‘Being able to see a doctor you trust is the lynchpin of GP surgeries’, says this retired Sheffield doctor
Having recently retired as a GP at Ecclesfield practice since 1989 I can look back on my career and reflect on the changes that have happened over the last thirty years, says Dr Richard Oliver.
Joining the practice as the junior of five partners, the practice was responsible for providing care to around 8500 patients in the Ecclesfield and Parson Cross area. We were early adopters of schemes to develop the practice team, with highly trained reception staff, practice nurses - a relatively new idea at the time - as well as a practice manager.
Surgery sessions would start at 8:45am, with five minute appointments running until about 10:45am. Five minutes was generally long enough as our appointments were dealing with acute but relatively simple problems.
After morning surgery, the team would then meet to discuss any challenging cases, read any hospital letters, review and sign repeat prescriptions and deal with the daily admin.
Home visits would then follow, with most doctors seeing four or five patients each day. Afternoon surgery would start at 3pm and generally be finished by 5pm, although the on call doctor would also see any urgent cases between 5pm and 6pm and deal with any late visit requests.
The duty doctor would then remain available all night, receiving any calls and if necessary visiting the patient during the night.
The internet hadn’t been invented in 1989 and computers were a distinct novelty in clinical settings. Clinical records were all handwritten and filed in separate rooms in alphabetical order. Finding and accessing the records was a logistical challenge every day.
Numerous contractual changes have altered the workings of the NHS. The concept of health care activities having a price has introduced the purchaser provider model which in turn has led to the current commissioner-led model.
GPs responsibility for 24 hour care has been changed and out-of-hours responsibility now rests with out-of-hours providers who, until recently, couldn’t access the patients clinical records.
Targets and contractual levers have pushed the whole NHS into a culture of counting and recording, which arguably has driven significant improvements in health across the country.
The General Practitioner, whilst remaining at the front door to the wider NHS, has seen their role change, with less acute reactive care to long term condition management and prevention with increasingly complex medical problems being managed by larger practice teams - none of which could happen without access to fully computerised records.
It isn’t unusual for patients to be expected to take upwards of 15 different medications every day whilst also juggling diaries to accommodate numerous medical appointments, pharmacy trips, notwithstanding those required for modern life in general.
GP appointments have had to lengthen with the norm nowadays being 10 minutes, although this should probably be longer, and the GP practice team has changed to reflect these growing demands.
More practices employ specialised nurse practitioners with advanced skills in chronic disease management, as well as acute care, and for many patients have become their main point of contact at their local practice.
As information has become more readily available public expectation of what the NHS can deliver has risen and along with that has come a growing anxiety about potential health issues which in turn has caused a rising demand on clinicians time.
Demand for appointments is higher than ever and surgery sessions now invariably run for three to four hours with increasing administrative tasks adding further demands on the doctors time. An average GP day lasts 12 hours with little chance of a break during that time.
Very few doctors are able to sustain this level of demand on five days of the week and we see more doctors deciding to adopt a healthier personal work life balance by working on fewer days, often whilst taking on a portfolio of other responsibilities such as specialist GP services , training of medical students, other GPs, nurses, pharmacists and other health workers.
More are involved in medical managerial positions especially with the growing dependence of the NHS on clinical leadership.
The concept of care from cradle to the grave has changed from being the responsibility of a named doctor to the joint responsibility of a named practice team.
This is what allows a practice to respond to an urgent problem whilst still supporting the right of a patient to see the clinician of their choice accepting that may involve a wait of a few days.
This remains a vital lynchpin of British general practice - that ability to choose to see the doctor you trust, whilst still supporting the ready access to health advice when required.
Having retired, I have received many messages of thanks from patients I have cared for over the years. The key theme which emerges from all of them has been an ability and willingness to listen, to be knowledgeable, accessible and most importantly of all to be there when needed.