The Good Doctor’s Blog: More scapegoating of GPs

More Scapegoating of GPs

“The search for a scapegoat is the easiest of all hunting expeditions.”
(Dwight D. Eisenhower)

Within the space of 24 hours the news media announced that 6 million patients last year went to A&E because they could not obtain an appointment with their GP. Simultaneously it was announced that Jeremy Hunt wants to red-card GPs who do not refer suspected cancer patients early. It was also announced that out of 32 developed countries we rank 30th in the use of MRI scans.

What was Mr Hunt trying to achieve?

Politicians want to be re-elected, at any price, and would say anything to get re-elected. They love deflecting blame to others and GPs are the punch bags of the NHS. The reason patients go to A&E, is only partly due to lack of GP appointments. However this is relative. Increase in demand has outstripped supply. We are 10,000 GP short in England alone. Politicians are good at talking big, bragging about our “world class” standards. Really?! If one of the poorest countries in the world, Cuba, has 500 patients per GP, and we the seventh richest nation on earth have circa 2000 patients per GP, what meaning does that give our “world class” standards?. Humbug!

With respect to cancer, the biggest problem is not that 1 in 10 are apparently referred late. It is that when GP’s refer, their knuckles are rapped for over-referring. Further, our patients have their first appointment 2-3 weeks after a referral. Then they have to wait a few weeks for their MRI or CT scan, and often have to wait for months before any treatment commences.

Why is that? Because we do fewer MRI scans than most developed countries. Yet it was British brains that developed the darn machine! Is this any surprise? No. We are the 7th richest nation on earth, but rank 63rd in terms of money spent per capita on health. 63rd! this is NOT world class. It is almost third world class!

Who decides whether a referral was timely?

It is not clear who has determined that 1 in 10 patients are referred late. It is convenient for some analysts to sit in judgement. Hospital doctors have all the toys that GPs do not have. In much poorer countries, GPs are equipped with ultrasounds. Why is this “world class” NHS not capable of supplying GPs with ultrasound equipment? An urgent ultrasound in general practice takes up to 6 weeks to arrange. By the time a patient has seen a specialist, the GP will have done the groundwork, the time consuming agonising work.

Why are some people referred late?

Cancers are inherently difficult to diagnose for all sorts of reasons. Most cancers only become apparent in the late stages. We have no accurate cancer markers for any of the known cancers. A GP referral depends on whit, not on any reliable science. Even some red flags that we utilise, such as early morning headaches for brain tumours are only 40% reliable. We know that some people present late. We also know that some people present with totally unrelated symptoms, and perhaps two or three visits later may present with something vaguely suggestive of cancer.

Decision time:

If the secretary for Health is hunting for an excuse to deflect attention from the underinvestment in general practice, scapegoating GPs may be the easiest option, but all he will achieve is an increased referral rate, longer waiting lists for suspected cancer patients, more early retirement for GPs and a falling interest in general practice amongst young doctors.

Mr Hunt cannot criticise GPs for over-referring, then blame them for late referrals. GPs do 90% of the NHS work and we get less than 9% of the NHS budget. Whilst demand on general practice is increasing, our politicians think it prudent to decrease investment in general practice.

To employ 10,000 GPs, the additional number needed to cope with the additional demand on general practice, it would cost the NHS £2 billion/year. However, most of this money would be recouped through reduced demand on hospitals, and through preventative medicine which is a life and pound saving approach to health.

NHS managers waste billions every year on useless, poorly thought out projects. Why baulk at a prudent investment such as this?! Because it is too commonsensical! The solution is to Invest in proportion to the wealth and claims to excellence, which our politicians constantly boast. Alas, this is too obvious a solution. Politicians love rearranging chairs to try and improve capacity. The obvious solution never appeals to them. Trimming down an expensive and overgrown civil service never occurs to them, except just before a general election.

To blame GPs for the failures of the NHS is having one sure outcome: fewer doctors want to be GPs. In some regions, over one third of training posts in general practice remain unfilled. Doctors do not want to be GPs anymore. If my daughter were to become a GP, I would think she has gone mad. Worse still, more GPs are retiring early because of the constant underinvestment in, criticism and defamation of GPs by politicians.

The public needs to mobilise and force politicians to do right by their local GP practices, or else we may wake up one day and find it is too late, if this has not occurred already. You cannot just grow GPs overnight. Of course you can always bring Romanian GPs over here to fill the gap, and they would be happy with a lower pay too. The worrying part is that history proves that NHS senior management are foolish enough to go down this suicidal path.

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