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

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.

 

Exactly.

They frequently talk about doctor shortages, but there has long been a surplus of medical school graduates. The only "shortage" is the money for training doctors.

 

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.

 

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.

 

Maybe the other half are related to people going back to complain about the doctor for getting their diagnosis wrong when they were in the first 50%.

 

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.

 

Ye why give someone 100 grand a year to sit there all day saying "next", when some one who cant stand working in a factory any longer can "retrain" to say next for the doctor on a fraction of the pay.

 

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.

 

Who is going to pay for these exercise or other sessions? Cost is a huge barrier for many to participate in such activities.
(Serious illness/disability being another reason why people cannot do these things, often compounded by the poverty of living on benefits or other severely reduced income.)

 

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.

 

Depression, anxiety, attention-seeking, hypochondria, drug seeking, somatising.

 

Westminster think tank Reform made a similar claim re half of GP appointments in April 2016 report, Who cares? The future of general practice:

 

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

 

I'm still curious to see how they do group consultations (which is apparently being rolled out).

https://www.networks.nhs.uk/nhs-net.../2-4-group-consultations-evidence-summary-elc

http://www.pulsetoday.co.uk/news/ho...ons-for-long-term-conditions/20037578.article

so maybe the next step will be for these group sessions to be run by pharmacists nurses etc.

 

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?