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- Page navigation anchor for Personalised care is still possible in 2021Personalised care is still possible in 2021
This excellent article sets out a welcome shift from a transactional model of care.1 Invested parties such as Babylon/Doctor First/Livi have successful lobbied for this model. It leads to a notion that any doctor will do. This taxi rank model of care misses the point of high quality general practice (disease in the patient context) and focuses on a purely biological model.
I agree that harking back to a bygone era is not helpful. Each generation of GPs face difficult challenges. In the 1980 and 1990 GPs faced 24 hour cover and large numbers of home visits- chronic visiting was common. I too am the son of a GP. I recall my father taking night calls from psychotic patients when the Co-op out of hours refused to speak to them and having to fit in sections just before the dash to the holiday ferry. But I learnt through osmosis and my role as a notes summariser/odd job man in my medical school holidays, that it is relational care that matters. Patients in a biopsychosocial context.
Personal lists are a mechanism of bring the advantages of relational care (easier in small practices) to medium and large practices. The research from St Leonards practice in Exeter led by Sir Denis Pereira Gray demonstrated over decades the benefits of continuity and personal lists. Norway faced a GP crisis in 2001 and introduced the Regular GP system, essentially personal lists nationally, to 4.5 million patients.
The evidence of how to rewild general practi...
Competing Interests: I am an unapologetic champion of continuity of care and work in a personal list practice. I share data with the St Leonards team in Exeter and have worked with North Tyneside CCG on continuity of care research. - Page navigation anchor for Need for innovation in acquisition and allocation of resourcesNeed for innovation in acquisition and allocation of resources
Time pressure is a vital issue for rewilding of general practice. Time pressure significantly reduced history taking, physical examination, lifestyle advice in GP consultations. Tsiga et al. stated: "it is important to safeguard the accuracy and efficiency of the diagnostic and treatment process, in order to reduce medical errors and increase patient safety."1 What kind of technology or collaboration can achieve it? We need to investigate innovation in resource acquisition and allocation further.
Reference
1. Tsiga E, Panagopoulou E, Sevdalis N, et al. The influence of time pressure on adherence to guidelines in primary care: an experimental study. BMJ Open 2013; 3: e002700. doi: 10.1136/bmjopen-2013-002700.Competing Interests: None declared. - Page navigation anchor for Rewilding general practiceRewilding general practice
Iona Heath's editorial gets to the heart of what is important in general practice, the relationship between patient and GP and how that can be used to explore, through a shared understanding of biotechnical and biographical frameworks, how best to address the patient's concerns and problems.
The rewilding metaphor offers a helpful way of exploring different and better ways of 'linking medical research, primary healthcare and the health of the planet' as the article states.
However, we also need to be aware of how the term can be used to re-invigorate outdated and dangerous ideas in the guise of new language. Fraser MacDonald's article1 illustrates how 'rewilding' can be used to marginalise people living in the Highlands and Islands of Scotland. 'When 432 people own half of Scotland’s private rural land', rewilding can happen easily enough without local support.' There are parallels here with current ownership and control in primary healthcare.
As Heath states, rewilding needs to be driven from the heart of the community, whether that is the GP community, or those living in remote and rural communities.
Reference
1. MacDonald F. Wild Beasts London Review of Books.2021; 43: 18. www.lrb.co.uk/the-paper/v43/n18/fraser-macdonald/diary
Competing Interests: None declared. - Page navigation anchor for Rewilding general practiceRewilding general practice
What an inspiring uplifting analysis of the nub, the essential core of what general practice should be. Dr Heath as ever is most eloquent painting an evocative alluring picture. One fears that it may be a retrospective glimpse of times past. Modern general practice evolved from the family doctor. In my father’s day (1951 to 1981) things were very different to modern practice.
For example:
- Records notes were minimal, perhaps a line or two on a Lloyd George card.Letters few and very short.
- Summaries of medical history and repeat prescribing non-existent.
- Staff he had one receptionist and my mother (unpaid) to answer the telephone
- Premises - rented three rooms one for the waiting room encompassing filing cabinet and receptionist. One consulting room with a desk chair and a couch. One telephone with an extension. No typewriter. One dispensary with three large Winchesters containing red, green and yellow mixtures possible gentian based.
- On call 24 hours a day. Local practice roster duty doctor from 6 to 11pm. Own night calls after that. Weekends, Saturday morning surgery local roster in turn one weekend on in four. Holidays Locum engagedAdvantage - he knew every patient on his list, as did the receptionist! Very close working arrangement with all other local GPs and hospital consultants.
Disadvantage - long hours, poor pay, minimal support staff, isolated, high stress, little...
Show MoreCompeting Interests: None declared.