Holidays

I love holidays. I don't love coming back from holiday.

Just about all GPs have a collection of patients who will only see one particular GP. They'd rather wait until you come back from holiday to be seen rather than see one of your partners. You'd think that we should be flattered by this. The problem is that they tend to be heartsinks.

When I return from holiday, I can write down a list of no more than 20-25 patients. I can guarantee that half of the patients I see on my first day back will come from this small group.

I think I'll go on holiday again.

Drugs and Therapeutics Bulletin

One of the more readable journals that helps keep Dr Phibes up to date is the Drugs And Therapeutics Bulletin.

It is an independent journal, advising about the most effective treatments for a wide variety of medical conditions, and for years has been circulated free of charge to GPs with the help of government sponsorship.

Now that sponsorship is being withdrawn.

So now Dr Phibes will need to pay a subscription to continue to be able to read it.

But why is that sponsorship being withdrawn? Possibly because it is too independent, sometimes openly criticising that other "independent" body NICE.

Nutramigen

I was reading Dr Jest's Caseblog. He posted on the topic of breastfeeding which reminded me of this situation that occurred to me recently.

Mrs Ward came to see me with her 10 week old baby boy. He was grizzly and appeared in pain every time he took a feed, and she thought he was not only lactose intolerant, but also soy product intolerant. She requested I prescribe him Nutramigen.

The thing is Mrs Ward had been here before with her older child. They had been referred to paediatric dietitians before a diagnosis of lactose intolerance was made, and nutramigen prescribed with good effect.

The history of the latest Ward child's feeding problems had been relatively short lived. What to do? Strictly speaking I should have referred to the dietitians again, or at least left things a little longer.

To complicate things however, Mrs Ward was clearly not coping, had had postnatal depression with her previous child, and was showing signs that this was happening again.

So I prescribed. The result is a much happier baby. But would things have settled down by themselves? The problem now is trying to convince Mrs Ward that her baby may not need Nutramigen. I've suggested a trial with normal formula milk, but to restart nutramigen at the first signs of problems. Perhaps understandably Mrs Ward is not keen in her current emotional situation.

Tricky one.

More on the NHS crisis in Bournemouth

Following on from my post yesterday, more reporting in Bournemouth's local paper about the crisis beteen the PCT and hospital.

NHS Deficit

So the NHS makes the headlines again for running up a huge deficit, estimated at £512m.

So how does the NHS lose money? Essentially the NHS is made up of lots of independent parts, all trying to balance the books.

Government gives money to the various PCTs around the country. The PCTs then have to prioritise how they spend this money; paying GP practices, paying for the cost of drugs, and, of course paying the hospitals for the care they provide.

Dr Phibes' attention has been drawn to a particular problem down in Bournemouth. It would appear that Bournemouth hospital have been doing a sterling job at treating patients. The problem is that the government has not given Bournemouth PCT enough money to pay for all this treatment. This means that either Bournemouth Hospital will be underpaid for the work it has done, or Bournemouth PCT will be overspent. In other words somebody has to lose.

Whose fault is it?

Well who is stoking up demand, promising that all patients referred to hospital will be seen within a certain time, while at the same time saying it has to be done with an inadequate sum of money?

Admittedly some trusts seem to deal financially better than others, but in order to balance the books this inevitably is going to lead to a cut in services, or longer waiting lists. If you read the above newspaper article, Bournemouth stress they have the capacity to deal with the work, it's just they're not going to be paid for it.

So it's divide and conquer. When 2 NHS organisations are arguing like this with each other over funding, what chance has everybody else got?

GP Star Ratings

It happened to hospitals, and now it is coming to a GP surgery near you.

I talk, of course, about today's suggestion that every GP practice should undergo regular assessment and be awarded "Michelin style stars".

On the face of it, why shouldn't you know how good your GP is compared to the surgery down the road?

The answer is "If only it was that simple".

History tells us what a disaster the hospital star ratings system has been, too crude to accurately portray how good or bad a hospital really is. Why should it be any different when applied to GPs? The fact that a star rating system has to measure something means that when it comes to medicine it is doomed from the start. Medicine isn't an exact science.

And who's going to do all of these assessments? Us GPs amongst others apparently. Has anybody tried to figure out how much time nationwide this process will take? It's going to take two days to assess each and every practice. Practices will cancel surgeries to fit these in. At a time when demand for appointments continues to rise, this just seems like madness.

Let's hope this is another idea that withers and dies.

Lazy GPs

Recently the press was full of information about how GPs were all earning £250,000 for doing less work.

I gather that there are about 6 out of approximately 30,000 GPs earning this amount. But I digress.

Newspapers and websites ran stories about it, such as the BBC. They also invited people to pass comment on "have your say".

There was the inevitable variety of comments, some positive, some negative. What made me sad were several comments suggesting that all GPs are lazy fat cats.

As I've said above there are approximately 30,000 GPs. Of course some will be lazy. But all of us? I don't think so.

So why the perception to some that we are all lazy? Perhaps they couldn't get an appointment as quickly as they wished. Maybe a request for a home visit was declined.

The conclusion I arrive at is that the complainers are ignorant as to what a GP actually does with his or her time. They can't see beyond the time that a doctor spends seeing patients in surgery, i.e. if we're not seeing a patient, we're not doing anything. They don't account for the administrative tasks we have to do, which takes over 50% of our time. Do the prescriptions sign themselves? Do the referral letters write themselves? And so on.

Are we worth the money we are paid? I would say yes, obviously, but this could be debated sensibly.

But are we lazy? Definitely not.