Desperate GPs behave unethically – We need their insurers to act..

Desperate people, including GPs who have cared all their lives, can be driven to desperate, perverse, and unethical measures. The Nuffield Trust explain NHS spending in Numbers and graphics, and in its latest press release highlights the 30% of Trust who are “bust”: Black alert? Or many shades of OPEL by Nigel Edwards and  Quality at a cost. (8th December 2016). Patients with early symptoms of serious illness need time and a mixture of history, examination and investigation before an “all clear” and reassurance can be given. Limiting problems to one symptom implies that the patient knows the diagnosis already, and is a high risk method of consulting. If I was their Medical liability insurer I would raise their premium, and increase their excess.. Irrational rationing?

Update 12th Jan 2017: It occurs to me that, ironically, if we had “no fault compensation” there would be a perverse incentive for doctors to increase risk – by making more diagnoses over the phone and reducing the number of symptoms patients could present with. So no fault compensation needs to come with adequate staffing levels – or better still over capacity.

Sarah Kate-Tomkinson reports in the Sunday Times 8th Jan 2017: “GPs tell patients: Just one illness per appointment”

The National Health Service is so short of GPs that patients are being told they can raise only one illness per 10-minute appointment and cannot extend the session even if they have multiple chronic diseases.

The move by GPs across Britain has provoked outrage from patients’ groups who say it is putting people’s health at serious risk.

The head of the Royal College of GPs admitted she was “saddened” by the move, especially as in some areas patients are having to wait up to a month for an appointment….

Katherine Murphy comments…

“Most importantly, our concerns are that patients will not be given the opportunity, or may be put off, from asking for medical advice because of this rule — which is a very serious patient safety risk.”

Stokes-Lampard said that although some surgeries might be able to offer some patients more time, others are unable to do so because of demand.

“I am saddened that we have signs up in surgery saying ‘Your appointment is to consider one problem only’,” she said. “Those signs sadden me because they are a sign of our flawed system, they are not the sign of an efficient healthcare system.”

In the leader “The doctor won’t see you now”:

This is not, so far, proving to be a particularly harsh winter but the National Health Service is already creaking under the strain. The British Red Cross is surely engaging in hyperbole when it says there is a “humanitarian crisis” in the NHS but this winter looks to be the worst for a long time. In accident and emergency departments, for example, the proportion of patients being seen within the four-hour limit is the lowest for 12 years.

Today we report on another manifestation of the NHS’s problems. As a result of funding pressures and a shortage of GPs, patients will be restricted to discussing only one ailment per visit to their doctor. This restriction, already in force in many practices, will become general. After a long wait for an appointment, anybody unfortunate enough to have two or more afflictions will have to undergo an equally long wait for another.

That this seems irrational and short-sighted appears to have escaped those who run the NHS. Often illnesses are interconnected. Is the patient meant to have the knowledge to prioritise one over others?

All this is a far cry from the promise of a new and highly responsive GP service of a few years ago. In the era of Tony Blair and Gordon Brown everybody was meant to be able to get a GP appointment within 48 hours. That target was dropped by the coalition government in 2010. As for the idea that patients should be able to see their GP outside normal working hours and at weekends, most cannot do so. An NHS England survey of more than 7,000 surgeries found that fewer than one in five offers “full extended access”, defined as offering appointments up to 8pm and at weekends.

There is a deeper problem with GP services uncovered by our own, much-missed AA Gill when he wrote last year about his cancer diagnosis. He asked his oncologist, Conrad Lewanski, why our cancer survival rates were so poor compared with other countries. Much of the problem, Dr Lewanski said, was due to the nature of the NHS and the separation of GPs from hospitals. Good cancer outcomes, which depend on the speed of diagnosis and treatment, are often thwarted by the delays inherent in the GP appointment process.

Successive health secretaries, in trying to reform the NHS, have come up against the roadblock of that 1948 structure. If the gatekeepers, the GPs, are difficult to see, then patient care will suffer. And sadly the problem appears to be getting worse.

 

 

 

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This entry was posted in A Personal View, General Practitioners, Perverse Incentives, 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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