Primary focus - do we ask too much of our GPs?

Given there is an ongoing review, due to report imminently, and negotiations are underway for a new Scottish GP contract, it shouldn’t be surprising we’re hearing a lot about primary care at the moment. 

Shona Robison’s announcement last month that the bureaucratic QOF system of GP payments will be dismantled will have delighted doctors.

The word ‘primary’ suggests a first port of call, and certainly many GPs would see themselves that way, but the Scottish Government’s 2020 vision to get everyone managing their own conditions at home or in a home setting would suggest a more fundamental shift in the way we view the roles of all practitioners is needed.

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If anything has been learned from the pressures on the NHS in recent years, it’s that the old-fashioned ways people interact with the NHS are no longer viable. 

People are struggling to get appointments with their GPs for an ailment, while those suffering from anything more serious are finding long waiting times for scans or at A&E while beds are filled by delayed discharge.

The Royal College of GPs in Scotland has called for a clear political strategy for general practice from the Scottish Government. That suggests they’re not hearing one from whatever is being said behind closed doors in the contract negotiations.

Figures revealed at the organisation’s conference revealed NHS Scotland funding for general practice has fallen by £1.3bn over the last decade, a time when consultations have risen by 11 per cent. 

“While we wholeheartedly wish to help deliver the 2020 vision, current trends, illustrated by these figures, represent a reduction in people’s access to GP services, a reduction evident across more than one parliamentary term,” said Dr Miles Mack, the RCGP Scotland chair.

Clearly the answer to the NHS’s woes isn’t just to throw money at it, but whatever the first port of call to health services should look like, whoever it should be made up of, and whatever advice it gives out, if it isn’t backed up by investment it will always be on the back foot.

GPs will point to the second meaning for the word primary, as in principal and most important, but doesn’t there need to be a bigger, socio-cultural shift in the way everyone thinks about their own health?

There is a message to the public – ‘Don’t go to hospital when a doctor will do, don’t go to the doctor when a pharmacist will do, and, ultimately, look after yourself so you won’t need to bother the NHS’ – which just isn’t getting through.

At the recent roundtable I chaired on prevention, this entered into the conversation. Professor Annie Anderson, co-director for the Scottish Cancer Prevention Network, said people were dependent on drug therapies in a “culture of medicalisation”. 

In other words, doctors have been so good at making us better, we don’t think about preventing getting ill in the first place.

James Cant, the new Scotland director at the British Heart Foundation, said when he was in a similar role at the British Lung Foundation, he told people their lungs were easy to break and incredibly difficult to fix.

“Everybody loves the NHS but many of us go in and say, ‘I’ve broken myself, fix me’, and there has to be ‘you love the NHS, what are you as an individual trying to do to make sure you’re not part of the thing that’s breaking it,’” he said.

The discovery of a new drug or technology will save lives and help people with conditions live longer. What it won’t do is make us all healthier. Anderson suggested pedometers on prescription. 
Training doctors, nurses, pharmacists and other health professionals to make more lifestyle interventions would shift the onus onto the person whose body it is in the first place. But can they shift the primary focus onto the patient? 

‘Person-centred’ is the lingo in health empowerment, but with great power comes great responsibility.