Columnist Dr Margaret Ikpoh says that both GPs and patients agree with more funding in primary care – the only people who don’t are the powers that be
“I can’t get no, sa-tis-faction,” (cue Mick Jagger voice.)
I am on call today. I used to enjoy being on call years ago. I enjoyed the fear of the unknown; walking through the door and dealing with the uncertainty that came with it all. Nowadays I am overcome with the fear of the known and the certainty that at least half of the gazillion issues I deal with today would be better dealt with in a routine appointment.
General practice, often defined as the bedrock, cornerstone and pillar of the NHS, has now sadly become a dumping ground. My duty days have reduced me to the role of a glorified clinical traffic controller. Green lights are unfortunately hard to come by. All appointments are gone by 08:12. Some of our staff are off sick (patients still express surprise that we are not immune to illness) which has exacerbated our staff shortages.
My first patient approaches reception with an upper limb fracture following a fall, his scheduled operation cancelled this morning. He was (allegedly) told to “see his GP.” So, whilst I prepare theatre space for an ORIF, my next issue to tackle is the distress of a patient who has just witnessed some raunchy video footage of his wife and postman in their back garden. Meanwhile, my acutely breathless patient with COPD can barely get his words out to express his unwellness to one of our receptionists.
It comes as no surprise that public satisfaction with the NHS and general practice is at another record low, amidst a background of low GP morale and reserve which is probably at a record high. I have yet to even mention the derisory below inflation uplift to the contract…
We are breaking all the wrong records in a system that is well and truly broken.
Most think tanks are now aligned with their recommendations that we need a new approach in how we deliver general practice. The recent Reform report ‘Close enough to Care’ discussed how we need to radically shift the location of power and accountability from national government to local systems, allowing them to become ‘agents of change.’ The King’s Fund also called for primary care and community services to be acknowledged, and accordingly realigned, as the core of the health system, arguing that funds should be targeted to those sectors as matter of urgency.
Even our patients support more funding to help ease their dissatisfaction with the status quo.
We are all aligned: Patients, service users and GPs alike. We just need those at the helm to jump on board and not abandon ship.
One good thing about my on-call days is that no matter how rough they are, they end. But just as I consider shutting my computer down, a nanosecond before switch-off o’clock, the phone rings. It’s a home visit request… and I try, and I try, and I cry.
Dr Margaret Ikpoh is a GP in Holderness, East Yorkshire
READERS' COMMENTS [5]
Please note, only GPs are permitted to add comments to articles
More funding for primary care is clearly needed as is ICBs that shift resources from the acute to the community and better funding of children to deal with intergenerational discrimination. But the way we do things also has to change. Appointment being filled by 8.12 also shows the need for total triage systems based on a comprehensive briefing by patients on their issues and well coded notes linked to treatments that enable a clinician to triage a patient to the most appropriate member of the team in the appropriate timescale. Someone ringing and just being given an appointment is not efficient for the patient or GP.
MI, your description of a working day will be depressingly familiar to most GPs. Realistic funding is the most important way to improve GPs lives and patient care. Who isn’t fed up with the glossy brochures of (double)think tanks giving their tuppence worth on work at the coalface? GPs have always been flexible and innovative in their work. If other contractors (say, builders) were forced to work under a regime which was progressively underfunded, over-regulated and nanomanaged, then they would have downed tools long ago and not a single suitable house would have ever got built!
Actually, my gut feeling is that some in the political class (both Tory and Labour) see in the NHS an opportunity similar to the Enclosures of public and common land of previous centuries. So parts of our publicly asset are being fragmented and (en)closed off so that they can be more easily privatised in the near future. Acts of Enclosure for the 21st century…where’s the Kett rebellion?
*publicly owned asset*
Unfortunately the government doesn’t know how to spend money on the NHS.
Yes it does need investment, but that should be patients paying at the point of use. We are at the coal face and we know where the money needs to go – more GPs, not noctors and digital phones and new IT. Cant that happening though with an election looming.