Any GP you want: so long as you’re healthy

Simon Wellesley in The Guardian 19th November reports:

Any GP you want: so long as you’re healthy

Jeremy Hunt wants to scrap GPs’ catchment areas to give patients more choice. Sounds great – until you think it through

“Patients will be able to pick a GP wherever they like next year, Jeremy Hunt has announced. It could be where you live, near your work or your child’s school, or miles away because you have heard that one practice offers something you particularly like – extra health checks, perhaps, or late hours. The health secretary says it’s about improved patient choice and healthy competition – the better GPs will attract more patients, get more income, and be able to invest more in their practice. What’s not to like?

For some, rather a lot.

The link between general practitioners and the population they serve has been fundamental to the running of the NHS. And for good reasons. Health services are planned around the GP as the patient’s “medical home”: community and mental health services, district nurses and much more are linked to the local surgery. GPs act as the eyes and ears of local communities.

But what now? You decide to register with a well-known doctor who understands why working people like you need to see a GP early (before the commute) or late in the evening – and is into holistic wellbeing. But unfortunately everybody for miles around has the same idea. So the practice can’t say yes to everyone – it hasn’t the staff or space, and it would defeat the object of delivering the personalised care that so attracts you. So, far from you choosing your doctor, it will be the doctor who chooses you.

And who will GPs choose? Those who are likely to bring in the best return for the least work; those who won’t “burst the budget”. In other words, healthy people…..”

Interesting wriggleing by the minister, trying to get off the hook of “lack of access” – caused by repeated political interfering. I can do no better than reprint Dr John Clarke of Co. Durham in today’s Times: Hard-pressed GPs

“The gradual erosion of general medical practice has been as the result of successive health ministers repeatedly trying to leave a “legacy”

Sir, In 1976 I became a family doctor in a North East ex-mining town. The practice did all its own on-call and night visits. It also carried out monthly visits on the vulnerable elderly who had a history of illness. Urgent patients were seen as extras in surgeries, and patients with minor and non-urgent complaints were generally happy to wait to see their own doctor.

Now if this sounds amazingly like the situation desired by the Health Minister today (report, Nov 13), I would have to point out that the gradual erosion of general medical practice has been as the result of successive health ministers repeatedly trying to leave a “legacy”, without understanding the consequences.

I found my work very satisfying for the first 15 years, and then more and more frustrating, with less patient contact and more paperwork. By 2006 I was happy to take retirement. When I visit my old practice I find morale distressingly low. Most of my colleagues will retire as soon as they can. The family doctor has now been consigned to history and no amount of political input will revive him.John A. Clarke Crook, Co Durham..

I was 3 years behind Dr Clark. And I agree – the start of the downturn was the first and relatively harmless “performance indicators” for cervical smears and childhood vaccinations.. In themselves these were fine, but they heralded the era of “over management” of General Practice which has culminated in today’s crisis. The golden age of GP was from the 1966 New Contract which allowed premises development, until 1998 when the “management by performance” started…. Yes, there have been some poor GPs, and some criminal ones, but the single best method to avoid these in future is to keep reducing the number of single-handed practitioners.

This entry was posted in A Personal View, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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