Red tape is strangling traditional family GPS
They are financially incentivised to prescribe ever more drugs to ever more of their patients
The vexatious matter of family doctors being now “too busy” to do home visits is inseparable from the profound changes in general practice over the past 20 years.
It all started in the year 2000, when prime minister Tony Blair, during a television interview, promised off the cuff an additional £12 billion in funding for the NHS.
There were no immediate plans as to how this windfall might be spent, but the British Medical Association recognised it as an opportunity to increase the earnings of its GP members. Still, if family doctors were going to be paid more they would have to do more, while at the time their main priority was to do less. Specifically, they were keen to shed the obligation to provide “out of hours” medical care at night and weekends, which was becoming increasingly onerous.
The subsequent negotiations resulted in a new contract, agreed in 2004, in which they would no longer be required to provide that out of hours care but in exchange would be expected to demonstrate increased productivity. They would in future be “paid for performance”, generously remunerated for their success in achieving measurable targets – the more patients diagnosed and treated for a given set of conditions, the higher their earnings.
The two predictably unfortunate consequences of this new contract are, first, that doctors are now financially incentivised to prescribe ever more drugs to ever more of their patients and, secondly, that GPS are now so burdened with the bureaucracy involved in demonstrating they have achieved those productivity targets that they are “too busy” to practice old-fashioned family doctoring – such as doing home visits to elderly people who are unable to visit the surgery.
No decent cuppas in Italy?
The gentleman whose bladder behaves so differently at home compared to away (when on his annual walking holiday in Italy) has prompted several suggestions. His urinary frequency (“every waking hour”) when at home and prolonged emptying are typically those of an enlarged prostate, but it is pointed out it could also be consistent with an overactive (irritable) bladder.
“It is difficult to get a decent cup of tea in Italy,” writes a Yorkshire reader, reflecting the views of several that his reduced urinary frequency when away could be due to a lower intake of the beverages habitually consumed at home, compounded perhaps by increased perspiration in the Italian heat. The further possibility is that physical exertion might on its own account reduce the need to pass urine.
“The more vigorous and sustained, the greater the effect,” notes a gentleman, based on his experience when out walking the hills in his native Fife. Finally, it is suggested that several of the ingredients of Italian cooking (tomatoes, almonds, pumpkin seeds, etc) can stabilise the muscles of the bladder.
Needle procedure hits the spot
Volunteering to do the washing-up and thus immersing the hands in hot water might well, as mentioned in the correspondence column last week, prevent the progression of the finger deformity Dupuytren’s contracture. But by the time the fibrous cords of connective tissue have pulled the fingers inwards, more definitive measures are called for. A decade or so ago, the standard surgical procedure, requiring a general anaesthetic, involved cutting away the fibrous cords, filling the gap with a skin graft, followed by several weeks of bandages and splints to allow the hand to heal.
Since then, the simpler technique of “needle fibrotomy” is increasingly favoured: piercing the skin over the fibrous cords with a needle 20 or 30 times, perforating it like a sheet of stamps. The experience is apparently no more stressful than a visit to a dentist. “Patients are astounded at the instant improvement,” notes Dr Christopher Rowland Payne of the London Clinic. “They can drive themselves home and return to work the next day.”
Please email medical questions confidentially to Dr James Le Fanu at drjames@telegraph.co.uk