Best medicine of all - always seeing the same GP . . .

PROmPT service is what you expect in a cafeteria — but now those at the top of the NHs want to see instant service in healthcare, too.

The political consensus today is about speed. The focus of all the new drives, especially in general practice, has been for people to see medics faster.

As part of this, surgeries have been merging in a bid to make them more ‘efficient’ — and it’s this that was behind the roll-out last week of the scheme for patients to see a GP over the internet, rather than in person.

The thinking is that everyone should be seen on the day, and this is where considerable resources have been focused.

Of course, I understand this. We live increasingly frenetic lifestyles and having to wait to see a doctor is frustrating.

But I do wonder if we’re not missing something about the real value of general practice. In our rush for everyone to be seen within five minutes of developing a cough, I think we are failing to really appreciate one of the most important aspects of medicine: the doctor-patient relationship and continuity of care.

There was a fascinating study published this week that illustrated this eloquently.

Researchers found that among older patients, those who were unable to see the same GP were more than twice as likely to end up in hospital compared to those who regularly saw the same one.

It is thought this is because patients have to repeat their medical history, which wastes valuable time and means symptoms of serious illness go undetected.

A few years back, I developed acne and rosacea out of the blue and went to the GP a number of times. Each time I saw a different doctor. Each time they asked the same question and suggested the same things, which I then had to explain I’d already tried.

It was incredibly frustrating, and it struck me that if I, as a fairly articulate doctor, experienced it like this, what must it be like for someone less able or older, without a medical background?

One of the great things about general practice is that a doctor gets to know you over years. It gives them a unique understanding and perspective.

Those who benefit from this most — people with mental health problems, the elderly and those with chronic or complex conditions — are all too often ignored anyway, and they’re the ones who have the most to lose from a lack of continuity of care.

In fact, research has also shown that continuity of care can cut hospital admissions.

ATITs best, general practice is about far more than just medical knowledge. It is about continuity and consistency; about medicine within a community delivered by people who are experts in that community, who know the people they serve and are able to see a patient holistically.

This simply doesn’t happen with a doctor that you see for the first time — and for just ten minutes. But this kind of value is hard to capture. It doesn’t fit nicely on a pie chart that NHs bosses can monitor and evaluate.

It’s far easier instead to look at hard outcomes, such as the number of days that patients have to wait to see a GP. This kind of data is easier to monitor and so the NHs big-wigs love it — but it diminishes general practice to a bland, inhuman interaction.

When I worked in geriatrics, we would often get referrals from GPs who couldn’t give a clear reason for the referral, except they ‘just knew’ something was wrong with the patient.

Time and again, these referrals turned out to be serious conditions such as cancer, yet there were no clear symptoms that would have indicated this. It was simply that the GP had a hunch based on a deep connection with the patient.

Just the other day, I received a call from a GP who had known one of my patients for nearly 30 years. He apologised for bothering me but said he’d seen her about some unrelated physical health problem and was convinced that something wasn’t right. He couldn’t put his finger on it, he said, but she didn’t seem herself.

I got her into my clinic and she confessed she was stockpiling medication with a view to killing herself on the anniversary of her mother’s death.

For me, that human connection between a GP and their patient is priceless. Yet in the rush for everyone to be seen quicker and quicker, it’s something that we are at real risk of losing.