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At the heart of general practice since 1960

We need a tough conversation about unnecessary GP appointments

Dr Renee Hoenderkamp

This weekend, the RCGP released stats on wait times for GP appointments across the country. Bleakly they predict ’that if current trends continue, the number of instances when patients will have to wait a week or more to see a GP will rise more than 20m over five years, from 80m in 2016/2017 to 102m in 2021/22’.

Much of the reaction has understandably been based around funding. But I wonder if there needs to be another focus - the increase in demand driven by inappropriate usage.

RCGP chair Professor Helen Stokes-Lampard states “GPs and our teams are now making more patient consultations than ever before - over 370m each year - and with workload continuing to escalate, and with continuing resource and workforce pressures, the worrying outcome is that we will be unable to see all our patients who need to be seen”.

This got me thinking about the number of totally and apparently unnecessary GP appointments. For example, in one two hour session last week I saw:

1. 24 year old with ankle swelling (it was 32 degrees outside)

2. An eloquent and well 9 year who told me she ‘just had a cold’ on entry

3. A 25 year old with a 3mm scar at the top of her thigh she didn’t like

4. Heat rash in a 3 year old

5. A blister from a shoe

6. A request for a letter for school to allow swimming goggles

7. 21yr old with a pea size bruise on her arm

8. 71year old who needed meds rationalised

9. 42yr old with hard skin on her heels

10. 12yr old with a verruca

11. Request for paracetamol on script for a child so that school can administer

12. Request to sign a ‘fit for endurance run’ form

This is by no means an unusual surgery. Surely this, and the duplicate surgeries that GPs countrywide are experiencing day in and day out, should act as a prompt to start a conversation around what is appropriate usage. I can’t help but think that if there were ways to discourage/redirect some of this, we wouldn’t have this impending appointment wait-time iceberg on the horizon.

So what could the solutions be?

I have never been a fan of charging for appointments, primarily because I worry about those who really do need to see a GP and can’t afford it. But I am moving more towards it but with careful safeguards and exemptions to cover those who can’t pay. It seems to work in Ireland and it must go someway to guiding someone with hard skin or a verucca to the pharmacist instead.

Public health education programmes need to be stepped up and not just focused on the ‘go to your GP if you have this’. It’s time to be clear, spell out what is and isn’t acceptable to present to a GP. But also to include solutions and direction to the right service, much of which will be the pharmacist.

Should the government not step in and instruct schools to re-empower parents?

It should be the parent giving the school permission to give analgesics /antihistamines/suncream etc. Who else should have a view and permit a child to wear a hat or even swimming goggles? Certainly not a GP! It’s ridiculous that our time is taken up with this PC nonsense.

And in terms of signing fit to parachute/fly/run… we are a small hop, skip and a jump from having to give people permission to go to work if this continues. It’s great that people are keeping active but how are we qualified on a particular day to state that on another day in the future someone will be fit for something? We aren’t and we shouldn’t be doing this. All of these organisers should have their own medical experts to carry out these assessments in the appropriate way for the appropriate fee if they insist on having them.

I have no doubt that if we can stop or redirect some of the unnecessary usage, there wouldn’t be an accessibility problem. The real question is, are we brave enough to have this tough conversation?

Dr Renee Hoenderkamp is a portfolio and Media GP in London

 

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Readers' comments (12)

  • Completely agree - we can have all the systems in the word, but until we reduce demand - there is no answer for the ever increasing pressure on NHS

    Like plastic bags, a small charge is needed. However we need to be careful of the politics - we don't want tot let the government turn round to patients and let them blame us for charging. We won't get rid of that tag for generations.

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  • Having been opposed to charging for many years I have now come round to the same view - a small charge is required to make the service 'valued'. Even a token fee for those who currently qualify for prescription exemption, perhaps £5? We all pay 5p for supermarket bags, and look at the impact that's had on demand!

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  • we charge £25 for all private letter requests, no matter who you are or your circumstances. we give online access to the medical record for free and the patient is more than welcome to share this with whoever thy feel necessary. if people are demanding information from us, then we ask the party to write to us with a formal request so that we can invoice them.

    with regards to paracetamol for schools

    https://www.bma.org.uk/advice/employment/gp-practices/quality-first/manage-inappropriate-workload/prescribing-non-prescription-medication

    a really good statement from the BMA website.

    I normally advise the parents to take this to their school. again if the school still has concerns, then I ask them to write to us so that we can invoice them for our medical opinion and time.

    we do not prescribe otc medication unless there is clinical ground and schools not understanding their legal duties does not count as one of them.

    - anonymous salaried!

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  • Healthy Cynic

    This article hits the nail on the head regarding unsustainable demand for primary care appointments. Our politicians are too concerned with buying votes to have this conversation. The profession needs to regain control of primary care. The RCGP needs to extract its collective heads from its collective arses and start to work for the profession rather than brown-nosing the politicians in pursuit of personal gratification and a gong.
    We need a little more militancy and a lot more backbone.

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  • I concur with Renee and Healthy Cynic..... Victor Meldrew, my hero.... if only he wrote articles for Pulse.......

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  • Demand outstripped sustainable levels so long ago that trying to reign it in can only be done politically. There never has and never will be any political appetite to pursue this. The profession is unlikely to regain control of primary care because of...

    1. The fact that too many GPs are too keen to please everyone.

    2. The RCGP is too keen to support 1, and VTS training teaches a mindset set by RCGP.

    This desire to please everyone is an admirable trait in a spaniel or a whore (to misquote Disraeli).

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  • Just Your Average Joe

    Couldn't agree more with need to stop self limiting illness, and just in case, can I see you for the 4th time with the same cold someone already gave me antibiotics for but I'm still coughing, can you sign and take the risk on your name for me mentality out of clinics by charging for each consult we do not initiate ourselves.

    Hence Chronic disease visits and appt requested by GPs are free, ie follow up on CXR and bloods etc, so real patients with real needs have no fear of charges, but those who want to save 16p for paracetamol script will reconsider with £5-10 charge ( I favour at least £10).

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  • A fiver would be fair. Its half the cost of a packet of fags and in 25 years I've not yet encountered a patient who stopped smoking because of the price. The idea that a truly sick person would not come if it cost a fiver really is nonsense.

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  • Rogue1

    The patient who comes to ask 'what happened at their clinic appointment', well they were there not me.
    The patient who pops in, 'just to let you know they have been to hospital', nothing for me to do just to inform me.
    The patient who comes for their review, but hasn't had their annual bloods done. So the have to come back again, despite telling them every year.
    The patient who has been to clinic and 'wants their new medication'. But secretarial services are so slow, we are often waiting 1-2months for a hospital letter.
    The patient with a sore-throat (etc), but just wanted you to check it before they got something from the chemist.
    Just a few of my non-favourite appointments..

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  • David Wrigley

    Re Ireland and their models of charging. Many families have to pay to see a GP in Ireland and I know parents being unable to afford the 50 Euro fee to see a GP and making a decision to 'wait and see if my child gets better'.... is that rash viral or meningococcal? Some can't afford to have that decision made by a professional in Ireland and just hope for the best. Do we really want to go down that route in England?
    We are drowning in work and practices are collapsing due to years of govt cuts and defunding. Direct our anger and angst to the politicians and we might make some headway!

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