Monthly Archives: April 2015

Key Message, What Great Value General Practice Is

Here’s a reflection.

Today, my wife and I locked ourselves out of the house. Silly mistake; we left the key in the wrong side of the door, and it shut behind us.

So, following a rather poorly conceived attempt to fish the key out the lock with a bit of stout wire, I called a locksmith.

He turned up three quarters of an hour later, put a gadget through the letter box, and opened the door. It took him about three seconds, and he charged us £60. I thought that was fair enough.

I left the house and went to do a home visit of my own; a rewarding one, which involved some chronic disease management, a bit of social care, and an incidental check on a spouse.

The care I give that patient – and which I am delighted to give, and which I enjoy giving – encompassed eleven visits since Christmas, alongside correspondence, test results, working with consultants and district nurse colleagues, meeting with a social worker and also involved two other GPs here, our admin team and our nurse.

Her care for an entire year from our practice costs the NHS about twice what the locksmith charged me.

Primary care is a good deal for the NHS, and a good deal for the patients we look after. This election, look past the empty soundbites, and the policitcal grandstanding, and ask yourself whether you feel that it’s going to be in good hands come May.

Dr James Booth

I Am Your GP

I don’t want much, I am your GP.
I want enough appointments, I am your GP.
I want longer appointments, I am your GP.
I want to feel that I can focus on the patient in front of me, without dreading the crushing workload waiting when they leave, I am your GP.
I want to smile and look up expectantly when someone knocks/calls/stops me in reception to ask me something, I am your GP.
I want to concentrate on personalised family medicine, I am your GP.
I want to see you when you are unwell with medical needs that I can help, I am your GP.
I want to feel optimistic on my way to work, knowing today my referrals will be read, my patients cared for in hospital and their concerns listened to in outpatients, I am your GP.
I am your GP, I cannot replace your sister, father or mother for sensible advice.
I am your GP, I have no legal qualifications.
I am your GP, I have nothing to do with housing, immigration or your ability to get into the school of your choice.
I am your GP, I know nothing of ‘mould’ in your bedroom, or heating or double glazing.
I am your GP, I have no idea how to manage your bullying boss, demanding mother in law and uncaring partner.
I am your GP but I cannot provide all medical services alone, unsupported, at the beck and call of patients, relatives, nurses, reception staff, carers, consultants or nurse specialists.
I am your GP and I am expected to respond to all and do all that is asked – even if I have no appropriate training, funding or experience. And if I refuse, I am made to feel that I am failing my patient.
I am your GP and know that pharmacists know more about medicines, physios know more about musculoskeletal pain, and psychologists know more about managing your dysfunctional thoughts. I also know seeing other professionals will inevitably cost you money.
I am your GP and seeing me is free.
To my patients, their relatives, local professionals and colleagues in both the community and hospital environment….. If you are asking ‘the GP’ to do something, have you really considered whether it is essential, or is there an alternative? If things do not change have you considered you are driving us to extinction? Have you considered life without GPs? I think you will wish someone told you sooner….

Petra House

A tragic death due to overdemand and undercapacity

I am writing from the bedroom of my parent’s house, having arrived here late at night. I wish it was in pleasant circumstances, but sadly my mother has just died, at 69. A life cut short, a husband bereaved, a son without a mother. Today I join the ranks of those who have been let down by the NHS, the professional leaders and academics, the government, but also a community of Britons. I’m breaching her confidentiality, because I know she would want lessons to be learned from her death. Some will simply decry this as grief speaking, but if we cannot express our frustrations in grief, then I fail to understand where our compassion comes from.

My mum died of biliary sepsis and hepatic encephalopathy after a month in a coma, on and off ITU. The care she received by the doctors, nurses and other workers was exemplary, both in primary care and hospital. I have nothing but admiration for them. But all are overworked, underresourced, and this was as preventable a death as I’ve ever seen.

My mum became generally unwell a few days before my dad found her in a coma. Being a working class miners’ family, who grew up in a spirit of solidarity and community support, and taking only what they really needed from the state, thy did not want to bother her GP. A day before she was admitted to hospital, they tried to get her an appointment with the GP, but not knowing how to press the buttons ahead of those more savvy consumers well trained in claiming emergency need for their complaints to get what they wanted (as a patient said to a colleague, ‘Well doctor, it might not have been an emergency for the NHS, but it was to me’), there were no appointments available until the next week. She retired to bed and never properly woke up again.

I am a GP. But I’m not the usual kind. I am solid working class in attitude, speak like it, would not be described as posh in anyway, believe in a strong welfare state, and grew up as a child through a year long miners’ strike during which I ate at soup kitchens. I lived in a community on our street (I grew up on the street where Billy Elliot lived in the film) where families supported and relied on each other, where help was provided with the sick and, the needy, and the doctor and state bothered less for the chronic illness that is prevalent in that community than should have been the case. I grew up with people who valued the founding principles of the 1945 compact to use the precious resource of the Welfare State responsibly, many having sacrificed sons, brothers and fathers in a war to create a better place for us. But that community is gone, destroyed by ‘progress’.

I have watched as the NHS I loved has been decimated, packaged for sell off, and consumerised by a succession of governments, Labour, Tory and Coalition alike, who claim to be ‘supporters’ but have done everything to destabilise the system to breaking point. I’ve watched as our medical leaders have colluded with this, sometimes for their own political or career gains, at the expense of patients and colleagues. I’ve seen academics push self-serving agendas that are unrealistic, claiming those at the front line need to do more without any additional resources or genuine understanding of the reality of the situation. As a former postdoctoral scientist and public health researcher who worked tirelessly to get the smoking ban enforced, I’m ashamed by the behaviour of some of them who tell overworked front line staff how to do better from the comfort of a computer desk and SPSS spreadsheet. Good officers lead from the front, and check their men’s feet before asking them to march into battle. Many have forgotten to do that. Others never understood such principles in the first place.

But mostly I blame the government and media. I blame the government for stoking demand and creating health anxiety and fear in our nation at every turn, at destroying our communities’ resilience to cope with illness, so that the ‘clinical iceberg’ model of care that once suggested 90% of illnesses were managed In the community without professional input has defied physics and paradoxically risen above the surface such that demand is swamping services. I blame the media for the constant barrage of 24/7 health scare stories, of ‘get your GP to check it’ being the legal backstop for everyone under the sun to pass on responsibility, and a culture of entitlement that has become the norm – ‘rights without responsibilities’ – in a very small, but massively overusing, section of the population

My ResilientGP colleagues were recently criticised for daring to raise these issues. Some argued that we were all right wing, and simply didn’t care about our patients. I and the rest of the ResilientGP team are hugely insulted by that sweeping assumption. I’ve given my life to patients who needed me, been there round the clock for them, and still intend to be in the NHS until I retire. The suggestion that inappropriate demand has become the focus of what ResilientGP is about is incredibly incorrect. We acknowledge it exists, and for once I agree with Dr Clare Gerada – in not blaming patients – but this is a factor, one of many, that needs debate. Explaining not blaming was our aim, and that is what we intend to do. Some may not like the methods, but I challenge them to find the methods to do so if they have the expertise, resource and academic freedom to do so, not pretend the problem does not exist. We all know it does – just some of us are prepared to put our heads into the shooting gallery to raise the issue.

ResilientGP is campaigning for a health service where we have the resources to do the job, safely and in a timely manner, for patients who need our care. The big reasons we cannot do this are the dismantling of the social contract between state and community, chronic underfunding, power brokers in the medical elite and government who have colluded to deliver their own agenda for their own gains, and not for patients. Many patients are scared and clueless where to turn, given that any ‘community’ beyond a daytime talk show really no longer exists for many. We do not have the capacity to meet all ‘wants’ anymore, and as much as I would like to, I have to be realistic in that I can only give so much of my time in a finite system to those who are ill and whom I can help influence their health. Give me the resources to do more, and I will. But I haven’t right now, and to pretend otherwise is to collude with those who have created the problem. By standing up and shouting ‘enough’ we are raising the problem and throwing the gauntlet at those who have created the problem in the first place, and that is NOT patients.

My mum died, too young, due to an uncaring government, a medico-political elite who debate in committees but have rarely experienced poverty themselves as I have, and yet profess to understand it better than I do, and a community who have not had to make sacrifices and no longer understand that a precious resource like the NHS should be used carefully, responsibly and should be cherished.

I hope that ResilientGP can work with others in both government, academia, Royal Colleges and the BMA to change the situation. My lifelong work in research, teaching and clinical practice has been dedicated to serving my patients, and trying to rebuild a community that has been lost, so it is resilient enough to fend for itself in days of need. I now dedicate my efforts in ResilientGP to my mum, so that she would be proud once again of an NHS able to respond and care when needed. She was proud of me becoming a doctor, and said ‘go get em son’. I won’t rest until we get a service for our patients that we can be proud of, despite whatever opposition is thrown at my colleagues and me. The battle is too vital not to win.

Rest In Peace Catherine Woodall (1945-2015), from a loving son and husband.

Alan Woodall