We should support the RCGP and GPs generally not ask them to do the impossible with stretched budgets and too few staff
We are asking a hell of a lot from our GPs at the moment. We want them to be in the community; available at residential and care homes; participating in A & E departments; making home visits; oh and by the way being available in 8 minute snatches to deal with the needs of the ill in their practices.
Could all this be achieved? Yes I suppose it could but not with the number of GPs we have at present. Calls for 7 day services don’t really understand the nature of a GPs work. It is very much a part of the Me, Me, Me society. I have a need now and it must be met now. But GPs are not hairdresser of bar keepers. They are skilled professionals who work in a number of environments and crucially there just are not enough of them.
We must also recognise that in the near future there will be a lot less of them. In some places up to 25% of the GPs are nearing retirement age. Our surgeries have been buoyed by a large number of immigrants from the Commonwealth and other places who are now reaching retirement age. They are often in single GP practices and there is no-one to replace them. We are desperately short of people who commit to becoming GPs after their training. It’s much more trendy to work in a deep specialism in a hospital than be out on the front line of work meeting people in their own community. For decades this has been the case and successive governments for those same years have failed to tackle this problem.
Now I do not for a moment believe that GPs practices should be the same as they were when Dr Finlay (or I) were lads. The work has become increasingly complex and demanding. GPs face the same problems as everyone else in the NHS. More people living longer but increasingly become more frail with greater health needs and demands.
Yes there is the demand for time and attention in surgeries and the need in many cases for regular home visits. But that is only part of a GPs work.
The Government want GPs to work in A & E units. That makes sense. Taking part in the triage process deciding who needs a quick fix or nothing at all and getting them out again enables the A & E staff to look after people with acute A & E needs.
We need GPs to spend more time in residential and extra care homes. 25 years ago about 12% of people in such accommodation had more than the occasional need for detailed medical services now it’s up to 80% of their residents. Having regular GP visits keeps people fitter, healthier and leads to less demand on A and E services and hospital beds at weekends and holidays.
We also want GPs active in their communities when we can involve them in campaigns like Dementia Friendly Neighbourhoods and Health Eating Campaigns. Having the Doctor there really makers people take things more seriously.
But to come back to my point we just do not have enough of them to do all these things. If we accepted that there is a need to increase the number of GPs now it will still take 7 years to turn them out in sufficient numbers and that is on the assumption that Brexit will not stop some doctors coming here to become GPs or take part in other parts of the NHS.
So what can we do to help GPs who will tell you that often they do not have time to talk to people with severe health needs as their appointments are clogged up with people looking for reassurance and low level services and not the services that we actually pay GPs to provide.
Most importantly we must use other front line services more effectively as part of a local network in which GPs play a major part. Too often the front line nature of opticians, dentists and pharmacists are overlooked. Far more routine work could be done inside pharmacies most of which are now equipped with consulting rooms. The clinical work of pharmacists, dentists and opticians in recognising specific complaints and getting people appropriately into the system is underused.
Secondly we ought to be moving more services out of hospitals into GP surgeries. There are a huge range of preventive and early reactive activities that could best be undertaken with the local community. In rural areas in particular people travel miles sometimes by rare buses to get services that could easily be provided locally.
To achieve these two changes we need to do two things:
Firstly, we need to change the mind set of both people and parts of the health community to understand that hospitals and particularly A & E departments should be seen not as the first port of call but as the last resort.
Secondly, we need to help GPs modernise their part of the health estate to ensure that they can act as what are in other countries called poly-clinics. Some practices are in the right buildings in the right place. Others are not.
Whenever I have spoken to GPs and their representatives at either a local or national level I have found that the vast majority of them are open to new ideas, a new way and the sort of enhanced role I have described here. When they say they are not prepared to open 7 days a week it is not, in my opinion because of a luddite tendency but because they want to do the right thing in the right way within the resource package that is available to the, forcing them into 7 day opening will massively reduce the other things that they do. This will have a resulting bad impact on illness, both mental and physical and hospital pressures.
If Theresa May wants changes and wants to improve things for people and GPs she needs to listen to them; work with them and not practice gun boat diplomacy from the wrong end of a loud hailer.