Per­sonal link to GPs key to na­tion’s health

The Press and Journal (Moray) - - AGENDA - Dr Miles Mack is a GP in the High­lands and the for­mer chair­man of the Royal Col­lege of Gen­eral Prac­ti­tion­ers Scot­land.

Dr Miles Mack

Last month marked 25 years of me be­ing a part­ner at Ding­wall Med­i­cal Group, as­ton­ish­ingly, con­sult­ing from the same room through­out all those years. Dur­ing this awe­some quar­ter cen­tury I have de­vel­oped many strong and mean­ing­ful re­la­tion­ships with my pa­tients, some of whom I did not find easy in the early days, though I’m pretty sure they may have felt the same way about me. How­ever, it is many of th­ese pa­tients of whom I now find my­self the most fond.

I have grown to un­der­stand what mat­ters to them and, hav­ing walked with some of them though their med­i­cal jour­ney over such a pe­riod, get great sat­is­fac­tion from not only un­der­stand­ing what they most need from me but also learn­ing what they see as of no ben­e­fit to them what­so­ever.

Doc­tors use the term con­ti­nu­ity of care when de­scrib­ing care that is pro­vided by one clin­i­cian to one pa­tient con­sis­tently over time, pro­vid­ing an op­por­tu­nity for a re­la­tion­ship and un­der­stand­ing to de­velop.

I value this con­ti­nu­ity of care more and more as time goes by. Over the years, I’ve learned that con­sul­ta­tions for mi­nor or self-lim­it­ing con­di­tions can form the ba­sis for the trust­ing re­la­tion­ships that can then be es­tab­lished and se­cured for more dif­fi­cult, long-term or life-threat­en­ing is­sues. Pa­tients I first knew as ba­bies are now par­ents them­selves and adults who cared for elderly par­ents are now them­selves in need of care. It is a priv­i­lege to have walked with them on their jour­ney.

I re­cently grew a beard for the first time in my life, a de­ci­sion on which many peo­ple found they had an opin­ion. I even re­ceived writ­ten feed­back – none too com­pli­men­tary – from one pa­tient. Some might have found this in­tru­sive, but I did not; th­ese com­ments were the same as my friends made and I took them on that ba­sis and the beard is stay­ing put for now.

This praise for con­ti­nu­ity of care is not just sen­ti­men­tal­ity. Ev­i­dence pub­lished in the Bri­tish Med­i­cal Jour­nal showed con­ti­nu­ity of care saves lives and re­duces hospi­tal ad­mis­sions. They found that where there was bet­ter con­ti­nu­ity of care pa­tients needed fewer, though slightly longer, GP ap­point­ments.

This meant pa­tients re­ceived bet­ter care, in­clud­ing a more pre­ven­ta­tive ap­proach and, in ad­di­tion, were more likely to take up the of­fer of vac­ci­na­tions and to take their medicines as in­tended. The GP’s work was eas­ier too, as pa­tients were more likely to vol­un­teer per­sonal or em­bar­rass­ing in­for­ma­tion, al­low­ing di­ag­noses to be made ear­lier. It is not sur­pris­ing pa­tient sat­is­fac­tion was higher with bet­ter con­ti­nu­ity of care.

But it is dif­fi­cult to pro­vide in the modern NHS. Book­able ap­point­ments won’t be avail­able if they have been sac­ri­ficed to pro­vide more same-day ap­point­ments for is­sues that other pa­tients be­lieve are ur­gent and as a di­rect con­se­quence, it is far harder to see the doc­tor of your choice for ur­gent mat­ters.

Con­ti­nu­ity of care is also com­ing un­der threat from the wider changes to pri­mary care. Pri­mary care is now de­fined as far more than just Gen­eral Prac­tice. It in­cludes phar­ma­cists, nurses, phys­io­ther­a­pists, paramedics and oth­ers, who peo­ple may ac­cess di­rectly in the com­mu­nity, rather than by re­fer­ral to spe­cial­ist ser­vices. The new GP con­tract aimed to re­duce the work of gen­eral prac­tice by shift­ing work to th­ese oth­ers in the pri­mary care team, but this will lead to the risk of frag­men­ta­tion of care, as th­ese pro­fes­sion­als do not rou­tinely have ac­cess to GP records and their scope of prac­tice is, by def­i­ni­tion, nar­rower.

We need the ex­per­tise of phar­ma­cists, spe­cial­ist nurses, phys­ios and oth­ers and proper in­vest­ment in th­ese branches of pri­mary care is long over­due. But this should not be at the ex­pense of fail­ing to in­vest in gen­eral prac­tice, in or­der that GPs may con­tinue to grow their work­force so as to re­tain their ca­pac­ity to pro­vide life-sav­ing con­ti­nu­ity and whole-per­son care.

All of this is hap­pen­ing at a time when we are recog­nis­ing how dif­fi­cult it is to meet the needs of our most com­plex pa­tients, a group that is grow­ing due to the chal­lenges of depri­va­tion, an age­ing pop­u­la­tion or the chal­lenges of de­liv­er­ing health care in ru­ral set­tings.

This ethic of con­ti­nu­ity of care grew from the small-scale, per­son­alised care that GPs used to pro­vide 24/7, of­ten in small com­mu­nity prac­tices. Pa­tients’ ex­pec­ta­tions have out­grown that model and GPs are now seek­ing a bet­ter work/life bal­ance. It is es­sen­tial to grow the com­mu­nity ser­vices in Scot­land’s com­mu­ni­ties but it would be short-sighted and fool­ish not to also in­vest in gen­eral prac­tice so that con­ti­nu­ity of care may con­tinue and thrive.

I have grown to un­der­stand what mat­ters to them...

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