THE doctor will see you now.
It used to be so simple. One turned up to see one's GP, who offered reassurance that nothing was seriously wrong, proffered a prescription, arranged a consultant's appointment or (rarely) sent you straight to hospital.
Today every aspect of the process is more complex for patient and GP alike. For the patient the process often starts with the unsatisfactory choice between the daily scramble for one of that day's appointment slots or a wait of up to a week. For the doctor there's the challenge of responding to the patient's reason for attending, while a computer screen fills up with pop-up reminders about topics ranging from a missed smear test to monitoring the patient's blood pressure or alcohol intake. All in 10 minutes.
Simultaneously, the GP is expected to co-ordinate a team of health professionals and administrative staff, conduct a myriad of procedures once done in hospital, and, increasingly, conduct extra investigations and follow-up work for patients who have been discharged from hospital.
In The Herald today Dr Alan McDevitt, incoming chairman of the BMA's Scottish GP Committee, warns that family doctors are already "at saturation point". We have more elderly people with more complex medical conditions living longer than ever before. If the Scottish Government is to achieve the integration of health and social care, if more people are to be treated in their own communities and if more are to get their wish to die at home – all desirable goals – primary care capacity must be increased. In plain language, we need far more GPs. Yet currently, the number of university places for Scottish medical students is declining.
In 2005 the Kerr Report set out a framework for a Scottish NHS that would be personal to each of us. Care once centred in hospitals would become community-based. Disjointed, episodic, reactive care would morph into integrated, continuous, preventative care. Patients would be partners in their own care, rather than passive recipients. It was an inspiring vision but it cannot be achieved without placing GPs at the heart of our health service and giving them the support and resources they need.
This particularly applies to practices in the most deprived areas where currently the inverse care law applies: health services are more stretched and least effective in the areas that need them most because the population suffers more ill health for longer periods than those in wealthier districts, despite the same patient-GP ratios.
As well as more GPs, communications between GPs and consultants, which have deteriorated as a result of centralisation and administrative changes, must be improved if we are to reduce the number of patients being admitted and re-admitted to hospital.
For their part, GPs, who did so well out of the contracts introduced in 2004, when they gave up responsibility for out-of-hours care, need to consult their patients on improvements to appointment booking systems and extended hours arrangements to fit around the working day.
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