‘Medical’ Malaise
As the NHS fragments, one Hastings patient is becoming increasingly impatient with the service – or lack of – provided at primary care level
I have a GP referral to a pain clinic. My NHS app tells me it’s a face-to-face appointment. After the customary long wait, it transpires I have a telephone appointment with a private company contracted to deliver this specialist service. I complain to my local surgery, pointing out that this for-profit firm has appalling patient reviews online. “Sorry, we are only allowed to refer patients to them and no one else.” What happened to GP discretion when making referrals or the previously much-trumpeted patient choice?
Few would question the importance of local surgeries and a designated GP as an overarching point of continuity: in short, ‘your doctor’. One who looks after you year upon year and doesn’t need rapidly to scan notes and be brought up to speed at every appointment.
I grew up in a place where, for the first 17 years, I saw the same physician – thanks Dr Wilson. Although wary of viewing the past via nostalgic recollections, sadly, locally and nationally, consistency of care is now rare. You’re increasingly unlikely to enjoy the continuity of seeing the same person and may instead end up with an appointment with another health professional, a nurse, physio or physician associate.
Which, in fact, can be exactly the right course of action. My excellent asthma nurse, more correctly a clinical nurse practitioner – meaning they’ve an MA in addition to their nursing qualification and can write prescriptions – has helped manage my condition for years. Currently on maternity leave, they’ve been replaced by a healthcare assistant. Lovely person, good people skills, but working from tick-box sheets, and clearly knowing less about asthma than I do.
Another example, personal but echoing the experience of other local patients I’ve spoken with. I request a medicine review, hopefully from a GP. Instead, I’m allocated a consultation with a pharmaceutical assistant, not even a pharmacist. I suffer what the NHS charmingly terms ‘multiple comorbidities’; in layman’s terms, lots of stuff wrong with me – common in those of more mature years. I’ve complex questions to ask about side effects and efficacy, which an assistant can’t and shouldn’t be put in the position of having to answer.
Why is this happening? Two main reasons. First, to support beleaguered GPs who, post Covid, and with many people still suffering long-term, intractable health problems, are under pressure like never before. And second, we’re caught in the doom loop of a national GP shortage, yet no money to employ the many expensively trained young doctors desperate to begin their careers.
We can bicker endlessly over the reasons why, but ultimately, the 2012 Health and Social Care Act ‘reforms’, which decided the NHS would be better if it functioned like a business, are very much in the frame. Enacted by politicians who couldn’t understand the difference between cost efficiency – cutting expenditure, and cost effectiveness – achieving the best patient outcomes.
The second reason is simply to save money: experienced doctors are expensive compared to less qualified health care professionals, and managers now dominate decision making based on financial targets rather than clinical diagnoses. Hence: don’t use a GP, get someone cheaper. Take a well-intentioned but undertrained NHS worker and set them up to fail; no wonder morale is low.
Worse yet, slowly, incrementally, the practice of medicine becomes dumbed down and deskilled and the possibility of mistakes due to lack of knowledge increases. Incorrect diagnosis and treatments deferred will cost more in the long term, but the current NHS managerial, process-driven culture is focused on short-term metrics.
Former GP Dr Phil Hammond, writing in Private Eye, quotes a Health Foundation estimate that between 4,200 and 6,700 new, full-time GPs are needed to meet current demand.
Meanwhile, other health care workers, physios, nurses and paramedics, are increasingly undertaking jobs traditionally performed by GPs. “These people can play a part but only if they are properly trained and supervised,” cautions Hammond.
Yet NHS primary care is becoming ever more fragmented and complex to use and understand, with doctors frequently unable to obtain clinical records and scans from other parts of the health sector. Of course, GP services need to change and evolve, but all too frequently, no one takes overall responsibility for individual patients or has an overview of their care. All your notes are ‘on the computer’. And ‘today’ the computer is down.
With over half of Health Trusts expecting to cut doctor posts this year, this is no temporary blip before normal service returns. There may be worse to come. As the popular beat combo The Who once succinctly put it, “hope I die before I get old.” Whoops, too late…
We hope you have enjoyed reading this article. The future of our volunteer led, non-profit publication would be far more secure with the aid of a small donation. You can also support local journalism by becoming a friend of HIP. It only takes a minute and we would be very grateful.
Yes, I remember the timer when you had “your” GP. Often working alone with no nurse or other specialist auxiliaries, and without the range of diagnostic tests which are now routine. And if “you” GP was rude or just brushed you off (“you’re just a young girl, you’re not important to me”), that was it. Personally, I much prefer the present system with all its stresses and strains.
The government needs to turn its full attention to GP services and primary care generally. They should not be expected to run businesses alongside their medical practice, which means rethinking the contract with the NHS. They need the money to employ new doctors – at the moment those can’t get GP jobs. And I suggest that we should all be prepared to accept appointments with a nurse, or a call from the pharmacist, if that answers our issue.