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Tuesday 25 October 2016
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Can we help put an end to patient dependency?

Practice Manager, West Midlands
Consultant Editor, Management in Practice

When a practice partner and I set out to attend the national self-care conference at the Royal College of Physicians in London back in November 2009, I don't think either of us quite anticipated that we would be expected to take part in some kind of situation comedy.

With an excellent line-up of speakers, and a programme clearly aligned to general practice, the conference, Time to Change the Culture of Dependency, hosted by the Proprietary Association of Great Britain (PAGB) and the Royal College of GPs (RCGP), promised to be a thought-provoking and engaging event.

Why was it then that the majority of delegates had roles outside general practice? Why were GPs so poorly represented? Perhaps it's because they are so busy dealing with the numerous minor ailments that present at their door each morning that they can't take time out to address what is, in my opinion, the fundamental problem to access in primary care: yes, the minor ailment.

Did you know that, according to PAGB research, the average patient waits 4-7 days before contacting their GP when feeling unwell? No, I bet you didn't. I am not sure where that statistic came from – I reckon this to be more like 4-7 minutes!

So, why do patients react like this? Perhaps it's because they have been told they can. The Department of Health has told us, as patients, that we can expect to get what we want, exactly when we want. It's just a pity that they didn't consider the resources and infrastructure necessary to accommodate such a dependent culture.

So, last November, there we were at the conference, being challenged to invest in that infrastructure to unpick the mess established by the nanny state we find ourselves in, to allow access to our services for patients that actually need them, rather than want them.

We live in a consumer society that has extended hours for primary care, extended pub licensing laws, extended shopping facilities … the list goes on. So why isn't education included?

Perhaps if our kids were taught a little more about the infrastructure of the NHS – eg, how every time mummy goes to the doctors for some Calpol, which is a couple of quid over the counter, it actually costs the NHS a tenner (a conservative estimate) – we may be able to start to see some changes to the reasons people actually access our services.

We also need to teach kids – and I think health visitors as well as the education system have a part to play here – that it's okay for little Johnny to have a snivel for a couple of days, that it's normal, it's part of growing up and developing immunity systems, and it wouldn't be normal if he didn't get the odd cough and cold, and that a good diet and some fresh air will probably work wonders on getting him all right again … although it may take a day or two to get results.

Which brings us back to wanting, and being told that we can have, everything immediately. So we in general practice now have to be the bad guys and start to say no, and redirect people to the pharmacist and self-management leaflets in order to protect our value to the NHS.

The problem is, I can't see it happening – en masse, I mean, because for some, saying yes to an acute appointment resulting in a script for Calpol is easier to deal with than a follow-up with a "chronic" patient. So are we our own worst enemies?

I for one think it would be great if we in general practice were more accountable. I appreciate this could be opening a can of worms – and that I'm being a little simplistic – but perhaps if we cut out the middle layer of management (ie, PCTs) and our actions had direct consequences for us then we would be impelled to make a change.

But until there is a fundamental change in the system and a broader change in relationships between health and education (perhaps schools could offer extended hours – I can see all sorts of advantages!), many GPs will continue to practise in the way they always have: dealing with the patient that presents in the best way they know how and working with the system rather than challenging it.

And why shouldn't they? After all, they are the ones who have to deal with the growing administration and complaints caused by thwarted patient expectation, so why make it hard for themselves?

The finale of the self-care conference was a role-play in which we, the audience, found ourselves on trial for fostering the dependency culture in the NHS! Not my thing at all, found it difficult to smile at that one.

However, I must say that I won't forget this conference in a hurry because the detail has stayed with me. I feel it is our responsibility in general practice to address the issues raised because the men in suits at Whitehall will move on and we will be left to pick up the pieces of the puzzle they couldn't quite fit together.

Let's make it easier for ourselves – although, ironically, this will take some effort. After all, life in general practice has to be sustainable … doesn't it?

Movement for Self Care in Practice

Related story: Primary care "dependency culture costs £2bn a year"

What do you think? Do you agree with Cathryn? Your comments (terms and conditions apply):

"I so agree with Cathryn, we had someone present this am with a temperature for 10 minutes! With one dr bereaved yesterday, another on holidays for half-term and a room out of use to facilitate building our extension, we are so pushed for appts it is not true, yet madam insisted she had to be seen or she would sue etc etc. She was very miffed when given the option of attending the local walk-in centre or waiting till end of surgery" – Name and address withheld

"I agree 100% with Cathryn. It is about time we accepted the facts. However, we can all say this till we go blue in the face and nothing will happen till the government, DH and PCTs keep on saying, 'It is your right and you will get it when you want it and where you want it', not when you need it" – Yasin Husain, Birmingham