Failing GP Services – Time to Finally Grasp the Nettle

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Apparently, pressures on GPs in England and Wales are so great they now feel they are failing patients and potentially providing unsafe care.

In recent days, British Medical Association GP spokesman, Dr Chaand Nagpaul, claimed this is the case as doctors are having to rush consultations with patients creating potentially dangerous consequences in terms of issues such as identifying cancer and getting medical prescriptions correct.

Of course, in the political game of ping pong that is state healthcare, ministers in England have instantly responded with statements promising they would invest in services to address the concerns.

Dr Nagpaul’s comments come as part of a lobbying push based on the BMA releasing the results of an online survey of nearly 2,900 practices in England and 145 in Wales.  That’s about one in three of the total that serve us.

Services deteriorating

It’ll come as no surprise to any patient of an NHS GP practice patient in England that the survey showed that 55 per cent of respondents thought the quality of the service provided had deteriorated in the past 12 months.  The cause? Some 68 per cent said their workload was unmanageable, while 92 per cent reported demand had increased in the past year.  The results from Wales were apparently similar.

Making his case, Dr Nagpaul was quoted on the BBC as saying: “It is unsustainable and getting to the point where it is not safe. The ageing population means many of our patients have multiple conditions and are on multiple medicines, but we simply don’t have the time to properly consider how they interact.

“On cancer we are having to make rushed decisions. And we are seeing growing numbers of patients with dementia – and yet just have 10 minutes to see them.

It’s not enough. We are being forced to let down patients. We need to see more investment in general practice so we can keep up with demand and have longer 15-minute consultations.”

Numbers don’t work

It’s pretty familiar stuff in terms of the challenges of demographic change even if general population growth was not cited too, and undoubtedly GPs are under pressure.

In England the number of GPs per head of population has fallen since 2009 to 60.6 per 100,000 people in 2014 and there are an estimated 370m consultations a year – up 70m in five years.  Add to this the fact that a third of GPs say they are planning to retire in the next five years whilst one in 10 GP trainee places went unfilled last year then you’d think things can only get worse.

Of course, being a representative of the doctor’s trade union, Dr Nagpaul believes the solution is to throw more of the same resources at it – provide another 10,000 GPs just to plug the current service gap in England.  Ever playing the same game, the government has said it will increase funding for GPs by 5 per cent every year and promised another 5,000 GPs this Parliament, but has raised the stakes by expecting these additional places to cover the envisaged seven-day opening policy.

The problem with these endless exchanges is that it is taken for granted that both sides are paternalistically arguing for the good of the patient who, of course, also pays for the service. But as I’ve said before the definition of madness is doing the same things over and over again and expecting the results to be any different.

Wrong argument

It seems to me the problem with the whole primary medicine resources debate is that is wrongly framed. Both sides are failing to realise the problem is the system by which primary healthcare is currently delivered.

If each really cared about patient welfare they would be embracing different and better ways of delivering service, not just arguing about how to scale current service delivery models by conveniently throwing more of the same money and resources at the issue.

The problem is neither the medical establishment nor the government is really grasping the nettle.   In order to square the circle of reducing GP’s workloads whilst improving service to the patient the way primary medical services are delivered is going to have to change fundamentally.

Good money after bad

The desire for 15 minute consultations may be laudable, but that simply increases a demand for GP time that cannot be fulfilled.  The current system still operates on the basis that every interaction with a patient demands an extensive and face-to-face meeting, too many of which are not attended or unnecessary.  This is not the case with service suppliers in the rest of our lives and should not be the case in medicine.

There are many innovators in medical technology, including platforms such as Medelinked, that offer the opportunity to lower costs, increase services and improve outcomes through better and more appropriate management, not just of the way GP services are offered but the way patients are engaged and held responsible for their health state.

Unless the NHS and its employees start to move into the 21st century world of service provision good money will continue to be thrown after bad and we’ll be reading the same headlines over and over.  And, of course, as mere patients, waiting ever longer to see our GPs and subject to the increasing risks that such visits apparently now entail.


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