Talk to a hypochondriac like me before advising patients to treat themselves to save the NHS

The mid-afternoon fatigue might well be a natural part of middle age. Then again, it could be an underactive thyroid, sleep apnea, leukaemia – or any of 61,000 other disorders

The internet is the GP’s 'second worst enemy after this government'. Self-diagnosis it will drive more people to the surgery (Rex )

I must say, it’s a tremendous stroke of luck that elsewhere in the NHS things are running so smoothly, or a report about the future of the GP system might cause concern about systemic failure spreading virally through the service.

No doubt feeling liberated to speak on other matters by the tranquil relations between government and junior doctors, NHS England seizes the moment to contemplate how to improve general practice.

The aim outlined in its new report is to “put general practice back on its feet” – and who (other perhaps than private physicians in Knightsbridge who charge £200 for a consultation) would pick a fight with that noble ambition?

In many parts of the country, after all, you wait so long for a GP appointment that, by the time the day dawns, the complaint will either have vanished or killed you.

With my west London practice, it’s a bare minimum of a fortnight before the chance to see a stress-laden doctor who uses the wall clock as a makeshift stopwatch, having seven minutes to get you out of the consulting room and the next patient in.

This is why so many young GPs are willing to sacrifice anything that might vaguely be described as “civilisation” by going to work in Australia; why urban practices find it incredibly hard to recruit replacements for them and those retiring early; and why hospital resources are being drained by people who, unwilling to wait for their appointment, pitch up at A&E instead.

And so to NHS England’s meisterwerk – a five-year plan (what else) to find an “additional £2.4bn” annually for GPs. Since every ha’penny of that is to be shaved from the existing NHS budget, this means either: a) that it won’t be found at all, or b) that it will be found by robbing hospital consultant Dr Peter to pay GP Dr Paul, in which case Dr Peter’s patients will suffer.

But sod them, and back to the salvation of general practice. The theme of this report seems to be this: the way to reduce the workload on GPs is not by dramatically increasing their numbers to the kind of levels they have in France, Germany, the Netherlands and other first world countries; but by drastically reducing the number of patients.

To that noble end, NHS England wishes not merely to devolve as many of a GP’s duties as possible to pharmacists and nurses, it will also encourage patients to “self-manage” their health by recourse to the internet.

Well isn’t that the most spiffing idea anyone ever had?

And yet for all its splendour, writing as one of the country’s leading hypochondriacs, I hear alarm bells in my head.

I suppose it could be a recurrence of the tinnitus to which I’ve been a martyr for so long. But in my expert opinion – and we’ll need to be medical experts in this brave new self-treating world – what I’m hearing is indeed a siren.

The problem inherent in this is one familiar both to hypochondriacs and doctors. If it isn’t plain to you, make an appointment with your GP and tell that doctor that you have been using the internet as a diagnostic device. Say that, and watch the world-weary despair seep across the face opposite.

On the internet, after all, every symptom – wherever in the body, however common or rare – is a symptom of something terrible. If you have a twitch in the leg, the internet will inform you that, while it may be a trapped nerve or muscle fatigue, it might also be motor neurone disease.

A nose bleed could be explained by the bursting of a blood vessel when you blew your nose – or by what we self-appointed doctors call a hypertensive crisis (dangerously high blood pressure, to you lay folk). The mid-afternoon fatigue that has you dozing at your desk might well be a natural part of middle age. Then again, it could be an underactive thyroid, an after-effect of sleep apnea, leukaemia, or any of 61,000 other disorders.

The internet, bless its heart, is the GP’s second worst enemy after this government. Advising the untrained to use it to “self-manage” their health is a notion of surreal lunacy. As more people visit online medical sites, there will be a corresponding increase in the numbers listening to Vivaldi for 11 minutes before the receptionist tells them the first available appointment with a human doctor is in June 2019.

There is one way, and only one, to get general practice off its knees and keep it upright. That is sufficiently large, sustained investment in training new doctors so that there are enough to treat a growing, ageing population – and not so few that they retire at 43, or self-medicate with opiates, because of the pulverising stress.

Anything other than that is gibberish designed to deflect the attention from dangerously-low levels of funding. This is a diagnosis which any urban GP will, without recourse to the internet, be pleased to confirm.