A Quality Service?

There was a lot in the press today about a new idea to find out whether GP’s and their practices provide a quality service. For most GPs we sighed heavily and wondered how much more paperwork we would have to complete and how many more hoops we will have to jump through.

We already have a new contract that means we have to achieve certain targets and this gives us a certain number of points at the end of the year. It is therefore possible to see whether your practice has done well in this respect. The targets cover clinical care, administration, patient surveys and many other aspects. It is very comprehensive.

So to hear of yet more targets makes us wonder just when we might be allowed to get on with seeing our patients and striving to maximise the care we offer to all our patients.

All Change!

One thing that is certain in the NHS is that it is reorganised every 10 years or so. This last week has seen the latest alteration to the structure of the NHS in your local area.

Primary Care Trusts (in England) were merged last week – roughly three PCTs into one. This means that many people in these organisations won’t know if they have a job next year. Local health professionals won’t know who they will be dealing with in the near future and it means a whole deal of uncertainty.

Just as we had built up some good relationships with local managers then it all changes and we have to begin again – how frustrating! Of course it is the politicians in London who decide all this and for those of us working at the coalface it all seems very remote and we wonder why they want to change it all yet again.

Then again – it is 10 years sine the last change so they must have realised it was time to do something – even if it is not clear why it needed doing…….

money money money

If you listened to the BBC today they were suggesting that GPs were earning around a quarter of a million pounds each! I wish! It does seem that a few GPs out of the 35000 of us do earn a vast amount but the majority do not come anywhere near this figure.

The focus on money is unfortunate given that the new contract GPs are working with is improving the health of the nation to a massive extent. The calculations show that the work we are doing will prevent 9000 heart attacks or strokes over a five year period. For me the prevention of just one heart attack is enough but to prevent 9000 is fantastic.

For GPs to do this work takes time, effort and the use of many staff in our practices. Most GPs are working flat out to help our patients. We all try and improve the health of our patients and to be told by the press that we are ‘fat cats’ or ‘not worth the money’ or ‘not needed’ can be very hurtful but we will carry on treating our patients to the best of our ability and hope our patients appreciate this!

Spotted Dick

For those of us who had lots of school dinners we know that this was a dessert that quite often tasted better then it sounded.

Now I am a GP though it has an altogether different meaning to me.

Quite often I will see a young man (usually he is young but not always) who has discovered some worrying spots on their tackle. It usually causes great consternation as all sorts of horrible things go through their minds. Will I need to go to a GU clinic – what will they do to me? Am I going to pass it on to anyone? Will it get worse? Will I need an operation on it??

Last month a young man, aged 20, came to see me with spots he was worried about. I had a chat with him and found out how long they had been there, and whether his partner had any problems.

Of course I needed to take a look and a quick glance made it clear to me that he probably had warts on his penis. This is sexually transmitted and can be dealt with by a GU clinic (you can find the number for them from your GP surgery or in the phone book). I can reassure you that they will not do anything to you like the stories you might hear in the pub!

It is always important to use condoms to prevent these sorts of problems and if you do become infected I always try and say to patients that they should also tell their partners so they can get treated too.

I saw the same chap last week and he told me he had been to the clinic and they had dealt with him confidentially and with no fuss. He was pleased he had them sorted out.

Choice

This is the BIG word in GP surgeries now. The government have asked (told) me to give ‘choice’ to all my patients who need hospital treatment. In reality they want me to ask whether my patient wishes to attend one of five hospitals when they need a consultant’s opinion. I know one of the hospitals very well – our good old local hospital which provides a pretty good service.

However the other four hospitals range from 40 to 150 miles distance from the surgery. I have never visited them and know nothing of the consultants there.

All the patients look at me in a strange way when I offer them this choice as if I have just told them Margaret Thatcher is our current Prime Minister! All they want is fast effective local health care. But tell that to the Department of Health!

So I will carry on getting strange looks from my patients for the time being and see if the politicians change their minds!

 

A close call

A man aged 61 came to see me a few weeks ago about his tablets. He mentioned towards the end of the consultation that he had a ‘pulsation’ in his stomach. This made my ears prick up and I examined his belly and indeed found a pulsation there. I decided to arrange an ultrasound scan (the one woman have when they are pregnant) fairly quickly.

I had an email very quickly from our local consultant saying this chap had a fairly large aortic aneurysm (a bulging of the main blood vessel in the abdomen). He needed seeing soon in the out patient clinic so I informed my patient, reassured him and arranged the appointment.

However he left me a message a few days later to say that the pain in his stomach had worsened. This rang alarm bells so I spoke to him and admitted him to hospital for more tests. It turned out the aneurysm had got bigger and was about to burst – something which would be likely to kill him.

The story has a happy ending though because an urgent operation was done,  with him recovering well over the next 10 days on the ward and I went to see him at home the other day to find him in good spirits and looking forward to another 30 years of health!

I don’t want any of you to panic about this. Aneurysms are rare but I did want to get the message across that if something feels not quite right in your body then have a chat to your GP about it – if only just to reassure yourself!

Flu

We have had a run on our flu jab clinics these past few weeks – so much so that we have run out and are seeking extra supplies for our patients. I have had some patients say they need one to cover them against bird flu. Unfortunately the annual flu jab does not cover you for bird flu.

There has been a lot in the media about bird flu and some may think it is all a bit OTT. The risk is that flu in birds could mutate and affect humans. The problem is we don’t know what sort of flu virus it will be until it affects humans. There are thousands of different flu viruses already with extra ones coming along and that is why we can’t beat flu as yet with one jab for all for life.

The main message I would say is that if you are eligible for a flu jab then get one this winter and keep yourself fit and healthy. There is no sign of any bird flu at present and lets hope it stays that way!