I blame the parents
News and Comment from Roy Lilley
Outgoing Confed boss, Mike Farrar, told an interesting story. He said his 20 year old son, now living away, rang him and asked; 'How do I get to see a GP?'
Stupid boy! The answer is obvious..... errrr... well... errr... you ask around, look in the phone book, local directory, newspaper, ... somewhere... just find one... stupid boy! Turn up at the practice, take a utility bill, passport, birth certificate, driver's license, Nectar Card and beg and grovel to be put on the practice list. Emphasise there is nothing wrong with you. This is very important; you don't want to look like a cost-centre. Then, go home, ring up between 0824 and 0829 and see if you can get an appointment that day. Simples...
Farrar junior lives in a world of on-line, username and password. He does not live in a world of utility bills, ID, traipsing the streets, hanging on the phone and fiddling about. That is the world Farrar senior invented and shall be his legacy.
Farrar junior lives in a world where 154.6 billion emails are sent each day, 400 million Tweets are Tweeted, 16 billion words are posted on Facebook and 52 trillion words are written on email and social media but patients can seldom email their GP.
Farrar junior lives in a world of Google, Bing, Ask and symptom checkers, where things are open and accessible. Farrar senior inhabits a world of strategy, planning, forecasts and waiting.
Find a GP; yer 'avin' a larf! GPs and their services are melting, just like the rest of the system. Primary care is portrayed as the New Jerusalem. Is it?
Well over half the GPs are +50yrs. Seventy percent of their premises are incapable of, or beyond modernisation and adaptation. Diverting flow away from hospitals to a fragile component of the NHS, already under tremendous pressure, seems to me to be a gamble. GPs are GPs. The whole idea is they do what they can do and refer the rest. The 'rest' usually needs expertise, space and kit.
Pay the GPs more to look after your Granny? Here's a story from last week's travels:
GPs used to be able to ask the district nurses, attached to their practice, to pop-in and see 'Mrs Brown' and sort out anything she might need. Now the DNs 'belong' to a contractor. They have to email for 'authorisation to visit'. The reply may not come back the same day. A visit is made and an assessment completed and emailed to 'head-office', who come back with a job-number and authorisation for a particular set of interventions to go ahead.
GP surgeries are stuffed full and diverting more flow to them is not a good idea. Dealing with demand is the issue. How to do that?
Closing half the GP practices would create bottle necks in the system and people with trivia might give up and not bother. Beware of the impact on people with sinister symptoms that might be missed. Charging for a visit? Ten quid would cost eight quid to audit, account for and collect. The bill to collect bad debts; likely to be £500 to collect a tenner. So, make it £50 a visit, or perhaps £75 with reimbursement for the elderly and long-term conditions along the lines of prescription charges? That's 80%... you can see it ain't worth the palaver.
Federate practices? Do you mean 'federate' or do you really mean 'confederate', be careful what you wish for. Anyway, making practices virtually bigger doesn't make them 'actually' bigger, neither does it deal with the reality of 'actual' demand.
The solutions are in Farrar Junior's world; where ever possible the presumption for all long-term condition patients should be they will be maintained on-line, on the phone and never get anywhere near a GP. It won't happen. The Carbuncle killed-off telemed last week. GPs say it doesn't work.
In Farrar Junior's world GPs would answer the phones. The evidence is 40% of appointments are avoided if GPs triage the calls themselves. Almost every GP I meet tells me it doesn't work...
In Farrar Junior's world medicines would be delivered by Amazon and pharmacies would become wine bars. In Farrar Junior's world consultations would, where possible, be by FaceTime.
Farrar senior has a lot to answer for. I blame the parents.