If you’ve been to the Royal College in recent years you may be familiar with the Cafe Caritas, an airy post-modern meeting spot at 30 Euston Square, headquarters of the RCGP. Now I’m no College regular, but am here in a caring capacity. Just yards away from my macchiato and newspaper, through a door and up a flight of stairs, my wife is waiting nervously to sit the CSA. There were 39 GPSTs on the list at the desk. Thirty nine young apprentice GPs who have studied and role-played for months, hopeful they’ll join our ranks.
Caritas. Charity, or care. A powerful concept, if you take a moment to let it resonate in the conscience. At school, we learned the moving Taize chant ubi caritas, deus ibi est. Set to soft chapel music, it was positively meditative. Where there is charity, there is God.
Care is clearly in vogue at the moment. There’s the Care Quality Commission, suggesting you can’t possibly care if you stock a depo that’s not behind lock and key. There’s the urban chic of Cafe Caritas, where the intelligensia of the profession meet to plan how we should be seen to be caring more. There is, of course, care.data, about which both GPs and patients clearly care a good deal. But how much do we genuinely care at the moment? The way that we were taught to on our VTS. And what is it we actually care about?
I’ve suggested before that 2013 was a year where patient care suffered. I’ve been reflecting (something that there scarcely seems time for these days) about my own practice over the last few weeks. I suspect many of my consultations haven’t been fit to pass the CSA.
For me, another day blusters by in surgery, more last-minute QOF chasing, more angered patients struggling to get appointments, more exasperated staff looking jaded and worn. More bad news, less funding, more work, less care. Then at home, I take on the role of patient as my wife works on the structure of the consultation, capturing the ICE, asking who helps them out, trying to contextualize their lives. I’ve been a teenager requesting a TOP, a drug-addicted doctor, a menopausal teacher. Her emphasis, and a key objective if the CSA, is to demonstrate care: show an interest in the patient and how things affect them.
How often consultations in practice contrast with those we aspired to deliver as a GPST. Its often hard to focus on the person in front of us. The talk of AQPs pinching our core services has been disconcerting enough: I care about delivery of core services to my patients, they should be able to have a smear at their surgery, bring their children for immunisations, get a flu jab. Patients walk in, barely have a chance to speak, and I’m all over their blood pressure, smoking status, contraceptive advice, BMI, asthma review, seizure frequency, CHADS2 and so it goes on. I care about their QOF, but do I care about them?
There are other big distractions at the moment which serve to derail the consultation. Colleagues have different coping strategies for the ongoing scaremongering. Some say its just part of a cycle of GP booms and busts: get your head down sunshine, the storm will pass. Others think this is it: GMS is dead, get yourself federated and fast, the bidding will start soon. Care less and earn more, it’s the future.
The CSA may have moved from its lofty octagonal location in Croydon to the more central splendour of Euston Square. The skills tested are the same though: do we have the ability to allow a stranger to enter our surgery, tell us unreservedly what’s the matter, hoping we won’t judge them, and then offer them genuine care.
Like those 39 hopefuls today, I sat my CSA with the conviction that GPs cared about patients and that care was at the very the core of our work. I appreciate there’s a sense of resignation at the moment, but I’m getting back to consulting with more care. Lost in a seemingly uncaring world, our patients should be able to turn to us. Ubi caritas, medicus conmunis ibi est. Where there is care, there is your GP.