NHS Blackburn with Darwen CCG

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Pace of change in general practice

Pace of change in general practice

First on behalf of the CCG, I want to wish you a happy Christmas and best wishes for the New Year.

Now for something completely different…

I recently watched a compilation of sketches from Monty Python and although I had seen clips before this was the first time I had seen some of the material in colour. When the programmes were made in the 1960s, we only had a black and white TV set and the same when I was at university in 1970. When my daughter rang up during the programme, I caught up on the bit I had missed the following day using iPlayer on my phone. This caused me to reflect on the pace of change. Certainly with technology a year is now a long time but is the same true in the world of general practice?

After just learning that my GP is to retire next spring, I realised that I have only been registered with three GPs in my life; the first from birth to teenager, the second from teenager to fatherhood, and the third for the last 20 or so years. This says something about the length of time GPs stay in their local community.

The GP I took my children to is the same one I now see with my grandchild, so GPs can be with a family for a generation or more. This must have a positive impact on effective medical care if caring for the patient means looking at the whole person. By treating the patient as an individual and considering their social, psychological and spiritual needs, a GP will have the opportunity to build strong relationships with patients.

There is also the importance of trust in the advice given by your GP. This is surely enhanced if given by a doctor who you have seen care compassionately for your dying father, allowing him to end his days peacefully and pain free at home surrounded by his children, or tenderly examine a sick infant recognising how precious the child is to the parents.

I imagine there are mutual benefits that if a home visit is requested by someone who has a good sense of what is an emergency the GP will arrange the visit without much questioning.

This led me to ponder if a surgery with GPs who have been with the practice for a good many years and a patient list with a relatively low turnover, this means fewer problems with access. Certainly not all patients in the town have difficulty in booking an appointment. This became clear at a recent meeting of representatives of practice based patient participation groups in Blackburn.

At the meeting, a plea was made on behalf of patients for much more sharing and implementation of good practice particularly around access. For example, the use of text messages to remind people about appointments and a handy hint that if the passwords were reset then this text service needed to be restarted.

Another suggestion was taking action to improve things that pose difficulties for a number of practices such as clarity about the services provided by the treatment room staff. There are also differences in the tasks undertaken by practice-based nurses who can, if appropriately skilled and qualified, see some patients and deal with them effectively without the patient needing to see the GP.

One of the trends today is to have instant access to news, your money, or your doctor, but how crucial is speed of access? It is clearly important in a life-threatening emergency but many conditions do not fit into this classification. We have tried a number of ways to get messages out that should help people access the right health service to deal with their ill health. Could we do more by helping GP practices design their web site, ensuring consistency about the advice offered via the site? For example, offering advice for parents whose child is poorly with a common childhood ailment. One suggestion was to get short videos of GPs offering advice and run these in the waiting rooms and reception areas. The Patient Participation and Involvement (PPI) groups are a very useful resource and I encourage readers to consider joining the one for their practice. General practice is evolving but in the NHS Five Year Forward View, Simon Stevens (Chief Executive at NHS England), says that the foundation of NHS care will remain list based primary care. Therefore, we need to have a clear idea of the key elements of a high quality primary care service.

I recently read an article by a lady who had been reading a book called ‘A Flourishing Practice’ by Peter Toon, published by the Royal College of GPs, in which she says contains comments about what would make a ‘virtuous’ doctor. In the piece, she talks about the distinction between being a customer and a partner and suggests that we should focus on the latter seeking to be partners in our own personal care and therefore share responsibility. The writer then goes on to describe what she thinks a ‘virtuous patient’ might be. This includes having good sense, which would mean knowing yourself well enough to recognise if and when you needed to see a doctor; realism, as in the end there is no cure for death and it is not possible in this life to eliminate discomfort pain ageing and grief; honesty, as doctors cannot help you if you are not open with them; and, trust, that the GP shares your desire for health and wholeness.