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Is no one else talking about the elephant in the room?



Before I worked in a job I care enough about to it gives me sleepless nights, I used to work in a zoo. Although this might sound exciting, the reality was that I was responsible for cleaning the ball pit in the play area when one of the children found some ‘chocolate’ (the worst type being a Curly Wurly). 

Back then the only perk of the job was having lunch watching the beautiful elephants, in awe at their gentleness and grace despite their immense power. (Well, that and having a go on the death slide).

But now the elephant in the room is a much less tangible thing.

Much has been made of the past months about the crises in A&E and in general practice. Politicians have blamed GPs and GPs have blamed politicians. The media have blamed both, and patients don’t know who to blame. It’s not unreasonable to suggest that general practice is receiving the worst of all this crossfire.

In response to our ever-increasing workload, the BMA have released Quality First: Managing workload to deliver safe patient care. This provides, among other things, template letters to respond to inappropriate requests such as early sick notes or unreasonable prescription demands. And herein lies the trunk of the matter.

Sometimes, patients demand too much. I’ve only worked in general practice for about a year, but I already finish surgeries exasperated at the sense of entitlement some people seem to have of an underfunded and overstretched health service. I have had patients take a relative to A&E because they wouldn’t wait for me to see them at the end of my surgery as an extra patient. A young man threatened to phone for an ambulance because I would not advise him how to best perform surgery on himself.

Even he who must not be named took his children to A&E because he didn’t want (want, not need, being the operative word) to wait for a GP appointment. I don’t blame the public – they are told that they have a right to see a GP at a time of their choosing for any problem, big or small. The problem is, telling the electorate that you can probably can wait to see a GP, let alone stave off that trip to A&E, doesn’t win votes or sell newspapers.

So it’s easier to bash us and our secondary care colleagues, who appear to have a moral responsibility not to send people away (that and the fear of being sued). Sending a patient a stern letter from a template only serves to break down crucial relationships. This responsibility should lie higher up the food chain, not with front line staff who already have enough on their plate. After all. wasn’t this the reason the templates were released in the first place?

Of course this ‘elephant’ is much more complex than I could ever fathom, but it remains off the political agenda. Until this changes, it seems that the sacrifices made by all manner of healthcare staff to keep the NHS afloat in the face of unprecedented demand aren’t going to result in a pat on the back.

Mind you, with all this elephant talk, perhaps that’s not so bad after all. 

Dr Danny Chapman is a GPST3 in Exeter.