Why GPS deserve to get more respect
Many years ago, when I worked as a junior hospital doctor, I happened to overhear the consultant taking a phone call from a local GP. There was nothing particularly striking about the content of the conversation – a routine discussion of a clinical problem. What took me aback was the respectful, almost deferential, tone in which the consultant addressed the GP.
This was a shock because the prevailing canteen culture among hospital doctors and medical students was uniformly condescending, if not contemptuous, towards GPS. They were generally regarded as, at best, clinically incompetent and, at worst, negligent in failing to undertake rigorous assessments of patients before referring them to hospital.
When I subsequently mentioned my surprise to the consultant, he explained that, unusually for a hospital specialist, he had spent some years in general practice and had come to appreciate how difficult it was. He observed that inexperienced hospital doctors expected GPS to make diagnoses, but, in his view, that was not their job. “A GP has to decide whether or not a patient is ill, which is not as straightforward as it might appear. It is then up to us to make the diagnosis,” he said.
I remember at the time being rather bemused by this statement. It was only after several years in general practice that I realised how profound it was.
A recent study suggests that negative attitudes towards general practitioners remain pervasive in hospitals and medical schools. It seems that little has changed since 1958, when Lord Moran, former president of the Royal College of Physicians and wartime physician to Winston Churchill, notoriously dismissed GPS as a “somewhat inferior bunch” who had “fallen off the ladder” of the hospital career structure. Leading GPS have been quick to condemn “archaic” perceptions of general practice and to demand that “we must confront systematic denigration within medical training” and “foster mutual respect”.
Before GPS rush to proclaim #Metoo victimhood, it is worth recalling the elevation in status of general practice over recent decades. We now have a Royal College of our own, research institutes and celebrity television doctors. If there is now a recruitment crisis, it is the result of problems of funding and working conditions, not the persistence of the prejudices of “Corkscrew Charlie” (as Lord Moran was known, for his affinity for fine wine as well as his negotiating skills).
Breastfeeding bonus
There was a surprising outbreak of consensus, from the panel to the audience, at a recent BBC Question Time debate broadcast from Barnsley in response to a question about a local study that claimed to have boosted breastfeeding by offering cash incentives. Based at the University of Sheffield, the Nourishing Start for Health (“NOSH” – eeh, by gum!, as nobody says in Yorkshire) scheme offers mothers vouchers worth £120 if they are still breastfeeding when their babies reach six weeks and a further £80 if they continue up to six months.
Researchers claim “a modest, but statistically significant” increase in breastfeeding, though critics point out that only half the eligible mothers registered for the scheme and the improvement was achieved only in areas where rates had previously been below average.
NOSH got a universal thumbsdown at the Barnsley Question Time. The scheme was criticised for patronising and guilt-tripping mothers and for avoiding the lack of practical support for breastfeeding.
Price isn’t right
An apparently endless series of scandals surrounds the relationship between the NHS and the major pharmaceutical companies. Last month the UK’S Competition and Markets Authority found that the firm Concordia had abused its market position to raise the price of liothyronine, used to treat thyroid disorders, by almost 6,000per cent.
The result was a bill for
£34 million last year, an increase from £600,000 in 2006. Earlier in the year Pfizer was fined £84million for overcharging for the epilepsy drug phenytoin. While big pharma firms are quick to justify prices on the basis of “research and development” costs, it is worth noting that both these drugs have been in use for decades.