“Safety fears made me quit being a GP. The system’s broken”.Phil Hammond

Phil Hammond writing in The Times as a leading article 24th March 2014, says “Safety fears made me quit being a GP. The system’s broken”. “The model of ten-minute consultations is not working”.

With apologies to the Times and Dr Hammond I reproduce the article below. I agree, and moreover I believe it’s going to get worse, as the minimum period to train a GP from start of Medical School is 10 years. Please read Medical Students’ Debt…. The NHS impending failure is due to “unlimited demand, limited resources, and no disincentive to make a claim”. The paternalism of the NHS (everything for everyone for ever) discourages autonomy which is inferred by Dr Hammond’s last paragraph. Unfortunately we have a Regional Health service (not an NHS) with Post-Code differences, gaming by patients located near frontiers, or who need access to “choice”, especially if they live in Wales (we should all rage against it’s dying). An NHS designed for assertive and informed people only (Be pushy!) – is that what we really want? Without overt as opposed to covert rationing, (note recent cancer posting) and encouraging autonomy for non-fearful conditions, the slow implosion will continue…..

“GP services are on “the brink of extinction”, according to Dr Maureen Baker, the leader of the Royal College of GPs. It’s a polite way of saying they aren’t always safe. Surgeries see 90 per cent of “patient contacts”, currently 340 million a year, at a fraction of the NHS budget (just 8 per cent).

It has ever been thus, but as patient expectations have risen with their life expectancy, the model of ten-minute consultations just isn’t working. Trying to treat patients with six illnesses and seven symptoms on 13 drugs in so little time is frankly dangerous.

I stopped being a GP in 2012 because it is so stressful and unsafe, and joined a specialist team treating young people with chronic fatigue syndrome/ME. It’s a horrible and complicated disease, but I now have 90-minute consultations.

Finally, I’m able to practise a standard of NHS care that I can be proud of. In the NHS the 20 per cent of patients with multiple long-term illnesses use 80 per cent of resources. They too need long consultations with specialist teams and continuity of care to keep them in their homes. With this approach, hospital admissions can be halved, with big savings, but it needs investment.

Dr Baker is asking for 11 per cent of the NHS budget and another 10,000 GPs. In the NHS, your care is crucially dependent on whether you have access to a professional team working in modern premises. Most chronic diseases are now managed in general practice and referral to nearly every other branch of the NHS requires you to go through a GP. Even if you go private, many insurers insist you go via a GP. If you have poor GP services, your chances of surviving the NHS take a big dent.

Instead of focusing just on GPs, we need to join up hospital, community and social care services. Staff must share expertise and information quickly across the system, and ensure patients get the right care in the right setting. This will need a common culture, budget and IT system and, like training 10,000 GPs, will not happen overnight.

In the meantime, patients who want to should be given control over their medical records and access to the best information to manage their illnesses and stay well.

By far the biggest health gains are through changing how we live our lives, and you don’t need a GP for that. Which is probably just as well.” (you do need education, information, willpower, and ability to game – something Times’ readers probably have, but which many people do not.)

This entry was posted in A Personal View, Post Code Lottery, Rationing, 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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