Grandma

I remember my Grandma, Marjorie, very fondly. When I think of her it triggers a cascade of memories including her little car with the squidgy window washer, of walking into the town holding hands with her and my mum with me swinging up into the air “one, two three, wheeee!”, of playing in her kitchen, sitting in the pantry on the seat that became step ladders and using the wall mounted can opener as some kind of space age device, playing on the stairs, hearing her answer the phone “Aldridge 52629”, picking raspberries in the (very large) garden, of her and my Grandpa hosting Christmas parties for the whole, extended family with food, presents for all and sherry for the grown-ups. She was there as I grew up someone I looked forward to seeing, someone who gave unconditional love in the way that Grandmas do. She was proud of my achievements, I have a photo of her at my graduation, at my wedding, and one of her holding my infant son. So many memories.

 

Ironic that memories became something that she ultimately struggled to retain herself. As she aged she began to forget. She began to become confused. She struggled to retain her personality, she stopped being the person she had been.

 

Dementia is a dreadful thing.

 

It isn’t just about memory, or rather we need to remember the importance of memory and how integral it is to your ability to function in the world. Taking away your memory can mean taking away your personality, your ability to interact with people around you, your understanding of who the people around you are. And it takes you away from the people that love you. It might not take them away physically, but I think you know what I mean.

 

My Grandpa worked very hard to keep my Grandma at home. He succeeded until her final illness when she fell, broke her hip and was admitted to hospital. He coped (barely) with her condition with very little external help, and my family and I all remember those difficult, stressful times.

 

I have blogged about dementia before two years ago (http://www.valeroyalccg.nhs.uk/blog/9482-dementia-friends). In that blog I talked about Dementia Friends (https://www.dementiafriends.org.uk/) and encouraged you to become one. I will still make that plea. In this blog I want to encourage you to take action by ensuring that anyone you may know with any memory issues has seen their GP, and that their GP has considered dementia as a possible diagnosis. In my part of Cheshire it seems that we might not have as many people diagnosed with dementia as one would expect. We are not sure why that is, but are doing a number of things across the health system to highlight the situation and make sure that clinicians understand the importance of diagnosis and the pathways to follow.

 

Sometimes I have heard people say that there is little point in making a diagnosis, because there is no effective treatment. I understand that perspective, but I don’t think it is correct. There are some treatments which are used to slow down the cognitive decline, but more importantly there is the additional support that comes with knowing your diagnosis, and the very fact that your medical record notes that you have dementia will potentially change your healthcare experience. Imagine being admitted as an emergency to hospital and your diagnosis of dementia was not known. It is likely that you would end up receiving unnecessary assessment – first to exclude physical causes for your confusion, then a mental health assessment, rather than being provided straight away with the care that you need.

 

A diagnosis of dementia allows friends and family the opportunity to seek out support and information for themselves, which can be essential. Having dementia is hard for the individual affected, but equally hard for their loved ones. We need to do all that we can to support these carers, and early diagnosis is a large part of that.

 

And did you know that individuals with a diagnosis of dementia can sometimes claim reductions in council tax payments? If you think that might apply to your household or to someone you know, then this helpful section of the Alzheimer’s Society website is worth a read.  https://www.alzheimers.org.uk/info/20032/legal_and_financial/83/council_tax

 

We are embarking upon a campaign locally to raise awareness of these issues among local health professionals, looking to recruit ‘Dementia Champions’ from each GP surgery and apply a new focus to this area. We will be looking to ensure that professionals have had Dementia Friends training and understand the pathways to diagnosis and treatment, as well as the support available for patients and their families. I have been looking at the outcomes of the CADDY study (http://nspccro.nihr.ac.uk/research-study-results/dementia–ageing/caddy-cfasii-dementia-diagnosis-study-dementia-undetected-or-undiagnosed-in-primary-care-the-prevalence-causes-and-consequences) which gives some pointers around who is more or less likely to receive a diagnosis which will also give us something to consider with our awareness raising. Sometimes we find that individuals are being treated and managed for dementia, without actually having received a formal diagnosis, or at least without the diagnosis being added to their record – we can look for these patients using computer searches. Those of you reading this blog can play a part in this by sharing on and talking about these issues, by seeking out Dementia Friends training and being aware of the issues.

 

Let’s do all we can to help people like my Grandma and Grandpa, their families and their friends – in essence people like me, and like you.

 

 

 

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

 

Follow Jonathan on Twitter @DrJonGriffiths

I am a GP

I am a GP

I am a General Practitioner.

 

Over the past year I have actively tried to promote General Practice as a career, trying to both encourage medical students and doctors in training to consider choosing GP, and also to encourage a General Practice workforce that is, in some places, struggling.

 

A couple of the things I have done in the last year to promote General Practice particularly stick in my mind – a blog I wrote called “Best job in the world?”, and my TEDx Talk “Choosing to be a Jack of All Trades”.

 

Check them out here (I’d especially like you to find time to watch the TEDx, I’m rather proud of it!)

 

Best Job In The World?

 

Choosing to be a Jack of All Trades

When I published the blog, I was expecting some push back, and readers did not disappoint – it’s always fun when you have to google the insults to find out what they mean (“Panglossial piffle…”).

 

I wasn’t really expecting anything negative to come from the TEDx though. And nothing has, really. It’s just that while at the RCGP Annual Conference last week and on Twitter subsequently I have felt a few anxieties about General Practice develop in my mind.

 

My TEDx Talk is unreservedly positive about the value of the generalist. If you are a GP or consider yourself a generalist in any other walk of life, then I suggest you watch it – it will give you a positivity boost! Regardless of how great I think GPs might be, however, clearly there are others whose experience of General Practice is not as positive.

 

On the first morning of the conference the Health Secretary Jeremy Hunt attended and addressed us all. During the brief question time at the end a Kent GP, Stephanie de Giorgio, made the clear point that many GPs are struggling to cope. There is increasing demand, difficulty in recruiting and GPs are suffering, resigning and in some tragic cases have ended their own lives. You can watch the question and response via this link:

 

https://twitter.com/Channel4News/status/918477328749121536

 

Not quite the glorious description of General Practice I have been looking to promote.

 

The following day, at the conference ‘NHS Question Time’ Roy Lilley was typically challenging and suggested that the Primary Care business model was ‘screwed’. He articulated the ask of many of our patients – that we are available as a family doctor providing continuity, chronic disease management, a known and friendly constant face through our illness, but that we are also able to accommodate urgent need as well as being available in the railway station for him to drop into during his daily commute. These seemingly contradictory requests are in fact what, increasingly, our patients want. Depending upon where you work as a GP more or less of your patients are looking for this ‘full service’. In the urban Cheshire town where I work there are not as many commuters, although when HS2 arrives in nearby Crewe, then we’ll see what happens!

 

So, there are two perspectives that caused me to pause and think. The third was a twitter exchange I had. During my session at the conference, where I delivered my TEDx Talk (have you watched it yet?) there was a Medical Student (@the_littlemedic) who also happened to be a talented illustrator. She created a graphic of the session which she subsequently tweeted.

 

Graphic from @the_littlemedic based on my TEDx Talk

 

This was picked up by many both at the conference and some who were not present. One was “Tired Old Man” (@tired_old) who took exception to the premise behind the graphic which implies that generalists, and GPs in particular, are able to take a holistic view of people, thinking outside the box and looking to help. He said that his experience of General Practice did not align with this – he did not feel that his GPs knew or cared who he was. He pointed out that he was only allowed to mention 1 problem at a time, and that GPs did not seem to know patients or their families. He was keen to ask if there had been a session or a graphic dealing with the reality of patient experience.You can read some of his tweets here:

https://twitter.com/tired_old/status/919134509513302017

https://twitter.com/tired_old/status/919133279307096064

https://twitter.com/tired_old/status/919203903979302913

 

This is quite a challenge to a hard working, well meaning GP.

 

So, who is right? Is my positive view of General Practice just naïve optimism? Is the reality a whole lot worse than I choose to believe?

 

As with many things I suspect there is no one right answer here. There are undoubtedly many GPs who are stressed, struggling, overworked and burning out. On the other hand I know many happy, balanced GPs who still love their jobs. Most GPs are caring, dedicated individuals who are constantly adjusting their services to meet the needs of the population they service, I struggle to think of (m)any who don’t care about their patients.

 

This doesn’t mean that we can always meet all of their needs all of the time, particularly when we seem to be faced with ever increasing demands, not all of which appear reasonable. It is no surprise that groups like Resilient GP http://www.resilientgp.org/  have arisen trying to support GPs in their day to day practice, and others like the GP Survival https://www.generalpracticesurvival.co.uk/  to help support and campaign for increased investment in Primary Care.

 

We also need to consider Roy’s point – how do we meet the many and diverse needs of the people we are trying to serve? I struggle with a model that has me being family doctor one day, and a train station walk-in GP the next. Perhaps, though we do need to embrace both models. Perhaps we need to work in ways that addresses both needs. Simple things like a joined up IT system would help – wouldn’t it be great if the GP walk-in centre had access to your electronic record? Where they could see your history, arrange investigations, arrange follow up back at your surgery at a time that is convenient to you? Wouldn’t it be even better if the GP working at said walk-in centre was one of your own family GPs, just working their weekly shift there, or even a GP from a neighbouring practice perhaps. There are many models and one of my fears is that someone will pick one and ‘roll it out’ to us all – that never seems to work. As Roy said to me in a tweet “It has to come from the ground up. Nothing works top down.”

 

https://twitter.com/RoyLilley/status/918832926107820033

 

So what am I trying to pull together from these various thoughts following the conference? I guess the following:

 

  1. That I still believe in General Practice as the bedrock of the NHS. That it is able to meet the needs of patients in a holistic and caring way that takes into account the diverse needs of the population.
  2. That many people don’t necessarily experience General Practice like that – patients and GPs alike.
  3. That the changing demands upon general Practice probably do mean that the traditional business model will struggle to meet those needs.
  4. That we therefore need to change. We need to look at alternative models that allow us to still provide the family doctor medicine, while also meeting the needs of the 24/7 “I can go to Sainsbury’s at midnight, why not my GP” culture.

 

Not surprisingly I have blogged about the challenges facing General Practice before. Interestingly, the blog that speaks to mind also features Roy Lilley. You can read it here (Outside Context Problem). The scary thing is that I wrote this blog 2 and ½ years ago. The question is, what have we done to prepare and change in the mean time? I think in some areas, a lot, but in others not enough. One message I took home from the conference was that the answers and solutions are in our hands. I acknowledge that the framework that sits around us can be a challenge to that, and the resources that need to flow into Primary care need to come from elsewhere (NHS England/CCGs), but one of the wonderful things about General practice is our ability to adapt and change. We need to see beyond the traditional models of practice and embrace the new. That means thinking about federations, working at scale, the GP Five Year Forward View, Accountable Care Systems, Integrated Care and more. Some of these might not work, or might not work in your area, but you really need to do something. The challenge to us all is that we need to take action now to ensure we are still operating as effective General Practice in another 2 years time.

 

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

 

Follow Jonathan on Twitter @DrJonGriffiths