Copperfield criticises the workload impact that stricter requirements for hospital referrals will have on GPs
I guess the elective reform plan’s £20 per A&G promise was so attractive/insulting because of its potential for gaming/work-dump that our delight/fury distracted us. So maybe we overlooked the document’s unexploded grenades, located in the mandate for ICBs to ‘standardise pathway referral criteria’ and to incorporate ‘pre-referral investigations’. If these go off, the fallout could be extensive and bloody, and it won’t just be the roof collapsing in many surgeries.
As we all already know, simply getting a patient to the point where they’re on a waiting list for an appointment that will never happen with a team that never picks up the phone is hard enough – with a 50/50 chance of any referral bouncing back for, say, using the wrong sized font. ‘Standardising referral criteria’ will simply turbocharge that rebound potential, with rigid proformas having us desperately trying to fit patients into boxes in the hope of avoiding the coffin-shaped one.
As for those pre-referral investigations, Gawd help us all. Frankly, having optimised my patient’s weight, BP and smoking status, screened and tweaked his bloods, and arranged and interpreted his ECG, CXR and spirometry, I might as well operate on his sodding aortic aneurysm myself, except it popped a month ago, so no need. At least he died knowing he was fit for surgery.
Up until around yesterday, we were collectively rejecting proformas and work-dump, and having robust LMC support to bounce back bounce-backs. If, as has been suggested, these ‘details’ around referral criteria and pre-referral assessments are being written into the new contract, that’s a hell of a U-turn. One moment we’re industrially defiant, the next we’re bending over and handing them the lube.
What’s in this for us? If the quid pro quo just means quids pro quo, I’d respectfully point out that there’s no point being money-rich if I’m not so much time poor as in negative equity. Soon, we’ll be chronic illness/prevention specialists, community housemen, pre-op assessors and pre-referral PAs. That’s a lot of full-time jobs to fit into one day. When do I get to be a GP?
Dr Tony Copperfield is a GP in Essex
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My replies to secondary care dumps usually clarify that I cannot function as community house officer as well as a FT GP…
I guess it makes it easier for PAs and ANPs to do referrals that are rational now that that they make up a significant part of the workforce.
Getting GPs to take a Procrustean axe and chop their complex referring behaviours into some pathetic simulacrum proforma so that LLMs can learn this “parrot-fashion” and massively stupid algorithms can take over the process. And eventually replace GP input.
I suggest GPs peacefully non-cooperate with this brainless politicians’ drivel.
@Mark Howson above… of course it does! That’s the point. We are not wanted. We are overqualified and overpaid. The way markers have been in plain sight for years. They want us to go. There are plenty of people who’d pay good money to speak to a medical generalist however, when they can’t any more in the NHS. For years, policy has been to push us to resignation.