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Patient demand is driving GPs into the ground

‘Cyberchondriacs’ and other ‘worried well’ patients must learn to use the GP properly, writes Dr Fiona Cornish

We read headlines of about reaching the ‘crisis point’ in general practice every day, with GPs on their knees and burning out through impossible workload. The components of the crisis are now well known: increasing patient demand, inadequate funding to provide all the interventions and drugs available, and an aging population.  As GPs we can’t magically increase the economic wellbeing of the country, and therefore NHS funding - and we are partly to blame for keeping patients alive for so long. But can we exert any influence over patient demand?

Ironically, Aneurin Bevan predicted at the start of the NHS that the demand for healthcare would decrease as people became healthier. In fact, the opposite is true. As GPs, we generally like to keep patients happy and to be liked, but there is a limit to our goodwill.

Patient consultations in England rose by 75% between 1995 and 2008, according to the RCGP. This is against a backdrop of growth in GP full time equivalents of 18% since 2000, compared with a 61% growth in hospital consultants. Workload has now become a political issue, and it is no longer acceptable for us to be told to work in ever ‘smarter’ ways.

Information for patients was thought to be a panacea: give them access to information, and they won’t need to see the doctor. How wrong that assumption is. As we know to our cost, information is seldom valuable without the doctor’s advice or interpretation. Patients come flocking in, proudly bearing a printout from a health website - particularly that highly educated, well-informed, health-aware breed who attend my surgery in Cambridge. These are the famous ‘worried well’. They are just checking that they are taking the right kind of vitamins, or that the capsules I have prescribed are suitable for vegetarians.

We have spawned a new entity: the ‘cyberchondriac’. We live in an instant society, with information available at a click, and the corollary is that we expect equally immediate answers, responses, and appointments to see the doctor. This is where the doctors and the rest of world diverge. Every patient questionnaire or political focus group comes back with the response that surgeries should be available for evenings, weekends, early mornings, and that patients would all like to have longer appointments and more time with the GP. But we know this is not the solution - like opening a new motorway lane, it will fill immediately, and demand will only increase again.

We don’t expect banks to be open all night just in case we need to pick up our Euros to go on holiday. We can get cash out of the wall in an emergency, mirroring the out-of-hours service for emergencies, but we know that paying in a cheque, like a sore throat can wait until the following day. NHS Direct has, paradoxically, increased demand - the advice for many calls, after hours or minutes of algorithms, is to ‘see your GP as soon as possible’.  

Most patients are decent people trying to get on with their lives, and are not remotely interested in my explanations of why I am not allowed to make certain referrals, or why the alternative to warfarin, which their consultant has advised, is on my blacklist and so I can’t prescribe it. The argument about payment as a deterrent is a thorny one, and provokes outbursts of disapproval and muttering about the Holy Grail of the NHS. But this is something to consider seriously - and carefully, given that it is such a hot potato. My instinct is that there should be a straightforward mechanism for payment and then some would be eligible for part or full reimbursement. This system is used in France, so why not here? Recent discussions at the BMA’s Annual Representatives’ Meeting in Edinburgh have begun to address this seriously.

For now, helping patients to understand how general practice is funded is the best method for tackling the problem of demand. You could start by hanging notices in your waiting room explaining that the consultation is 10 minutes long, how much it costs, how many missed appointments there are per month, what the allocation of funding is per patient per year. And what if all prescriptions and investigations showed what the cost is per item?

The patient should be advised to ‘help the doctor to help you’, and encouraged to use self help remedies before they come to see the doctor. They should be reminded not to come in to the surgery too soon - or to cancel appointments if symptoms vanish.

Even common sense advice bears repeating: be clear about what you want the doctor to help you with, don’t wear tight sleeves to a blood pressure check.

Although GPs seem to be the scapegoat for all the ills of the NHS, patients still value our time. They just need to realise that we are a valuable resource, not to be abused or exploited.

Dr Fiona Cornish is a GP in Cambridge and president of the Medical Women’s Federation

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Readers' comments (60)

  • Annoymous 11.07 If contract says GP's see patients who are ill or believe themselves to be ill why is it acceptable to chase patients under QOF to collect biometric data, housework, erectile dysfunction snd smoking status etc? A lot of the demand is surely to QOF?

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  • I would love to give up QOF and would do so if I did not need it to pay for the 'bread and butter' General Practice that the patients need and value.

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  • I really wish Pulse would restrict access of this site to healh professionals. I am fed up of reading Daily Wail moaners on here.

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  • I really wish Pulse would restrict access of this site to healh professionals. I am fed up of reading Daily Wail moaners on here.

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  • Some of these daily wail comments have NO idea of reality of general practice. Erm why would a doctor work for half that of their hospital colleagues and pay triple the pension. There would soon be no nhs GPs left .....

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  • It is very interesting that comparison with the demand side of European healthcare is seen as "legitimate" whereas comparison with the supply side of European healthcare (where more doctors are trained and employed at lower rates of pay) is dismissed as "Daily Whailing".

    It's worth noting that the countries that train and employ more doctors but pay them less (eg. European nations, Cuba etc.) are hardly the great bastions of neo-liberalism so beloved by the Daily Mail.

    Whereas the countries with market-driven healthcare and high salaries that are so beloved by the commenters here (the US etc.) are natural Daily Mail territory.

    There seems to be a great deal of cognitive bias in the comments on this site.

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  • I am not sure how GP's claim to be flogged to death when appointment slots are ten minutes, and when they are all booked the list is closed.

    Same for pre booking, fill the ten minutes slots and the list is closed!

    I have already paid to see my GP as and when need be, it is called taxes! When I worked I paid my NHS contributions without choice.

    Pharmacists get paid more to handle a prescription than sell a cheaper solution over the counter, so why bother!

    One of the issues never mentioned here is the amount of patients that book appointments, do not turn up and are too lazy to cancel them! t
    This can amount to hundreds per month and anyone that does not attend should be banned from pre-booking, being made to come in on the day and be seen by whoever is available.

    The real problem is that there are not enough GP's and outpatient clinics need to be open 7 days a week. You may need to see a GP several times whilst waiting for an OPD appointment. time the hospital clinics started working 7 days along with the consultants!

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  • Perhaps all prescriptions should include the cost of the medication?

    Might be a problem when somebody is charged £7 for an item that costs pence but only available on script!

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  • If patients were paying an admission fee, then they would be less likely to accept some of the sub standard consultations on offer by many GP's.
    Many GP's would find themselves at the bottom of patient's list, and would find themselves moonlight for ATOS and such like

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  • Shurleea Harding | 26 December 2013 9:00pm

    " I am not sure how GP's claim to be flogged to death when appointment slots are ten minutes, and when they are all booked the list is closed. "

    The list is not closed. The duty doctor tries to see extras, all those that could not be fitted in but might be developing a life threatening illness. It is the triaging of those patients that is incredibly stressful, especially as many patients very selfishly demand to be fitted in regardless of need. We are only human but we try so very hard not to miss things. The job can be incredibly difficult and the rewards are rapidly diminishing. These rewards i speak of are not all financial but are the important soft rewards of respect and good standing.

    I often feel I am being treated like dirt on someone's shoe. We are sneered at in the press and people often try and do down our degree as 'not a real PhD' .

    Small wonder we are deserting our posts.

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