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If I go down, the NHS goes with me



Patient #1 has been feverish and achy since yesterday, so I send him to the Medical Assessment Unit to rule out sepsis.

Patient #2 has had diarrhoea for 10 days, so I do a two-week referral to exclude colon cancer.

Patient #3 has a sore throat and cough, so I give him a week’s worth of amoxicillin.

Being a GP can feel like having to smile serenely at everyone while being punched repeatedly in the face

Absolutely no complaints from the punters, and no prospect of any, either. Whereas I assume you’re howling in protest. And quite rightly, too. Because the above scenarios are, of course, a pack of lies. In fact, the first patient received advice, the second was given my standard gastroenteritis patter and the third got a flea in his ear. Plus safety-netting, of course – except patient three, because it’s hard to safety-net after ‘sod off’.

But there’s always that nagging doubt, isn’t there? Because #1 might actually turn out to have sepsis. And #2 could conceivably have bowel cancer. And #3? In some cruel, anti-GP parallel universe, #3 could go on to develop life-threatening pneumonia, just out of spite.

Should any of these catastrophes occur, there’s a fair chance that, despite my safety-netting, I’ll receive a complaint for failing to send to hospital/refer to outpatients/prescribe. Doing ‘nothing’ may be spot-on clinically, but is a high-risk strategy unless you actually enjoy subsequently fending off pages of green-ink underlined capitals berating you, your attitude and your competence. Ever heard, on the other hand, of a GP getting a complaint for doing too much? Nope, me neither.

And this is the point. For years, we GPs have been experts in – and shouldered the burden of – uncertainty. We bear the stress of alternative diagnostic possibilities so the patient and the NHS don’t have to. Otherwise, we’d practise medicine so defensive that patients would be angst-ridden, poly-investigated and overtreated, and the NHS would implode.

The result? Being a GP can feel like having to smile serenely at everyone while being punched repeatedly in the face. Our rewards for taking on those risks and responsibilities have been increasing stress, a rise in complaints, rocketing indemnity fees and a spiralling media hate campaign.

So the news the Government plans to cover inflationary rises in medical defence subs is a welcome break from the beatings, even if, as ever, it has all the hallmarks of being hastily scribbled on the back of a departmental envelope.

Now, I don’t want to suggest, like some sanctimonious compensation-seeker, that, ‘It’s not about the money’. With defence subs, it most certainly is about the money and, frankly, we need something way beyond an inflationary top-up. But I want more. I want this to mean ministers have actually started to get what GPs do every day, and do so well. I want them to grasp that, were we to protest by referring and prescribing every time to save our own skin and sod the consequences, we could bring the NHS to its knees.

In other words, I want them to appreciate the cost. But what I really want is for them to acknowledge the value.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield