From the Fibromyalgia News Desk of Jeanne Hambleton
By THE JOBBING DOCTOR
In the first of his new weekly blogs for pulsetoday, The Jobbing Doctor recalls how his last patient of the week exemplified what general practice is about and demonstrated why it will survive despite the Government’s efforts to destroy it.
My last patient of the week (6.30 on a Friday evening) was a young lady who is making her way in the world. She is now nearly 21, and is moving onwards and upwards in her career.
She is working in a large utility group, and has started to apply for managerial jobs. Nothing strange in that, I’m sure you’ll agree. Except that, apart from her mum and nan, I have been the one constant feature of her life. I remember when her mum was in labour, and I attended to her on the local GP unit (and may well have stitched up the episiotomy), looked after all her childhood illnesses, saw her in junior, then senior school, then she became a teenager.
Then, as she started to grow into an adult, it was me who put her on the pill and gave her sexual health advice. Then she left home, and set up home with her boyfriend, but made sure we was close to mum and in Jobbing Doctor’s practice area.
This is one of the stories that many GPs up and down the country could tell, and is the bedrock of the way in which healthcare is delivered in this country. It has worked pretty well until now, although we are beginning to see the cracks in this system as more and more roles are done by non-doctors, and Government values convenience over continuity, and puts all the resources in that direction.
I was reminded of the time when I was a young dad, and would pick up my two daughters from primary school, as we had a new baby. There were little knots of mothers standing around the playground, and as I was a bloke, I didn’t fit in with any particular group, so I drifted from group to group.
They were all talking about the things they had in common, and what they had in common were the experiences of pregnancy, birth, early childhood illnesses, immunisations etc. I heard them referring to colleagues saying ‘Dr Smith came to see me’ or ‘I was examined by Dr Brown’ – I knew Drs. Smith and Brown (but the mums didn’t know me as I live just outside my practice area).
Two things then struck me. Firstly, there would be an identical playground 3 miles away where they would be talking about me! Secondly, whenever they referred to the hospital experience, they would talk about the nurse, the consultant, the midwife, the paediatrician; but whenever they talked about their GPs it was always my doctor, my surgery.
So there you have it. The difference between general practice and hospital medicine is down to the personal possessive pronoun, first person singular versus the definite article. ‘My’ not ‘the’.
Unfortunately, the Government just don’t understand this. Generally, the patients do understand this. This is why General Practice will survive.
The Jobbing Doctor is a jobbing general practitioner in a deprived urban area of England. I tend to write about what I see and experience in primary care – the highs (and there are many of them), the lows (some of them as well), and many other things in between.
There is a long history of doctors who write. Whilst I would never put myself in the same league as almost all of them, there seems to be a compulsion to write down our experiences, as we are often the chronicler of the common man. Writing a blog is really a form of this.
The difference between general practice and hospital medicine is down to the personal possessive pronoun, first person singular versus the definite article. ‘My’ not ‘the’.
MY GP & CUSTOMER SERVICE
If only this man was my doctor? I am signed in to a practice with oodles of GPs and when I want to see my doctor I have to run the gauntlet. By that I mean it is not enough to be feeling so ill you want to see a doctor, but you are faced with telephone calls on an 0844 – not even the receptionist knows how much a minute the calls are.
So you start at 8.30 am precisely ringing the surgery in the hope you might see ‘your’ doctor that day. How could you book yesterday or the day before when you did not feel ill? At 8.30 am precisely I dial the 0844 number and I am advised by a recorded voice that the surgery is receiving a high volume of calls – what? At 8.31 am and 30 seconds. So I wait and wait and even wait until suddenly I hear a voice with a number. Does that mean I am 11th in the queue. The minutes tick on – 5 minutes – shall I hang up, will I feel better later – no I will hang on. I watch the minutes pass on the BBC television newscast screen.
A different message – press 2 for appointments. I am suddenly talking to a real voice and I am so excited I forgot to look and see how long it took. I ask to make an appointment – but my doctor is not in today. Who can I see please? The registrar or a locum. I choose the registrar. Ooophs sorry that appointment has just been taken. Well I will go for the locum. I had the distinct impression that was the last appointment available unless you play the waiting game – sit in the surgery and hope the doctors are not running late and you might be lucky. I once sat there ‘forever’ when the duty doctor I was seeing was called out to an emergency….. It was also chaotic when two GPs were off sick – can you imagine the fun they had juggling the appointments. Boy am I glad I was well that day.
What kind of system are surgeries running? Is there a criteria – rules laid down? It appears you cannot make an appointment for tomorrow – the next day my doctor is off -and so it goes on.
The alternative is to be ill by appointment. If you can book an appointment for Thursday week, then it seems that is the day to be ill. I certainly am not interested in polyclinics with people untrained in fibromyalgia and saying “Fibro what?” Give me the old bedside manner, a doctor who remembers you have got fibromyalgia as well as cares and understands. I think they call that plain old customer service.
Dear Jobbing Doctor will you be mine? You might even be the one to prescribe some co-proxamol for me, if you knew me well.
What I also find hard to bear is the cost of hanging on line from 8.30 am precisely using a mobile telephone to book an urgent appointment (as you have no alternative telephone at home and the telephone boxes are in pieces). I have been told this cost one person £12 on the mobile. You could say that person was sick – sick to the back teeth with it all.
Now the Government is pushing up the prescription and dentistry charges while much of the British Isles enjoy free prescriptions. The hospital car park charges will be going up next. Who can afford to be ill – is it the credit crunch do you think?
Having said all that I can remember when we had a very angry receptionist – she was so unpleasant patients called her the Rottweiler. I am glad that has changed. At least we now see a smiling face when we are feeling proper poorly even if we did have to wait until Michelmas to see a doctor. JH.
The practice-based structure of UK general practice is ‘unsustainable’. That’s the verdict of the BMA and RCGP, which have begun radical moves to overhaul the GP business model. including a move to large umbrella organisations running several surgeries. The far-reaching policy paper from the two organisations also envisages the end of the distinction between partners and salaried GPs and proposes new ‘primary care director’ roles.
The report comes as NHS managers admit GPs face a battle with Darzi centres for their practice nurses. Also, following SHA reports under World Class Commissioning which showed even even trailblazers were failing to meet Government targets, PCTs are set to ramp up their drive to attract private providers.
To help you get to grips with the changing landscape, we’ve got aspecial report on maximising your practice profits, with advice on boosting income, bidding for contracts and assessing the profitability of enhanced services.
Much talk this week about patients being able to rate practices online. Well, the host site for this, NHS Choices, is riddled with errors, with half of listings not showing if practices are offering extended hours or having wrong opening hours.