Saturday 29 November 2014

General Practice: Selfridges or Tescos?

Where do you do your shopping? If you want a designer suit, I’d wager you’re more likely to go to seek a personal fitting from a high end department store on Oxford Street than to get it from a supermarket. However, if it’s a pair of socks or even a shirt you’re after, I’m guessing you’d make a best guess or take advice from your partner on the fitting, maybe even get a recommendation from a friend or internet review and pick it off the shelf when you next visit the supermarket. Otherwise, you run the risk of paying far too much for something bespoke that your washing machine will destroy.

When it comes to your health, if you fear you have cancer, you’re going to want swift, personalised, confidential and professional service and medical expertise. If, however, you have a snotty nose and a rotten cough, you’d probably be better off taking advice from your partner or even a trusted friend or internet site.

Since its inception, the NHS has provided, free of charge (at least at the point of use), the equivalent of a Selfridges personal shopper: personalised, confidential and professional access to medical expertise in the person of your GP for whatever medical needs - or none - that you might have. Just the job (in theory) if you’re worried you might have cancer or some other condition that, without medical treatment, might hasten your death.

Initially, good GPs were able to discourage people from consulting them about snotty noses and other conditions for which there was no effective medical prescription, simply by issuing simple reassurance rather than a prescription. However, even this has discouraged patients or those around them from giving simple reassurance (“you can’t be too careful”, “you can’t put a price [especially if someone else is paying] on health”).

Faced with problems which, quite frankly, were scarcely mentioned in medical school, many GPs succumb to the temptation to reach for the prescription pad: antibiotics (effective only against bacteria) for the viral illness, addictive sleeping tablets for insomniacs, scans and the false promise of surgical cure for back pain and now even cholesterol-lowering drugs for a longer life for anyone! The more enlightened GPs recognised that their patients’ real problems had no medical solution and set about as their patients’ medical advocates arguing on an individual basis for better housing, transport and even employment.

What is not to like! For no cost to users and no additional cost to tax payers, GPs now promise to address all life’s ills. Sadly, this is deceitful at best and, in reality, positively harmful, as it absolves sections of society with the ability to really make a difference - wise friends and family members, landlords, councils, employers and, most of all, government - of their responsibilities.

All this while our patients are living longer and therefore more likely to develop cancer and other conditions which sorely need medical intervention.

General Practice has therefore now reached the point where, with the resources of a single store on Oxford Street it is expected to deliver all the services of a national supermarket.

While general practice has largely simply absorbed this extra work, it has now reached the point where other sections of the NHS, such as A&E departments, have started to pick up this extra work. (In reality, thanks to general practice, very many A&E departments have seen no increase in demand, but have chosen not to contradict national statistics suggesting the opposite.) Quite reasonably, they refuse to take on such an open-ended commitment without additional resources.

The solution

The solution is simple: pay GPs for the work they do.

If as a result a Selfridges’ price tag for a Tescos' service seems too expensive, perhaps tax payers, government, council and local community will strain every sinew to see that a more suitable alternative is provided.

Can GPs please get back to fitting suits and let others go back to supplying socks, shirts and bread?

Please see my next post for a consideration of how this proposal might be incorporated into the current vogue, outcomes based commissioning.

This post was published on Huffington Post on 10 December 2014.

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