Re: The role of NHS gatekeeping in delayed diagnosis
I'm a GP and I do agree that the gatekeeping role can cause delays in diagnosis, but I don't believe that this is because we are bad gatekeepers, or that we are not really trying, but that we do not have sufficient resources to meet the demand for appointments, have adequate time with the patient, have adequate access to quick investigations or similarly quick access to hospital care. To blame all this on the gatekeeping role seems unfair. The language used in the article is disparaging towards GPs - we apparently 'put patients a poor second to staff' and we 'complain we are overburdened' and we are so medieval we should ' discover the 19th century invention of the telephone.'
I have been a GP for over 20 years and I can say we truly are overburdened.We are working harder, seeing more patients, conducting more telephone consultations and managing more complex conditions. We work very long days - our work does not end when the consulting ends, as we have to manage referrals, deal with results of investigations ordered, read and action hospital letters, deal with prescription requests and queries, as well as innumerable other unseen tasks that we do behind the scenes to help our patients, in addition to mandatory training, meetings and continuing personal development. We have to maintain a high level of concentration and accuracy, as to make a mistake can have grave consequences.
We are undoubtedly letting patients down; we have no spare capacity to offer additional appointments - we often add in extra emergencies and telephone calls to our normal list to do what we can, but this is still not enough. Short of working all the hours of the day, and never seeing my family, I still believe there are insufficient resources to offer enough appointments, as well as a serious lack of trained GPs who wish to do the job, which can still be an extremely rewarding one.
I do believe a better integration between primary and secondary care, having a more blurred interface, can help, but this can only be achieved with adequate resources. It is much cheaper to deal with patients in primary care so the investment should be directed here, and this would help to relieve the burden on secondary care. If we could offer patients appointments quickly, within a week, have easy and quick access to investigations and secondary care, the patient experience would be vastly improved. This needs to be supported by adequate investment in social care, as I cannot personally keep elderly patients out of hospital without this.
Nigel Hawkes says that the GP can see thousands of patients with headache and to divine the one true case out of thousands is asking for miracles. But short of asking a specialist to see every single person with headache, or carrying out an MRI scan on every patient with a headache, how is anybody going to be 100% accurate?
On the telephone issue, 20 years ago we did no telephone consultations; now this is an every day part of GP life, and has been for years. We have introduced booking of appointments online, prescription requests online. We could offer email advice, but at the moment there is no capacity to allow this, unless we offer fewer face-to-face/telephone consultaions.
Expanding emergency departments and employing GPs to see patients here is a possibility, but many patients want to be seen locally, and where are these GPs going to come from, since there is a chronic shortage of GPs? This only really moves the problem from one place to another. It would be easier to access investigations/specialists in a hospital setting, but only if the resources exist to fund them. Patients seen in emergency departments are often told to go back to see their GP to request (sometimes unnecessary) investigations and referrals. Hospitals do not want to fund this so ask the GP to do so. In the end, it is all just NHS money so blurring the funding boundaries between GP and hospital would be welcome, and would allow too, consultant-to-consultant referrals without needing to use the GP as a go-between, which creates more appointments, increased frustration and further delay in treatment for the patient.
His other 'solution', i.e. go private, to the vast majority of ordinary people, is not a realistic option. Even if they can afford an initial consultation, they may not be able to afford (sometimes unnecessary)investigations or treatment, and then it's back to trying to make an appointment with the GP.
Rapid Response:
Re: The role of NHS gatekeeping in delayed diagnosis
I'm a GP and I do agree that the gatekeeping role can cause delays in diagnosis, but I don't believe that this is because we are bad gatekeepers, or that we are not really trying, but that we do not have sufficient resources to meet the demand for appointments, have adequate time with the patient, have adequate access to quick investigations or similarly quick access to hospital care. To blame all this on the gatekeeping role seems unfair. The language used in the article is disparaging towards GPs - we apparently 'put patients a poor second to staff' and we 'complain we are overburdened' and we are so medieval we should ' discover the 19th century invention of the telephone.'
I have been a GP for over 20 years and I can say we truly are overburdened.We are working harder, seeing more patients, conducting more telephone consultations and managing more complex conditions. We work very long days - our work does not end when the consulting ends, as we have to manage referrals, deal with results of investigations ordered, read and action hospital letters, deal with prescription requests and queries, as well as innumerable other unseen tasks that we do behind the scenes to help our patients, in addition to mandatory training, meetings and continuing personal development. We have to maintain a high level of concentration and accuracy, as to make a mistake can have grave consequences.
We are undoubtedly letting patients down; we have no spare capacity to offer additional appointments - we often add in extra emergencies and telephone calls to our normal list to do what we can, but this is still not enough. Short of working all the hours of the day, and never seeing my family, I still believe there are insufficient resources to offer enough appointments, as well as a serious lack of trained GPs who wish to do the job, which can still be an extremely rewarding one.
I do believe a better integration between primary and secondary care, having a more blurred interface, can help, but this can only be achieved with adequate resources. It is much cheaper to deal with patients in primary care so the investment should be directed here, and this would help to relieve the burden on secondary care. If we could offer patients appointments quickly, within a week, have easy and quick access to investigations and secondary care, the patient experience would be vastly improved. This needs to be supported by adequate investment in social care, as I cannot personally keep elderly patients out of hospital without this.
Nigel Hawkes says that the GP can see thousands of patients with headache and to divine the one true case out of thousands is asking for miracles. But short of asking a specialist to see every single person with headache, or carrying out an MRI scan on every patient with a headache, how is anybody going to be 100% accurate?
On the telephone issue, 20 years ago we did no telephone consultations; now this is an every day part of GP life, and has been for years. We have introduced booking of appointments online, prescription requests online. We could offer email advice, but at the moment there is no capacity to allow this, unless we offer fewer face-to-face/telephone consultaions.
Expanding emergency departments and employing GPs to see patients here is a possibility, but many patients want to be seen locally, and where are these GPs going to come from, since there is a chronic shortage of GPs? This only really moves the problem from one place to another. It would be easier to access investigations/specialists in a hospital setting, but only if the resources exist to fund them. Patients seen in emergency departments are often told to go back to see their GP to request (sometimes unnecessary) investigations and referrals. Hospitals do not want to fund this so ask the GP to do so. In the end, it is all just NHS money so blurring the funding boundaries between GP and hospital would be welcome, and would allow too, consultant-to-consultant referrals without needing to use the GP as a go-between, which creates more appointments, increased frustration and further delay in treatment for the patient.
His other 'solution', i.e. go private, to the vast majority of ordinary people, is not a realistic option. Even if they can afford an initial consultation, they may not be able to afford (sometimes unnecessary)investigations or treatment, and then it's back to trying to make an appointment with the GP.
Competing interests: No competing interests