Des seems to have been working in an alternative universe of general practice.1
Numerous pressures from outside general practice control have driven up workload. Computers have allowed identification of all of one’s patients to be tested, checked, and ripened for preventive medication. Chronic disease clinics in practice have driven up attendances, tests, and workload. Cancer detection systems, which require 98 fit people out of a 100 (to detect two with cancer) to be referred, caused rising referrals. Ineffective anti-anxiety medications remain a major obstacle to removing the worried frequent attender. As far as depression is concerned it is well known that societal malaise drives up depression rates in communities. At present the practice has been asked to identify more dementia patients by the local CCG but explaining that the practice has no nursing homes in its patient catchment fails to assuage the relentless work to find what is not there. An older population with multimorbidity creates work: in the 1960s your surgery did not need a lift to get patients to first-floor consulting rooms. Finally, what about those checks on non-diseases such as the ill-named chronic kidney disease register, a sort of modern-day general practice Hans Christian Andersen’s Emperor’s New Clothes story. Please Des, come back into reality and start knocking the issues that really have caused the rising workload and professional deskilling.
- © British Journal of General Practice 2016
