Saturday, February 23, 2008

I Told You I Was Ill

I really don't know about this one: Ignore GPs. Polyclinics are the future. My first thought was that DA was being a 'friendly journalist'/'useful idiot' for the government position, but I think he has some good arguments. Shorter DA: GPs are out of date; we need something new. There are some poor arguments as well as the convincing ones.

When I saw this claim, I thought long and hard about it. And decided that this "holistic" approach [ie the current GP], is, in fact, code for "inexpert". What I increasingly want from a practice is accurate and fast diagnosis and screening, combined with the best possible advice about my condition. At the moment I tend to use my GP's practice as a way of getting referral to specialists and accessing prescriptions that I have already decided that I need.

Against this, I think calling anyone with six years university education behind her "inexpert" is a shade disingenuous. I think we've always wanted fast and accurate diagnosis (with the latter having priority). If screening requires special equipment such as x-ray machines, you're not going to get those outside of a hospital anyway. And if Dave knows what he needs before a doctor does, bully for him, but he should consider it possible that he may not always know best.

One GP further complained of how polyclinics were part of "this 24-hour, consumerist environment [which] has raised demands for a 'dial-a-pizza' approach to healthcare - instant gratification with least discomfort - with the profit-based business model that motivates supermarkets". It is hard to imagine a more contemptuous attitude towards patient demand. When did illness stop being 24 hour? And since when was minimising discomfort regarded as being somehow un-NHS?

Here he finally began to win me over. I think those are fair points. So I'm on the fence here. If anything tipped the balance, it was my dislike of anonymous comments. The first comment is from "Dr GP, London, London [sic]". And I'm the highest regarded Proust scholar in the US but I'm not going to give my name.

Edited to add I should have included a link to the Times letters in reply. I read this after Captain Cabernet's comment, and the third letter clarifies my position. (It's from a GP - I assume - in Cardiff where I live, but I don't know him.)

Sir, I don’t think most UK GPs would be too upset if we ended up with Scandinavian-style polyclinics, but the recent past would suggest that we are more likely to end up with a cross between the out-of-hours care fiasco and the patchy level of NHS dental provision. Private companies will only want to operate in "profitable" areas. The government drive for cost savings would mean the polyclinics being run by private companies employing overseas-trained doctors on short-term contracts. When complex medical problems are encountered then the quickest, cheapest way to deal with them will be to pass the buck to the hospital sector. The cost savings would be rapidly swallowed by increased admission costs to A&E.

To be clear, I don't object to the polyclinic idea or to NHS reform. I do distrust this government (and the Tories too) when it comes to running things and I side with Capt Cab on GPs/clinics "paying foreign locums to do the actual work for them".


Anonymous Anonymous said...

GPs are out of date; we need something new.

A succinct summary of DA and New Labour's neophilia?


2/23/2008 12:57:00 PM  
Blogger ejh said...

It is hard to imagine a more contemptuous attitude towards patient demand.

I would have thought it was relatively easy, unless one misunderstands the point the doctor was making.

I dunno, doctors can get on my nerves (almost entire inability to see any wrong in themselves or their profesional colleagues) but as often with this NL stuff, one tends to think that the attack on the profesionals on the part of the consumer is largely a front for recasting something in a more business-friendly shape. It's also likely to be pretty rhetorical as NL tends not to upset the professions for very long - except the lower-paid ones of course.

I would have thought DA's claim to have thought long and hard would be more convincing if he did not usually to claim to think long and hard and yet did not always come down on the same side as NL.

2/23/2008 01:34:00 PM  
Blogger Captain Cabernet said...

I'm with CC and DA on this one. The BMA has being going on about the personal relationship between Doctor and patient. What we really get from GPs is the overpaid bastards slacking and generally enjoying a nice "work-life balance" whilst paying foreign locums to do the actual work for them.

2/23/2008 04:06:00 PM  
Blogger pj said...

Dunno about the claim that foreign locums are doing all the work but the BMA is definitely just defending the current very-nice-thank-you work-life balance for GPs. It can't last and those of us in the next generation are rather more open to ideas such as polyclinics and out-of-hours opening because the alternative is the crap all-the-hours-that-god-sends of hospital medicine (where interestigly 24hr consultant cover is still not a reality in many specialties).

2/23/2008 08:40:00 PM  
Blogger pj said...

Blimey, DA is almost right in that article. Most people can't see 'their' GP every time because most GPs are only working part-time (boo hiss, family friendly working practices) and their opening hours really only suit those without jobs.

But I don't think we're going to have cardiologists hanging out in polyclinics, that's what hospitals are for, but GPs with special interests (and thus skills) are definitely the way forward, allowing primary care to triage out a lot of the dross that ends up in hospital after months on waiting lists only to be told there's nothing much wrong with them.

2/23/2008 08:52:00 PM  
Anonymous Anonymous said...

I want to know how they sneaked in private tendering for GP services by talking about modernisation and 'polyclinics'. Privatising the NHS is a bad idea, isn't it?

2/23/2008 11:36:00 PM  
Blogger pj said...

No obvious reason why polyclinics should have any connection with private tendering.

But private companies can tend for GP services anyway (and GP practices are not exactly communes - now that practices do not have to have a set number of GP partners for a set number of patients they can just act as businesses hiring labour).

I imagine they're talking about the two together because the government will likely use polyclinic tendering as yet another way to sneak through some more backdoor privatisation/favours to US healthcare firms

2/23/2008 11:44:00 PM  
Blogger cian said...

Rock and hard place really. I don't like doctors, or their professional institutions. Arrogant, selfish and the cause of a huge number of the NHS's problems (the deliberate limiting of the supply of doctors through medical schools, the old boy network for advancement through the system and the scandalous hours worked by many consultants).

On the other hand I have zero confidence in the government's ability to successfully analyse any problem, or successfully implement a solution. Plus pretty much any NuLab idea seems to be a way of trying to smuggle in private companies, and I fail to see why this has to be the solution to every problem. I see very little evidence that the profit motive is effective in medicine, and the NHS's problems have always been connected to the dominance of the medical profession and a starvation of resources.
Plus, anything on as large a scale as this needs a decent IT infrastructure to manage patient records - and there's a pretty serious problem there, we ain't getting one.

So its a tough one, though judging by that article Aaronovitch is not the one to steer us through it.

2/24/2008 01:21:00 PM  
Blogger Alex said...

Hell, the NHS's biggest problem is diagnosis, and that's where the GPs are in the first line. They are the problem.

2/24/2008 02:36:00 PM  
Blogger cian said...

Its hardly their biggest problem. Currently the biggest problem is insane micro-management, previously it was insufficient resources and management by doctors (who much like anyone else would, set it up for their own comfort/benefit).

Is the NHS any worse at diagnosis than any other health service?

2/24/2008 03:45:00 PM  

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