Monthly Archives: June 2015

“It’s not our fault, those nasty GPs made us do it”

“Morning, how are you? So you’re struggling with your knee? Ok, let’s take a look, pop up on the couch.

Right, what I suggest for the time being is some anti-inflammatories and gentle exercise. It’s better to avoid those drill wielding hospital doctors for as long as possible. It’s a bit of a slippery slope once you embark on the surgical route. Let’s see if time and patience will do the trick.

Hello again, no better? Physiotherapy for you then I think. They can work wonders.

Still no better? Righto, let’s get an X-ray sorted and we’ll get you off to the orthopaedic guys, to see if they can help. There are a number of possibilities and treatment options depending on X-ray and scan results, let’s see what they say.”

So, this is option one. This is what goes on in every GP surgery, every week of the year, but let’s take a look at the parallel universe of the British Orthopaedic Association.

“Morning, how are you? So you’re struggling with your knee? Ok, let’s get an MRI and ask the orthopaedic surgeons to see you.

REALLY??? Are you serious?

General Practice and Practitioners are becoming inured to the constant barrage of abuse and approbation from politicians and the media, but there is a particularly offensive sting to ill-considered criticism from colleagues, who frankly should know better than to throw stones in their secondary care glasshouses.

http://www.boa.ac.uk/latest-news/boabask-response-to-media-reports-regarding-knee-arthroscopy/

The phrase, “…….if GPs are doing their job properly….” has a wonderfully arrogant and patronising ring to it don’t you think? And as for, “………performance of this investigation (MRI) replaces the traditional medical skills of history taking and physical examination of the patient…”, well frankly, words fail me.

General Practice effectively manages the vast proportion of clinical presentations without the need to refer to secondary care. Those that are referred are done because further management is beyond the clinical expertise of the referrer, hence transition to the supposed ‘specialist’.

But it appears not. Orthopaedic surgeons are apparently incapable of utilising “the traditional medical skills of history taking and physical examination of the patient”. Nor are they able to deal effectively with patient expectation. No, instead it appears it’s the GPs fault for not managing the patients properly in the first place.

If we listen carefully outside the orthopaedic clinics, we will hear the bleating cries of the poor little lambs, “we didn’t want to do an arthroscopy, those nasty GPs made us do it.”

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NHS Titanic

I’m not known for being a drama queen, (stop muttering at the back!) but I’m getting increasingly edgy with Primary Care strategy planning, so perhaps a little drama is actually required.

This morning opened with Jeremy Hunt’s vision for the future of General Practice.

10,000 new clinicians

Improved marketing

New data to highlight under-doctored areas

And that piece de resistance, 7 day access

All day, the Twitter feed and Facebook page of ResilientGP has been buzzing with angry, disaffected GPs venting their spleen at this charade; calls to arms, suggestions of mass resignation, genuine despair.

Examples abound of 7 day access pilots shutting their doors because of limited interest in weekend appointments, surgeries closing because of inadequate funding, story after story of the dumbing down of Primary Care Services. I’ll share one with you…..

“It would appear that my locum services and that of my three GP colleagues are no longer required at one surgery that we work at. We have been replaced by 2 (yes 2) Nurse Practitioners who will apparently do the same work, charge less and have agreed to sign the lease to the building.

News of this came ironically after I had just been reviewing a patient who our Nurse Practitioners had been dealing with for the past 12 months – normal spirometry but on Spiriva, Symbicort and theophylline for ‘chronic cough’. After loads of scripts for steroids, expensive inhalers and antibiotics, the patient came to see me as she had been told by said Nurse Practitioner that she needed a referral to the allergy clinic as nothing is working. (Even had the name of the allergy consultant written down that I ‘had’ to refer to).

After 1 year of inappropriate management, she has now been sorted with some omeprazole.

Nurse Practitioners and Physician Assistants – really the future of General Practice???”

Now, don’t get me wrong, nurse practitioners are highly skilled professionals in their own right and I’m all for skill mix, but how can this be right? We have seen the chaos that has been created with 111 by taking clinicians out of the triage process; inappropriate use of the ambulance service, increased waiting times in A&E, ramped up demand in Primary Care and reduced self-care, (after all, you can’t be too careful!)

Do the public realise that the official strategy to the future of the NHS is this dumbing down?

It takes years of training and experience to practice medicine effectively, safely and cost-effectively. Patient safety will be compromised, costs will rocket, the Secondary Care system will collapse with the lack of risk management.

And what’s with this extra marketing business? That’s like standing on the deck of the Titanic after it had hit the iceberg saying “Roll up for the most amazing cruise of your life, sign up, sign up……” The only people coming aboard this Titanic will be the treasure hunters after it has sunk!

I feel like standing on a soap box on Hyde Park corner, I’m no soothsayer, but the end of the NHS is nigh.