There are a few conditions that always leave me slightly frustrated when I see them. It is not necessarily because of the condition itself, but because of the way in which they present. There are three in particular that I see in this regards: Hand, Foot and Mouth, Slapped Cheek and Conjunctivitis. GPs reading this will probably already have worked out why these in particular cause me frustration, but for everyone else, let me enlighten you.
It’s because often what I hear from the mum, dad, nan, auntie or carer when they sit down is that they have made the appointment because “the school/nursery say they might have slapped cheek, and if they have then they can’t go back to school/nursery tomorrow”.
I invite you to have a look at the patient information leaflets for all three conditions (as an aside you can go to www.patient.info and search for conditions, many of which will have info leaflets – the same one’s I print off from my consulting room for patients.)
If you look at each leaflet towards the end of them there is a statement about whether individuals who have the condition need to remain off school/work/nursery. You will see that the guidance is clear that they don’t need to stay off unless they are too poorly to go. There are usually exceptions to this in the event of an outbreak, where guidance from public health will usually be sought. This does not stop the schools and nurseries from telling parents what they tell them. There is an interesting line in the conjunctivitis leaflet where it mentions this and acknowledges that nurseries have the right to have their own rules about this. Maybe they do, but I’m not sure they have the right to create additional work for the NHS? You will also note that no treatment is needed for any of these three conditions. If the child is otherwise generally well, then there is no need to see the GP. There is no treatment for Hand, Foot and Mouth or Slapped Cheek, and antibiotic drops for conjunctivitis are rarely needed. By sending these children to the GP we are using up valuable appointments that we could really do with having free for those who do need to be seen. (Quick note – some parents will bring children they are concerned about and where they do not know what the diagnosis might be, I am not talking about these – I am talking about those who otherwise would not have attended without the achool/nursery telling them to do so.) Some nurseries have the even less logical policy that children with conjunctivitis have to be excluded unless they are receiving antibiotic eye drop treatment – treatment which, as we have just mentioned, is not actually required in most cases. The pressure to prescribe is great as working parents with a child suddenly unable to attend pre-school are usually desperate to get them back as soon as possible.
My plea in this blog, therefore is that we, as a society, look at some of these issues and acknowledge that decisions are being made about health by non-health professionals, in this case schools and nurseries.
There is a wider issue that all GPs will be familiar with of work being pushed to us from other aspects of society for a variety of reasons. Requests for letters for employers, schools, gyms, dance studios, sky-diving organisations and many, many more. Others have looked into this area in far more detail than I, and written much more about it. If you want to read more, then could I suggest this is a good place to start: http://www.ganfyd.org/index.php?title=Get_a_note_from_your_doctor
The fundamental issue I am raising is that GPs are dealing with a not-insignificant amount of work being passed to them from others where it is not necessarily required, and in many cases not a function of the NHS. It seems to be in part a passing of responsibility to the GP to deflect complaint or litigation when something goes wrong. GPs once again are being used as the backstop for everything. It’s just not sustainable.
Please can we inject a healthy dose of common sense, trust and the ability to carry a degree of risk without having to ask your local GP to be the person who has to carry everything? We are becoming a society where no one is prepared to manage risk, where we are all fearful of being sued, where we all think that it is ‘better safe than sorry’, and I’m not sure it is taking us to a good place.
A recent blog of mine talked about Risk https://drjongriffiths.wordpress.com/2017/08/24/risk/. I think it’s an issue. Let’s not let things get any more out of control. Your GP is a valuable resource. When you need them, you want them to be available. You don’t want them to be too busy to see you because they are writing letters to the gym, school or college. You don’t want them seeing people who don’t need to be seen, who have self-limiting conditions that don’t need any treatment and which will (by definition) get better by themselves. We hear a lot about the difficulty people have in getting in to see the GP. We hear a lot about how we need to be offering extended GP access and more appointments at convenient times. We don’t’ hear much about the unnecessary work that GPs are doing that would save a huge chunk of time, releasing the much needed capacity.
So, next time you are advised to go to the GP, or to take your child, just stop and question it perhaps. You never know, there might be a handy info leaflet somewhere that could help you instead.
Dr Jonathan is a GP at Swanlow Surgery in Winsford, Cheshire, and Clinical Chair of NHS Vale Royal Clinical Commissioning Group.
Follow Jonathan on Twitter and Instagram @DrJonGriffiths