Continuity of care is becoming ever harder to provide, but Labour’s proposal for patients to be able to request a particular GP is not the way to go about it, argues Dr Zoe Rog
Early one morning a few weeks ago, I found myself kneeling on the cold, hard tiles of our practice reception area tending to one of my patients who had collapsed as he approached the desk.
The patient has a complex history, and my colleagues were relieved that I was in the building as I know him well, which was helpful in dealing with the acute situation. When the paramedics arrived, I was able to give them a summary of the important details of his medical history and a brief sense of the person he is.
In his semi-conscious state, he started worrying about his sick note and that his benefits would be stopped, so I was able to reassure him about this and persuade him to focus on his recovery. I was also able to extract a promise from him not to discharge himself from hospital before he had been assessed and treated, as I had an inkling he may think about doing this as soon as he felt able to get off the trolley.
We have even reached a point recently where he will agree to take medication consistently that he was previously reticent about because I have suggested it’s a good idea. Sometimes continuity of care is fantastic, and sometimes it is achievable.
Early in my career, I remember finding out that a patient had sadly died. The patient was well known to the senior partner and we had both been seeing her. She had been taken to hospital and died suddenly of a pulmonary embolus. The news had been conveyed to the surgery by her devastated family.
The senior partner was at a meeting in London that day, but I knew he would want to know what had happened. Unsure whether I was doing the right thing, I phoned to let him know. He thanked me and told me that he would call in to see the family that evening when his train got back from London. I offered to give him the family’s address.
‘I know the address,’ he told me. ‘I delivered their youngest daughter; she was born at home soon after I started at the practice.’ He visited the family that evening and cried with them, sharing their communal grief. I will admit I was quite envious of the relationship the senior partner had with most of his patients. He was the epitome of the British cradle-to-grave family doctor, and it was the kind of career I aspired to when I was drawn to the profession.
But even then I knew that this model of care was unlikely to be sustainable. All the partners in the practice previously had been able to work full-time and with personalised lists. Even then GPs were beginning to need to reduce their sessions to accommodate the demands and complexity of their work.
Over time, more work has been pushed back from secondary care, mental health services and social care. And in the absence of promised extra GPs, our teams comprise many other highly skilled healthcare professionals, not just doctors. It is surprising and laudable that we manage as much continuity of care as we do, and much of this comes from our personal drive to go above and beyond for our patients.
Shadow health secretary Wes Streeting suggested that the Labour party will give GP practices financial incentives to let patients see the same doctor every time to boost continuity of care, because patients like this, and because it will motivate more GPs to stay in their jobs. We know that this means trying to take money away from practices that they are earning in some other way.
My grandparents used to like it when their local bank branch had a manager who knew them by name. The bank is now a coffee shop and the closest customers get to a personal experience is having their names written on their takeaway cups. Mr Streeting needs to understand that financial threats are not the way to motivate and retain GPs, and that continuity of care with the same GP isn’t as simple as writing someone’s name on their coffee cup.
Dr Zoe Rog is a GP in Runcorn, Cheshire