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We need a tough conversation about unnecessary GP appointments

This weekend, the RCGP released stats on wait times for GP appointments across the country. Bleakly they predict ’that if current trends continue, the number of instances when patients will have to wait a week or more to see a GP will rise more than 20m over five years, from 80m in 2016/2017 to 102m in 2021/22’.

Much of the reaction has understandably been based around funding. But I wonder if there needs to be another focus – the increase in demand driven by inappropriate usage.

RCGP chair Professor Helen Stokes-Lampard states “GPs and our teams are now making more patient consultations than ever before – over 370m each year – and with workload continuing to escalate, and with continuing resource and workforce pressures, the worrying outcome is that we will be unable to see all our patients who need to be seen”.

This got me thinking about the number of totally and apparently unnecessary GP appointments. For example, in one two hour session last week I saw:

1. 24 year old with ankle swelling (it was 32 degrees outside)

2. An eloquent and well 9 year who told me she ‘just had a cold’ on entry

3. A 25 year old with a 3mm scar at the top of her thigh she didn’t like

4. Heat rash in a 3 year old

5. A blister from a shoe

6. A request for a letter for school to allow swimming goggles

7. 21yr old with a pea size bruise on her arm

8. 71year old who needed meds rationalised

9. 42yr old with hard skin on her heels

10. 12yr old with a verruca

11. Request for paracetamol on script for a child so that school can administer

12. Request to sign a ‘fit for endurance run’ form

This is by no means an unusual surgery. Surely this, and the duplicate surgeries that GPs countrywide are experiencing day in and day out, should act as a prompt to start a conversation around what is appropriate usage. I can’t help but think that if there were ways to discourage/redirect some of this, we wouldn’t have this impending appointment wait-time iceberg on the horizon.

So what could the solutions be?

I have never been a fan of charging for appointments, primarily because I worry about those who really do need to see a GP and can’t afford it. But I am moving more towards it but with careful safeguards and exemptions to cover those who can’t pay. It seems to work in Ireland and it must go someway to guiding someone with hard skin or a verucca to the pharmacist instead.

Public health education programmes need to be stepped up and not just focused on the ‘go to your GP if you have this’. It’s time to be clear, spell out what is and isn’t acceptable to present to a GP. But also to include solutions and direction to the right service, much of which will be the pharmacist.

Should the government not step in and instruct schools to re-empower parents?

It should be the parent giving the school permission to give analgesics /antihistamines/suncream etc. Who else should have a view and permit a child to wear a hat or even swimming goggles? Certainly not a GP! It’s ridiculous that our time is taken up with this PC nonsense.

And in terms of signing fit to parachute/fly/run… we are a small hop, skip and a jump from having to give people permission to go to work if this continues. It’s great that people are keeping active but how are we qualified on a particular day to state that on another day in the future someone will be fit for something? We aren’t and we shouldn’t be doing this. All of these organisers should have their own medical experts to carry out these assessments in the appropriate way for the appropriate fee if they insist on having them.

I have no doubt that if we can stop or redirect some of the unnecessary usage, there wouldn’t be an accessibility problem. The real question is, are we brave enough to have this tough conversation?

Dr Renee Hoenderkamp is a portfolio and Media GP in London