This site is intended for health professionals only


There’s no such thing as ‘full’ in general practice



So, is it true? These rumours I’ve been hearing? I’ll find out sooner or later. Are you cheating on me or not?

Look, we’ve been in this together for so long. Years. And I’ve spent most of them banging on about how we GPs do a nigh-on impossible job nigh-on impeccably. About how, despite the micromanagement, the complaints, the guidelines, the impositions, the patients, the politicians, the policy wonks, the resource cutting, the media baiting, the constant change, the chronic headache, the continuous criticism, the doom, the gloom and the despondency, we GPs all sing from the same hymn-sheet, united on the front line, doing the best we can.

Then the rumours started. They may be just that, of course. But I’ve heard them repeatedly. All alleging the same thing.

This is what they’ve said: you, whoever you are, wherever you are, have been doing the dirty. Specifically, you’ve been arbitrarily declaring your day/surgeries/capacity for work ‘full’ and bouncing patients, whatever the problem, to A&E. Even worse than that, supposedly, some of you have given a standing order to your staff to do the deed for you. No wonder it’s currently A&E armageddon.

The first inkling was an email from our CCG asking practices not to divert patients to A&E when they can’t offer a same-day appointment, and to direct them to NHS 111 instead. True, as NHS 111 will refer them straight back to us, or A&E, this is hilarious. But the implication – that some of us are using A&E as primary care overflow – is less so.

Now, I don’t want to come over all holier than thou. But in the fortnight leading up to Christmas, and in the weeks since, my practice – besieged by the viral hordes – has regularly seen scores of extras each day.

Yes, we bitch about it. But we get on with it – it wouldn’t occur to us to do anything else, and certainly not to divert these patients to A&E. Not just because they’re obviously not sodding accidents or emergencies. Nor because they’d have to wait hours, suffer inappropriate tests and treatment, and be told to get us to refer them for their headache/sore throat/painful knee to neurologist/ENT surgeon/orthopod etc. Not even because every child who attends our local A&E, inexplicably, receives a free teddy bear.

No. We don’t do it because it’s wrong. There is no such thing as ‘full’ in general practice. And the moment we pretend there is, and use A&E to bail us out, we lose a lot of arguments about what makes GPs special. Besides, ‘full’ implies some definition of ‘capacity’, and that definition is open to manipulation. Imagine the fun our detractors could have with that, and the glee with which the Government would then try to set a minimum appointment provision per thousand patients.

Maybe those rumours are wrong. Maybe it’s all a silly misunderstanding. I bet most of you have been stoically working your butts off just like we have. But if there’s someone out there, right now, feeling guilty, let me tell you. It’s all over between us.

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