Any GP you want: so long as you're healthy. A news article by Wessely.

[Bob]

Any GP you want: so long as you're healthy
Jeremy Hunt wants to scrap GPs' catchment areas to give patients more choice. Sounds great – until you think it through
Simon Wessely
The Guardian
Tuesday 19 November 2013

http://www.theguardian.com/commentisfree/2013/nov/19/any-gp-so-long-as-you-are-healthy

 

[Bob]

Actually, I think he makes some interesting points, but perhaps he might not like the idea of patients being able to choose their doctors partly because then ME patients will not choose the doctors who tell them that they have a behavioural disorder and who treat them accordingly.

Being able to freely choose our own doctors could potentially make a big difference for many UK ME patients, in my opinion.
(At the moment, in the UK, we can only choose our NHS doctors from within a local catchment area. For patients living in rural areas, this can mean that they have no choice whatsoever.)

 

[heapsreal]

I think thats the difference between the UK and australian health care systems.
Here in australia we can see any gp we want, fly to another state or maybe see a couple of different gp's.
It makes a big difference as we can then hunt out a good cfs doc.
All we need is good testing such as viral titres and nk function testing available out side of research and antivirals, immunoglobulins etc covered by the health system for cfs so we dont have to pay full price for medication.
I get fed up with the health care system here and how cfs is managed but then i see whats happening to our pommy mates and u guys are getting a raw deal.
I hope things improve for u guys.

 

[taniaaust1]

Im sure if most patients with ME/CFS have a choice whether to go to Simon Wessely or not, they wont be going to see him!! It's no surprise he's against patients having a choice.

 

[Firestormm]

Thanks @Bob I thought it was - generally speaking - a good commentary piece. Raised some issues you wouldn't normally think about if given more 'choice' - which always sounds like a good thing, but usually requires some thought.

On the other hand I wonder how many people will actually be inclined to change to a surgery that isn't convenient for them? Assuming your present surgery and GP is convenient of course.

I am less convinced by the age-olde argument that you have a relationship with a long standing GP that cannot be replicated by someone else. I think that speaks of a 'golden-age' that no longer exists - if it ever did.

If there was a GP or a surgery in my area that designated itself 'chronic disease and complex needs' would I be inclined to use it? If it was to be staffed with experts who are able to provide more time with a patient, then perhaps I would; but alas this kind of thing isn't what is being offered. And that is a shame - and a mistake I think.

What is perhaps needed - and controversial - is a something akin to a Tesco's Metro. So for those who are healthy, and only tend to see a GP occasionally, they can use the Metro; but for those who do need to see a GP more regularly - more resources are centralised perhaps (certainly made available) in other surgeries.

That might work for Primary Care. And that's not to say that specialist services should be removed for those who need to see disease experts/consultants and mutli-discplinary care.

Another patient I have been seeing for years has poor health, lots of unpleasant symptoms and is in constant pain. The problem is that no doctor can find very much physically wrong with her. She herself doesn't think that her traumatic early life, coupled with longstanding depression, might be a factor. The new euphemism for patients like her is "frequent flier". She uses up a lot of resources and, frankly, many doctors find her irritating. Where on the scale of one to four do you think her GP will be?

Hmmm... A case of CFS/ME perhaps? I remember the days when I was considered a 'frequent flier' and, by some, a 'yuppie'

 

[Esther12]

Some of the problems he says he's worried about could be solved by increasing the number of places for medical students, increasing the supply of doctors, and leaving them needing to compete for patients in order to make a living. Universities are currently restricted from doing this by professional medical bodies who know that their scarcity increases their power and wages - their power in this area needs to be restricted.

A lot of the other problems could be resolved by providing patients with chronic health problems with control over additional funding to help them manage their condition.

When it suits him, Wessely writes as if doctors are uniquely benevolent creatures working only to help their patients, and then here he writes as if all the four-star doctors are just going to be committed to playing the system. If doctors are as self-interested as he seems to expect here, then what utter madness it is to extend their authority over the psycho-social aspects of patient's lives whenever a clear cause of symptoms is not found (or when it is too). If doctors are just like other human beings (which seems likely to be the case), then we need to ensure that they have as little power as is possible over their patients.

I'm keen to see reforms that will increase the power of patients within the NHS. No reforms are perfect, but that Wessely is so concerned about these ones makes me think that they're likely to be more useful than I had realised.

 

[Snow Leopard]

I agree with some of his points, but overall he seems to be saying that the reason why we shouldn't have more choice is because then GPs will have to pick and choose between who they see and some people will miss out!?!

That looks like a non sequitur to me.

 

[Firestormm]

Thing is, and I don't know about round your way, but if people hear that a certain doctor is a 'good' ME doctor with a listening ear, then patients will and definitely do, switch to him/her. So in that respect at least - you can already change doctors on a whim/recommendation from someone else.

 

[alex3619]

I would like to see psychotherapy removed from medicine entirely, and classified as alternative treatment. Its basically counseling, not science.

As @heapsreal has noted, Australia has the system of seeing any doctor you like, despite a national health care plan, with the exception of some specialist services that are in high demand. It works quite well, but its not perfect. Its certainly not a disaster. There is a tendency for many docs to dismiss problem patients, which sees those patients move elsewhere, which might lead to some of the problems that SW writes about. However I think freedom of choice more than makes up for that.

 

[maryb]

Thing is, and I don't know about round your way, but if people hear that a certain doctor is a 'good' ME doctor with a listening ear, then patients will and definitely do, switch to him/her. So in that respect at least - you can already change doctors on a whim/recommendation from someone else.

Yes but only within a small catchment area

 

[Esther12]

Yes but only within a small catchment area

Yeah - and the extent to which this restricts choice is really variable. For some people, it's not a problem, for others, it really is.

 

[Firestormm]

Yeah - and the extent to which this restricts choice is really variable. For some people, it's not a problem, for others, it really is.

And the solution is? Rhetorical question

My local charity do issue a list of 'recommended GPs' and this comprises those GPs that members have 'rated' as being good.

I did ponder some time ago, whether the NHS was heading in the direction of Amazon. Where patients would apply a 'star rating' and review the GPs and consultants they visit.

Would be rather novel to think that such ratings might one day - in my 'pie in the sky' thoughts - influence their salaries.

Then again, 'performance related' pay is anathema to the NHS.

 

[Undisclosed]

I can choose any doctor I want to see in Ontario. If I want to travel to Toronto or Thunder Bay, that's my option. The problem is that most practices are closed to new patients because we have a huge shortage of doctors. In the end, I really had no choice of my doctor because I had one option. I am happy though that, in theory, it is my choice.

I wonder how Wessely's peers will feel about being painted as lazy (re: only wanting to see healthy patients). He's already managed to alienate ME patients and Gulf War Veterans. I don't think his reasoning is well thought through and he is making huge generilizations -- typical.

 

[Esther12]

And the solution is? Rhetorical question

I think it's likely that allowing universities to offer more places for medical students, and reducing the restrictions placed upon patient choice, will do more good than harm.

I wonder how Wessely's peers will feel about being painted as lazy (re: only wanting to see healthy patients). He's already managed to alienate ME patients and Gulf War Veterans. I don't think his reasoning is well thought through and he is making huge generilizations -- typical.

Wessely's promoting the interests of doctors, and they're not likely to turn on him for that (at least, the self-interested ones who want a system which serves their interests).[/quote]

 

[Firestormm]

Wessely's promoting the interests of doctors, and they're not likely to turn on him for that (at least, the self-interested ones who want a system which serves their interests).

Clare [the wife who wears the trousers] and is sat at leisure in front of the fireplace drinking tea]: Hey, Simon, write something for me would you?

Simon [removing his apron and with an obedient bow]: Certainly my dear, I shall get right onto it as soon as I've done the washing-up.

 

[peggy-sue]

It's reminding me a bit of a certain Dundee gp who works near the university buildings.
Dating back to the mid-'70s, he is "in there" during fresher's week, drumming up all the students he can to join his lists. All they're going to want is contraception and the odd valium during exam times, and he gets a huge increase in his salary for having such a massive patient base which does not bother him very often.