HEALTHWATCH: Will GP changes be enough?

The uncompromising notice in the GP surgery spelled it out.

It announced that the practice was closing for five days over Easter and told patients to ring 111 if they needed medical attention.

In a way, it also spelled out that plans to change the first level of healthcare will mean that the relationship between family doctors and their patients will never be the same again.

It was a shock to me when the Oxford Mail summed up the future for the much loved family doctor network that looks after us with a headline which said: The doctor will not see you now.

But it appears to be true, despite claims that the health authorities have come up with a plan which claims that everyone will get a same day appointment through GP practices working differently.

When you get down to the detail this appears to mean that the most used and most personal part of the NHS is turning itself into a giant DIY healthcare system, where the role of the GP will be diminished except for people with complex and constant needs.

It is no secret that the family doctor network is in crisis.

A Healthwatch survey showed that it can take three weeks to see a doctor, caused by many GPs retiring and practices closing and merging with others.

The new way of “working differently” – which opponents claim is another way of bringing in cuts to the service - is for GP practices to work together and for patients to look after themselves better to reduce the need for medical attention.

That sounds sensible.

But is it enough, and how can it be achieved?

The answer, say the authorities, is to widen the network by increasing the skills of existing staff such as practice nurses, join up more with pharmacies and opticians, reduce bureaucracy, and introduce new ways of consulting the doctor or the GP practice by email, telephone or Skype.

The idea is to free up family doctors to deal with patients with serious ongoing needs and delegate the routine to others, some of whom may not be medically qualified at all.

The authorities say the way of making it easier for patients to get advice would be for GP practices to work closely together so that someone is available for consultation on a 24/7 basis and that people can be seen on a daily basis by a “healthcare professional”, or get a 10 minute appointment with a doctor within a week.

Again it sounds sensible. But is it achievable or is it a flight of fancy by the NHS mandarins who seem intent on tinkering with the system because the politicians refuse to invest at the level of other European countries?

It sounds as though it is a re-invention of the 111 system at a local level and some people will remember that the previous out of hours services that relied on Oxford GP practices co-operating to provide weekend cover failed.

The new model appears to rely on “healthcare professionals”, with the GPs taking a back seat and running surgeries on a 9-5 five day week basis, but those putting forward the plan claim that it will result in being the lynchpin of the new health system. They claim it will enable people to manage their own care better and “manage populations”, whatever that means, which will reduce the need for hospital based care and provide more time to manage complex care and patients with long term conditions.

That may be pie in the sky. As with other aspects of the health service there seems to be a lot of tinkering with the health system rather than real change.

There is no doubt that if this plan comes to fruition it will have the biggest impact on family doctor-patient relationships and it will do nothing to stop people heading for hospital accident and emergency departments if they cannot see their own doctor.

Our hard pressed GPs do a brilliant job in looking after 70 per cent of the total health needs of people in Oxfordshire and I am sure they will be wanting to continue this in the future.

However, under the new system the GP practices will still be private companies and there is a danger that the levels of co-operation and togetherness will be variable if the evidence of current practice is anything to go on.

It may be time to change that and integrate family doctors fully into the NHS by becoming employees on terms and conditions similar to that of doctors in hospitals.