Do you want to know how valuable it is to have your own primary care doctor who knows you and who you see at every appointment? Yesterday the Mail reported that almost a third of patients “rarely” saw the same GP, and only half “always” or “sometimes” saw the same GP.
Let me show you what happens when you don’t have this, because at A&E we pick up the pieces of this every day.
Last week, an 84-year-old man arrived at the ER with difficulty breathing as a result of complications from his heart failure. Until then he had almost managed, but a recent chest infection had pushed him over the edge.
But when she called her GP to make an appointment, none were available in time, so she was told to call 111.
Now, if you had seen your regular (and experienced) GP, knowing him as you do, they would have done everything they could to keep him out of the hospital and most likely would have given him antibiotics and increased his dose of heart failure medications.
Instead, the 111 call operator typed his symptoms into the computer and the algorithm decided an ambulance should be called. Three hours later the paramedics arrived; They are highly trained essential members of the NHS, but their training is in managing acutely ill patients.
My patient was not seriously ill, but chronically ill, and a chest infection was the proverbial straw that broke the camel’s back. The paramedics were unable to do what the patient needed, which was to modify his medication and prescribe antibiotics.
Instead, they took him to the ER; Arriving late at night, he was placed (yes, you guessed it) in a hallway and began receiving a battery of tests, many of which he didn’t necessarily need, such as an ECG and a chest X-ray, but which the protocol required. because he had a respiratory problem.
One of these tests, a D-dimer test, showed a problem. This test looks for a clot in the lung, but it’s not a great test: it increases in other conditions. Including chest infections.
The test was ordered by an inexperienced staff member because the patient was having difficulty breathing. When a doctor-in-training saw the results, he was understandably concerned.
Having spent most of their training in hospitals (and never having worked in a GP practice), they reacted according to their training: they had to rule out a potentially fatal lung clot.
And then an expensive CT scan was ordered; This was not only normal, but it delayed scans for patients who really needed it.
When I was asked to check this patient, it was 3 in the morning.
And although I would have otherwise discharged him, I couldn’t because it was too late and there was no transportation available to take him home.
All I could do was admit him into a room. Out of his usual environment, he lost confidence, suffered a fall and ended up in the hospital for more than a week.
What could have been resolved in a ten-minute face-to-face consultation with his own GP, who knew him well, ended with an unnecessary hospital admission that cost many times more than a GP appointment would.
This is not an isolated case. And as someone who has dedicated her entire career to working in the NHS, it pains me to write this, but the NHS really is failing.
No wonder the public has lost confidence in him, as revealed by the latest annual British Social Attitudes Survey.
The results showed that, although the public still supports the principles of the NHS, satisfaction with the health service is now just 24 per cent (in 2010 that figure was 70 per cent).
While there are many problems with our healthcare system, the core is the lack of continuity of care from your primary doctor.
If patients received a different treatment, outcomes would be better and more cost-effective, and the data supports this.
And yet, what the Government is doing is not trying to retain GPs, especially experienced ones: in fact, while there has been some additional funding for GP surgeries, they are specifically not allowed spend them on family doctors, but they must spend them on other (cheaper) ones. staff who do not have the level of experience, such as associate physicians. This will further undermine patient satisfaction.
But let’s get back to why it’s important to see the same primary care doctor. In a new study published in the journal Management Science, researchers at the University of Cambridge analyzed data from ten million GP consultations.
They found that when patients visited the same doctor, their care was better (as evidenced by the fact that the time between their appointments was 18 percent longer compared to patients who visited different doctors), thus reducing demand.
This echoes a 2017 BMJ study that reviewed the medical notes of 230,472 older adults in England: continuity of care reduced the number of hospital admissions.
Another review of 42 studies, published in 2021 in the journal BMS Primary Care, found that continuity of care for patients with diabetes or hypertension reduced their risk of premature death and the need for hospital care.
But for me, the key study is one from 2022, which showed that the longer you had the same GP, the lower your use of emergency and out-of-hours services, the fewer hospital admissions you had and the lower your risk of dying. prematurely, the British Journal of General Practice reported. This was based on data from more than 4.5 million patients in Norway, so we must take this research seriously.
What all of these studies have in common is that continuity of care is the key to improving outcomes and, more importantly, making the healthcare system affordable. Experience, however, is crucial.
The experience (and autonomy doctors have) allows them to become “risk experts”, which is what is needed to help the NHS survive.
Riskatician is my word for making decisions in the best interest of the patient, but knowing that there is an element of risk in that you can miss a diagnosis because you are not doing all the possible tests.
Professor Rob Galloway writes that experience (and the autonomy doctors have) allows them to become “risk takers”, which is what is needed to help the NHS survive.
The other thing all of these studies have in common is that they are being ignored by those who run our NHS (who have chosen to waste money on initiatives to improve access, but not by those healthcare professionals who know the patients or have the experience to make decisions). these risk-based decisions: GPs, of course.
This is where that additional funding comes into play. To cope with the number of GPs retiring or leaving their jobs, practices are receiving an extra £1.4bn of funding.
But the problem is that they are not allowed to spend it on GPs who can provide that much-needed experienced continuity of care. Instead, they must spend it on support staff such as associate physicians, health advisors, musculoskeletal specialists, pharmacists and paramedics.
They are all good at the role they are trained for, but are often asked to care for patients that a GP would normally care for.
Without the same degree of experience, training, and autonomy, the decisions they make are often risk-averse and not in the best interest of the patient.
On a recent shift, I saw a patient who had been seen by a paramedic in a GP surgery.
This patient was dying of pneumonia. The paramedic had referred them to the hospital for fluids and antibiotics: this was safe care, but the patient was in a nursing home and had dementia. What was really needed was a conversation with his family about how to keep them home and make them feel comfortable while nature took its course.
This is what GPs are experts at. Furthermore, some of those who do not have the experience of a GP but perform that role, such as GPs, literally do not have the experience to recognize how sick some patients are and, unlike the paramedic, may not refer to the GP. patient to the hospital when they need it. he. But that is a topic for another day.
As doctors we use evidence-based medicine to treat our patients. NHS leaders must do the same.
Evidence shows that the most cost-effective use of NHS money is to ensure GP surgeries have the resources to provide continuity of care from an experienced doctor. Only then will public perception of how well the NHS is doing begin to recover.