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- Page navigation anchor for Reducing general practice workloadReducing general practice workloadDes Spence’s opinion piece on reducing GP workload makes uncomfortable reading, turning the mirror back onto GPs and our role in fuelling rising workload by ‘fanning health anxiety’. The skill of general practice lies in dealing with uncertainty; inevitably this involves risk. Yet risk management is an increasingly dirty word in a culture where health professionals face criminalisation for missed diagnoses1 with “zero tolerance” for patient harms.2 This fuels a wave of fearfulness amongst GPs, which must be addressed if we are to ‘prescribe less, intervene less, and refer less’. In our qualitative study3 inflammatory marker tests were often requested for reassurance and to avoid ‘missing something’, yet paradoxically inconclusive results generate increased uncertainty and anxiety. One GP highlighted the effect on workload:
“I can't remember what happened but I think I snapped… the path links were just too onerous, there were so many of them…I think that was the start of a very useful discussion with one of my colleagues who was doing similar things…And he said we, as a practice, ordered too many blood tests and we need to look a little bit more at that.”
As well as trying to avoid ‘missing something’ clinicians also used tests to ‘reassure patients’. Yet recent systematic revi...
Show MoreCompeting Interests: None declared. - Page navigation anchor for General practice workloadGeneral practice workload
Des seems to have been working in alternative universe of general practice. Numerous pressures from outside general practice control have driven up workload. Computers have allowed identification of all of one's patients to be tested, checked and ripened for preventative medication. Chronic disease clinics in practice have driven up attendances, tests and workload. Cancer detection systems which require 98 fit people out of a 100 (to detect two with cancer) to be referred caused rising referrals. Ineffective anti-anxiety medications remain a major obstacle to removing the worried frequent attender. As far as depression is concerned it is well known that societal malaise drives up depression rates in communities. At present the practice has been asked to identify more dementia patients by the local CCG but explaining that the practice has no nursing homes in its patient catchment fails to assuage the relentless work to find what is not there. An elderly population with multi-morbidity creates work: in the sixties your surgery did not need a lift to get patients to first floor consulting rooms. Finally what about those checks on non-diseases such as the ill named chronic kidney disease register a sort of modern day general practice Hans Christian Anderson's Emperor’s New Clothes story. Please Des come back into reality and start knocking the issues that really have caused the rising workload and professional deskilling.
Competing Interests: None declared.