Thursday, 5 August 2010

More GP idleness?


Several news stations yesterday carried stories similar to this one about the idleness of GPs and how it affects their patients particularly pregnant ones.

Now being in the trade and listening to various news stations during the day they all said that the most important contribution that GPs could make is their knowledge of patients and their families. Not their prowess in obstetric medicine for nowhere was there any mention of GPs carrying obstetric forceps and performing emergency forceps deliveries or Caesarian sections on kitchen tables.

If you want to read this “report”, although it seems to be little more than the opinions of a GP and a couple of researchers at the Kings Fund you can do so here (takes a few seconds to download). There does not appear to be any medical obstetric input (apart from in the copious references at the end) but then reports don’t need experts in the field to be involved in their preparation. Think General Practice reform report and surgeon.

Now GPs do not act in isolation so we thought about the changes in our obstetric care. In general practice a good practice based midwife is a godsend. Getting a bad one is a nightmare as they usually have ex directory mobile phones, every afternoon off, frequent large areas of no mobile phone coverage and refer everything to you or the hospital usually without seeing the patient. They are often grossly obese as well.

The amount of antenatal work you get is therefore midwife dependant. Now lots of GPs will have lost their health visitors, district nurses and possibly midwives as the current “thinking” = political interference is that such “specialists” should not be practice attached but in Party sponsored centralized barracks.

The “report” highlights communication as an issue and cites electronic communication as the solution. Communication in our neck of the woods has been destroyed with 2 out of the three groups above for the above reasons.

We still see our midwives and have that old fashioned but politically incorrect and therefore inefficient means of communications called a “chat.” This outdated mode of communication leads to an exchange of information about patients.

We used to have such “chats” with our district nurses and health visitors which meant we knew about our patients and vulnerable children but the move towards electronic communication with records held on different computer systems which cannot (as yet? if ever?) talk to each other means that there are no longer any such “chats”.

We should all know by now what happens when information is not shared (hint Baby P et al).

The idiots in charge know about these problems but they are happy because there are supremely thick and ignorance, especially in child protection, is usually bliss.

We digress. A few years ago it was decided that healthy mothers should be looked after by midwifes for this is what they are primarily trained to do. To look after the normal but be able to recognize the abnormal but not necessarily be able to deal with all of it. So at a stroke most GP work with healthy antenatal patients disappeared.

We do usually see most pregnant women to filter out the high risk obstetric and medical cases, give them their Folic acid and smoking and other healthy lifestyle advice but as most pregnant women in these exceptionally affluent areas of Northernshire are so well we don’t usually see much of them until their post natal checks.

Our currently practiced based midwifes do an excellent job together with the local obstetricians. Any that do get ill we usually see and sort and, if need be, refer on.

The new GP contract also took away a financial incentive to see and look after pregnant women and as the above two centrally imposed ideas happened close together then the result is that which the “report” highlights.

So if you have nothing else to do then please have a read of the report. It tells GPs nothing that we don’t already know and you could write a similar report for any specialty that has been withdrawn from general practice over the last few years and come to the exactly the same conclusions.

Makes for good headlines, will make bugger all difference to the grunts on the ground and it is not our fault.

Praise be to the Party for changing everything and then blaming everyone else for their actions. We like accountability especially the kind where you always get away with it when things go wrong.

If only midwives, district nurses, health visitors, social workers and doctors had the same “accountability” when a system that they did not design (and even opposed) fails.