Dr Copperfield on ICSs trying to overhaul acute care
You only have to witness one day duty surgery to realise that we GPs are masters at creating order from chaos. So we can relate to ICSs’ attempts at trying to overhaul acute care. They’re trying to do on the macro what we do so successfully on the micro.
There’s two problems, though. There’s the obvious one about putting up barriers around A&E in the form of an appointment-only service. Our reflex – and probably correct – response to this is that it means work is diverted our way. That said, with current A&E waiting times, a slot in three days for that compound femoral fracture feels like a result.
The other issue is the assumption that, to put out acute fires, you need flowcharts rather than firefighters. This is a big mistake. On-the-day illness is full of uncertainty in presentation, notoriously unpredictable in progression and experienced by patients who are frightened and – durr – feeling ill. These patients are therefore not functioning at their best. An unclear start point, variable direction of travel, and confused patients mean protocols crumble immediately.
Chuck in the mandatory digitalisation of everything and you don’t have a patient pathway; you have a highway to hell.
Take the pathway highlighted in the Pulse story above for exacerbation of COPD. Just play the role of a hypoxic patient for a moment. Have you got end stage COPD?! Are you getting worse?!! Go online via your GP website (click ‘COPD’) or by accessing an iPad at your neighbourhood health hub!!! Complete a short online form!!!! Wait for a text with either self-help advice and a community health worker or an invitation to a face to face appointment!!!!! Then wait for a call to confirm all the above!!!!!!
What could go wrong? It almost makes being seriously ill fun.
One end point in this flowchart is, ‘Discussing… what a good death looks like’. Trust me, it looks nothing like this. A good death in COPD does not involve neighbourhood hubs, iPads and texts. It involves hand-holding, morphine and continuity. It’s your GP, not ChatGPT.
So good luck, ICSs, with your attempts at sorting out acute care. I just wonder if you’ve asked the right people, those with the superpowers. Because there is something dying here – and it’s not just patients with COPD.
Dr Tony Copperfield is a GP in Essex
