‘My local practice was a centre of excellence. Now we face a future of depersonalised, rationed healthcare’

Melanie Reid in The Times Magazine 24th May 2014 opines: ‘My local practice was a centre of excellence. Now we face a future of depersonalised, rationed healthcare’

I must say that I too would like continuity of care, AS FAR AS IS POSSIBLE, especially when I am dying. The caveat is in the capitals… How much “on duty”  or work do we expect our GPs to do? A young mother who is also a GP on part time hours (to ensure she does not need re-training) cannot be expected to work the same hours as someone without the children to care for. An older GP should be helped in reducing their hours if the only other option is retirement. Larger practices are often less personal. Should large practices work in “teams” to try to give as much continuity as possible? The performance managerial culture has not worked as far as patient’s like Melanie Reid are concerned.

I was a GP myself from 1979-2012. I started my working career on duty every night and weekend as well as 4.5 days a week. (9 sessions) The intensity of the working day allowed me to keep active and fit, sometimes to play squash during the day. We also delivered 56 children a year, at all hours, and looked after patients dying at home. I remember transfusing, chest drains,  and paracentesis (draining the abdomen)  being performed at home for my patients.

All this is possible if the profession were allowed to lead their own destiny, and if overt rationing, and co-payments for services that we are not “fearful” of being without were allowed.

Melanie Reid broke her neck and back falling from a horse in April 2010. She spent 12 months in rehab and is now tetraplegic.

In the news recently was the story of a Portsmouth GP who was so popular that, when he retired after 32 years, his patients queued for 4 hours to say goodbye to him.

It’s somehow poignant: the thought of a community bereft at the loss of a respected friend with special skills. Their doctor, the person who knows them, who has seen their families grow up, listens to them, heals them. Because we all know, deep down, that such quaint last-century ways are doomed; and, once lost, will never return.

I’m in a similar state of mourning. My GP resigned last week, after 20 years in post, to a collective howl of dismay from her patients, who are devoted to her. Jennifer Foster is a damn good woman and a very fine doctor: wise, perceptive, committed and thorough. Since my accident, with her on my side, I never felt alone. And that’s a big thing.

The tragedy is that she doesn’t want to leave us. She was left with no option. Because with her departure will inevitably go her small, five-star rural practice; one of those where you can get same-day appointments, lots of support services, and where the receptionist and the in-house pharmacist know your name and smile in welcome. We got Rolls-Royce treatment. And we had to be punished.

I hardly knew her before my accident. When she came to visit me in hospital – how many GPs would do that, for a start? – I worried I might not recognise her. She told me she had little experience of spinal injury but would do her best to learn. And in the years since, she’s been a Trojan: I can email her or phone her; she sends her equally fabulous district nurse to check me out regularly; and every six months or so she visits on her afternoon off and spends a couple of hours sorting me out physically and mentally. I know others get the same personal treatment.

My first trembly solo drive was to her surgery. I parked outside, phoned the receptionist – “Oh yes, of course, no problem” – and both she and the pharmacist cheerily brought my prescription out to my car and had a quick chat (“Just so you know who we are”). You want a definition of community? That’s it.

But it was too good to last. My GP practice was a centre of excellence. Now we’re going to be like the sad souls in urban areas who get poor service and doctors they’ve never met before and who wouldn’t know what a home visit was if it hit them between the eyes. We face a future of depersonalised, rationed healthcare.

Jennifer Foster didn’t retire. We didn’t have to lose her. She quit in frustration and exhaustion at the health authority’s refusal to support her. The local health board, Forth Valley, changed its policy and agreed to a pharmacy application in the village – a chemist’s shop, as if over-the-counter essentials were not already on sale in the local Spar. Thus in a stroke the small surgery’s pharmacy became unviable. Without its vital income from dispensing protected, it cannot continue. The health authority says “several options are being considered for future provision of primary care services”. Which at best means a part-time service with locums, and further to travel to attend clinics. But hey, at least we’ll be able to buy nail varnish and perfume on our doorstep.

As one of the village leaders put it: “We’ve only had four or five doctors in the past hundred-odd years. Now we’ll have a different one every ten minutes.”

Four other small rural villages have all been shafted by the authorities in exactly the same way recently; all of them in isolated areas where, guess what, there aren’t a lot of votes to lose. Oh, and wouldn’t you know, in one of those areas, it’s said to be costing the authority £50,000 a month for locums.

I appreciate that NHS funding set-ups vary across the UK. But I defy anyone to tell me the over-arching strategy is not precisely this: instead of aspiring upwards, and trying to recreate a five-star GP service everywhere, we aspire downwards, towards the basic minimum. Because it’s only fair that we all suffer equally, isn’t it? Onwards, then, to a mean, fractured, impersonal future.

In the limited correspondence is a reply from Karen Clarke, a dispensing GP:

I read your column with great interest as I am a rural dispensing GP. Your Dr Foster sounds fantastic and will clearly be a great loss to your local community. We also like to think that we offer a 5 star service to our patients and take a great pride in striving to provide a personalised service. We also, however, live with the threat of a predatory pharmacy being granted rights to dispense in our area. In our case, the same as you describe, we would be destabilised to the point of closure.

The point that I would like to make that isn’t clear in your article is that currently as the law stands, if a pharmacy opens up within 1.6km (as the crow flies) of someone’s home they will no longer be able to use the dispensing services of their local GP. This is a 100 year old law that seems archaic and anti-competitive. GP practices would be happy to compete with pharmacies but they simply have to turn away their patients – even if, bizarrely, the patient lives next door to the surgery and it is far more convenient for that patient.

Dispensing practices are usually in rural areas with sparse patient populations where services are limited and public transport is poor. In our case, patients would have to travel at least 6 miles to another practice and the bus services are infrequent.

If anybody would like to sign the e-petition against this 100 year old law and therefore giving the chance for the patient to decide where they would like to collect their medication and at the same time the chance to save their rural GP practice, please find the link:

http://epetitions.direct.gov.uk/petitions/60645

Dr Karen Clarke

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This entry was posted in A Personal View, Community Health Councils, Patient representatives, Political Representatives and activists, 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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