Monday 10 September 2007

Primary Care

Most poor mental health isn't anything to do with illness and disease and being sick.

Most mental health is to do with feeling rubbish, transiently, as life's given you a good kicking.

The severe problems (psychotic breakdowns) are few compared to the large number of folk with difficulty coping for a while (but not quite having an anxiety disorder or depressive disorder or whatever).

Thus, as we all know, most mental health work happens in the community and mostly in Primary Care.

It's of interest to me, then, that today it's reported that the Government is keen to whip GPs back in to working nights and weekends.

Will this generate better patient care?


Dr Andrew Brown said...

Thanks for your support, Shrink. Yes, it's a load of bollocks.
Primary care practitioners are under stress, as I report in my blog today.
But in any case, the whole thing is impractical. I currently consult for 7 hours per day. If I start at 6pm for the convenience of people at work I won't finish until 1am. Do people really want to nip up to the surgery for a routine consultation at midnight? It might be appropriate for insomnia, I suppose.

The Shrink said...

I was in a Journal Club where a paper was presented a trial showing that a hot milky drink was as effective as a hypnotic like zopiclone.

Can the NHS really countenance GP's being available at 1.00am to help someone out with some Ovaltine or the like?

Dr Andrew Brown said...

If focus groups of worried-well taxpayers think it would be a good idea then yes, I think it could.
Cynical? Moi?

PhD scientist said...

Ah, but how does warm milk *authoritatively recommended in a Telephone Consultation by an NHS Direct Nurse PhonePerson* compare with plain ol' warm milk?

Andrew - what do you think of the possible solution of occasional "late surgeries" running until, say, 7 pm (I always though Family Planning centres did a lot of these ) plus GP walk in centres at hospitals in large popn centres? The idea of these last was that the prospect of a wait might deter time -wasters.

Competing interests: other half of disgruntled hospital doctor and drinking acquaintance of several assorted hospital folk and GPs.

The Shrink said...

A COI in a blog?

My oh my, that's the first time outside more official forums that I've seen a Conflict of Interest cited.

What stunningly high levels of probity, PhD Scientist!

Dr Andrew Brown said...

Our evening surgeries are booked until 6pm plus extras, so we are often still seeing patients up to 7pm. But these are for emergencies rather than routine appointments.

There seems to be some confusion in discussion between emergency care and routine appointments "out of hours".

Most people who need our services are able to attend during the day: because they are elderly, medically unable to work, or have enlightened employers who allow them time off to see the doctor. Members of Labour focus groups evidently do not fall into any of these categories.

But whereas out-of-hours services used to be co-operatives of GPs, run by GPs, they now appear to be a mixed bunch of organisation trying to provide care on the cheap by using nurses and protocols.

PhD scientist said...

Re the COI, Shrink, I guess it shows I've spent too much time on medical forums like the BMJ comment comments.. usually debating "Alt Health" things like bogus nutritionists, MMR-fear, or "Electrosensitivity".

Re Andrew Brown's comments, agreed that it is notable there is rarely any discussion of exactly HOW much demand there would be for "booked routine evening appointments". I can see that City Folk and Highly-paid Lawyers might feel they are FAR TOO BUSY to ever take half the morning or the the late afternoon off. But then they can afford to pay private GPS if they really find 8.30-6 hrs too irksome.

I would only be worried if I thought there were lots of people in less well-paid jobs who really couldn't get time off to do see the doc. But that sounds to me like a problem with UK employment legislation rather than with GP surgery hrs.

A Q I have put on other medblogs, Andrew - GPs all opted out of OOH with the £ 7K /yr "pay cut". How much (though I suspect the cash is just as much symbolic as anything else) do you think they would need to get to go back to running OOH local co-ops?

The Shrink said...

I left Primary Care and wouldn't return in the current climate for love nor money.

GPs are being royally screwed.

"Achieve these targets, but we're giving you no more resources."

"We've raised expectations massively so now you have to deliver, we're giving you no more resources."

"Successes are through prudent Government reform. Failures are from lazy, avaricious, inept and under-regulated GPs failing to perform."

"Out of hours is too expensive and sees people who aren't emergencies. Telephone triage and nurse advice can curtail activity and costs big time. Whoops no it can't, those doing it for years were right all along. Erm, can you do it all again, please?"

Few GPs, surely, would be muppets and take the poisoned chalice once again . . .

PhD scientist said...

Well when you put it like that, Shrink, no they wouldn't.

I sympathize with them. My old PhD supervisor was married to a London inner-city GP and used to regale us with tales of "family life in the face of OOH GP on-call" ...and another mate's GP wife used to entertain us a decade or so back with her "GP housecall war stories from the Moss Side badlands".

I don't know what the solution is in rural areas, but in the cities I was thinking GP walk-in clinic next to A&E at the local hospital (which operates where we are).. plus maybe a free patient bus service (which used to operate in Glasgow...? ...maybe other places?). This would certainly take care of the people who would otherwise try and phone the OOH GP to give them aspirin for a hangover on Sunday at 11 am.