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Take out the ‘gatekeepers’ and watch the system collapse



I’ve finally regained my power of speech only two days after reading the headline, ‘Patients to be allowed to self-refer for cancer diagnostics without going through GP’.

I won’t dwell on our reflex (but absolutely correct) concerns about overdiagnosis, overtreatment and overwhelmed outpatient departments – even though these problems suggest that this Bright New Idea is about as sensible as encouraging every cancer specialist to shoot him/herself in the head, which may indeed happen anyway.

What bothers me more is what it says about politicians’ view of the job we do, and the value they place on it.

Gatekeeping for cancer services is an incredibly difficult but necessary task combining science, art, experience and the twitching of the GP’s antennae. It’s impossible to do perfectly, but I’d defy anyone outside general practice to do it better.

But now, it seems, the Government wants to drive a coach and horses through it. Fine. But why stop there? If general practice really is such a redundant medical filter, why don’t I also dump in my waiting room a pile of sick notes for the work-shy and a trough of antibiotics for the sniffly snuffly masses?

Maybe the DH should remember what happened last time they pulled a stunt like this. Taking out-of-hours out of GP hands to be run by people not used to taking risks, living with uncertainty or saying ‘no’ – in other words, those who’ve never held a gate in their own hands – might have seemed like a good idea at the time.

But it wasn’t, as the ‘A&E like war-zone’-type headlines I’m reading today, again, would testify.

I’ve regained the power of speech. I just wish they’d lose theirs.

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