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Tuesday 17 June 2008

GPs and medical registrars


GPs are being pilloried from all sides now. They are under tremendous pressure politically. Hospital doctors' view of them is tinged with envy for their lifestyle and money mixed with mild contempt as they are seen to have opted out of the tough parts of medicine.
I try to see things from their perspective. We, that is the hospital doctors, moan about the amount of paperwork, this is nothing compared to the mountain that the GPs have to go through. Most hospital doctors will be nonplussed to be put in a clinic with no quick access to basic investigations or indeed no way to pick the brains of their colleagues from other specialities. GPs regularly work with no support at all. We have our share of time wasters, nothing I guess compared to the amount of people GPs have to see who have nothing wrong medically.
I've seen a lot of hospital doctors whinging about GPs, sometimes where the patients can hear them! I usually have a quiet word with my juniors if I hear them doing this. Not only unprofessional but also very dangerous to the GP concerned.
I field a lot of enquiries from GPs, mostly when I'm on call and also as an endocrine registrar. Some are genuinely difficult problems and some make me wonder why they just don't open a text book or google it. Some questions are so ludicrous that I wonder how they passed out of medical school, pause, take a deep breath and remind myself of surgeons and psychiatrists who are much worse than this at general medicine and reply politely.
Worst GPs I find are who sent people into hospitals either exaggerating their symptoms, mostly in order to bypass the clinic waiting times or who know perfectly well that it is a social issue/non-medical issue and sends them in any way, to an overcrowded hospital with no beds available. There are admission avoidance and social teams available pretty much 24 hrs where I work. Worst offenders are out of hours GPs, I find. The hospital I work in has >95% bed occupancy rates, we never have a free acute medical bed.

Punter comes into hospital and I ask
'Did your GP see you?'
He says, 'No but I spoke to him on phone and he called an ambulance for me.'

This for a purely social admission! Often the OOH(out of hours)GP doesn't know the patient at all and thinks, 'this is too complicated for me in the middle of the night, let me sent him to the hospital and they can sort him out'. Which is fair enough I guess, but annoying none the less if you have no beds a lot of sick patients to sort out in the wards and the admissions are piling up. Worse if you find that there is nothing much wrong with the guy and the GP hasn't actually pulled up his old records or indeed hasn't seen him at all.
I shudder to think what will happen when we have polyclinics and GPs won't know their patients at all. 99% of GPs I deal with are reasonable and conscientious, but as with all professions there are the lazy and the bad ones. Amazing how often they end up as locums and OOH.
When you think about it dispassionately, GPs are such good value for money for the country that the idea of getting rid of traditional GPs for polyclinic led service is mind bogglingly stupid. I agree that polyclinics may be useful in some urban inner city areas which are poorly served in term of numbers of GPs. The idea however that each PCT must have a polyclinic is so patently ill thought out that the ministry of health must be forced into to a rethink
We already have built in polyclinics, they are called district general hospitals(DGH). We need to streamline the working of hospitals and integrate it with existing GP surgeries so that they have quick access to the facilities. For that we need the PCTs to commission local hospitals for their diagnostic services instead of parcelling it out to different private outfits. We need to integrate GP computer systems with hospital ones so that they have access to investigation results quickly.
There are so many simple and cost effective ways these and other things can be done, instead of spending massively to build new polyclinics. All it needs is intelligence and common sense at local level, blunting the internal market a bit so that short term cost is not the overriding issue but long term cost effectiveness/patient care is the issue.
Polyclinics will not only sound the death knell for the traditional GP surgeries but also will put most of the DGHs into financial doldrums. Most of them are already in the red, if they have to compete with polyclinics for providing diagnostic and therapeutic services they will face financial ruin. The way most DGHs finance their acute ans emergency care and inpatient care is from outpatient clinics and diagnostic services. If they are removed to polyclinics, most hospitals will have to shut down.
Then we will see fewer larger hospitals and polyclincs - and huge increase in health expenditure. Has the government thought of the implications of this? Are they prepared to raise the taxes and NI contributions, some how I don't think so.
This has been discussed ad nauseum I guess in different medical blogs, but I feel saddened and angered at the waste and short-termism of current NHS policies and I need to let it out a bit.
Long rant, but I have the day off after nights.

1 comment:

Jobbing Doctor said...

Welcome Dr Raconteur.

Came across your blog via 'a fortunate man' who has also tagged you.

I am really pleased to read your thoughts. I agree that some of my GP colleagues are, frankly, rubbish. All you have written has the ring of truth.

However, as you know, the lazy, the rude, the arrogant, the stupid are not confined to GP-land.

Welcome to blog-world.