Zara Aziz: GPs should start saying 'no'

I have had an obsession of late. I have been excitedly jumping up and down on the bandwagon that the government has been hurtling along. I became so fixated on that elusive elixir of efficiency that probably doesn't exist at all, that I seemed to lose my way.

Until one evening when I was going cross-eyed over my laptop at 11 pm on a Friday night, my husband remarked. ‘You have too many tabs open.’ Indeed. It felt like a light bulb moment.

GPs are not inefficient. Unlike in many hospitals, practice managers work on a daily basis with jobbing GPs. Many practices including ours have novel ways of working - be it with their QOF, online consultations or collaborative working with advanced nurse practitioners, CPNs and clinical pharmacists.

But any big strides that we make feel like a drop in the ocean.

I deal with my emails, tasks, prescriptions and blood results before morning surgery. But in the evening two hours or so after my last patient has left the building I am still doing paperwork – going through drip feeds of Docman and discharge letters that by that time have ceased to make any sense at all.

And as a medical student said to me in surprise after a day of sitting in on consultations: ‘There is a whole load of pathology out there in primary care: the very ill but also the incredibly well.’

The balance has shifted

The balance has indeed shifted – sick patients are being passed to us too quickly due to pressures on secondary care. Then there are the worried well or the frequent attenders who are constantly being told to seek advice from a GP for anything from a common cold to hand strain during exams.

This is the inevitable result of living in a litigious society. What is a patient to do when they are constantly bombarded with mixed messages?

There are many who I wish would see us more because they have genuine health needs. But I also get the occasional ‘I was going to get something from the chemist for this but as you are free I came here first.’

I have yet to see anything materialise from any self-care campaigns from the DH. And, it is too much to hope that Jeremy Hunt will change the heart-sinking mantra ‘see your GP’ (even though you are not sick) that is chanted by everyone from schools, universities, airports, Department for Work and Pensions or your boss.

‘Follow the example of the banking world’ is the bizarre advice to GPs from the health secretary.

I fail to see any similarities. How can advising patients to take ownership of their chronic or minor illnesses on top of doing everything else in the ten-minute consultation be as simple as filling in a sort code and account number on a cheque?

The government is creating demand

The government on the other hand will shirk its responsibility and continue to create demand (where it does not exist) by pushing forward its unfunded utopian vision of seven-day routine care in and out of hospitals.

It seems that the health and wellbeing of NHS staff is of little concern to the government. Our time has no value. 

I do not have an answer to our workload crisis. I know it does not lie in apps, online consultations, physicians’ assistants or banking models. But we could start by looking after ourselves. And saying ‘No’.

‘No’, to the inappropriate requests.

‘No’ to the shift of work from secondary care to us.

‘No’ to working seven days a week.

And 'No' to the impossible.

  • Dr Aziz is a GP in Bristol

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