I worry we are delivering care to a society that knows the cost of everything but the value of nothing, where we are driven to tick boxes instead of treating patients holistically and where we have rejected 24-hour responsibility – a seismic change many believe is to the detriment of our profession. I worry too that it is now us who must ration care for our patients, putting at risk the essence of UK general practice, the doctor-patient relationship. So, here we havea sample of these issues for us to consider.
We learn our profession is already being asked to sign off decisions to deny care to patients either because the treatment itself has been designated low clinical priority, or because the patient who seeks it has been judged not worthy. And we have a sense too, from this week’s front-page story, of what the consequences will be for such responsibilities. GPs face complaints, and even legal challenges, under the NHS Constitution.
Has our profession moved so far from our ideals when we applied to medical school that the idea of a GP-patient relationship is now outdated? Can someone who has breached trust ever be forgiven? Will our patients fear if we choose not to refer them it is not because we are confident in our own ability to manage them, but because it would affect opportunity costs for other patients, set the 18-week clock ticking or, worse, prevent us lining our pockets with a quality premium? Dr Simon Poole addresses some of these issues here.
We are privileged to visit our patients in their homes, but see the findings of the recent Equality and Human Rights Commission report at first hand – that care of older people is so poor their human rights are being overlooked, as they’re left to choose between a wash or help to eat. We have a voice in the debate into how care of the vulnerable and elderly should be paid for. Are we spending too much on medicines and not enough on hands-on care, as this story might suggest? Macmillan recently highlighted huge discrepancies in end-of-life spending – one PCT spent £186 per patient, another £6,213.
Increasingly, we’re asked to sign forms labelled DNR. We have a new role to play in discussing with our patients and their carers their wishes at the end of life, but we must be wary of accepting forms completed by others for us to idly sign. And would our society not be better served by discussions about dying a natural death?
There is a lot at stake. I hope this issue stimulates you in your leadership role as a GP to make your own views on the future of healthcare heard.
Dr Helena McKeown is a GPC and BMA Council member, and a GP in Salisbury, Wiltshire
View all of the guest editor issue here.
Video: Dr Helena McKeown introduces her guest editor issue of Pulse magazine