Here, here to _all_ that!  PLease make it so by the time we qualify and
more of us might become GPs!

BFN 

Nick.



>Here's the nub of the question. What do you, we, HMG and the Great
>British Public (to say nothing of the tabloids, m'learned friends et
>al), mean by Drs' workload? My workload at present includes seeing a lot
>of people who have self-limiting illnesses whose interests would be
>better served by being kept away from Drs (who might prescribe wholly
>unnecessary treatment and reinforce inappropriate help-seeking
>behaviour). I also see a lot of people who say (like a patient today in
>my "emergency" surgery) "my neighbour attacked me on New Year's Day and
>I'm scared to go out of the house so can you write a letter to the
>council for me?" She hadn't been to A+E, nor consulted anyone and had
>one tiny healing abrasion. Is this a doctor's job? (I wrote the letter
>anyway but immediately regretted it).
>
>Of the 31 patients who attended emergency surgery there was only one
>true emergency (or, more accurately, justified urgent consultation - a
>perianal abscesss which required admission for incision and drainage).
>Many of the others were the aforementioned minor illnesses - each of
>which required a careful explanation of why they didn't need
>antibiotics.
>
>So, much of this "Drs' workload" oughtn't to be *Drs'* workload at all.
>The use of nurses to give advice and reassurance, seems much more
>appropriate than simply squeezing as many patients into a surgery as the
>GP can get through in the time. My doubts about the advice service are
>because it is separate from primary care. It should be integral to the
>PHCT so that the nurses giving advice know exactly what services are
>available within the team and can advise patients:
>
>1) If the patients could manage the illness themselves, and how to do
>it.
>2) When to reconsult
>3) If a consultation with a nurse or nurse practitioner would be
>appropriate, and when.
>4) If they should see another member of the team (counsellor, GP,
>dietician, physio etc) and when.
>
>and so on. 
>
>The main problem we face is that because primary care is GP centred,
>patients keep demanding to see GPs "now!!". The present patient-practice
>interface is usually managed by receptionists who are no longer allowed
>to be the fire-breathing dragons of former days. So they act as a
>conduit rather than as a guide, have basically outlived their function
>and should only book "routine" appointments (by which I mean those which
>the GP or other member of the team has made available on a routine
>basis). If patients want immediate advice, they should get it from a
>nurse who would assess their needs and negotiate the practice's response
>if they can't sort the problem out on the spot.
>
>I'd envisage the PHC nursing team as a semi-autonomous group who will
>gradually develop its own style, body of knowledge and appropriate
>response to demand. Hierarchical styles of practice should go and GPs
>would be able to function as doctors again - to the very great benefit
>of the minority of primary care patients who actually need a medical
>opinion.
>
>Toby
>-- 
>Toby Lipman 7, Collingwood Terrace, Jesmond, Newcastle upon Tyne. Tel
>0191-2811060 (home), 0191-2437000 (surgery)
>
>
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Nicholas David JENKINS [Undergraduate 96]  ([log in to unmask]) 
Imperial College School of Medicine at St.Mary's
Norfolk Place, LONDON W2 1PG 
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