The ‘one ailment’ GP appointment is literally killing us
You don’t need to be a genius to figure out that something is very sick in our GP system
As we are still struggling to make up our minds whether the coronavirus is panic or pandemic, I had lunch with a friend who told me that her teenage daughter had been really unwell. “I had to take her back to the GP six times,” she sighed. Good heavens, why? “Because at our surgery, you can only raise one thing at each appointment. The doctor said it was a virus, and it wasn’t. So we went back. Then he said it was her stomach, and it wasn’t. Back to the surgery again. She was getting worse. I was really worried.”
In despair, my friend turned to a private GP service. After a 20-minute consultation, where she was actively encouraged to mention her multiple symptoms, she finally got a diagnosis and an urgent course of treatment.
Then, at dinner over the weekend, I sat next to an eminent scientist. Same story. John had several symptoms, but his GP cut him off when he tried to draw attention to a second ailment he was sure must be related to the first. “I rarely go to the doctor,” John said, “so, when I do, I’m there for a reason. It’s clearly preposterous to expect a doctor to arrive at a correct diagnosis if you’re only able to discuss one problem.”
John is right. Well, he has got a Nobel Prize. However, you don’t need to be a genius to figure out that something is very sick in our GP system.
On impulse, I decided to ask people on Twitter if anyone had run into these problems. Oh, boy, light blue touchpaper and stand well back…
Comments ranged from Simon in Milton Keynes who reported his “one problem, one appointment” ended in an A&E visit with a necrotic gallbladder and 7.5 hours’ surgery because his “side pain” went undiagnosed, to a mother telling me her daughter had ended up in A&E with pneumonia because of a GP’S refusal to examine her cough as her visit was about depression.
Someone else noted that the diagnosis of ovarian cancer often involves a number of different symptoms while another pointed out how hard it is to get that second appointment if you need to go back. And, finally, perhaps the saddest comment of all: “It’s like we’re on our own these days. My dad had pain in his back for months. GP finally referred him to the physio, in the meantime he ended up in A&E. Diagnosed with terminal lung cancer.”
It’s like we’re on our own. That’s what all these frustrated and distraught people are saying about a GP system that doesn’t have time to take a holistic approach to patient care. You’re on your own.
“It’s even worse, Allison,” one disillusioned veteran doctor told me. “The elderly need more time to walk to your room. They need more time to get undressed. You’ve got eight minutes to meet your target. By the time they’re ready to be examined maybe you’ve got four or five left.
“Sometimes people are reluctant to express concerns about the thing that’s really bothering them. They like to build up to it by discussing a minor thing first. But their time is up.”
This can literally be a matter of life and death. The UK still has worse survival rates than Canada, Australia, Denmark, New Zealand and Norway for key cancers including lung, colon, rectum, stomach and pancreas. Researchers suggested that one key reason for our poor survival rates was “delayed diagnosis”.
Well, yes. If people are waiting three weeks to see their GP and, when they do see them, they are only allowed to discuss one ailment, then it’s hardly surprising if arriving at the correct diagnosis takes a while.
The problem, according to my medic friend, dates back to a deal that Tony Blair’s government cut with family doctors in 2006. GP leaders negotiating the pay contract with the NHS Confederation were “stunned” to be offered a lucrative package which enabled them to opt out of working evenings and weekends in return for a pay cut that they considered “a bit of a laugh”. It was win-win for GPS, who could give up their responsibilities outside the hours of 8am and 6.30pm, and a total disaster for patients.
The NHS has never recovered from that ludicrous deal. To that burden you can add 6.5 million migrants registering with a GP between 2007 and 2017. Plus the fact that more than two thirds of GPS work part time. Very high salaries (roughly twice what a French GP earns) enable them to live comfortably while working just two or three days a week. Hence people are less and less likely to see the same doctor twice in a row.
And the solution to this God-awful mess? Let’s tell the patients they’re allowed an eight-minute appointment and can only raise one ailment!
It’s desperate stuff. A sticking plaster on a gaping wound.
During the election campaign, Boris promised to train thousands more GPS, but that will take several years. Introducing a modest charge for appointments would be a bold start. In Ireland, a visit to a GP costs between €45 and €70 (£38-£59). Those with incomes below a certain level get a medical card that entitles you to free GP and hospital care. All children, students and pensioners are exempt.
It’s a sad fact, but people simply do not value what they get for free. More than 15million GP appointments are missed annually in the UK – that’s one in 20; the equivalent of more than 600 GPS working full time for a year.
The Government has a huge majority, which enables it to do difficult things. The Prime Minister should announce a Royal Commission into the NHS, which will study different funding models and patient survival rates around the world and decide what actually works best.
As fans of ITV’S Doc Martin will tell you, that grumpy physician rarely guesses what’s wrong with a patient from the first thing they tell him. I bet the reason the series is so popular is because it shows general practice as it used to be, not as the callous conveyor belt it so often is now.
It pains me to say it, but the fiction Britons are sold about “our NHS” is literally killing us.