The one thing a Doctor does, which others don’t do, and for which he is indemnified for mistakes, is to make a diagnosis. The first consultation is the important one, and afterwards, follow up can be done by many others. Physiotherapists, psychologists (or cheaper and less trained nurse counsellors) , Parkinson’s or Macmillan nurses etc. The achievement of a diagnosis involves examination, usually physical, but often psychological as well. Many patients present with “vague” or multiple symptoms, and some poor practices have demanded only one symptom per consultation!
The follow up rate of GPs differs according to their ability and willingness to live with uncertainty. Achieving a full diagnosis in physical, psychological and spiritual dimensions may take more than one 10 minute consultation, but this is unusual in todays accelerated world. All GPs need to know their follow up rate compared to their peers, but remember it needs to be adjusted for age and complexity of patients, and older GPs see older patients. Not many practices know their follow up rates, and very few GPs know theirs.
One technique to reduce uncertainty is to refer everyone. Nobody complains, but they do wait! Consultants used to know the GP, and after reading their letter, would often prioritise the referrals from those who sent patients infrequently. This unofficial form of rationing was reasonable. What happens today? Are letters sometimes handled by administrators and then treated equally?
Wriggleing on the hook of rationing health care in different ways, means that we will see many experiments until the numbers of diagnosticians increases. if a GP is needed for a 2 hour group surgery he could have seen 12 new 10 minute appointments in that time, along with the opportunity to examine and personalise the consultation. The old definition of a GP giving “personalised continuous care to patients and their families” has been abandoned in the modern world, but this does not mean we should not aspire to it. But if a GP practice follows up so many patients that they personally need to see groups, then that is not good use of resources. Others can do the follow ups. Leave doctors to diagnosis…
I found several current definitions (I have excluded those that focus on the negative (a doctor who did not specialise) and none of them mention the ability to live with uncertainty or to use time as a diagnostic tool. The GP was the goose that laid the golden eggs of efficiency in the original health service. No longer, and the fox is at the door..
The RCGP 1977 definition is here and
WONCA updated it’s definition in 2011
a medical doctor who attends to the everyday medical needs of individuals within a community.
a doctor based in the community who treats patients with minor or chronic illnesses and refers those with serious conditions to a hospital.
A physician whose practice is not oriented to a specific medical specialty but instead covers a variety of medical problems in patients of all ages. Also called family doctor.
A fully registered medical practitioner in the UK who provides general medical services to a particular group of patients or “list”, either in partnership with other GPs, as a salaried GP in a group or, less commonly, as a single practitioner. GPs may also provide inpatient care in community hospitals. A GP will refer patients “forward” to a consultant (hospital specialist) when the patients’ needs cannot be addressed locally. GPs in the UK are not NHS employees, but rather contract independently with the NHS.
Both the Telegraph and the Mail last weekend reported on the shortage of GPs, and that they were looking at solutions whereby GPs see patients together. Obvious confidentiality issues – but also a group support ethos…. GPs to see groups
Hannah Mays in the Times 8th October reports: GP surgeries to see 15 patients at a time.
Group consultations of up to 15 patients are likely to be made “the default” for the NHS in its ten-year plan to tackle waiting times, it was claimed last night.
The scheme has been promoted as a strategy to ease the strain on family doctors and cope with growing shortages of GPs, and been piloted in areas including London, Birmingham, Manchester and Sheffield.
Doctors involved in the pilots said that they had reduced the time spent repeating advice and that patients were given as much as 90 minutes to discuss their condition with fellow sufferers. The longer sessions could also help doctors to develop closer relationships with patients and their families. They said that the consultations had proved more efficient at tackling health complaints including obesity, diabetes, arthritis and erectile dysfunction.
NHS England describes group consultations as medical appointments provided by a clinician in a peer-group setting that “potentially doubles productivity and access to routine care”. The clinician may be a receptionist, clerk or healthcare assistant with one day’s training who would be able to direct the group towards advice on their condition. Patients are asked to sign confidentiality forms to ensure that what is discussed remains within the room. In some sessions test results are posted on a board and a consultant, GP or nurse leads brief discussions with each patient.
However, Joyce Robins, from Patient Concern, said: “This is a ghastly idea. GP appointments are supposed to be a private matter where you can openly talk about your most personal health issues. If you’re discussing things in front of a group of strangers, you might as well tell the local town crier.” Rachel Power, of the Patients Association, said that the sessions would be helpful in some cases but added: “We are concerned that these group consultations are said to replace traditional appointments, apparently without exception.”
Any GP you want: so long as you’re healthy
The flock of geese that laid golden eggs has been culled. It takes years to rebuild, and the fox is at the door.
Letter in the Times 9th October:
SHARED GP VISITS
Sir, I thought my eyes were deceiving me when I read your article “GP surgeries to see 15 patients at a time” (Oct 8). I was also surprised by the Patients Association being reported as saying that this move “would be helpful in some cases”.
Are we now all to believe that Samuel Butler’s work of fiction, Erewhon, is likely to become a reality? He wrote about an imaginary visit to a topsy-turvy country where it was a punishable offence to be physically ill but where criminality and immorality were looked kindly upon as treatable diseases.
Wrexham, north Wales
Sir, In deeply rural villages, we all have the same doctor. Now I love my neighbours, but do not yearn to know the condition of their nether regions, or to recount my symptoms to the butcher, the baker or the gossip maker.