General Practice 1 – Is it Fit for Purpose?

Is General Practice Fit for Purpose or is Lockdown another nail in its coffin? In a suitably grandiose and hubristic style, the Royal College of General Practitioners pronounces that ” a strong primary care system is the absolute foundation for protecting ourselves against this pandemic and any future pandemic”

Covid19 has changed General Practice – workload reduced by by a quarter and now fewer than 1 in four consulations are carried out face to face. This is not a good thing, not least because it is impossible to collect essential physiological data over the phone: through direct observation; through touch; examination or investigations. All patients are now triaged by a doctor / receptionist and a small number get through to having an appointment

The new Mantra is “GLANCE & GUESS”. At best a video consultation with a smart phone (assuming the patient has one) gives the inquiring mind a glimpse of the patient. This consultation enables the doctor to decide whether the patient needs to be seen in person or can be safely given a prescription on the strength of the call.

If you are over the age of 65, the chances are that you do not own a smart phone (60%) and cannot access the Internet on a phone, this compares to 100% of those aged 18 – 24yrs. The UK already spends less on its elderly population than anywhere else in Europe, this will reduce further. Of course, there is a relentless logic to this – old people are unproductive and expensive. And as the Veterans of World War II die away, it is difficult to find uses for an old person. Unlike handicapped children, they do not have parents to vocalise their needs and are more likely to slip away quietly. Not many youngsters are going to complain about inheriting a house and preserving what is left of their inheritance free from the fees of care home.

This suggests that the changes in General Practice which has led to most consultations taking place on the phone or through a video link will become permanent. Less detail, less admin, and as long as your Electronic Medical Records are up to date, then what is there not to love about the “New Normal”.

However if you don’t see your patients, you will miss 90% of their clinical data. Opportunistic screening won’t take place and intuition – the backbone of an old fashioned General Practice is difficult to practice at the same time as (anti-) social distancing.

This feels as though it is part of the “War on Old People” which began when people were sent to Care Homes with Covid19(84) infections. Should this matter to young people?
Three reasons:
1 – If Aldous Huxley’s Brave New World is the blueprint, rather than Orwell’s 1984, then “old” is a rather youthful 30yrs.
2 – Hitler began on by attacking the Old & Infirm
3 – Pastor Martin Niemöller (1892–1984), a Lutheran pastor and outspoken public foe of Adolf Hitler, who spent seven years in concentration camps.

First they came for the Communists
And I did not speak out
Because I was not a Communist

Then they came for the Socialists
And I did not speak out
Because I was not a Socialist

Then they came for the trade unionists
And I did not speak out
Because I was not a trade unionist

Then they came for the Jews
And I did not speak out
Because I was not a Jew

Then they came for me
And there was no one left
To speak out for me

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