I got the MRCGP in 1997 (7 years after taking a partnership) so that I could take my turn being a trainer. I paid the compulsory first year's subscription, and after reading a couple of the journals I ditched my membership.
Went from 9 to 6 sessions when I hit 60. Most weeks are about 33 hours, so I reckon I'm getting off lightly. I don't count appraisal work, cpd, practice meetings - so it's probably more.
The reality is that telephone triage simply tells you which patients didn't actually want to be seen in the first place. Even the urtis come back a few days / weeks later when they have earned their appointment. I never believed that telephone triage would reduce demand, but what it does do is make it slightly harder for a patient to see a GP and makes them work harder, and possibly appreciate the service when they get it ? Naive?
That in a nutshell is my point - supply is most definitely limited, and if you want more of one type of appointment you get less of the other. The current contract had lots of good things about it, but sacrificing so much time on the altar of preventative medicine, especially the low/no risk stuff like mild to moderate hypertension, primary prevention treatment of hyperlipidaemia and clinics for the unwilling asthmatics (75% of them), was very wasteful. True we as GPs are less involved now, but it still generates secondary appointments and lots of admin.
We have been doing triage of same day requests ('urgent' in the patients' minds but usually not) for about a year. The receptionists rôle is key in that they get the basic reason when permitted from the patient, and from that the triaging doctor can fairly quickly decide who needs to be seen anyway, and receptionists phone them back, and who may be managed without face to face. To do this we have far more emergency slots and have lost a huge number of booked appointment slots, and that is the price the patients have had to pay - they can be fairly guaranteed to see a doctor today if they claim urgency, but if they want to see 'their' doctor they may have to wait weeks, and many do, adding problems to their list in the process. The patients are learning the rule of the penny and the bun - you can see Dr Anyone today, or Dr Popular in a month, but not Dr Popular today - yes Dr Popular may be working today, but then patients don't know that when they phone, and are not told. We encourage continuity of care for specific conditions follow up, (the doctors themselves make the follow up appointments) but traditional continuity of care where patients only ever see their own doctor started to die when we began to share on call, and cross cover for holidays, became terminal when we ditched out of hours, and died when part time work took off. I only ever hear about continuity of care these days when a doctor is trying to avoid seeing a patient.
Pain clinics are behind a lot of this.
The only thing I can suggest is that you ignore guidelines and most preventative medicine and practice clinically and using your judgement. The trouble is that younger GPS have grown up with guidelines and some cannot function without them.
Interesting what the NNT website says about primary prevention - not worth it, don’t it.
They won’t have any obligation to meet demand though and once their appointments have filled guess where the overspill will go?
If you believe the NNT website some of our current guidelines aren't worth it - treating mild to moderate hypertension, and primary prevention of CVD with statins to name just two.
Would be nice to know what the symptoms were that were dismissed too. Did she say 'I've got symptoms of bowel cancer'? Or were these symptoms mixed up with a host of others all raised at the same consultation?
Patients and politicians go to the same school of evasive answers.
Don't forget 'you've been busy today, doc', code for 'why are you running an hour late and delaying me?' before getting out a list written on a toilet roll.
Now do 6 sessions down from 9 and earn more. The 4 days off in a row are great, the 3 days in a row are a chore......but just about worth it.
The trouble with the word polypharmacy is that it really should be polypharmacology, because that is where the harm lies in polypharmacy, and to assess polypharmacology needs someone trained in clinical medicine, who can diagnose and prescribe, and really only GPs can do that in primary care. We could reduce our polypharmacy burden hugely if we stopped the treatment of hyperlipidaemia and mild to moderate hypertension as serious illnesses, instead of what they are, which is weak (at best) risk factors in primary prevention of cvd. If we treated diabetics individually instead of to targets that would also reduce it. The trouble is that (especially the younger ones) GPs are terrified of litigation that could result from failure to follow guidelines, we end up overprescribing.
Our urologists give a far more helpful instruction of a level threshold, which is usually well above uln anyway. Vague instructions are unhelpful and should be resisted. Good comment about reading the notes though - some of my (possibly) work shy colleagues will use the 'no continuity of care' defence to justify refusing to see patient/act on results, because they don't know the patient, but that is after all why we are taught history taking and note keeping, crucial now that the majority of GPS are part time.
I'm not going to do it. Statins don't work in primary prevention, in any clinically significant way, but they certainly cause side effects.
Are the nocters the driving force behind employing them? I suspect not, so is it fair to belittle them when they are pitching in the help our crisis? When people are taught the rudimentaries of a foreign language to help in a situation that needs communication with a lot of monoglot people, do the fluent speakers of the same language laugh at those less fluent that are helping out? If we're not careful the nocters will vote with their feet and one raised middle finger.
That is a fair point.
How about practicing evidence based medicine rather than seems a good idea medicine? That would get rid of most of our preventative medicine by which I mean medicating mild to moderate hypertension, most prescription of statins (keep the secondary prevention in middle aged men), most asthma clinics (the patients vote with their feet on this anyway), most copd clinics (ditto) and most work to do with ckd. Also how about stopping the continued testing for microalbuminuria in diabetics after the diagnosis is confirmed? It adds nothing. Some guidelines I suspect are not evidence based - the new breed of gps is so terrified of sanction that a patient with a haemoglobin 1 below the lower limit of normal is sentenced to a 'spit roast' endoscopy.