They say that the evacuated waste products of life rotate towards the place where gravity can exert its force, or words to that effect.
And thus, fresh from a teaching evening by a secondary care colleague, I sleep soundly having heard them wax lyrical about working together, working efficiently, sharing the load.
We cannot say no
Fast forward one week. Hidden amongst my many emails and offers of ‘hot mums’ (I subscribe to a menopause newsletter) is a small notice to GPs from the said colleague.
‘Dear comrades,’ it reads, ‘We have reviewed our policy in line with the CCG’s recommendation and will no longer be monitoring or prescribing this specialist drug. We would kindly ask you to do it. We know it will result in increased workload for you but frankly my dear, I don’t give a damn’ (paraphrased for clarity).
A few murmurs are heard the next day over coffee and someone mentions the LMC, but deep down we all know what’s going to happen. If secondary care, or a dentist, or social services or any and many other services don’t or won’t do something, the silent expectation is that general practice will.
Given that we are named and responsible for our patients, and we are the most accessible form of comprehensive health care despite what the headlines say, the buck inevitably stops with us. Other services are fortunate that if they say no, there are GPs to pick up the work. Other services know if they don’t do something, the onus of responsibility appears to fall back on the GP to figure out what to do next.
We cannot say no – properly – because if we say no patients have nowhere else to go. Say no to prescribing the specialist medication? Sorry mate, your condition is going to have to get a lot worse whilst we sort out this ridiculous situation. And seeing as my patients really are my priority, I’m probably going to add this prescription to my dentist-cum-social worker-cum-occupational therapist hat.
We are therefore not bearing the load, we are the foundation. And if the foundation fails, the house tumbles.
Dr Danny Chapman is a locum GP in east and south Devon