We’re all doom looped

Copperfield takes on the NHS admin ‘Doom Loop’

Patients love labels, don’t they? You know, CFS, fibromyalgia, MUPS et al. They feel much better knowing what’s wrong. Well, maybe not better. But validated and comforted by the fact that others have similar unexplained symptoms, and feckless, unsympathetic GPs like me.

So I was delighted to come across a brand new label: ‘Doom Loop’. This has recently been coined by various health think tanks to describe the syndrome suffered by patients facing dysfunctional NHS admin.

Spot on. The way they are obliged to bang their heads against an NHS wall is tragic, and ‘Doom Loop’ sums it up nicely. But the greatest sufferers of this new syndrome are, of course, us. Because so much of this Kafkan nightmare actually occurs well before the patient experiences their unanswered calls to a secretary, their appointment date arriving in the post a week after the appointment, or their discharge from all care resulting from an expedited request. And it happens to us GPs, working in the background, with patients unaware how we have suffered just to get them to that point.

Our mental health team, in particular, seems to have gone completely Doom Loopy. Only this week, I’ve had two examples. A female patient with complex psychiatric needs who the mental health team diverted to the Perinatal Mental Health team who bounced her back to me because she’s not pregnant. So I again referred back to the mental health team who again diverted her to the perinatal mental health team who again bounced her back to me because, again, she’s not pregnant. Yes: a Double Doom Loop.

And, rather more simply but no less excruciatingly: a lady with potentially very concerning psychiatric pathology whose detailed and considered referral from me was met by (and I quote), ‘No role for the psychiatric team, discharged to the GP.’ OK, more of a Doom Bounce, but a Loop has to start somewhere.

On the plus side, at least now we can short-circuit those consultations where patients produce numerous impenetrable appointment letters, say ‘I haven’t a clue what’s going on, doctor’ and start weeping. ‘Can I stop you there?’ I’ll say. ‘This is a classic case of Doom Loop’.

And the treatment? A navigation to the Patient Advice and Liaison Service, of course. That’s what they’re for. Except the last time I tried that, the patient was back in a fortnight having been told that ‘Your GP is the only one who can sort this out’. Not so much PALs as FOE, then. Clue if you’re puzzled: the last two words are ‘off’ and ‘everyone’.

Which is when you realise this has gone beyond Doom Loop – what we have now is Death Spiral. And maybe that’s the idea. They have to get those waiting lists down somehow.

Dr Tony Copperfield is a GP in Essex