INMYVIEW... BEWARETHEPHONECONSULTATION
RECENTLY I appeared in court as an expert witness following the death of a child from appendicitis. Over a number of days, the parents had consulted three GPs about the symptoms by telephone — there being no appointments available — and each time they were told ‘it is just a winter vomiting virus, there is a lot of it around’.
Not one doctor actually examined the child, despite their continuing to be so unwell.
This week, I heard that an acquaintance went to our local surgery with abdominal pain only to be met by someone who called themselves a ‘practitioner’ — not a nurse or doctor — who asked about the history of the symptoms but appeared to be reading questions from a typed list. No diagnosis was made and the patient left entirely unconvinced.
Neither story fills me with confidence. Practitioners are being brought in to shoulder much of the routine work of GPs, but they can never take the place of a doctor.
They’re like the police community support officers who were brought on to our streets to create the perception that we were being better protected; while they do a wonderful job, they’re not fully trained police officers.
Similarly, the use of practitioners leads to second-class medical care.
But clearly the current system needs to change — children should not be dying because they can’t get to see a GP.
My proposal is that GPs are no longer subcontracted, like small businesses, but paid a salary and housed in teams at local hospitals, with each GP given a stated patient list to ensure continuity of care.
Access for patients would inevitably improve, as would co-ordination with consultant care, and there would be better communication. There would be direct access to other services such as lab tests, scans, physiotherapy and other paramedical treatments, with one set of medical notes and improved outof-hours care with properly structured covering arrangements.
To solve the crisis we face we need this sort of root-and-branch reform, rather than trying to heal the gaps in the current system with yet another sticking plaster.