case of bleak, teetering-on-the-edge, insightless despair, it’s sectioning.

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at or follow him on Twitter @doccopperfield