15 June 2008

The death of GP care

Dr Grumble has just read this stunning article. He was stunned because, for the first time, a journo appears to have got it right and understood exactly the problem with polyclinics. Well done the journalist, Keith Hopcroft, on excellent research producing a simply brilliant article deserving of the highest journalistic accolades. Just who is this journalist with something useful between his ears? But wait. Isn't Keith Hopcroft an expert on itchy bums? Strewth! He's not a journo at all. He's a GP moonlighting.

Dr Grumble has a message for Dr Hopcroft. Keith, you are wasted on itchy bums. Stick to getting out the message on the polyclinic problem.


niku said...

I don't understand your arguments, and that includes the ones made by the Times reporter. As a patient with a family, I am far more inconvenienced when I have to access reasonably uncomplicated tests at another facility, or even my local hospital.

Two years ago my local GP joined a group practice in the next village. I do have to travel 3 miles on the bus, but there is a stop in front of the new clinic so it isn't a problem. The building is new and clean, looks professional, in stark contrast to my doctors old house that was in dire need of remodeling. They provide services that my doctor was not able to at his home and if he is not available, it is not ideal, but I can see one of his partners. They provide for much more of my care in this new building.

My neighbor is elderly and must go to the "local" hospital, some 12 miles away to have tests. As I understand it, many of those could be provided locally. Can you please explain why that is so disastrous?

Dr Grumble said...

Niku you are right in that this is not a black and white issue. Your views are similar to those of Lord Darzi which have been widely aired. Young people seem to be very much in favour of the polyclinic approach. That's probably why they are being introduced. They are the people who turned up at the focus groups. But the elderly who are heavy users of the GP service may not agree. You can do quite a lot without special tests and it's unrealistic to think that you can have the full range of tests available in a medium sized hospital available in every polyclinic. If you have to get on the bus to go to the GP you might as well stay on until the bus reaches the hospital. And putting the polyclinic in the hospital is one of the possible Darzi models. But none of this has been properly thought through or discussed. It's being imposed and privatisation seems to be part of the process. Even that is not a black and white issue either but it should be discussed. Instead it is happening by stealth and there's no public discussion. Unless you are involved you will not be aware of it. It does seem that there must be some covert privatisation policy because, effectively, GPs are being prevented from preparing bids for these new Darzi centres.

The government with the new GP contract has already damaged the GP out of hours service which has to have been one of the best in the world. It would be a shame if they went on with their ill thought out policies and cause further deterioration in out of hospital care. All Dr G is insisting on is a proper and informed debate.

Actually there are some hospital doctors (for example a gynaecologist called Professor Smith) who think that GPs do their own speciality so badly that all patients should see a specialist. That's a model used in some other countries but this is not really a black and white issue either.

The arguments against the Darzi clinics are in the Guardian article and you have put the alternative view. Much may depend on just which of various models is adopted as to how successful they might be.