healthmedicinet

By

Dr Margaret Mccartney

Published:
20:42 EST, 24 November 2014

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Updated:
20:42 EST, 24 November 2014

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Last week in the Mail, surgeon Professor Meirion Thomas suggested that we GPs are largely responsible for the problems in the NHS.

Not only do we ‘no longer try to provide an even remotely personal service’, he said, but we make ‘often unnecessary referrals’ to hospitals. 

‘We ‘do not keep up with the latest developments in healthcare’ and act as ‘amateur psychologists and counsellors to the worried well’. 

Patients trust their GPs. That’s what 92.5 per cent of almost a million patients completing the NHS GP patient survey this year said

‘In his view, what the health service needs is fewer GPs and more specialist nurses.

Previously Professor Thomas had women doctors in his sights, earlier this year suggesting that women were less worthy of admission to medical school because they might have babies and work part-time. 

He caused quite an outcry and even the then president of the Royal College of Surgeons said he had ‘a major problem with [Professor Thomas’s] foray into gender politics and the medical profession’.

My view — and I am not alone — is that Professor Thomas’s latest allegations are just as misinformed and, as a GP of 15 years’ experience, I find them frankly absurd.

Let’s start with this basic fact: patients trust their GPs. That’s what 92.5 per cent of almost a million patients completing the NHS GP patient survey this year said.

It also goes without saying that most people don’t want to end up in hospital if they can be cared for locally.

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Our NHS needs general practice to work well. We are now living longer — an NHS success story — and with more chronic diseases. 

As doctors we are dealing with ‘multimorbidity’, where patients have more than one condition at once.

About half of those over 75 have three or more chronic diseases, such as chronic bronchitis, angina and diabetes. 

Many older people are frail, and many of the medicines designed to prevent one problem (such as high blood pressure) can end up causing other problems, such as dizziness and falls.

Trying to balance the benefits and harms of medication together with treating pain, or low mood, or bronchitis, is often complex.

This is where general practice comes into its own. Rather than treating diseases separately, GPs take an overview of physical and mental health. 

There is good evidence that when patients get ‘continuity of care’ from their GP — seeing the same doctor over time — they get higher-quality care, visit AE less and save the health service money.

Research by the Commonwealth Fund this year reported that the NHS scored top — above the U.S., France and Sweden — on its quality, access and efficiency.

GPs have tried to respond to the increased need for appointments — there are 40 million more this year than six years ago — but there is no doubt they are struggling with workload and offering continuity of care

Sure, the NHS has many faults, but considering the extraordinary changes in our population, scoring this high despite austerity budgets is impressive.

GPs have tried to respond to the increased need for appointments — there are 40 million more this year than six years ago — but there is no doubt they are struggling with workload and offering continuity of care, which is why we need more GPs trained.

Professor Thomas suggests that the answer is to train more specialist nurses. But this makes no sense, especially if you have more than one condition. You’d need to see a specialist nurse for each disorder.

He also takes issue with GPs over the Care Quality Commission’s recent findings about GP surgeries, which, as he puts it, have shown a ‘worsening’ performance, and that ‘one in six practices could be putting patients at risk because of their inadequacies’.

The CQC has pulled together lots of data, some from the GP contract which sets out the tasks we are paid for doing, such as blood pressure readings. 

Practices are rated highly if, for example, they have asked many patients whether they smoke and want help stopping.

It’s daft that I must ask this no matter what the circumstances — it’s unlikely that a 70-year-old lifelong non-smoker will suddenly take it up. 

So who is the better GP: the doctor who asks everyone whether they smoke, or the doctor who listens to you and thinks of your needs first, rather than the payment they get for ticking boxes?

Professor Thomas seems to think that practices scoring low could be inadequate, when in fact the doctors may simply be concentrating on their patients’ needs.

This is why the data released by the CQC is of uncertain use: not just to the commission itself but also to patients reading it.

Furthermore, I suspect that patients don’t need the CQC ‘data’ to know when they’re being listened to or fobbed off. 

I also know that although I usually have to wait to see my own doctor, I’d prefer to do that than see someone else. 

As I overheard in the waiting room, ‘he runs late because he actually listens to you’. So he might not score high on ‘access’ but he does on ‘caring’.

The real problem is not individual groups of professionals, such as GPs — or surgeons, for that matter.

It’s politics: GPs have been forced into a massive bureaucratic exercise by the CQC, taking doctors away from patients in order to fill in forms.

Lots of money has been put into the NHS, says Professor Thomas. 

Yet ‘despite (this) patients are simply not receiving the care they deserve’. 

In fact, general practice is getting proportionately less — from 10.75 per cent of the NHS budget in 2006 to 8.4 per cent in 2012, despite 90 per cent of interactions with patients occurring in primary care.

As a medical student I thought that general practice was all sore throats and prescribing the Pill. That was until an elderly friend became unwell and didn’t want to go into hospital.

I watched as her GP and a district nurse visited her, talking to her about her fears and getting her back on her feet.

I was dazzled. I’d assumed hospitals were the only place capable of getting people like that better. 

Strong general practice ensures that we don’t send people to hospital inappropriately, meaning there are hospital beds for people who really need them.

In hospital, patients are often seen, diagnosed, treated and discharged. In general practice we look after people, often with several problems, from cradle to grave. 

And afterwards we will still be there for your bereaved husband or wife.

I’m not saying GP practice is perfect. The truth is that the NHS needs high-quality general practices as well as hospitals. 

We need both to keep the NHS caring, safe, effective and affordable.

Dr Margaret McCartney is a GP in Glasgow. Her new book, Living With Dying, is published by Pinter Martin (£11.99).

 

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