Telling it as it is…time for change is now – for all of us

I have been writing a blog about healthcare for a few years now. I usually get a few hundred people reading it, my most successful blog before this year had 1,500 views. I was pretty pleased with that. Then an interesting thing happened. My first blog of 2018 has had over 100,000 views.

This has left me wondering. What was it about this blog that proved so popular? I know that many GPs liked and shared it, and this seemed to be instrumental in getting it viewed so widely. This begs the obvious question – what did GPs find in the blog that they liked so much? Here it is so you can judge for yourself. It is called “10 insider tips I bet you don’t know about your GP.” In the blog I try to explain how General Practice works and make suggestions to patients to help them work within this system.

I think GPs liked it because it expressed a lot of the things they were already wanting to tell their patients, but were unsure how to. I had some positive feedback from many non-GPs, but the reaction has been slightly more muted. When I published a follow up blog, “Everything you know about going to the doctor is wrong”, the local newspaper ran a feature on it. The reader comments on-line were not so kind. The general feel I got from the comments was “Stop telling us how to behave, and get your own house in order!”

So, I wonder if there is a split between what GPs want to hear, and what some patients want to hear?

Those of us working within the health service recognise the pressures and the hard work. Many of us also recognise that there are areas we could do better at, and are doing what we can to improve those areas. We also recognise that there is much that needs to be done to change help-seeking behaviours, to improve knowledge of self-care, to better signpost people to appropriate services and educate about self-limiting illness. My question is, do our patients want to hear this message? The comments received by the newspaper readers suggest instead that some patients don’t want to know that I only have 10 minutes, or that I struggle with their list of multiple problems in that slot. They don’t seem to worry that I am working long hours at the surgery, and that I might not feel that I am the best person available to help them (the point was made that I am well paid – inference being that I should therefore just get on with it).

If this is true then I think we have a fundamental problem. While I might want to have a grown-up conversation about responsibility and a wish to work together with my patients in an over-stretched system, do my patients just want me to be there for them regardless of the level of need or how appropriate it is for me to be dealing with them? I attended the RCGP Annual Conference last year where Roy Lilley talked about wanting his GP to provide long term continuity of care for him and his family as well as immediate drop in services in his commuter train station. On the face of it these asks are mutually exclusive – Roy needs to choose which kind of service he wants, surely? His point was that he wants both, and so do our patients. That is, I think, what I was experiencing here.

As GPs we have a view as to how we wish to run our services, partly based on what we believe our patients need, partly on how we have historically always run our services, and partly, if we are honest, based on what we have capacity to provide. It was this capacity issue I was highlighting in my blog, and the bit that at least some responders did not want to hear.

How we choose to deal with this is crucial. We could take a view that these individuals do not understand and should be ignored. We could decide that they are perhaps in a minority – I certainly had more positive feedback than negative overall. If we don’t listen though, and don’t pay attention to the negative comments, we might be missing a trick. Perhaps we need to be prepared to be flexible.

In General Practice at the moment, it feels as though we are working as hard as we can under very difficult conditions. Demand is endless, resources are short and recruiting additional GPs and nurses increasingly challenging.

Everyone needs to know this – including our patients. I believe this should prompt a change in help-seeking behaviour, and if patients understand how the system works, surely this is to their advantage as well as ours. This is a win-win.

However, as a profession we need to acknowledge that our satisfaction rates are lower than they have been for many years, and that levels of expectation are rising. If we don’t do something to address this, then our patients will vote with their feet. They will choose the convenience of the app-based provider. They will register with the practice down the road who are providing a slightly different offer to you. One of the strengths of General Practice is its ability to innovate and change. Being a small business owned by the partners means that we can be agile and respond to changing needs (and ‘wants’). There is risk in dismissing all concerns and complaints. There are ways we can do things differently, and many practices are looking to do this. Perhaps it is time to embrace an increasing multi-disciplinary approach, perhaps we need to seriously look at IT-based solutions, perhaps we need to re-think how we provide General Practice as many small individual businesses.

I’m not saying that we do need to do these things, but I am pretty sure that some will. What I am suggesting is that if you choose not to even consider working in a different way, you might be missing some opportunities.

This is a hard message. I doubt I will get 100,000 views for it. I hope, however, that it might start some conversations.

I think therefore that there is a message in here for GPs to hear and consider. There is also an ongoing message for society though. My recent blogs are saying it as it is. If this does not align with what society feels we should be offering, something needs to change. In this blog I have challenged GPs to think about how they might need to change, but I would also challenge the expectations of individuals and ask whether this also needs to shift. Either that, or someone will need to help General Practice to make the changes you expect. And a few more GPs and resources will probably be needed for that.

My suspicion is that demand and expectations will continue to rise. My fear is that society is too focused on other areas of the NHS (A&E for example) to turn its attention to primary care.

Something does need to change though. And hopefully before it is all too late.

Dr Jonathan Griffiths is a GP at Swanlow Surgery in Winsford, Cheshire, and Clinical Chair of NHS Vale Royal Clinical Commissioning Group

Follow Jonathan on Twitter @DrJonGriffiths, and read his blog here.

  • Fiona French
    Posted at 11:51h, 08 May Reply

    I cannot imagine there are many patients in the country who do not know about the crisis in our NHS and the pressures on its staff. I am sure most will understand that the lack of funding is one of the reasons for this. I am a member of the online prescribed dependent and harmed community whose membership grows by the day in the absence of any appropriate or useful help from prescribing doctors. I worked in the NHS for 25 years, worked closely with GPs and consultants alike, conducting research projects.

    I am appalled at the way I have been treated by my GPs in recent years and I am equally appalled that so many patients have to seek help online from other sick and desperate patients. Prescribed drug dependence is now a public health disaster, hence the year long review by Public Health England. The BMA supports a 24-hour UK-wide helpline for patients. Antidepressant prescribing rises year on year as does opioid prescribing.

    I have yet to meet a patient online who feels they were adequately informed about the risks and benefits of antidepressants. They are promoted as “safe and effective” by RCPsych. What is not said is that they have been tested for safety in the short term and they are effective for a minority of patients in the short-term. I was never advised of this in the many years I was prescribed these drugs. Patients are now petitioning the Welsh Assembly and the Scottish Parliament. Patients were never informed there was a risk of irreversible damage from antidepressants. They were never informed that the risks of long-term prescribing is unknown. The NICE tapering guidelines are not fit for purpose, they are based on short-term studies. Profs Wendy Burn and David Baldwin wrote to the Times newspaper in February stating that withdrawal symptoms last two weeks for the vast majority of patients. A formal complaint was lodged by 30 academics, clinicians and patients – they dismissed it and refused to produce evidence supporting this statement. Prof Clare Gerada was recently featured in a podcast by RSM along with her husband Prof Simon Wessely. Prof Gerada stated that she had spoken to patients who “claimed” their lives had been destroyed by antidepressants. The reason patients are campaigning on this issue is primarily because GPs and psychiatrists do not believe patient accounts of their suffering or the reasons for that suffering but they believe patients when they say they have benefitted from the drugs. And so I do believe it is time for a very grown-up discussion between patients and GPs and psychiatry of course. However, RCGP has chosen to block me on Twitter after I sent them an article from the press stating that it was harder to withdraw from antidepressants than it is from heroin. I can only surmise they did not like that statement as no reason was given for blocking me.

    My health is now destroyed, my retirement in tatters. My doctors have lied to me. It has taken over 4 years for an honest acknowledgment that I am indeed drug damaged form long=term consumption of benzodiazepines. I cannot believe that nothing was learned from that prescribing disaster and here we are again in exactly the same situation with antidepressants and opioid painkillers. I did not plan to spend my remaining years conducting research into prescription drugs and prescribed drug dependence. I certainly did not plan on campaigning for something I believe is entirely the responsibility of politicians and the medical profession.. I also do not believe it is the fault of the patients who consume these drugs. Patients consult medical professionals for professional advice and that is what they expect to get. They do not expect to be misled about the benefits and risks of the drugs they are offered but that is indeed exactly what is happening.

    And so again, I will say let’s have a grown-up discussion, patients, campaigners, prescribing doctors, politicians and the medical establishment. As with the benzodiazepine medical disaster it is once again the patients who are harmed who have raised the alarm. I am astonished that this should have been necessary at all.

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