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The enemy within

Half a day in general practice. One point proven. By two cases.

Case 1: I receive a message to call a health visitor. That’s never good, is it? Could be anything from buttock crease asymmetry to child protection, typically with the same level of angst for both.

Anyway, according to the HV, one of my postnatal patients is behaving oddly. No, she’s not suddenly decided to breastfeed and read the child AA Milne – which, admittedly, would pass as strange locally, given that the average infant’s diet consists of a bottle of carbonated drink and a morning watching Jeremy Kyle. I mean really oddly. Psychoddly.

With a sinking heart, I envisage my half day imploding. But wait. What’s this? ‘I’m not phoning you to do anything,’ says the HV. ‘I just wanted some background information. I’ll sort it out.’ Hang on; health visitor? ‘Sort it out?’ How does that work? Health visitors don’t do ‘sort it out’. They do ‘screw it up’. And then they have coffee.

But she did. She contacted the community mental health team, arranged an urgent assessment – patient sorted, child protected, GP advised, etc. Stunning.

Case 2: I’ve spent much of the past two days making phone calls about a prescription for magnesium oxide tablets. Never heard of them? Nor have I. And nor has the BNF. My patient’s just been discharged on them, though, and is requesting a repeat. No indication on the hospital letter. No suggested duration. So I have no idea. Everyone at the hospital end has been in a meeting/busy/not answering their bleep/hiding in a cupboard hoping I’ll go away. Messages are passed to and fro, but nothing is resolved.

A repeat prescription normally takes, what, 15 seconds? This one has now entered its third day. The patient’s getting agitated and so am I. In fact, I’ve had enough. I aim for the top, but the switchboard tells me the consultant’s away, though, obviously, not on a primary/secondary care interface communication study day. I tell them that if they don’t track down the registrar, pronto, I know a bloke down the pub who will, and it’ll be a grand well spent.

Two minutes later, I’m talking to him.

‘I’ve had a look at this,’ he says. ‘No idea why he’s on it. Just stop it. We’re seeing him anyway next week. I’ll sort it out.’

Ah, those magic words again. I switch off my computer, prepare for an afternoon’s R&R and phone the patient to tell him the good news.

‘Funny you should ring, doc,’ he says. ‘The hospital just called. They’ve cancelled next week’s appointment.’

Now, we’re all part of one happy, clappy team doing our best for the patient, right? When it works well (case 1), it’s glorious. When it doesn’t (case 2), you feel like you’re working with a bunch of saboteurs. And that’s the point. The ‘enemy without’ – CQC, QOF, NICE et al – are but a minor irritation. Because the thing that knocks half days off your week and years off your life is the enemy within.

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