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Aren’t general practitioners already working hard enough Mrs May?

Right on cue in 2017 one government has made public pronouncements that the healthcare service is failing people because doctors, and specifically general practitioners, are not working hard enough. And their prime minister is prepared to penalise them:

Mrs May wants GPs to provide services 8-8pm, seven days a week, unless they can prove there’s no demand.

Her three point plan would see extra funding for docs slashed unless they provide weekend and evening appointments when patients need them– not when they offer them.

Practices getting extra cash for opening outwith core 8-6.30pm hours during the week will also be asked to expand online services. Lynn Davidson

It is as if the health of the nation can only be managed in one way- increase the number of people who consult a GP. It implies that the quality of those consultations couldn’t possibly suffer because tired doctors are forced to work longer hours. The government appears to be armed with a hammer and to them, everything looks like a nail. If these are the public pronouncements of the UK government, and there is a GP shortage how are they making a career in general practice an attractive option? Five experts presented their views on the subject of the current crisis in another article in a different national newspaper:

Nursing: Poor strategic decisions and budget cuts to care services have exacerbated pressures on emergency care.

Think Tank: More people attending hospitals and more of them are older and sicker. In many hospitals, beds are fully occupied, making it difficult to admit patients and causing waiting times in A&E to lengthen

Medical association: Demand is so great that hospitals are now full all year around, meaning there is no spare capacity to deal with a seasonal spike in demand

General practice: Cold weather inevitably brings more illness. But while we hear a lot about the crisis in our A&E departments, the explosion in demand for GPs is being overlooked or ignored.

Emergency medicine: It is not inappropriate patient attendances that are causing this; it is simply the volume of ill, elderly people made more complex with the wide range of existing medical conditions many suffer from.

The answer according to each expert is to ask for more money. But there are hints of an understanding that there is a more fundamental problem:

More money on its own will not help when the current system is fundamentally flawed and needs to be redesigned from scratch. Admissions should be prevented through early intervention and supporting people in their homes by anticipating their needs before they experience a crisis. Chris Ham

If that is so what does a ‘redesigned from scratch’ health service look like? In the UK there has been reform of the National Health Service by every government in the past thirty years. We have known about the coming tsunami of chronic and complex conditions for decades. How then is it that at least one developed country has woken up to this nightmare seemingly unprepared?  What happens in the interaction that matters the most- the one involving only two people- the health practitioner and the patient? What is needed to prevent a crisis in the patient’s life? In a society where autonomy is a fundamental right who makes the choices that lead to the need for medical intervention? How can we redesign the system so that we are turbo-charging the very interaction that has the most potential to prevent the crisis? It surely isn’t to ask doctors to work hours that are unsustainable.

Picture by Damian Gadal

Comments

  1. Sonny Morton, md says:

    Government control of health care and personal autonomy are mutually exclusive. US physicians and patients, take notice.

  2. Primary Prevention of illnesses and diseases, including chronic ones, is possible. We already have research that proves it is possible to reduce illnesses. In fact, we have research that shows a way to increase the number of healthy years of life by 18 years (all these numbers refer to averages as individual results would vary) while simultaneously increasing the lifespan by almost 11 years. The research that positively focused people live about 11 years longer than negatively focused people has been documented in longitudinal studies that followed people for more than 7 decades. There is a large body of research demonstrating that negatively focused people spend 6-8 years dealing with chronic illnesses and pain at the end of their lives while positively focused people are only chronically ill in the two years prior to their death even though the death occurs over 10 years later.
    For those who believe the lie that pessimism and optimism are inborn traits this seems like a cruel twist of faith but research also shows that both pessimism and optimism are nothing more than the result of habits of thought and like any habit it is possible to change one’s habits of thought.
    A Harvard meta-analysis stated clearly that it was not the absence of negative emotion that confers the health benefits but the presence of positive emotions.
    While physicians can support the effort to teach healthy habits of thought, schools and parents should be taught so succeeding generations can learn from them.
    The world it is possible to have is so much better than the one we have.

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