On my recent holidays I ran into an old friend who is a GP in the north of England, and who also happens to be the son of our old family doctor. While he had followed in his father's footsteps, he did not appear to be very happy with his career and almost the first thing he asked me about was about the prospect of working in Australia.
His main gripe was that he felt he was no longer able to function as a family doctor in Britain. The changes in the UK health service meant that it was almost impossible to provide continuity of care for patients, he said. The move to multidisciplinary care teams meant that many of the routine tasks of a general practitioner were now done by allied health professionals such as nurses in specialist clinics or by community health workers such as midwives, and he no longer saw his patients all the time.
While this might be considered more 'efficient' it meant he did not provide holistic care, he said, especially as there seemed to be less of the informal chats about patient care between team members.
Unlike his father, he rarely did house calls, with after hours work outsourced to agencies and patients being encouraged to call the telephone triage service, NHS Direct or to use new nurse-staffed 'walk-in' centres. And whereas his father was able to refer his patients to a network of trusted local specialists, he was now forced to use a computerised "Choose and Book" system that allocated patients to unfamiliar hospital 'care team', with whom he had little or no dialogue.
The upshot of all this was that he was no longer familiar with many of his patients and their ongoing treatment, despite them being enrolled at his practice. I recalled how his father, the GP, had always seemed to remember us and our medical histories, on our visits to the old practice.
Like many Poms, my friend believed the grass would certainly be greener Down Under. I wasn't sure if he was serious about moving to Australia, but I suspect he will be less enthusiastic when he reads about this week's proposed health reforms.
Comments
Your article highlights a point I have been making for some time regarding the dangers to general practice and to medical care in general of devolution of duties. Whilst it is clear that you don't need a medical degree to take a blood pressure reading, it is the time we spend doing mundane tasks like that which allows us to develop relationships with patients that come in to play at a time of serious illness. The only attraction of General Practice over speciality medicine is the relationships we have with patients and their families. GPs who are only doing high-end work will burn out much faster than those who have a mix in their day. GPs who don't have deep relationships with their patients won't feel a sense of commitment when there are extra demands from a patient in crisis. Ultimately, I fear, task substitution will make GP a less attractive, less fulfilling place to work. Posted by David Ringelblum on Monday, 3 August 2009
