Say goodbye to your local GP

While 24-hour shopping and TV are taken for granted, medical advice remains hard to obtain

WHEN DID you last see your doctor? I ask because it is entirely possible you do not know who he or she is. A recent government survey showed that one in four patients waits at least four days for an appointment with their GP, but my own completely unscientific poll of friends and colleagues suggests this is a conservative estimate. The Radio 4 Today presenter James Naughtie recently complained he had had to wait two weeks, and delays of up to four weeks are not uncommon.

In these circumstances, it makes sense to opt for whoever can see you first. Most patients - with the important exception of the chronically ill, who make regular visits to the surgery - want rapid treatment and are less concerned about who provides it. But that means that the link with the personal family doctor is weakened.

In a society in which round-the-clock shopping, banking and TV are taken for granted, medical advice remains astonishingly hard to obtain. GPs' surgeries are open for a couple of hours morning and evening, and if you cannot get an early appointment the only alternative is to queue for a couple of hours in the walk-in surgery.

As the Prime Minister noted in a speech to GPs earlier this month, although most patients are happy with the care they get, they are less happy with how long they have to wait for it.

That is about to change. The scale of the change that is planned has been unheralded and little written about. Put simply, it is to replace GPs with nurses as the first point of contact for patients. This change will fundamentally alter the way patients obtain medical treatment, by opening up a new gateway to the NHS. It could even spell the end of the traditional GP.

Major changes in social institutions are always difficult to date. But the winter crisis in the NHS last Christmas may have set the seal on a process whose origins can be traced back years or even decades.

There were four days over the holiday when hospital casualty departments were overwhelmed with patients suffering from flu. Beds were full, trolleys were wheeled out and the health service found itself unable to cope.

Nothing new there, of course. But when the causes of the winter crisis were investigated, it was GPs who got the blame. Because Christmas fell at a weekend, surgeries were closed for longer than normal. Out-of-hours deputising services were unable to cope and scores of sick patients took themselves off to their local accident and emergency departments.

What ministers saw as the failure of the primary care service over Christmas chimed with government plans for its reform. The Christmas crisis helped forge Tony Blair's speech in Birmingham earlier this month to a conference of GPs, nurses and managers in which he set out his vision of the NHS in the 21st century. A key aspect of that vision is instant access to medical advice when people need it.

Ministers are determined to do something about the problem of access, a key determinant of the way people perceive the NHS. Nurses, who would be contacted by telephone or via the Internet, would provide a filtering system, helping patients with minor ailments to treat themselves while referring trickier cases to... how shall we describe this new style of second- line general practitioner? Not so much a family doctor, seeing everything that comes through the door of the surgery; more a "primary care consultant", perhaps.

Here we have the medical equivalent of 24-hour banking, an image used by Tony Blair last week. For everyday problems, patients would be able to seek instant advice, 24 hours a day, from the nurse-run telephone helpline, NHS Direct, which is being rapidly rolled out across the country. Access points are to be established in post offices and libraries. Computer links (the medical cash machine) and a network of walk-in centres led by nurses would provide hands-on care. Doctors, like bank managers, would offer appointments for more serious problems.

It is, of course, far too early to tell how far this process will go. Much will depend on the response of the public and of the professional groups. But the direction of travel is clear. Stephen Thornton, director of the NHS Confederation, said the vision set out by the Prime Minister in Birmingham last week required "nothing short of a complete transformation".

It has, however, an undeniable logic to it. For more than two decades, health policy makers have worried about using expensively trained doctors to hand out cough medicine and laxatives to the worried well. Surveys show that GPs consider many of the problems brought to them are trivial.

In the Seventies, there was talk of introducing Third-World-style barefoot doctors to the UK - medical orderlies who would sort the simple problems from the serious. What curbed these moves were warnings from the royal medical colleges that an apparently trivial symptom could hide a serious underlying disease. Only a trained doctor, taking a full history and making a proper investigation, could tell the difference. For patients to place their health in the hands of nurses risked disaster.

That view is now history. What has made the use of nurses possible as front-line practitioners is the development of computer-based protocols - lists of questions that cover all eventualities. The protocols used by NHS Direct have been adapted from America and so far the service has met with almost universal approval.

Surveys of callers in the three pilot sites have shown 97 per cent satisfaction with the advice received - even though it came only from a nurse. In some cases lives have been saved, but more often patients who would otherwise have turned up at the surgery or accident and emergency department have been helped to deal with the problem at home, saving themselves the trip and the NHS a consultation.

Nurses are understandably enthusiastic, but GPs notably less so. They feel their territory invaded and their autonomy threatened. The BMA warns of threats to continuity of care and the doctor-patient relationship. It knows that if the role of GPs providing round-the-clock care to a defined list of patients is eroded, they could lose their coveted status as self- employed, independent contractors with the NHS.

But GPs have been living on borrowed time since 1995, when they negotiated an end to their contractual requirement to work at least some nights and weekends. Although they remain technically responsible for their patients 24 hours a day, in practice many work something close to normal office hours.

Now they are being reorganised into "primary care groups" comprising GPs, nurses, health visitors and other staff, which will ultimately control more than three-quarters of the NHS budget. These groups will serve populations of an average of 100,000, providing their primary care and buying their hospital care within a fixed budget - the first time GPs have been cash- limited in this way. They will therefore have a financial incentive to encourage any innovation - such as the greater use of nurse-led advice and care - that improves their efficiency.

The strategy is, however, not without risk, as Professor Chris Ham, a health policy expert at the University of Birmingham, has warned. Britain has a unique system of general practice that provides care to the entire population and is admired across the world. Its strength lies in the personal relationship between patient and doctor. For many patients, who need only occasional attention, continuity of care by a familiar doctor may not matter. But for those with chronic conditions, who tend to be older, it matters more.

Bringing nurses into the medical front line is overdue and could yield real benefits for patients in terms of convenience and speed of access. But if the personal link between patient and doctor is broken, a pillar of the NHS will be lost. This will depend on whether the new nurse-led advice system is to be an additional service or merely a money-saving replacement for the traditional GP.

Have you tried new the Independent Digital Edition apps?
Arts and Entertainment

ebooksNow available in paperback
Arts and Entertainment

ebooks
Arts and Entertainment
Feeling all at sea: Barbara's 18-year-old son came under the influence of a Canadian libertarian preacher – and she had to fight to win him back
TV review
Arts and Entertainment
Living the high life: Anne Robinson enjoys some skip-surfed soup
TV review
Arts and Entertainment

Great British Bake Off
Arts and Entertainment
Doctor Who and Missy in the Doctor Who series 8 finale

TV
Arts and Entertainment

film
Arts and Entertainment
Chvrches lead singer Lauren Mayberry in the band's new video 'Leave a Trace'

music
Arts and Entertainment

music
Arts and Entertainment
Home on the raunch: George Bisset (Aneurin Barnard), Lady Seymour Worsley (Natalie Dormer) and Richard Worsley (Shaun Evans)

TV review
Arts and Entertainment

TV
Arts and Entertainment
Strictly Come Dancing was watched by 6.9m viewers

Strictly
Arts and Entertainment
NWA biopic Straight Outta Compton

film
Arts and Entertainment
Natalie Dormer as Margaery Tyrell and Lena Headey as Cersei Lannister in Game of Thrones

Game of Thrones
Arts and Entertainment
New book 'The Rabbit Who Wants To Fall Asleep' by Carl-Johan Forssen Ehrlin

books
Arts and Entertainment
Calvi is not afraid of exploring the deep stuff: loneliness, anxiety, identity, reinvention
music
Arts and Entertainment
Edinburgh solo performers Neil James and Jessica Sherr
comedy
Arts and Entertainment
If a deal to buy tBeats, founded by hip-hop star Dr Dre (pictured) and music producer Jimmy Iovine went through, it would be Apple’s biggest ever acquisition

album review
Arts and Entertainment
Paloma Faith is joining The Voice as a new coach

TV
Arts and Entertainment
Dowton Abbey has been pulling in 'telly tourists', who are visiting Highclere House in Berkshire

TV
Arts and Entertainment

TV
Arts and Entertainment
Patriot games: Vic Reeves featured in ‘Very British Problems’
TV review
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    Refugee crisis: David Cameron lowered the flag for the dead king of Saudi Arabia - will he do the same honour for little Aylan Kurdi?

    Cameron lowered the flag for the dead king of Saudi Arabia...

    But will he do the same honour for little Aylan Kurdi, asks Robert Fisk
    Our leaders lack courage in this refugee crisis. We are shamed by our European neighbours

    Our leaders lack courage in this refugee crisis. We are shamed by our European neighbours

    Humanity must be at the heart of politics, says Jeremy Corbyn
    Joe Biden's 'tease tour': Could the US Vice-President be testing the water for a presidential run?

    Joe Biden's 'tease tour'

    Could the US Vice-President be testing the water for a presidential run?
    Britain's 24-hour culture: With the 'leisured society' a distant dream we're working longer and less regular hours than ever

    Britain's 24-hour culture

    With the 'leisured society' a distant dream we're working longer and less regular hours than ever
    Diplomacy board game: Treachery is the way to win - which makes it just like the real thing

    The addictive nature of Diplomacy

    Bullying, betrayal, aggression – it may be just a board game, but the family that plays Diplomacy may never look at each other in the same way again
    Lady Chatterley's Lover: Racy underwear for fans of DH Lawrence's equally racy tome

    Fashion: Ooh, Lady Chatterley!

    Take inspiration from DH Lawrence's racy tome with equally racy underwear
    8 best children's clocks

    Tick-tock: 8 best children's clocks

    Whether you’re teaching them to tell the time or putting the finishing touches to a nursery, there’s a ticker for that
    Charlie Austin: Queens Park Rangers striker says ‘If the move is not right, I’m not going’

    Charlie Austin: ‘If the move is not right, I’m not going’

    After hitting 18 goals in the Premier League last season, the QPR striker was the great non-deal of transfer deadline day. But he says he'd preferred another shot at promotion
    Isis profits from destruction of antiquities by selling relics to dealers - and then blowing up the buildings they come from to conceal the evidence of looting

    How Isis profits from destruction of antiquities

    Robert Fisk on the terrorist group's manipulation of the market to increase the price of artefacts
    Labour leadership: Andy Burnham urges Jeremy Corbyn voters to think again in last-minute plea

    'If we lose touch we’ll end up with two decades of the Tories'

    In an exclusive interview, Andy Burnham urges Jeremy Corbyn voters to think again in last-minute plea
    Tunisia fears its Arab Spring could be reversed as the new regime becomes as intolerant of dissent as its predecessor

    The Arab Spring reversed

    Tunisian protesters fear that a new law will whitewash corrupt businessmen and officials, but they are finding that the new regime is becoming as intolerant of dissent as its predecessor
    King Arthur: Legendary figure was real and lived most of his life in Strathclyde, academic claims

    Academic claims King Arthur was real - and reveals where he lived

    Dr Andrew Breeze says the legendary figure did exist – but was a general, not a king
    Who is Oliver Bonas and how has he captured middle-class hearts?

    Who is Oliver Bonas?

    It's the first high-street store to pay its staff the living wage, and it saw out the recession in style
    Earth has 'lost more than half its trees' since humans first started cutting them down

    Axe-wielding Man fells half the world’s trees – leaving us just 422 each

    However, the number of trees may be eight times higher than previously thought
    60 years of Scalextric: Model cars are now stuffed with as much tech as real ones

    60 years of Scalextric

    Model cars are now stuffed with as much tech as real ones