Sacrificed on the altar of patient choice
Lord Darzi’s assault on traditional general practice threatens GPs’ livelihoods, but it’s the patients Phil feels really sorry for
Lord Darzi's assault on traditional general practice threatens GPs' livelihoods, but it's the patients Phil feels really sorry for
It's a well-known and reproducible fact that you and I, as GPs, spend 75% of our time and resources looking after 25% of our patients. From personal experience I would estimate those figures at nearer 90 and 10, but I bow to the expertise of those academics who work this stuff out.
It would be odd if this were not the case. Everyone has an equal right to NHS care, but it is blindingly obvious that not everyone has an equal need for care at any given time, and the vast majority of people don't need us most of the time.
This is particularly true of men. It is entirely possible to spend the time between your GP appointment for acne at the age of 16 and your first hospital admission with chest pain at 55 without having a medical consultation. Nearly 40 years of blissfully NHS-free existence are not to be sneezed at. Your traditional family GP will leave you alone to enjoy life.
However, I will still extract £100 a year from the health authority to cover the costs of your healthcare. I won't spend it on you though. I'll spend it on the ill, the elderly, the very young, and the unfortunates that actually need my services.
From now on, however, we have competition. And competition – by definition apparently – is a good thing. In my city, there will be three Darzi practices and one Darzi polyclinic (how that name will come to be hated in years to come) and they have to start up from scratch. They will need some of our patients. Which ones do you think they might want?
We can rely on the loyalty of those patients who actually see us regularly. They appreciate the value of regular personalised primary healthcare, because they understand what it means. We'll never lose them. Unfortunately, they are the people who absorb most of our time and generate less than a quarter of our income.
All the others are fair game.
Here is my prediction: within a year or two we will see full-page advertisements in our local newspapers. ‘Come and join New Town practice! Same-day appointments every day of the week until 8pm! Get £25 iTunes voucher when you join!'
Then, in small print: ‘Admission not guaranteed, discretion of management.' Punters with more than one drug on repeat prescription might find they are not the sort of customer the new practice needs.
Incredibly, rumour has it that Darzi practices do not need to be staffed by GPs. Only one member of staff needs to be a GP with a certificate to practise, all other members of staff can be literally anything. This is for up to 6,000 patients. At a stroke, GPs' complex training process has been reduced to an irrelevance.
We have fought so hard and for so long for credible GP accreditation. As a trainer myself, I know what that training means. As of later this year, it is not needed. My own conviction is that this will have a hugely negative impact on patient care. No one in the Government seems to share my concern.
Uninformed and misdirected
The majority of patients who don't need you right now might be easily swayed by Nectar points or promises of free Air Miles. They don't know what we know; that at some point they will need the expertise and continuity of care that makes us special.
By the time they find out that an immediate appointment with a nurse practitioner is not what they need, many of you who are reading this will already be out of business.
Our model of primary care is to be sacrificed on the altar of patient choice. That choice is uninformed and misdirected. I'm not advocating protectionism; our profession is no more worthy than any other of special treatment.
But our patients are, and Darzi clinics will reduce them to economic impersonal business units to be used and traded like any other. I genuinely believe that the loss of your livelihood and mine is a less serious disaster than this.
Dr Phil Peverley is a GP in Sunderland
They will need some of our patients. Which ones do you think they might want?