Our Doctor Writes
There is a famous quote about lies and statistics. I was left pondering this following the outcry from our politicians and the media about A&E bursting at the seams. Apparently all being all the fault of GPs following the contract negotiations that changed the way that Out of Hours services were delivered around 2004. There is no doubt that Casualty departments across the land are under more pressure than they have been in the past and that it has come to a head over the last few months. A quick look at the data shows that there was indeed a surge in recorded activity shortly after the new contract came into effect. A closer scrutiny showed however that the way data was recorded changed at that time as well. For the first time it included attendances at minor injury units as well and this was responsible for the sharp rise. Between 2004 and 2012 the underlying main A&E activity did rise but at a very low rate. So what is happening? Like many things there isn't a single answer. The health care system is a complex, not to say chaotic one. Even in the last 10 years there has been a change in the demography of our society and the effect of this is amplified by many more people having multiple conditions. Combine this with the desire to manage more and more people with more and more complex problems in the community and the pressure starts to mount up. I think it is fair to say that a large proportion of out of hour services struggle to meet demand and that very experienced clinicians are spread very thinly. Add into the mix the adoption of the 111 urgent care line on April the 1st, the day which also saw the biggest change in the organisation of the NHS in it's entire history, and it becomes clear why things have come to a head!
So what of solutions? It has been interesting to see the call for more investment in hospitals and in A&E in particular to deal with the increased demand. General Practice has been been beautifully described by a good friend of mine, David Haslam, as the risk sink of the NHS. Around 90% of patient contacts in the NHS occur in primary care for around 10% of the budget. Of course by the very nature of case selection most people in hospital are more ill and need more doing than those in the community and this is how it should be. The key is making sure that only the people who need to go to hospital go there. Once there risk is managed very differently, with many patients having investigations done to try to "prove" that they are safe to go home rather than never having gone there in the first place. A recent Nuffield Health report showed that with total NHS spending being static in the last two recorded years, General Practice now receives £ 400 million less than it did and hospitals £ 400 million more. With a small overall redistribution of resource we could reverse this trend but General Practice needs to try to rise to the challenge. We need new ways of getting care right for patients with multiple conditions. Continually striving to improve access and continuity of interpersonal care is important. We need longer consultation times and to do this we probably need more GPs to deliver them. On the flip side though having great access brings with it an important responsibility of only using a service delivered free at the point of need when it's really needed rather than because the access is easy. We're all in this together.
Clare Gerada the leader of our Royal College has been in the media again in May raising the profile of health care and support for carers. This is a really important area. There are things we can do to help and support but first of all we need to know who you are. It can be difficult to recognise, and sometimes difficult to want to say that a relationship may have undergone subtle, or not so subtle change, and that someone has become a carer for a spouse or other family member. Have a think. Are you a carer? If you are please let your doctor know, in a consultation, with a call or with a note or email. I'm thrilled to say that at Great Bedwyn we have recently been awarded a Gold recognition for our work with carers. A big thank you needs to go to the whole of our practice team in but a particular big thank you goes to Keith Marshall our Practice Manager who has driven this initiative forward. Well done everybody!
Dr Tim Ballard