Dr Copperfield looks to Kafka while lamenting the increasing workload being handed down to GPs
I like describing general practice as a Kafkan nightmare, because it is. It’s the Department of Dystopia. Here are three examples from yesterday alone:
- A mother whose baby has CMPA and whose paediatric dietetic input has lasted about as long as the child’s gut transit time. A helpful letter from the ex-paediatric dietetic clinic explains that the service is no longer being commissioned. What am I going to do about it?
- A family whose care package for their demented and paranoid mother – who will only accept medication from her carers – is being pulled. A lively exchange of emails between me and social services has established that, according to them and the Care Act blah blah blah, the administration of medication (as in getting it down the patient’s throat) is my responsibility. What am I going to do about it?
- A teenager with ADHD who is being transferred to adult services and has discovered that the waiting list for this is currently ‘indefinite’. But he still requires medication and monitoring in this ‘indefinite’ interim. What am I going to do about it?
To take these in reverse order: I have no expertise whatsoever in managing and monitoring child or adult ADHD, not least because it’s not my job; I don’t get how the physical act of administering oral medication, as opposed to prescribing it, is a medical rather than social issue, nor how social services can delegate this to me when they 100% know I can’t resolve it; and I know as much about paediatric dietetics as I know about making children’s clothing, probably because I am not a paediatric dietitian in the same way that I’m not a contestant on the Great British Sewing Bee.
So what am I going to do about it? I haven’t a clue, which is a reasonable response when presented with insoluble problems. Yes, workload dump, groan, moan, yawn etc. But these examples (and I have many others) go beyond that. They are a complete abrogation of responsibility by those who know that, ultimately, they can hand anything and everything back to the place where the buck stops. They understand that patients might suffer as a result, but as long as the witness to, and brunt of, that suffering is the GP, that’s fine.
It’s a bit of a Trial. Josef K was tried for a crime that was never specified. We are liable for problems that were never ours. Kafka’s story didn’t end well, and nor will ours. On the plus side, I woke up this morning as a gigantic insect, so I couldn’t go to work.
Dr Tony Copperfield is a GP in Essex
Lovely description of those indefinable aspects of GP life (which hospitals, or policymakers won’t get). Agree work can leave us feeling like Kafka but, thank our lucky stars, the picture you’ve painted doesn’t leave us feeling like Van Gogh….😉
Have you tried parachuting into the ‘practice’ (obviously in a black jump-suit with a black canopy)?
It mightn’t work but should distract the more frequent flyers? (OK only temporarily—-but ‘respite’ is respite’!).
When services are simply not there or suddenly disappear, and the provision of care is denied, patients and their families need to be talking to the commissioners, not the GP.
1) mother is responsible for feeding the child; and should be encouraged (‘enabled’) to obtain necessary help from the secondary care department, paediatrics, via PALS/CHC if necessary;
2) family is responsible for demanding SS provide a Nurse to Nurse the patient, and should be enbaled to obtain this from SS by pvoding contact details for ombudsman/PALS;
3) Patient or Mother should be ‘enabled’ to take responsibility by providing contact details for consultant’s secretary, PALS/CHC, Ombudsman, and local MPs
simples !
Just drop any ideas of becoming an MP !
Patient returns from oncology outpatients, told to see GP urgently to discuss if safe to have COVID booster, which oncologist advised they need to have, with their chemotherapy regime.
Patient referred to ENT with a neck mass. There’s no way a specialist trust grade Dr could advise them of results of their normal TSH. Instead advised to see GP and ask for referral to endocrinology.
Or their MP – thats where I send them now ( in my locality, a Conservative a— who has spend 13 years running down all these services and who now tries to claim that they are in fact the champion of local services. Couldnt make it up).
My advice – hand out their number or suggest just drop in direct. They call them ‘surgeries’ so why not get them to help out with some real work?
It was my last day i
I find that patients/the public are increasingly aware of how poor services are. Its a slow dawning that we are sinking to semi third world status. This has one benefit in lowering unrealistic expectations.
When services are simply not there or suddenly disappear, and the provision of care is denied, patients and their families need to be talking to the commissioners, not the GP.
Absolutely @George Forrest – The problem should be returned to the commissioner at the ICB, and it is up to them to come to a solution, and resolve the issue – and it may be referring the child to a neighbouring ICB which does offer the service, or send the child to the top of the queue for an urgent Review and get her care picked up, even if she then joins the queue for follow up. Care provision is outside the scope of your remit – and should be sent back to social services, perhaps with a referral to the pharmacy ICB team to help with medication challenges and how to overcome them.
All unfunded and work dump should be redirected to its source or ICB commissioning team.
Yep George – we need to direct these patients to the “Integrated” Commissioning Boards.
Lack of or delay to commissioned service doesn’t make 2 or 3 my job.
Case 1….. I guess prescribe what you think best based on experience and get HV to monitor weight
We need a clear boundary on what is not GP work. GPs need to realize we can only do GP work and we are not a general dog’s body or a dumping ground. The push back starts and it works. Just say no. We cannot and are not obliged to provide all the answers or solutions.