Jobbing Doctor explains why he is handing over his commissioning responsibilities to someone else
People still trust their GPs. We are one of the few professional people that are highly-trained and available to every person.
The relationship I have with my patients is complex, but also unique to each patient. Some patients I really enjoy seeing – we talk about their illnesses, but we also talk about mutually shared experiences, be it places we have travelled to, authors we like reading or football teams we support. Others less so.
I think some of my hospital colleagues would be surprised that part of my consultation time revolves about no medicine at all.
This is what GPs do.
A significant amount of my time is spent listening to stories that people tell me about their experiences, usually in hospital. One recently involved a physio patient of mine who needed to have a cholecystectomy. She fulfils the typical criteria of the five Fs of gall stones: fair, fat, female, fertile and forty. She has had one episode of biliary colic, and has confirmed gall stones on scanning.
Fairly obvious what to do here. We select a hospital, although – thanks to the wonders of ‘Choose and Book’ – she cannot choose a consultant, and anyway, many of the older and more experienced surgeons have retired, ushering in a newer breed of under-trained and under-experienced consultants, many of whom ought to have served a longer period of training in the old senior registrar grade.
She sees a young consultant whom I have never met, and he does not know me. He spends most of the time in clinic berating her about her weight, and says he won’t do the operation until she loses two stones in weight, and lists the complications of being overweight and surgery in apocalyptic detail, and refers her to another consultant (a chemical pathologist) to begin weight reduction.
The consultant has the listening skills of a politician, and the communication skills of Hannibal Lecter.
Cue the patient coming to see me, in floods of tears, and angry. She spends 10 minutes reliving the nightmare appointment in coruscating detail, banging my desk with her fist. She is not angry with me: I am her ‘friend’. But I represent the accessible and professional part of the NHS, so I listen to her story. We select another hospital, in a different part of Dullshire. But my time has been wasted, NHS money and facilities have been wasted, and I have to listen to it all.
I suppose this is part of the misguided logic that has been used to ask GPs to commission services for their patients. I guess, in the facile nirvana dreamt up by the right-wingers who inhabit every nook and cranny of the NHS, this would mean that we should decommission services from this consultant and this hospital. But he may be the best laparoscopist this side of Ulan Bator, despite being a charmless and rude individual.
People tell me stories, and I am expected to make major management decisions on largely anecdotal evidence. There is other evidence there (spreadsheets galore) but I neither have the time, energy, enthusiasm or the mathematical skills to judge quality in this respect.
I am handing over the commissioning portfolio in my practice to one of my colleagues. She will make a very good job of it, and steer us and our pathfinder consortium in the right direction. She is aware of Mr Rude, the surgeon, as she has also had a patient mangled by his generally rudeness.
I shall stay in my room, and listen to the stories that the patients tell me.
I am the chronicler for the common man.
The Jobbing Doctor is a general practitioner in a deprived urban area of England.
Click here for more Jobbing Doctor Jobbing doctor blog