UK: Social prescribing on the NHS (and possible implications for ME/CFS services)

Adrian said:
It can take many appointments with the GP before they acknowledge a problem think about thinking about what it may be. I assume they discount the earlier visits when they dismiss patients out of hand as not directly related to medical conditions.
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Yes the MUS approach should be properly assessed for financial cost and what impact it has on patients physical and mental health.
 
Trish said:
I think this is about saving money, not spending more. It costs a fortune to train and employ a GP. Far more than the other professions they are proposing we see instead.
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I agree. The government have failed to recruit the additional numbers of GPs they promised to (can't remember where I read that) and are keeping very quiet about it while attempting to make it look like they are doing Great Things for the NHS.
 
Sarah said:

Army of workers to support family doctors
NHS England: News 28 Jan 2019




A bit more from Prof Stokes-Lampard:



Matt Hancock:
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Professor Helen Stokes-Lampard, chair of the Royal College of General Practitioners, said: “Often the underlying reason a patient visits their GP is not medical
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This is a dubious claim that is impossible to take at face value considering how many patients with serious medical problems are fobbed off. The most likely explanation is the underlying medical reason has simply not been identified. It's possible either way but this claim has no basis in evidence and plenty for the opposite.

What is often anyway? And how is it verified? This is an opinion and assumptions can be very misleading. This is very bad.
 
Adrian said:
It can take many appointments with the GP before they acknowledge a problem think about thinking about what it may be. I assume they discount the earlier visits when they dismiss patients out of hand as not directly related to medical conditions.
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Over 90% of my consults lead nowhere and likely concluded I had no actual medical problems. It is the mother of all false positives to take that and extrapolate it to mean that most consults have no genuine medical concern. Completely irresponsible and unscientific.
 
It is interesting to see this view put in black and white. Not long ago I talked with a GP relative who is intelligent and committed. She now works in a hospital A/E department as an acute general physician, which I think is a role that a lot of GPs should move to. She noted that she found hospital doctors 'risk averse'. What she meant by that is that they worried a lot that they might miss something. That made me think there is still a culture in GP that assumes that it is OK not to worry too much about missing things.

A similar conversation, in reverse took place forty years ago with an Australian colleague when we were both trainees responsible for acute medical care. He said that he had noted that UK medicine works on the basis that you judge what the most likely explanation is and go with that rather than checking for all the other options. He said he thought that had merits but he was clearly brought up in a different culture.

My conclusion is that UK medicine has actually been slow to become rigorous. You cannot afford to go with the likely diagnosis. You need to cover all the possibilities because in a good proportion of cases the problem is not the most obvious one. US and probably Australian medicine took that on board probably in the 1960s. UK hospital medicine did not really take it seriously until the 1980s when acute care protocols were brought in, and often not until even later. My impression is that UK general practice is still stuck in the pre-1960 model. If it wasn't it couldn't function because you cannot cover the relevant possibilities form a health centre much of the time.

And it seems that the political will is to go backwards.
 
rvallee said:
Over 90% of my consults lead nowhere and likely concluded I had no actual medical problems. It is the mother of all false positives to take that and extrapolate it to mean that most consults have no genuine medical concern. Completely irresponsible and unscientific.
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I think some of this may well be an issue of people doing stats on low quality data without realizing it because they never assess the data quality. For example, one quality check would be to take people with a cancer diagnosis and track back through records to see if the GP visits increased in volume prior to this when signals that should lead to early diagnosis were ignored and missed. I take cancer here as an example because doctors in the UK have a reputation for being very poor on early diagnosis.
 
MEMarge said:
Who is going to pay for these exercise or other sessions? Cost is a huge barrier for many to participate in such activities.
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If the problems were not actually medical it is a bit difficult to see what would be written in the records to justify prescription:

Non-medical problem of being fed up with boyfriend - aerobics twice a week for six weeks

Non-medical problem of imagining you are ill - aerobics twice a week for three months

and so on.

Maybe some of us should apply as disinterested parties for places on the NICE guidelines committee for management of being fed up with the boyfriend.
 
Jonathan Edwards said:
That is true but I thin the GPs themselves still think this is a legitimate way to practice medicine. I think my relative was doing a bit of re-thinking.
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GPs clearly think this but rather than challenging those thoughts the systems are reinforcing them with things like the incentive payments and also the MUS story where GPs are encouraged to ignore symptoms and send people for CBT. Its another reason to worry about the whole MUS agenda in that I suspect it just slows down all diagnosis beyond the obvious acute problems.

Incentives are usually used to try to correct problems but in this case they are being used to reinforce issues because the issue of under diagnosis is not recognized by a large proportion of the medical community and certainly not by GPs. Whilst they get away quoting unjustified numbers based on bad data that won't change.
 
Around half of GP appointments are not directly related to medical conditions, according to experts.
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Westminster think tank Reform made a similar claim re half of GP appointments in April 2016 report, Who cares? The future of general practice:
A number of experts interviewed for this paper explained that GPs could pass 50 per cent of appointments they currently conduct to other professionals. A more diverse workforce could, for instance, see pharmacists or nurses administering the estimated 57 million appointments (15 per cent of the total number of appointments) consumed by common conditions and medicines-related problems each year.
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Summary of recommendations:

1. The Government should abandon its target to employ 5,000 more GPs. NHS England should conduct an audit of general practice appointments and work with providers and representative bodies to understand how consultations can be delivered more efficiently by other clinicians. NHS England should build a recruitment and training plan based on this information.

2. Current funding streams should be replaced with contracts that commission services covering the whole care needs of defined groups of people.

3. Contracts should focus on outcomes that matter to patients, rather than outputs or process. Commissioners, providers and patients should work together to determine these outcomes.

4. Commissioners should fund services from an integrated budget. The Government should investigate the optimum size of commissioning bodies and work with NHS England, clinical commissioning groups and local authorities to understand how these bodies should be constructed.

5. The Government should develop a long-term plan to collect data from general practice and across the NHS to be used to design contracts. The Government should satisfy itself that the care.data programme is best-placed to achieve its aims, clarify providers’ legal obligations and ensure that people are adequately informed of their right to opt out.

6. Commissioners should nurture nascent markets through risk-sharing agreements. The nature of these agreements should vary by market maturity, but be designed for providers ultimately to assume full financial responsibility for patient care.

7. Future contracts must be fixed-term to encourage competition and the best services for patients. Exact durations will depend on market maturity, but best practice suggests between five and 15 years are optimal lengths.

8. Commissioners should uphold patient choice throughout the care system. Funding should follow the patient to incentivise providers to deliver the best care for all users.
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The problem is that once a patient has been passed off to some Lifestyle, Link Worker "professional" the chances are they won't have the skills to spot the cues of a genuine medical problem, or that what they are recommending may well cause the patient harm.

I can sympathise with people wanting to get rid of what they perceive as the boring/easier/more mundane part of their work. Every job on the planet has boring and mundane aspects. I can understand bosses wanting lesser qualified and lower paid people to take over chunks of the job.

However, in my own technical,non medical environment this kind of approach can cause a problem to escalate into a catastrophe as the lower qualified person quickly gets out of their depth. More dangerous still, they often don't realise they are out of their depth until things have gone too far.

Edit -clarity
 
Don't any of the GPs or other doctors worry about their jobs being dumbed down?

If you're a GP and care about the quality of the health service, does it not worry you?

If you're an A&E doctor do you not worry about the extra load of emergency patients coming in because no one picked up there was a genuine medical problem before folk collapse and need an ambulance?

As a hospital specialist, do you not worry about the possibility of only seeing patients in time to give them the old - the good news is we can cure that, the bad news is you're too far gone?
 
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