Ticking Boxes is on the way out in the NHS…

Ticking boxes is on the way out in the NHS… but there is a need to think wider and deeper to change it.

The idea of giving the million most frail older people a named GP to look after them was trailed last week by the Health Secretary and on the face of it seems like a good idea – the aim is to get away from a box ticking mentality and to focus more on the needs of the older person.

My worry here is with some practical problems – not least that older people themselves can be quite stubborn when it comes to their GP and might not take kindly to this idea if it involves the local practice changing their contact. GPs also report that older people come to see them over trivial matters when all they really want is some company – having a named GP might actually make this significantly worse, if older people believe they now have a real right to see the named person.

I’m also wondering what will happen within GP surgeries? Will the named GP actually become a dumping ground for all the patients no-one else wants? And what is the betting that this will be the newly qualified doctor rather than the managing partner? And let’s not forget that most GP surgeries operate on a tight timetable of appointments – I’m not sure this idea will help that time-scale and will probably put more pressure on it.

However, I’m quibbling here and the emphasis on needs rather than box-ticking is a very positive move.

But is it enough?

Er, no.

There are some real basic cultural problems with the NHS that mean the turning of this particular supertanker may take longer than any of us may have left to live. The main one is the medical focus of the NHS…

Medical focus of the NHS? Isn’t that what it’s there for? Well yes, but the problem here is that NHS care is far too blinkered when it comes to other treatments and interventions that may help a patient.

And I can see where this comes from – doctors and nurses train hard for many years and experience things every day that most of us would lose our lunch over, so they are right to be protective of their expertise and dedication. And they are also pushed for time – GPs have 5 minutes to see a patient and five minutes to write up the notes? Does this seriously give them a chance to really engage with a patient?

Given the time available, they have to see a condition and then prescribe a pill or some tests, without maybe looking at the whole person and what else is going on in the patient’s life. What about the patient’s finances? Or the falling out they’ve had with their only living relative? Or the fact that they are 87 and also a full-time carer? I think this is what Jeremy Hunt is getting at with the line about returning to the “old fashioned family doctor”, but it actually needs to start with the doctors themselves.

Doctors need to have it ingrained into their daily practice that social care solutions can dramatically improve patient health, and that the combination of health and social care solutions can bring benefits to patients greater than the sum of the individual parts. Here in Bexley, tentative steps are being made in this direction, with the Council and CCG working together on an integrated care pathway for hospital discharge. It is early days, but the fact that it is happening and that both health and social care professionals are committed to it means that patients here will benefit.

We don’t want doctors to become social workers, but how do we get them to appreciate the social care side of improving a patient’s life?

My solution? Every GP and nurse should have a social care module as part of their training, that they have to pass in the same way that they would with medication and anatomy.

If anyone wants help writing this course, give me a call.

Paul Goulden

Paul has been our Chief Executive since November 2016.

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