If we used the tools of our time would returning out-of-hours responsibility to GPs still be ridiculous?

Medicine at the sharp end by Dr Chris Lancelot

I’m surprised to read a former GP who obviously get’s the social media opportunity for Healthcare Professionals (I think the guidance on Social Media use by Doctors is even more fundamentally flawed) being so dismissive of the capacity of GP groups to take back responsibility for out of hours care.

Some of my thoughts on the article:

Returning out-of-hours responsibility to GPs would be ridiculous

I think it’s even more ridiculous that GPs were paid to give up this responsibility in the first place. To take it back without change is impossible and it should be obvious that the tools of our time offer huge potential.

I wonder what mantra the DH slaves in the back of Jeremy Hunt’s chariot have been reiterating? ‘GPs are lazy and overpaid’ I suspect. And this, repeated ad nauseam will ultimately have brainwashed him

I’m not surprised that Jeremy Hunt has encountered this backlash as GP morale across the NHS is under massive attack eg. they face daily criticism from Hospitals for taking an increasingly defensive approach and referring too many Patients but the odds of being sued have never been so high (claims have risen by 40% in a year!) and obviously the Doctors working in the A&E of a Hospital are covered by their employer (unlike the GP who pays for their own medico-legal insurance).

His first foot-in-mouth decision was to announce that the NHS should be paperless by 2018. He’s mad! Or, more likely, the slaves in the DH chariot have been telling him that this goal is perfectly achievable

I agree wholeheartly. When you spend any time at all near Westminster you quickly realise there are much more important drives to paperless needed first eg. why don’t we have electronic voting and why are affluent politicians advocating paperless futures and Skype consults for Patients when they still use so much paper and needless travel in their own work?

His next plan was to identify all patients with early Alzheimer’s. (‘Compassionate and laudable,’ said the slaves.) But what, in
practical terms, do we do with the information?

Most fast tracked efforts by governments are poorly considered. To me it seems daft to focus on Alzheimers identification when so many other things are being brushed under the carpet because we don’t give GPs the time and we’re not using clinically validated tools to listen to Patients and let them document their needs. Leading with what might be percieved to be an Alzheimer’s focus is also one sure fire way of decreasing Patient interest in the preventative health opportunity.

Now Hunt has said that the increasing level of A&E attendance is because GPs aren’t doing their job properly, signalling that we will soon be asked to take back responsibility for out-of-hours

I think this is because persistent government efforts to make change regardless of evidence based medicine have created a diverse variety of choices for Patients during the time when GP clinics are closed (you can call 111, call NHS Direct, go to a walk in clinic, see a GP in an A&E, visit your GPs website, visit the NHS Choices website, visit A&E, go to a 24 hr Pharmacy, etc, etc). Can you imagine any other business trying to serve needs as complex and continuous as healthcare that operated with such a range of uncoordinated initial contact points?

This risks being the straw that breaks the camel’s back. Clearly the slaves in the DH chariot have no understanding of the current stresses on general practice. (They even think that our morale is ‘high’.) With reductions in MPIG, revalidation, CQC, the CCGs, a 12-hour working day, increased devolvement of hospital work and — crucially — reduced GP recruitment and increasing early retirement, it would be ridiculous to give primary care the additional burden of out-of-hours

I wonder if Dr Lancelot would change his mind if Jeremy Hunt said that he would be ring fencing the £100,000,000 plus per year that was being used to fund NHS Direct and would be using it to pay for a single point of contact for OOH care that would use clinically validated Patient History Taking tools and create remote/home flexible working opportunities for semi retired GPs, the ~8000 registered Doctors who are on extended paternity/maternity leave, the rural GPs who may find their clinics too quiet to scratch a living or employ an assistant, etc, etc.

Obviously this will require an acceptance that we need the most experienced and expensive GPs being used efficiently to do the triage but can you imagine the impact if the NHS had a learning system that was ensuring every patient accessing the NHS was being guided to the right place every time and every single Patient that had to be actually seen arrived with the Healthcare Professional best suited to help them together with electronic documentation of their particular concerns and needs?

I appreciate that most Doctors learnt to do their work in very different times and although it’s typically a disaster when anyone is led down a path involving technology by people who don’t actually use the technology themselves, it’s equally clear to me that there are analogies we can follow from other verticals and we live in a time of unprecendented exponential change…









What do you think?

About David Doherty

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1 Response to If we used the tools of our time would returning out-of-hours responsibility to GPs still be ridiculous?

  1. Pingback: With 70% of UK Medical Students now female isn’t it obvious that the changed workforce needs more than just flexible working hour arrangements? | mHealth Insight: the blog of 3G Doctor

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