18 September 2009

Burnham banishes boundaries - but only for GPs

At the King's Fund event at which the health secretary announced his ill-thought-out plans to allow patients to have a GP tens of miles away from where they live, those gathered at the briefing were asked who would take the opportunity to change their GP, if offered the freedom to do so under the new rules. Not a single hand was raised.

One of the things that drives Dr Grumble crazy is the compartmentalisation of many other NHS services for which there seems to be no good reason. Quite often Grumble offers his patients some service or other only to find they live on the wrong side of the road and it is not available to them. Why doesn't Mr Burnham do something really useful and breakdown the boundaries for services like mental health, physiotherapy and the like?

Unfortunately Mr Burnham is only interested in young healthy people and not sick elderly people. Now why do you think that is?


No One said...

na youre wrong grumble

for a whole bunch of reasons you dont appeat to understand

try living in the centre of coventry and going to one of the few GPs you can choose from, and come back here and tell me youre happy with the service

try working away from home most of the time and yet being expected to go back to your home town 200 miles away to get a GP to refer you or whatever

the nhs needs to change big time

probaby burnham doesnt understand either

Prisoner of Hope said...

@ No-One: been there (Sheffield not Coventry)and done that too (working in London Glasgow Denmark Saudi Arabia) while attending 5 or 6 acute clinics, having in that time 4 major operations and numerous tests. Yes you are right when I was young active & running my own business it was a real pain. But what was more of a pain and - continues to be - is the lack of continuity of care that is forced on me by the compartmentalism Dr G mentions.

There is a real tension in the demands of young economically active businessmen and the increasingly complex needs of an ageing population with multiple co-morbidities and polypharmacy.

If you don't understand that - well then it is you do not appear to understand let alone have any empathy for those who (unlike you) are not able even to articulate their frustration.

Many of those who feel disenfranchised are frustrated with the way the service has been pandering to the complacent majority who have a misplaced faith in the ersatz market and choice agenda.

Perhaps the forthcoming general election might make this real choice clearer and we might get to vote for whether priority is given to those in employment (which after all was behind Beveridge's original concept)and let the old and infirm go to the wall. We obviously cannot satisfy both "constituencies", especially if we continue to be beguiled by false efficiencies and lose sight of the economic value of effective health care provision.

Sam said...

Having choice to change GP does not neccessarily mean choosing another miles away from home, although this remains a perfectly valid option for those who wish for this kind of change. For many others, changing GP means moving from one you're not happy with for one reason or another to one that suits one's circomstances more ... even at the same locality ... ie, doing away with the current rigid 'you're with me whether you like it or not' approach to a more flexible system that allows for the humanity of individual patients and their differing needs.

Anonymous said...

P o H

Yea I have close friends and relatives who are "ageing population with multiple co-morbidities and polypharmacy." and they have had one GP imposed on them by the local PCT much to the upset of the GP they and he would have rather had, such people do indeed have many issues, but I see no reason at all why they should not be able to choose which GP they see

re "young economically active businessmen" even women eh? its very hard to do a normal job that involves even a small amount of travel if you are something like diabetc, the nhs is setup totally assuming folk are tied to one town all the time, compare and contrast with somewhere like belgium where the system bends to the needs of the patient and not the other way round like we have to do

im not in the complacent majority thats for sure

i dont have total faith in markets, but like democracy its the best of a lot of bad choices, needs good regulation, but end consumer choice overwhelmingly produces the right kinds of pressures in a system

simple things like the arrogance of typical UK GP receptionists would change within a few months of the patients having any real choice like they do in the entire rest of the planet

I could take Grumble round a few towns and cities and show him how crap the current setup is, I dont think he realises

no one (too lazy to log in)

Dr John Crippen said...

Spot on again, Dr G.

The "abolition" of GP boundaries is cheap political point scoring by a government bereft of policy. It is another step on the road to 24/7 supermarket medicine provided by "intermediate practitioners".

The overwhelming majority of patients do not want to change their GP. The few who wish to change almost always can do so. Yes, in country areas there may be no viable choice...but quite how the "right" to change to a doctor 50 miles away will help anyone is beyond me.

This is about catering for resource-hungry middle class commuters who write letters to newspapers about "free access" and "choice" and whose agenda is to establish their "right" to be able to pop in to a doctor (any doctor) close to work to get their ears syringed during their lunch hour.

It is another step on the path towards the end of continuity of care


No One said...

dr C you should know better

havnt I convinced u yet

i must get round to writing you a letter with some real world examples so that you can see how ridiculous the current situation is

Dr John Crippen said...

No One

I'm closer to you than you think. The NHS is falling apart. Something needs to be done. But meaningless bogus policy changes like "abolishing" GP boundaries will do nothing.


Dr John Crippen said...

No One

I'm closer to you than you think. The NHS is falling apart. Something needs to be done. But meaningless bogus policy changes like "abolishing" GP boundaries will do nothing.


phatboy said...

What's wrong with being able to choose your GP?

Personally, I live in west London and work in east London. This means that if I need to see the doctor I have to take at least half a day off work.

In the last year, I've seen my GP for a variety of reasons (chest pain (turned out to be muscular), various skin disorders and back pain). Only one of those was urgent, but all of them required a lot of time off work.

If I'd been able to see a GP near work rather than home I would have missed an hour of work at most!

I don't see a dentist because he's the one closest to home. I don't chose a solicitor because he's in the next street. Why should I go to a GP (who let's face is may be less that brilliant) just because he's the closest?

Prisoner of Hope said...

@phatboy: Why choose a GP just because he is close? Well it might just have something to do with the concept of GP as "gatekeeper" to other services. It also has something to do with protecting the needy from losing out too much to the greedy.

If you are a fit active commuter with occasional health concerns then its fine to shop around and to pick and choose from competing service providers. However without control of your own medical records you will likely not receive anything approaching continuity of care - but then that's a risk you can take and pay later for the consequences.

For those with multiple long term health problems that require intelligent and sensible co-ordination of a range of possible interventions then someone who not only knows what services are available locally but can refer to them and help judge between them will be a godsend - particularly for those who are not mobile or are housebound.

You see we have (at least) 2 distinct groups of patients with demands that pull in opposing directions. (I choose to define these - for the purposes of argument - as the needy and the greedy)

Perhaps we need to separate out a National (Acute) Illness Service with vastly diminished resources (used efficiently - but not necessarily effectively) alongside a new National Care Service. The former could be funded by insurance or direct payments and managed by Tesco, Virgin etc and the latter could be funded from taxation, national insurance and the Care green paper's proposed (one off retirement lump sum) insurance premium.

Of course this would mean accepting the reality of a 2 tier service and continuing (if not increasing)geographic and social disparities in health outcomes. Some would be happy with these - others are not.

20 years ago there were 3 key values that the NHS tried to keep in balance. They were (1) Quality of Care, (2) Equity of Provision and (3) Responsible Stewardship of Public Money. This is a difficult juggling act to pull off and it is a lot easier to manage with just 2 of these concerns rather than all 3.

Some commentators seem all too eager to drop Equity and to ignore the needy in favour of the greedy.

Some people seem all to ready to drop Quality of service as a key value.

We are of course in danger of giving the greedy what they demand (and have been doing so for the last 20 years) while surrendering equitable access to high quality health care for the needy.

While there will no doubt continue to be some poor local GPs most remain altruistic and committed to equitable access to high quality care for all. For the sake of the needy we should do all we can to protect the good GPs from the consequences of the selfish demands of the greedy among us and then ensure that as Dr C argues it will always be possible to change GP if a relationship has broken down.

No One said...

whats greedy about working your socks off, paying lots of tax, and needing to see a GP while working miles away from home?

where is the "Equity of Provision" for diabetics who move house frequently? or travel all the time for work?

where is the "Quality of Care" for anyone who doesnt fit the neat stereotype of staying at one address continuously which the NHS assumes and provides care for?

P o H you are not making sense to me

Anonymous said...

GP boundaries suit the GP not the patient. I want to have a GP near my place of work, that would be convenient for me and as I am the one who is sick, I should choose.

In the event I would ever need a GP out of hours, then it would be life or death & I would rather call an ambulance so that's a fatuous argument.

If you're correct then no one will move from their local GP.

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