rowan.depomerai

Hey laddie,

That’s the problem though, there isn’t a nice big national database that has everybody’s medical record (yet) – it’s a massively flawed project which is wasting the taxpayer billions and it doesn’t look like they’re going to fix the problem anytime soon (Private Eye are going nuts over it!). And it’s great that you didn’t have to wait long, but god, I’ve waited HOURS in the godawful places..

I do believe the long term plan for the NHS is just that – create super-sized polyclinics that have a GP-service. Likewise most hospitals now have a walk-in healthcentre attached to them..

..one problem with removing local GP surgeries is that to have hospitals in every village or small town would be prohibitively expensive, yet people in rural areas might not have the means to travel to their nearest hospital. The other issue is that a GP, in theory, is meant to have a fairly small catchment, so should (theoretically) know his or her patients fairly well and be able to make better diagnoses based on the history of a patient.

Interesting that your experience differed, Kate. As for a national database, it’s absolutely ridiculous that such databases don’t exist and entirely down to the government’s inability to pick IT contractors I suspect… the challenge of creating such systems shouldn’t be any worse than those at the heart of every single bank. I’m all for the government being held to account when they cock up, but the basic idea is a good one, and I think that to ditch the project is totally the wrong response and just leaves us all in a worse situation. I’m not saying that you’re necessarily advocating that, but some are…

Darren, you’re right about rural communities, and they’re a separate case. But polyclinics don’t have to be at hospitals, and I’l all for them in cities – my experiences of similar things in London have been good. I note you say “in theory” when when referring to a GP’s ability to know his or her patients better, so I can see that you recognise it’s a flawed argument. I’m registered with a GP in London and out of 4 or 5 trips I’ve taken to that surgery I’ve seen a different doctor every time, and never once my named GP. I’ve had similar experiences at just about every surgery I’ve been registered at in my life (at least 4). So personally, I simply don’t buy that as an argument. It’s flawed anyway – what if that doctor is ill, or moves, or dies? The systems should be good enough to record enough relevant information such that any doctor can make a valid diagnosis. And to be fair, in my experience they are.

While I can see many valid points in your argument, I think you’re missing a trick here.

As you know I love a good analogy, and for me healthcare is a little bit like owning a car.

When my car breaks down (or, like last Friday, I leave the lights on all day and the battery goes flat, ahem) I don’t care who sorts it out, I just want it fixed. That’s why I’m in the RAC, and so far it’s been worth every penny. It makes no difference who jump starts it or whatever, as long as they know what they’re doing. With healthcare, most of the time, I have the same view. If I’ve got a sore throat (excuse the blatant stealing of your storyline), earache or a cut on my finger that I didn’t clean and got infected (not based on real life events honestly) it doesn’t matter who looks at it and writes the prescription. When I first went to and subsequently dropped out of university I didn’t re-register with a GP for years. Saw a different person every time and had no problems. I’ve had three GPs since I was a little kid and having ditched the first one when I went to uni (his kids were in my year at school, and seeing pictures of them in his office was a bit disturbing on the old confidentiality front) I’ve haven’t seen either of the other two more than twice. On the basis of experience up to about a year ago, I’d have agreed with you 100%.

But more recently, my attitude has changed slightly. To go back to the car analogy, when something just needs fixing quickly, it doesn’t matter who does it. But when it comes to long term servicing, I go back to the same place every year and would think twice about going elsewhere. Several main reasons for this:

I trust them to tell me what needs doing, and not rip me off with stuff that doesn’t
They know what my expectations are in terms of customer service (thanks mainly to a rather impressive CRM system – here we are back at that database again)
I get continuity of care for my car – if something goes wrong with the new engine thingy they put in last time, they have an obligation to sort it out

Trust, expectations, and continuity of care are the key things here that I can get from my GP but not any old Doctor at a walk-in polyclinic. If I have a health condition, physical or mental, that’s going to need ongoing treatment over a number of years, I need to be confident that the person I’m seeing has my best interests in mind, knowing what I want the outcome to be and how I want it to be achieved. The argument that your GP will know you well if you go in every three years with a bit of food poisoning is indeed flawed, but when things get a bit more interesting in health terms the flaws in that argument are reduced. You could argue that I would get that continuity anyway from the specialist I will inevitably be referred to eventually, but most PCTs have such stringent funding policies that I need my GP to fully understand the issue before I can even get a referral.

Yes – there is always the risk that my GP will have an accident while crossing the road (especially working so near to Morrison’s) but that’s a risk I’m prepared to take.

So yes, I think polyclinics are a good idea to provide an efficient responsive service covering the middle ground of short term, minor ailments and injuries thereby reducing pressure on GPs and A&E. But will they ever replace my GP as my primary healthcare provider?

I hope not.

OK Helen, point taken, it’s a good argument. But maybe this is it – one solution does not fit all. Perhaps what we need is a situation whereby there are some doctors who act as traditional GPs, and I can chose to book an appointment with my named doctor. But there are some (probably more, if we look at the proportion of healthcare visits that are along the lines of cold/flu/tonsillitis or minor injury) who work in a drop-in manner. So I don’t *have* to book an appointment, but I can where it’s appropriate. And if I choose to, I would have a much higher likelihood of seeing my own GP than I currently get, as all the people with a cold or a cut wouldn’t be fighting for the same appointments. In densely populated areas, I’d argue that putting these two services together, along with specialists and so on if appropriate, is a very good idea. Clearly in more rural areas it would not be as they’d be too few and far between.

My point is that an old fashioned GP is not the only way to get healthcare, and that’s been a pleasant revelation to me. I’m certainly not suggesting that we ditch all old fashioned GPs as a result though!

A fair compromise indeed.

And get well soon!

Hi Rowan,

My two penn’orth on the matter:

The biggest problems with GP surgeries are that they still operate in an antiquated way. Why should we have to phone up at 9am that day to get an appointment or go in to the surgery? The biggest resentments I’ve seen from people is that they have to fit into the surgery schedules rather than the other way round. The NHS as a whole isn’t patient responsive but then it has no reason to be, they get paid regardless of anything you say or do.

You could operate 24 hour GP surgeries if the government had re-negotiated GP contracts properly, most surgeries have several GPs, why can’t they work on a shift system as in a hospital rather than nice cushy office hours? More and more people work irregular hours why should the medical profession be exempt? You could have one GP on from 6am to 1pm, another on from 1pm to 8pm and another from 8pm to 3am.

I guess what I’m saying is make the GP surgeries into mini walk in centres. Okay a 1:30am appointment wouldn’t be brilliant but as has been said if you’re ill, you’re ill – are you going to care if it’s a 1:30am appointment as long as you get seen quickly?

As for the modernisation, I have some experience with this – when I went to York I had to go to the walk in centre a couple of times and they put all my details into a computer and I was impressed with that. When I came back to London and had to see my GP they had no records of me at all – it was only down to my saying I’ve been coming to the surgery since I was a baby that I wasn’t chucked out. My records I fear were still in their records stands they had in the back office. So they had to create a new record for me which meant I got a sort of health MOT. (Another service I feel they should be providing regularly, like dentist’s check ups). My point is the miraculous efficiency isn’t there – I think it’s probably more the migration of past records than the creation of a database that’s causing the problems?

I’m not sure the way the NHS is funded helps either. I fully agree with funding healthcare through general taxation and that it should be free at the point of use. But there must be a better way of personalising the service so it has to respond to patients rather than the Ministry of Health. I don’t think an insurance based system would help – except to add more bureaucracy. Perhaps we could all have an NHS card – a little card which contains our medical records and every time we go to a surgery or walk in centre they would get paid a set amount per patient they treat – to encourage treating more patients and give patients choice and healthcare providers an incentive to respond to the patient. Could also be useful for a lot of the administration I’d imagine meaning we could cut costs there.

Just a few ideas to chuck into the mix although I think I raised more questions than answers….

Sorry to hear about your illness Rowen. Actually MRI have a GP facility especially for people in your situation to which the drop in may have referred you, but I think you were dealt with by A&E. so you drugs were free. (hospital drugs are!) As for the hesitation, the protocols are strict at MRI and treatment/ prescriptions may have to be authorised by a ‘full’ doctor Check their badges. I hope you did not have a long wait. As for your medical record you can serve an FOI on your GP for a copy if they have them in data form and encript them on to your flash drive. or card.

Hi Rowan,
As an advanced nurse practitioner, nurse manager and independent prescriber working in a walk-in centre I have read your post and the replies with interest, and a sinking feeling in my heart (not caused by you lot I must add!). You all have some very sound ideas, and if you would like a reference to work for the department of health think tank then I will happily give you all references – after all you guys are the ones sat in waiting rooms (several on the same day by the sounds of it with plenty of time to kill whilst you wait!) who have actually experienced our disjointed NHS services, and have some practical and realistic solutions.
The sinking feeling was because all of your ideas have actually (apparently) been translated into reality, for example, a new breed of GP services which combine traditional GP services with a walk-in service for those who are not registered or cannot get an appointment are springing up all over the country, are open 7 days a week from 8 am until 8 pm and are called ‘GP led equitable health centres’ (rolls off the tongue, doesnt it and really informs the general public of their purpose?)
summary care records have been piloted for some years and at some point will be rolled out nationally, meaning that if you agree, your GP will upload basic details of your medical history, prescribed medicines and allergies on to a national spine so that those working in unscheduled care services like walk-in centres and A&E can access this very basic info – (very useful if you have a semiconscious person in front of you who has no idea who they are, never mind the complicated name of their heart condition or which exact antibiotic they are severely allergic to) . However, our wise GP colleagues (some, not all) have put the brakes on this rollout in the interests of patient confidentiality – however as a patient as well as a nurse I know that I can choose what goes on my summary care record, e.g. serious heart condition and potentially fatal allergy to penicillin whilst choosing to withold the fact that I suffer from an obsessive desire to stick a bread knife in my mother-in-law’s back and an annual requirement to have a sick note so I dont miss wimbledon (not esential when I have been scraped of the road and delivered to A&E, though the other info may well save my life and prevent the staff from ending up in court after killing me cos they didnt know any better).
there are lots of services developing and expanding to ensure that those requiring urgent care from a clinician can access this without having to attend A&E or make an appointment to see their GP, and are ideal people who suffer from a minor illness or injury, those who work long hours and cannot afford to take time off work to sit by the phone waiting for the engaged tone to transform into a ringing tone, only to be told the next available appointment is three weeks on Thursday, ……….. when you feel ill, you are ill and need to see a clinician . However, as Helen says, if you have an enduring condition which may require ongoing monitoring and treatment which may change throughout its course, then your GP service is the place to go to ensure continuity and a proper management plan is followed.
Finally, I would be really annoyed if I attended a walk-in centre, saw a nurse who was able to ask all the right questions, perform a physical assessment and analyse these findings to make a diagnosis and tell me what the appropriate treatment is ……………. only to be show the door and pointed in the direction of a doctor with a precription pad (or a cupboard full of drugs in this case). I would say that the majority of walk-in centres employ nurses who are qualified to prescribe, or have been trained to provide drugs to treat common ailments according to a PGD (patient group directive). I recently visited the walk-in centre that you attended and the staff (very highly qualified and experienced nurses) told me how frustrating they found it not to be able to provide routine remedies such as antibiotics because the PCT would not allow them to have these drugs on PGD as they didnt want the local population to increase their resistence to such useful drugs ……………….. sounds a rational arguement? However, reasearch shows that nurses are far better at saying no to providing prescriptions if they are not clinically indicated, and spending time with patients educating them about how to manage their condition without the need for prescription drugs rather than proffering a prescription when they didnt really think it was required, which seems to have been the situation in your case?
Maybe you should point you pen in the direction of the PCT?
However, the unprofessional nurse in me must admit that a prescription does get rid of those pesky patients on a Sunday morning when I have the mother of all hangovers, if only I knew the latin for artificial sweeteners……..!

Jo – very interesting comments, thanks so much for reading and replying. I have both positive and negative reactions to my experiences – my throat improved but never 100%, and after it started deteriorating again 3 weeks later I returned to the infirmary walk-in centre only to be told that the 5 day course of antibiotics I had been given wasn’t enough and given a 10 day course. Judging by the fact that it still hasn’t gone away, I think that the whole thing was viral after all and I just need some more sleep! (The infirmary were always dubious as to whether the antibiotics would help but thought it worth a try!) But the basic fact remains that the walk in centre got me to see a professional in no less time than my GP manages, only without an appointment and at a more sensible time of day. I love the NHS, and particularly with the current discussions in the US, I think it’s important to stand up for the great job you all do. Yes, there’s foibles, and things could improve, but I certainly wouldn’t complain overall.