The RCGP has produced a poster for patients saying GPs need to take breaks - but will this do anything to reduce workload? Claire Davies outlines a 7 point alternative plan.
The RCGP played its latest card in the game of GP politics last week in the form of a poster campaign, aimed at patients, featuring a cheery pilot and a statement that GPs need breaks in order to practice safely.
Decision fatigue is a well-recognised problem but primary care has no safeguards against this and the work just keeps on piling in. A recent study in the Lancet showed that GP consultations have increased by 14% in 7 years and that patients spend longer with their GPs.
But it’s hard to imagine what this poster is going to achieve. Are patients going to read this in the waiting room and slink away? I doubt.
What I would like to see is a more honest conversation with the public about careful use of resources yet as GPs, we seem so averse to this.
This doesn’t have to take the form of hand-to-hand combat or be anti patient; yet any mention of this brings out a twitter storm from both doctors and patients along the lines of “whaddaboutdavulnerables then.”
Here’s a seven point plan to help get on top of our workload - and perhaps enable us to take those elusive rest breaks to help us practice safe care:
1. A campaign enabling people with minor illness to self-care
Anecdotally, we are seeing mounting numbers of patients with colds and minor illnesses, driven by the ‘can’t be too careful’ culture.
A&E have adverts on buses informing people that Accident and Emergency means just that. So why are we as GPs so afraid to let patients know when they don’t need a GP.
We need signposting for patients to reliable online health information - such as the NHS website or patient.co.uk or else promote pharmacy and enable self care (note 111 is not in this list).
2. Call time on the GANFYD culture
Patients are being sent like naughty schoolchildren to get sick notes for schools, letters for skydiving, eyebrow tattooing, skin piercings or for having a day off work with a cold. It just goes on.
GPs cannot continue to dish out letters to cover the backs of the rest of society. We don't have time for this.
3. Help patients use their precriptions wisely
I expect hate mail from this, but there was once a brief moment when I agreed with Jeremy Hunt when he proposed putting the drug value on prescriptions. (There was the inevitable backlash from the ‘whaddaboutdavulnerables’ brigade.)
Patients in other countries already get this information, Holland being one example.
4. Co-payments for consultations
This always meets with huge resistance, claiming GPs do not have capacity to administer this or it will disadvantage patients.
But France, widely held as one of the best health systems in the world, does fine with this system. Patients pay 23 euros for a GP consultation, most of which is reimbursable. Those on low income are covered by the Aide Medical d’Etat (State Medical Aid).
Ironically, French GPs went on strike in 2014 at proposals to move to a free-at-point-of-use NHS style system, saying it would drown them in red tape.
Which side of the channel is right?
5. See your dentist
A GP is not a dentist as much as they are not a lawyer or running a burger bar. Please just stop.
6. A swift rebuttal of any well-meaning group or individual with an idea beginning with the phrase, ‘GPs are ideally placed to…’
This trend has included boiler prescriptions/central heating checks/delivering marriage guidance and treating porn addiction.
If you find yourself uttering this phrase, stop and ask: is this a medical question? If not, please **** off.
7. It’s time to put the ICE on ice (Ideas, Concerns and Expectations)
It’s good to gently help patients get their cards on the table but clinical judgement should not be hostage to them.
We need GP training to include how to say no in a way that respects patients whilst upholding the value of good clinical care and judicious use of resources. No to unwarranted tests, ‘annual bloods’ on young healthy people, repeated lost prescriptions or unnecessary antibiotics.
None of these seven points above are bad for patients or unkind. Most patients are adults and deserve to be treated as such.
If we keep frittering away resources on needless appointments and lost medications, then general practice, as we know it, will cave in. Surgeries are already closing, partners are handing back their contracts and getting an appointment is harder and harder.
Before you know it, private health care will move in.
Whaddaboutdavulnerables when that happens then?
Image by FotoGuy at Flickr.