Columnist Dr Copperfield ponders the state of acute care for patients following new GPCE guidance
I’m confused, amazed, or both by GPCE’s latest version of ‘Safe working in general practice’. In one key passage it says, ‘Practices are obliged by their GMS contract to provide for the reasonable needs of their patients and for the assessment of urgent problems arising in their patients in their practice area. Emergency or urgent problems can be directed to emergency departments, 999 or 111’.
So here’s the confusion. Are we obliged to deal with acute stuff as per the first sentence of the above? Or can we just divert, as per the second?
Or is the idea that we assess, as in triage, fulfilling part one? And then, if deemed ‘urgent’ (and that word is obviously open to interpretation), we bounce, as per part two? If so, then that’s where amazement kicks in.
I’m not sure if this really is GPCE’s vision of the future or they’re simply trying to make a point. I’m as ground down as every other GP and, yes, my blogs sometimes betray a sense of doctor-centricity – aka survival instinct. But even I feel a tinge of sympathy towards patients here. It can’t be much fun having, say, raging earache and either being caught in an infinite loop between 111 and general practice. Nor can it be much fun being sent to join a nine hour queue in A&E to be seen by a casualty officer who: a) Is pissed off; and b) Doesn’t know one end of an auriscope from the other.
The problem is pretty clear. Acute illness exists. A reliable service for it doesn’t. None of the various agencies where acute care randomly lands – GP, 999, 111, A&E, pharmacy etc. – actually believes it’s their problem. Hence a buck-passing and patient carouselling system that is frustrating, inefficient and dangerous.
The overarching answer is to have a specific service dealing with acute care which is funded appropriately and commissioned clearly – and which, above all, owns the problem. Specifically for general practice, this would mean splitting acute care away from our contract, in a move analogous to the transformative one removing OOH duties in 2004.
In the meantime, whether GPCE is promoting their hard line approach as a temporary ploy or a genuine way ahead, the one certainty is that it will further alienate patients from general practice. And if we really want a better future, I’d rather have patients who smile benignly at us, rather than patients who want to punch us in the face. Not least because public opinion may sway the political one.
Besides, you might think it’s tough, clever and justified to take a stand right now. But wait until your earache kicks in.
Dr Copperfield is a GP in Essex. Read more of his blogs here
I am curious to hear your solution Dr Copperfield?