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I’ve a shortage of patience

The Pulse pages are sometimes criticised for being lopsidedly bleak and negative. So, for the sake of balance, let’s consider the positives of a typical Monday.

Good. So, moving onto the negatives. I’m duty doctor and I’m triaging to vacant or emergency slots. All of which are filled shortly after 9am. I am now triaging to slots which don’t exist, which is tricky.

Onto some routine consultations and phone calls. I hear the usual litany of patients unable to book outpatients appointments after referral to secondary care. The situation has become so bad locally that we are, in effect, running without a neurology or dermatology service.

Then there are the justifiable patient complaints about quasi-services – local ‘resources’ set up to give a semblance of service provision, but in reality a faceless body effective only at rejecting our referrals for not fulfilling arbitrary and ever-changing criteria (CAMHS, adult mental health etc).

We can’t even survive by self-medicating, because the sodding fluoxetine has run out

And, finally, an angry call from a patient because the ‘nursing assessment’ I had arranged for his disabled, dependent and acutely unwell wife has not materialised – apparently because we are stuck in a loop with the community nurses insisting on knowing exactly what her needs are first and me stating that she needs an nursing assessment by them to answer that question.

In desperation, to try to help someone, somewhere, I prescribe some drugs. The prescriptions return to me about half an hour later with a scribbled message from the pharmacist stating: ‘Medication shortage, please provide alternative’.

This, by midday on a typical Monday, is the state of general practice. There’s no way to put a gloss on this. We are now working in a system where there are no appointments, no means of referral, no functional local services and not even any f***ng drugs. Nonetheless, being the final common pathway with responsibility for my list, it is for the ‘GP to sort’.

How? How can we possibly work in this system? We can’t even survive by self-medicating any more, because the sodding fluoxetine has run out.

So Mr Hancock, a scribbled note for you: ‘NHS shortage, please provide alternative’.

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