Does NHS = Hospitals?

I am a GP. This morning there was a national issue affecting GP computer systems up and down the country. The system kept crashing, and then not re-connecting to the server. It happened multiple times over the course of the morning and into the early afternoon. While it was down we could not access patient records. Bearing in mind this affected thousands of GPs in England, and many more of their patients I was slightly surprised to find no mention of this in the news. Well, actually not that surprised*. If hospitals up and down the country had an IT issue like this, I think you might have heard about it. And this is a problem the problem.

The NHS is often seen as being all about hospitals.

I have blogged about this before, most recently at Christmas time (https://drjongriffiths.wordpress.com/2018/12/21/a-gp-is-not-just-for-christmas-admission-avoidance/).

Despite the vast majority of healthcare contacts in the UK taking place in a community setting, what gets talked about in the news? Hospitals. What do politicians talk about? Hospitals. Where does the money go? Yes, you’ve guessed it – to the hospitals.

The above statements are, of course, linked. The journalists reports what the politicians talk about, and the money follows all of this. Investing in hospitals is a politically savvy thing to do – investing in GPs is perhaps less likely to win you votes – although I would question why.

It is time for this to be tackled. We need to promote General Practice and other community based services (which includes the majority of mental health care) and ensure the pressures being faced here are understood, as well as the need for support and investment. We need to ensure that everyone understands the huge amount of work being undertaken by GPs and other community staff, and how effective it can be to invest in this.

I sit on our local A&E Delivery Board. I think we are pretty good at recognising that we need to work as a whole system to deliver the healthcare our population needs. Sometimes, however, it seems as though the regulatory system for our health services is so focussed on delivering targets in the hospital setting that General Practice and Community gets overlooked, and even becomes the potential solution for the hospital’s problems, without any additional resource to help. This is why we now have ambulance crews ringing the GP rather than taking people to hospital – I’m not saying this is inappropriate, but no one talked to us about the implications of this before enacting it, and no one gave the GPs more resources to deal with these extra patients.

The solution seems to be to take General Practice seriously. To realise that we are not just a cuddly, ineffective add-on to the NHS, nor are we an irritating barrier to get through to see a ‘proper’ doctor. We are a highly skilled, highly qualified workforce specialising in generalism. We are able to diagnose and treat a wide, wide range of illnesses, and come alongside you and your family providing long-term continuity of care regardless of what medical condition you may present with next. We understand how the system works, we want the best for you and can usually achieve this in a very efficient way.

There are so many myths and misconceptions out there about GPs that we have hard work ahead of us to change some perceptions. My blog from Jan 18 tried to do some of this (https://drjongriffiths.wordpress.com/2018/01/30/10-insider-tips-i-bet-you-dont-know-about-your-gp/) and my TEDx Talk from 2016 sees me passionately extolling the virtues of the generalist (https://youtu.be/-BfcvI49GCw).

We need more though. More noise, more positivity, more myth busting. Hopefully this might lead to more resource. If this happens then we could see significant, positive transformation of the NHS.

Next time you see an NHS headline, therefore, why don’t you stop for a second to see what it is about – usually, it’s about hospitals. Perhaps you could consider redressing the balance – comment to your friends and colleagues, point out the lack of reporting on community heath services, post something on social media. The more we start to talk about this, the more likely we can effect change.

 

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

Follow Jonathan on Twitter @DrJonGriffiths

 

*Rumours of Boris Johnson possibly calling a General Election will not have helped the news stories today!