Thurrock GP defends not signing up for health checks for Thurrock residents with learning difficulties

HEALTH watchdogs have named and shamed the Thurrock GP surgeries that, according to them, are yet to sign up for annual health checks for people with learning disabilities.

The subject has been at the forefront of discussion for over a year now.

All practices in Southend and West Essex have signed up but according to health professionals, Thurrock still lags behind.

The practices that have not signed up are:

Suntharalingam Surgery: Tilbury: 7

Balfour Medical Centre: Thurrock: 38

Shehadeh Tilbury: 41

Masson KK: Thurrock: 7

Thurrock Health Centre: 19

So, we spoke to one of the GPs, Dr Emil Shehadeh, and asked for his response.

Dr Sheahdeh said:

"I have been handed a list of GP practices, who apparently do not provide health checks for people with learning disabilities. Shock and horror, my practice is on that dreaded list of baddies! Should I curl up in shame and embarrassment?

Firstly why are these new health checks deemed necessary? Secondly, why do some practices offer them whilst others do not? And thirdly, is general practice the right setting for them to be offered?

Why Are These Health Checks Deemed Necessary?

The health checks are based on evidence that people with learning disabilities are at higher risk of mortality, especially from cardiovascular disease. For instance they tend to have a higher rate of obesity, which increases cardiovascular risk. Allied with anecdotal evidence, the NHS has decided that these health checks should be offered through GP practices, who may opt to offer them to patients. It is important to underscore this point. GP’s are not obliged to offer these health checks. Why not?

Just because there is evidence of increased mortality, it is wrong to assume that health checks would make a difference to mortality. A health check showing that a patient is obese would result in a recording of that fact in their medical records. What then? They may be referred to a dietician? What next? They may or may not attend. If they did attend, is there any reliable evidence that such referrals lead to sustained weight loss, or improved mortality?

Having said that, we routinely measure and record BMI ( obesity) and offer interventions, regardless of whether patients suffer from learning disabilities. We immunise children and adults regardless of whether they have learning disabilities or not. We measure their blood pressure and offer them all the screens offered to those without learning disabilities. These screens involve asking questions such as : “do you have a cough?” and “Do you bleed when you open your bowels?”. Firstly, are we to believe that the carers or parents of such a person would not seek help from their GP in the presence of such symptoms?! And if so, how many times a year should we be performing these checks?! Therefore I think these health checks are more emotive than evidence based.

Why do Some GPs Offer Them, Whilst Others Don’t?

Because some GPs are bad? Of course this is the implication in the press. Firstly, GPs are not obliged to offer them. Secondly, is it unreasonable to assume that those who offer the service are better or more caring GPs than those who don’t? So why would a GP forego £100.00 per health check?

These health checks are only one of numerous services GP’s can opt to provide or not provide. These services may include taking blood samples, an anticoagulant clinic, family planning, minor surgery, extended evening hours and so on and so forth. There seems to be a kind of crusade to shame practices that do not offer health checks for learning disabilities. No practice is demonised for not providing an anticoagulant clinic, or a coil clinic or even child health surveillance. Why the different attitude? Because when it comes to disadvantaged people, emotions get in the way. These are not rational criticisms.

In my last blog I touched on how busy general practice is. Some practices cannot cope with the basic core work which has doubled in the last 10 years, whilst funding has decreased. How are they supposed to cope with all these additional services? One cannot just hire a doctor, if such a doctor could be found, to do these medicals. 40 patients is too few for a practice to recruit a doctor to do them. It would be akin to buying a quarter of an apple from your grocers. The health checks, as is the norm in the NHS, are poorly remunerated. They are very time consuming, and often result in repeat encounters. Many GPs have good reason to doubt whether they are necessary, and may believe that their time is better spent pursuing activities that are proven to improve health rather than those that are simply politically correct. Some practices may be larger and better resourced. The readers may not be aware that until recently, some practices were paid half as much for doing the same job. The NHS preaches equality, but practices and maintains inequality. Practices are still on different tariffs even now..

Is General Practice The Right Setting for The Learning Disability Health Checks?

My practice attempted to offer this service. However, it meant other services had to suffer. We therefore bought in provision from a third party. This year, we have been told that the same provider has withdrawn this service! Why? If it is such a good idea to have these health checks, and if they were fairly remunerated, why are GPs and other providers not so keen on offering them?

General practice, through sustained underinvestment is in the grip of a premises crisis. As one patient put it, her dog’s vet premises are far superior to her GP’s premises. Why? Because the NHS prefers to pay lower rent on inferior premises. But this means that even if some GPs wanted to offer these additional services, there is no space for the additional staff to work from.

If it is right for health visitors, midwives and district nurses to work outside GP surgeries, why cannot these health checks be performed by an expert team rather than an overstressed, overburdened under-resourced general practice? Is it because, yet again this service has been poorly thought out by politically correct, well intentioned, zealots?

If government and members of the public continue to increase expectations from General Practice, we are going to see the crisis of attracting and retaining GPs further exacerbated by this irrational and unreasonable approach to provision of health care. General Practice cannot be the panaceum to all the nation’s problems, certainly not without adequate support.

It is uncanny that on the day that I was asked to write this blog, the British media was reporting a warning by the Royal College of GPs that due to early retirement, fewer applicants to general practice, and fewer GP trainees, 543 practices in England are at risk of closure if something isn’t done.

According to the RCGP, the number of unfilled GP posts has quadrupled from 2.1% in 2010 to 7.9% in 2013. In that same period, applications for GP training have dropped by around 15%.

90% of GPs in practices at risk of closure are over the age of 60. The average retiring age for GPs is 59 years. Why? It has become an extremely stressful career with unreasonable expectations, constant criticism and underinvestment. I for one do not need the stress of offering a poorly thought out service, whose benefit is dubious and which is underfunded.

If the NHS insists on these health checks being performed in general practice, the only way forward is for GPs to federate and employ specially trained staff to cover an entire area such as Thurrock. We hope to have such a federation up and running In the New Year. Will the area team adequately fund such a service? We shall find out in due course.

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