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Gold, incentives and meh

General practice is not as simple as it seems

Once again in Baroness Young of the Care Quality Commission we see a well-intentioned policymaker coming on strong about the need for GPs to provide the best possible treatment for their patients. Could anyone object to that? Why should the Government go to the trouble of setting up NICE and then ignore its advice?

GPs may not like change but if they can't adapt then they deserve to get into trouble, don't they? It can't be that difficult to follow guidelines. Everyone knows what GPs do. Everyone sees GPs in their surgeries, although perhaps not quite as easily as they would like. What can be so difficult about prescribing antihistamines for hay fever or referring someone with a hernia for surgery? Simple as ABC.

If only it were. Members of parliament are very unusual. There are only about 650 of them out of a population approaching 60 million. In general they are very successful and tend to enjoy better than average health. They are movers and shakers in control of their lives and quite unlike the human flotsam that eddies in and out of our surgeries.

Politicians don't know what GPs do, they only think they do. They know better than to attempt to reform cardiac surgery or mental healthcare. But they all believe they know how to improve general practice and can't wait to do it.

Have we GPs told them what we do? We are usually too busy for serious introspection. Patients must be seen and the waiting room cleared. NICE deals with problems but GPs deal with patients and almost no patient presents with a clear-cut problem. Often they are quite unsure what might be wrong. At times the presentation is a cover for an illicit request for psychoactive medication or to escape trouble via medical sanction.

Judicious referral

GPs deal competently with the vast majority of problems across the entire medical spectrum and refer judiciously to more specialised colleagues where appropriate. It is amazing how rarely GPs refer to the wrong agency.

We could do better. With more resources and access to investigative services we could be more complete primary care physicians dealing with an even greater fraction of the health burden. With more investment in practice infrastructure we could improve the patient experience and in combination with colleagues could extend our hours of business to improve patient access. Better IT and audit would underpin clinical progress and more effective interaction with specialist colleagues would improve patient care and professional satisfaction. But we are human and occasionally need to be cut a little slack to deal with stress, illness and burnout.

As Bob Dylan sang when the world was young: 'Don't criticise what you don't understand.' To quote another now discredited politician, there are things that we don't know that we don't know. Perhaps we might ask politicians to look before they leap and not embark on a crusade to reform general practice based solely on their own individual experience.

From Dr Lewis Miller, Belfast

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