Doctors urge SNP to come clean on its plans for 800 extra GPs
DOCTORS have demanded that the Scottish Government spells out how and when the 800 extra GPs it promised will be recruited.
Ministers pledged a year ago to increase the number of family doctors to ease spiralling pressures and increased demand.
But critics say there is no detail about how many GPs would be newly-trained, how many are expected to be qualified doctors from elsewhere, or even what proportion might be tempted out of retirement.
Last night doctors said action was now vital to ensure pledges to boost the workforce were fulfilled. Ahead of a major GP conference this week, Andrew Buist, chairman of the British Medical Association Scotland’s GP committee, said: ‘The Government has made commitments to recruit and train 800 GPs.
‘Now we must see the detail of how the Government expects to meet its promises.’
Meanwhile, a conference motion from medics in Dumfries and Galloway says general practice is threatened as much by ‘overdemanding patients as it is from underperforming doctors.’ One prominent Scottish GP, however, urges caution.
Writing in today’s Scottish Mail on Sunday, Dr Miles Mack says far more pressure is put on general practice by long-term underinvestment than by patients asking too much of their doctor.
IT’S now 25 years since I welcomed my first patients to the consulting room I still occupy. While plenty has changed since then – thank goodness for computers instead of bulging files – much remains the same. I still have the same view over to Ross County’s ground with Ben Wyvis behind. But perhaps the greatest constant has been my patients.
I still see many of the same people I saw as a green young doctor. In many ways, we have grown up together and, over time, that forges a unique relationship.
For example, I recently grew a beard – and it seems everyone has an opinion on it: friends, family and also, it turns out, my patients. For months, people talked about the beard instead of the weather.
One patient even wrote a letter, suggesting I remove it. Some people were shocked at that, but it was fine: the patient’s disapproval was nothing compared to my mother’s. But my patient’s willingness to offer their opinion on the beard hints, perhaps, at the unique relationship between patient and doctor.
That relationship is now under more scrutiny – and perhaps more at risk – than ever, with unprecedented pressures on general practice as more people live with complex conditions. These will be discussed at the BMA’s GP conference in Clydebank this week.
One recurrent theme is that patients demand too much from general practice. But we should be very careful. Measures to ease the undoubted strain could undermine the special doctor-patient bond and erode the core values which have served all of us well.
I’m not just being sentimental. Research suggests continuity of care – another way of saying a patient regularly sees the same doctor – saves lives and cuts hospital admissions. It found such patients needed fewer appointments and were more likely to take medicines and be vaccinated.
They were also more likely to share personal or embarrassing information, which means earlier diagnosis. And earlier diagnosis saves lives.
Research also suggests continuity of care could mean 20 per cent fewer deaths. That seems extraordinary, but we should keep it in mind.
Despite the family doctor’s unique position at the heart of the NHS, that role has probably never been under more strain. Some GPs say ‘overdemanding patients’ are partly to blame. I’d suggest, however, that while general practice is struggling, that is not always because our patients are too demanding. I’d suggest it is more to do with long-term failure to invest in general practice.
We should cherish the GP’s special role in the NHS. Traditionally a
Sometimes,‘ patient’s first point of contact with the healthcare system, our unique medical training and our knowledge of people in the community means we are well-placed to make that crucial first assessment.
Like any relationship, that with a patient develops over time and is not always straightforward. if you’re lucky, it happens at the first appointment. Sometimes it takes a lot longer.
Some patients I found less easy than others in the early days, and I’m pretty sure the feeling was often mutual. Now, those relationships are among the most rewarding.
You get to know what is important to your patient. And, just as important, what’s not.
Once, quite early in my career, I raised the issue of smoking with a patient. She already knew me well enough to tell me exactly what she thought. ‘You doctors,’ she said, ‘that’s all you ever do, just nag me about my smoking. You’re not there for the problems I really have.’
In any case, it’s very difficult to define exactly what being ‘overdemanding’ is. How do we decide when people should not come to us?
Just as some people avoid the doctor until things get really bad, others become anxious about minor conditions. In the same way that we want patients to see us if they have an illness that needs treatment, we also have a key responsibility to reassure the people who don’t.
Labelling patients as overdemanding really says more about the strain many practices are under.
The new GP contract, signed in April, aims to ease that strain by shifting some care to other healthcare professionals such as pharmacists, nurses, physiotherapists and paramedics.
There are issues other members of the team can better deal with. We need the expertise of our colleagues and investment in those areas is very welcome. But it should not replace investment in general practice, which is at the heart of it all.
A longstanding failure to invest in GP services has already led to us losing out-of-hours care. Consultant numbers have doubled to 4,500 in the past 20 years while GP numbers have remained static – there are now the equivalent of around 3,300 full-time GPs – and that throws into sharp relief where care is being provided.
If we’d had the 11 per cent rise in funding promised in the past I believe the situation would be different and I am concerned the new contract may cost the NHS more and reduce continuity of care and all its benefits.
Let’s say Dougie, who has a terrible smoker’s cough, comes in to see me about something else. In the past, I’d suggest he rolls up his sleeve and I’d give him his flu jab at the same time. That’s exactly the sort of medicine we should be doing.
But if, under the new GP contract, I tell Dougie he’ll need to make another appointment to see a nurse he’s never met before, maybe somewhere he’ll need to get a bus to, there’s a high chance he won’t turn up. That’s bad for Dougie and for us all.
It’s cost-effective for me to do it – and I can’t see how employing lots of nurses and vans will save money.
The danger is that more patients will die because they miss out on the benefits of the unique patientdoctor relationship. I wouldn’t be surprised if we see mortality figures rising. One leaked report has suggested certain rural populations are already seeing that.
So I would warn colleagues: let’s not lose sight of what’s important.
People already trust you because you’re an NHS doctor, working in their local health centre. But you earn a different sort of trust when you have given advice over the years.
Some of my patients I first met as babies now have children of their own. Much of my job is walking with people as their outlook and plans for the future change and it is a privilege for me to accompany them on this journey.
With that in mind, I’d like to say to colleagues meeting this week: please, in our eagerness to tackle problems, don’t forget our core values.
Don’t drop services which affect continuity of care and get in the way of the comprehensive care we have provided for years. Paradoxically, that might make it more difficult to recruit. Let’s concentrate on trying to secure proper investment.
Remember – GPs are the keystone of the NHS. Without strong general practice, the rest of the healthcare system will collapse.
We should cherish the family doctor’s special role in the NHS