Monday 3 June 2013

There is a future for GPs, but it's flexible

While I was doing the government's review on Barriers to Choice last year, the most common complaint at round tables was about getting appointments to see GPs.

This was unexpected because the official research for the Department of Health, every year, does not pick this up.  Nonetheless, anecdotal evidence - which is important here - suggests that some people, maybe older people in particular, do have difficulties here.  I find it quite hard myself sometimes, at least if you wait until you really need it.

So when I woke up a few days ago with another mild chest infection, I thought of this - and found myself planning ahead to book an appointment with my GP, not to tackle the problem now (which isn't really necessary), but in case I need one at the end of the week.  Because, if I wait until then, I won't get an appointment.

Imagine that kind of decision - pre-emptive GP appointments - being made and booked all over the country and it begins to become clearer why GPs are being overwhelmed.

The influential NHS blogger Roy Lilley tackled GPs at the end of last week, and absolutely hit the nail on the head about how they need to be reinvented.  Doctors who answer the phone in the morning to triage the patients themselves.  Special practice nurses to coach the long-term conditions to self-manage, and surgeries linked to classes, drop-in coffee mornings and, he might have added, time banks - like the one at Rushey Green.

It is true that GPs are now under increasing pressure as the the most frontline service of all.  It means they now have to be the gatekeepers also, via their surgeries, of the new mutual support infrastructure that can provide people with advice, companionship, expert patient support and the gateway also to social care.

That is not something they can do all by themselves, which means that the old days of sole practice doctors - like the wonderful one who used to treat me when I was a child (Dr Morgan) - are probably now on the way out.  But there are ways of doing things differently that will make a difference, if they can get their patients to help - if surgeries become hubs capable of knitting society back together again, relationship by relationship.

And if they can abandon the old rigities that assume that access by patients has to be controlled, and then they must all be offered precisely seven minutes in the consulting room and a new prescription, when many would prefer an occasional email to make sure things are OK - and not all of them will need to be to the doctor.

These kind of rigities are repeated throughout the NHS.  Why do patients have to see their consultants every six months, come rain or shine, well or ill?  Why can nobody talk to doctors by email?  Why do people with chronic conditions need to be maintained in ill-health for the rest of their lives at great expense?

All of which is a way of saying that the resources are there, if we can be more flexible.

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