Tue. Dec 7th, 2021


When Joanne Hodson sought help from her family doctor for perimenopausal symptoms, exacerbated by emotional distress following the death of her mother, the reaction left her stunned. The Greater Manchester Nursing Manager was offered a phone call – in about a month.

Only after suggesting to the receptionist that she could possibly be suicidal did she quickly get attention, albeit still at a distance. Hodson, who considers herself “very assertive” but had to fight to get the care she needed, lamented the loss of continuity that has long been seen as a strength of the cradle-to-grave British system . “I have not seen my own named GP for more than two years,” she said.

The much-loved GP, the first haven for those seeking help from the UK’s taxpayer-funded universal health care system, is a national trope. But the growing demand of a population that increasingly needs complex care, with fewer doctors to deliver it, means the model is coming under pressure like never before.

While politicians and doctors are arguing over the lack of face-to-face appointments after many surgeries largely switched to seeing patients virtually during the pandemic, some general practitioners believe that focusing on the doctor as the source of all care and knowledge does not more sustainable. and the model needs to be reformed.

GPs need to work harder as the demand for care increases;  Estimated year-to-year% change in demand for general practice consultations GM091107_21X

While many health systems are under pressure from aging populations, the nature of primary care in the UK poses particular challenges. According to Nigield Edwards CEO Nigel Edwards, while every comparable European nation has some form of primary care, the job description for GPs in the UK tends to include a wider range of services, including minor medical procedures , pediatrics and more of the treatment of chronic and long-term diseases, such as diabetes ”. While in France or Germany, for example, “you would expect more of these types of services to be handled by specialists”.

Faced with an overwhelming workload, some medical practices are looking at ways to reduce patient demand through “social prescribing”. On a sharp autumn day in Woodley, near Stockport in Greater Manchester, a group of over 70 gather for their weekly walk through scenic lanes, followed by a cup of tea at a nearby cafe.

Derrick Brammall, a nearly 90-year-old retired engineer who underwent a quadruple diversion at 63 and never misses the event, cheerfully shares his prescription for longevity: “Keep your weight low, a good diet, exercise and a clean mind.”

Dr Mark Gallagher referred some of his patients to a walking group © Jon Super / FT

Mark Gallagher, a local family doctor, said he saw a measurable decline in the demand for conventional health care from some of those he referred to the walking group and other similar activities. “We can actually see that a lot of people are happier,” he added.

But while such social prescribing is one successful approach to improving patient health while conserving resources, more radical changes may be needed if common practice is to satisfy a 21st century population.

The NHS’s long-term plan, published almost three years ago, highlighted the role that broader primary care teams, including nurses, physiotherapists and “medical assistants” can play in patient care. Beccy Baird, a primary care expert at the King’s Fund, a brainstorm, said she recently spoke to a practice in Gateshead where they have a GP vacancy and decided. . . [instead] to recruit a poor nurse and two community liaison workers ‘because these people are better than a family doctor for our population’ ”.

Expenditure on general practice has increased

However, such examples remain unusual. Staff shortages and the time required to integrate the roles into difficult practices mean that the approach has slowly taken root.

Dr Harpreet Sood, a 36-year-old practicing in Kennington, South London, is part of a new generation of leaders who believe medical and technological advances can be harnessed to make primary care more responsive to its users, and the pressure on GPs. The current model of between 7,000 and 8,000 physical GP practices is outdated, he argues.

Instead, he believes more resources should be devoted to community labs, giving patients quick access to blood and other diagnostic tests so they show up to see their GP who is already armored with the essential information on which a diagnosis can be based rather than being “turned around”. between surgery and hospital before their conditions can be identified and treated. “We have seen so much progress in diagnostics, and laboratories and radiology, why do we not accept it in terms of how we offer a primary care service?” he asked.

Sood pointed to countries creating new primary care systems, such as the US and India. With no legacy structures to contend with, “the family doctor is not the first resort. . . the family doctor is only there for more difficult situations rather than seeing everyone and triaging everyone, ”he said.

The walking group in Woodley; Derrick Brammall is third from left in the photo

The approach is illustrated by Boston-based Iora Health, part of One Medical, another U.S. healthcare provider. It has tripled the resources it has devoted to primary care, using technology to monitor people in their own homes, along with a system of “coaches” who help patients stick to treatment plans while supporting them in their improve lifestyle.

Moving away from a “reactive and transactional” model centered on visits to the primary care physician resulted in “about a 40 percent drop in hospitalization… As well as a drop of about 10-20 percent.” in total health care spending, even taking into account the increased primary care spending ”, according to Rushika Fernando Pulley, Iora’s chief innovation officer.

In Sheffield, GP Ollie Hart has set up a coaching company with a fellow GP to work with operations across the country. He says he has had some “incredible success stories” since he started using the approach, and estimates that about 20 or 30 patients in his own practice either cured their diabetes or at least became more motivated to manage their own health. .

“It’s possible to move the system, but it requires a new rhetoric, a new narrative to go along with it,” he said. “And that is what we are really missing at the moment. People still long for the old model of general practice and it just falls apart. ”



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