Dr Peter Moore: GPs must get to know patients and their families

Torbay Weekly

When I started my GP training I was told by an older colleague: “You don’t have ten minutes with the patient. You have 30 years.”

As a GP, I was living in a soap opera.

When a character comes on in Coronation Street anyone who has been following it will immediately know the character, their background, their relationships and any other back story.

In my practice I got to know the patients and their families.

I also knew the community, the housing estates and local businesses. By reading the local paper I kept up with any news.

If there was a tragedy or good news it would usually impinge on my practice. Even if it did not involve one of our patients it was often a close relative, neighbour or friend.

As I got to know my patients so I could spot anything unusual. Nonverbal clues were crucial.

The normally relaxed and happy person might appear withdrawn or the stoical person in real pain.

But, unlike a soap opera, patients knew me.

I remember sitting in on a very experienced GP during my training.

A woman came in with a sore throat. He examined her throat and said: “OK, Jane, we both know there’s nothing wrong with your throat. What’s the real problem?”

She then started crying and all her problems came out.

This technique only worked because the doctor and patient knew each other very well.

This also meant that if I saw someone who usually saw one of my colleagues I would not know all the background.

If I watched an episode of a soap opera which I had never seen before I could look up the story so far but would miss the subtle nuances enjoyed by a regular viewer.

Unfortunately, this aspect of general practice is not always understood by politicians.

As pressures on GPs increased and appointments became harder, it was decided that we should offer everyone appointments on the same day.

This meant that people had to ring first thing in the morning and, if all the appointments were gone, told to ring the next day.

It is important for anyone acutely ill to see a doctor on the same day but many people who see GPs are not acutely ill. They may just need a follow up.

It also meant that patients would be fitted in with any doctor. And now, as GP surgeries face serious problems and virtual appointments are criticised, so the Government is making the same mistake.

Surgeries must offer face-to-face appointments with any doctor and be “named and shamed” if they fail.

I did wonder whether I’m just a dinosaur suggesting 'it was better in my day'.

Is the old-fashioned personal care not possible today?

We no longer have a personal bank manager or even a parish priest so why should GPs be any different?

All medicine should be based on evidence and we now have clear evidence that having a personal doctor saves lives.

Norwegian research looking at 4,708 GPs found that if a patient has the same GP for more than 15 years there was a 28 per cent reduction in hospital admissions.

Patients who have the same GP for two to three years were 13 per cent less likely to need out of hours care, 12 per cent less likely to be admitted to hospital and eight per cent less likely to die that year.

After 15 years, these figures increase to 30 per cent, 28 per cent and 25 per cent.

But the study also showed that each GP looked after an average of 1,113 patients, half the number UK GPs are expected to look after.

Helping patients to have a personal GP is a challenge. Many GPs now work part time.

I bought into a practice with a massive loan at 30 and stayed for over 30 years. This may not be realistic today.

But rather than obsessing over same day appointments and face-to-face consultations, the best way to reduce hospital admissions and save lives is to find a way to offer every patient their personal GP.