I’m asking for your help today because I’m hearing two apparently opposite views from GPs on what a GP is for. More precisely, which patients they should be seeing and for what?
The two schools will be represented by Dr Kronik and Dr Cute (*names may have been changed). With GPs stretched for time and recruitment under pressure, making the best use of them is pivotal for the NHS.
Dr Kronik: “The real priority is to keep patients out of hospital. Most of them are in for chronic conditions which could be managed in primary care, but GPs don’t have time to manage them. We are seeing too many acute patients, simply because they have presented and we have to do something. Most of these patients need to accept longer waits, go elsewhere or be managed by someone other than a GP, else nothing will change.”
Dr Cute: “GPs are the best trained diagnosticians. The nature of generalism means we are usually best placed to deal with everything first, though having assessed the patient we may hand over to another for treatment. Even something apparently minor & acute like earache is better managed by a GP, for example without antibiotics, or without a visit. Our best long term value is in preventing LTCs. Treatment of them is more protocol driven, nurses do this well, and GPs should only need to be consulted by exception when decisions are needed.”
Chaand Nagpaul speaking last week at Commissioning Live said that better use needs to be made of the wider primary care team (mentioning pharmacists as the only clinical profession with an excess of supply). But there is a tension between spreading the workload and losing control. It’s clear from NHS 111 and similar exercises that reducing the level of clinical expertise at the point of entry ends up costing more.
I have no axe to grind, except as a patient and taxpayer to ask, “What works, how can it work better and what’s the evidence?”
What are your views and do you have any evidence?
Founder, Chief Executive
GP Access Ltd
PS as evidence all I can offer is this study on demand, which looks at what GPs actually do without attempting to say what the balance should be. Acute 57%, routine chronic 33%, exacerbations of chronic, 10%.