I don’t know about you, but I’m fast reaching some final straw moments in my life which have made me question the purpose of my role.
The first of these is public perception of general practice, formulated through repeated vilification from the Government and the media. I used to be adept at ignoring these articles and clinging to the belief that our patients understood our value, both financially and emotionally. However, the recent GP Patient Survey reveals a significant decline in patient satisfaction with GP access, leading to the inevitable tsunami of patient complaints.
As complaints lead, I am spending hours of my time, ironically time which could be better spent seeing patients and improving access, dealing with the outpouring of vitriol about matters which GPs often have little control over. When the starting point for many patients is to go into battle with us, it is often hard to remain positive and buoyant.
But the other final straw moment for me was when I read this Pulse article about NICE approving a drug for raised triglycerides at a cost of £144 per month. With full implementation of this drug, it would cost over £20 million pounds per year in our area alone. This is on the back of other screening and preventative prescribing measures which are being pushed by NHS England and the PCN DES.
The year started with the inclisiran debacle leading to a joint statement from the BMA and RCGP expressing concerns about long-term safety and outcome data. The reimbursement offered by the drug company is only available if delivered in primary care, illustrating once again how easily big pharma can manipulate governments.
The PCN DES in England has jumped on this bandwagon through the cardiovascular and cancer prevention projects. Instead of dealing with the hordes of patients banging on our doors, we are trawling through our lists looking for eligible targets to send for prostate screening or to refer to lipid clinics. And no-one in the ivory towers has done any sort of modelling, to work out the impact of these referrals on secondary care activity, and what must be stopped by both primary and secondary care to accommodate this.
No-one is disputing that prevention is better than cure. But where is the investment in non-medical prevention such as weight loss and smoking cessation; measures that are not funded by drug companies? Before we start to identify silent diseases such as chronic kidney disease and slow growing prostate cancers, shouldn’t we be properly managing those people who are known to have a disease and are in desperate need of secondary care treatment?
I feel like I’m living in some kind of parallel universe where patients in dire need of treatment are on waiting lists to go on waiting lists for out-patient appointments, yet vast sums of money are being directed at population health management and looking for disease in an otherwise well person. This universe also allows elderly people to lie on a floor for twelve hours with a hip fracture, as well as allowing people to die of a cardiac arrest whilst waiting for an ambulance (which is obviously not the fault of the hardworking paramedics).
These days I have a sickly, sinking feeling when I have to admit a patient, as I know they will be languishing on a trolley in ED for hours, only to be discharged far too soon to make room for the next person. The reality on the ground is that we are practising third world medicine, yet the government is spending millions on appearances while Rome burns.
Dr Shaba Nabi is a GP trainer in Bristol. Read more of her blogs here