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Seventy five years ago a GP saved my life.
I’d been quite ill for a few days. The combined wisdom of neighbours and a sage granny was unable to help a new Mum fathom what was wrong, never mind divining a cure.
The NHS had not long started. Like a lot of working people, Mum and Dad didn’t believe it was free. They didn’t trust they wouldn’t, somehow, get saddled with a bill.
The drama of the days turned into a nighttime crisis. At ten o’clock Dad decided it was time to act. No phone, no ambulance.
He wrapped me in a blanket… carried me the mile and a half to the GP’s home that doubled as his surgery.
The Doc opened the door in his dressing gown. He had a look, bundled us into his car, drove to hospital…
… and here I am today.
That was then, this is now.
Now there are the hoops and hurdles of phones and appointments and aggressive warnings not to be aggressive.
Press 1 for an appointment… 2 to cancel an appointment… 3 to confirm a cancelled appointment… 4, if you are anxious and need to press numbers repeatedly until you calm down.
Press 5 if you you are a masochist and want to be told again, what you can't have and when you can't have it… 6, if you’ve forgotten why you called.
Press 7 to scream into a void.
We navigate care navigators to be seen by helpful health professionals who very likely after three weeks, will send you to the GP because they can’t prescribe or realise your lower back-pain might be metastasised prostate cancer.
I don’t think real GPs like this anymore than we do… and not seeing a GP first is madness that adds to failure demand;
‘… the additional work created when a service fails to deliver what the ‘customer’ needs the first time around… follow-ups, corrections, and complaints…’
I don’t think real GPs want to be involved in the industrialisation of family practice. My fear is there is likely to be a cadre of young GPs who have no idea how good it could be.
Is anything any better?
For the eyes-down, thumb-wigglers with smartphones… probably.
They think they’re seeing a bright young GP in their practice. Actually, he’s in his back bedroom, hundreds of miles away. A warm smile, shirt and tie.
Really, he’s sitting in his underpants.
Technology creates access to your practice records. He’ll send a prescription to the pharmacy around the corner.
Do we care. Yes and no.
Telephone consultation was the most popular patient preference, 55%, in 2021. Requests for a response via SMS/online messaging accounted for over a third.
The latest… GPs have overwhelmingly voted to go on strike… work to rule… or whatever they’re going to call making life really difficult and risky for us.
We get well over 90% of our first contacts with the NHS via primary care for about 11% of the budget. GPs cover a million appointments every day. Most seeing 40 patients a day.
The safe maximum is supposed to be 25.
GPs are small businesses. Income derived from contracting with the NHS, paying their overheads and living off the difference.
Just like a chip-shop; when overheads and costs exceed income and aggravation and grind exceeds the joy of the job… time to shut up shop.
In the past few years a fifth of practices have closed or merged… 6,500 remain, out of 8,010.
Now there’s a ludicrous row over ring-fenced funding for non-GP staff that can’t be used to hire GPs and threats of the ‘first strike in 60 years’… actually not true, they went on strike 12 years ago.
Shuffling the deck, who we see and when, all the palaver is because there aren’t enough GPs… simples.
We are persuaded it is better. It is not. It's a make-do, a compromise, improvisation, scrape-by.
GPs say about a quarter of their premises are unfit for purpose… 88% of doc’s claim they don’t have sufficient consulting room.
Streeting’s plan is to get GPs to do more… who, where and what with?
We have to make our minds up.
Do we want GPs as gatekeepers? If so, bring money…
Do we want GPs running hubs and mini-hospitals? If so, bring loadsamoney.
Primary care is becoming dysfunctional because policy makers are in the grip of aboulomania…
... a pathological inability to make decisions.
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