{"id":1865,"date":"2009-03-21T18:24:27","date_gmt":"2009-03-21T18:24:27","guid":{"rendered":"https:\/\/www.onlinefocus.org\/?p=1865"},"modified":"2009-03-21T18:24:58","modified_gmt":"2009-03-21T18:24:58","slug":"a-doctor-writes","status":"publish","type":"post","link":"https:\/\/www.onlinefocus.org\/a-doctor-writes\/","title":{"rendered":"A Doctor Writes…."},"content":{"rendered":"

At the end of last month we wrote about<\/a> a presentation given to councillors by our local Primary Care Trust.<\/p>\n

One GP read the item and has sent us the following , very illuminating review of how things are working out in practice. It’s well worth reading!<\/p>\n

We should add that this doctor does not <\/strong>work in the South East Essex area, so the comments do not <\/strong>specifically apply to our local primary care trust. We do know who the doctor is, but this person would like to stay anonymous, and we fully understand that. We are very grateful to “Dr X” for writing in such detail.<\/p>\n

1- OUT OF HOURS CARE (6.30pm – 8am weekdays and all weekend)<\/p>\n

With the new government GP contract, a few years ago, the government took away out of hours care from GP’s (all weekend and from 6.30pm – 8am on weekdays) and this is now mostly provided by private agencies contracted by the PCT’s. So Andrew Pike is responsible for the out of hours provision for this area, although this is contracted out. The PCT would have seen tenders from lots of different agencies, I am sure cost plays a big part in the decision making process. My personal view (in our area) is that the out of hours provision of care is extremely poor. Only one or two out of hours centres, requiring people to travel quite some distance and really only for absolute emergencies. That’s why someone with earache, for example, would be considered low priority and either be advised to wait for their own GP or travel miles to see someone over night. It would be interesting to see the numbers, but my guess would be that there may be only one doctor in the centre and one visiting for a very large area that this PCT cover. This obviously saves money but means that provision of care is very poor. In my area by the time the patient manages to be seen by their GP the next morning they are generally pretty cross!<\/p>\n

I regularly come across cases that I feel should have been seen and assessed the night before. I had a call last week by someone in extreme back pain from 7pm the previous night. He had rung the out of hours service 3 times over night and when he eventually did speak to a doctor at 6am was told he may as well now wait until his own surgery opened at 8am! So you can imagine his frustrations when he got through to me at 8.30 am to discover I had a full surgery and wouldn’t be able to get out to him until 11.30am! Actually I did go out to him during the morning and gave him some well needed painkillers but at the cost of my own surgery running very late! How irritating when a decent out of hours service could have offered him some pain relief over night.<\/p>\n

People are also frequently advised just to go to A+E and really could have been dealt with by a GP, terminally ill patients or housebound confused elderly patients for whom a trip to hospital is quite traumatic and certainly places huge unnecessary demands on A+E. These few cases are not going to show up in audit figures but at an individual level have a big impact.<\/p>\n

I am not criticising the doctors, nurses and paramedics involved in out of hours, just the resourcing of the service.<\/p>\n

2 – INFORMATION SHARING<\/p>\n

Poor communication happens due to the above out of hours split in provision and people being seen in a variety of different settings over night. The other reason for poor communication is the horrendous information technology within the NHS.Electronic notes transfer rarely works and the famous “spine” really isn’t up and running despite millions spent on it.<\/p>\n

In the past I have found that when the out of hours care was provided in small GP co-operatives (a group of GP’s sharing the out of hours care) communication was much better as the GP’s had a responsibility to inform their colleagues<\/p>\n

3 – POLYCLINICS<\/p>\n

Polyclinics may be good if it really is better provision and an additional service to existing practices. My feeling is it may well not be the case and once the new polyclinics are established the exisiting surgeries will then be closed down.<\/p>\n

The clinic planned for Rawreth may well be a polyclinic, possibly run by private providers and possibly with a plan that a lot of GP’s are eventually moved in down there instead of being central.<\/p>\n

This if it happens it will end up being a huge centre with outpatients, minor surgery, physio etc as well as traditional GP facilities. Possibly even encorporating out of hours care too.<\/p>\n

4 – PROVIDING OTHER SERVICES<\/p>\n

The NHS has become more obsessed in saving money than providing good health care. The statistics really don’t mean very much in my opinion! I am a reasonably young GP partner and I have seen the out of hours care deteriorate in the last 9 years quite significantly. Things like waiting times, which fit nicely in to figures for statistics, have improved greatly which is a good thing, but at a much greater cost to individual care.<\/p>\n

GP surgeries are small businesses, the GP’s are therefore funded for specific services they provide. The PCT will not fund GP’s to provide nurses to do blood tests. Our PCT said they would provide a contract for us to do it, but the money didn’t even cover the cost of the nurses salary let alone the other overheads! This doesn’t sit comfortably with me as I became a GP to diagnose and treat patients not to decide on care based on money. However, we are a small business currently finanically struggling like never before and therefore these decisions unfortunately do have to be made. The reality is we do offer blood tests from time to time when the patient would really struggle to get anywhere else but we do it because we care!<\/p>\n

Primary care has changed quite a bit over the last few years, patients leave hospital often only a day or two after an operation. There are Admission Advoidance Teams who try and keep people out of hospital and far more is expected to be looked after by GP’s in the community rather than sending people to a hospital consultant. I agree in principle with most of these changes, most of us would prefer to avoid being in hospital. However, these changes mean that something else has to give. Making time for home visits and having time to really get to know patients is what is being slowly ebbed away. Cramming patients in to 10 minute appointments, with their list of ten questions (because they have been trying to get an appointment for weeks) and trying to adequately cover everything proves very stressful. Then being asked to book them their hospital appointment online (rarely fast), prescribe from the PCT directed Low Cost Drugs List and give them their Government Patient Survey to see what they think of the whirlwind appointment!! <\/p>\n

I agree GP’s need to be accountable and efficient and move with what patients now need within the new NHS. I am very keen though that these new services come with proper funding to ensure we don’t lose the precious service of having your own GP who knows you rather than a stranger in a polyclinic 20 miles away from where you live.<\/p>\n

I am aware this has been a therapeutic ramble for me but I hope it has helped in your questions!
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