DR MAX THE MIND DOCTOR: Using receptionists to assess how unwell someone is is cost-cutting dressed up as efficiency
The ‘care navigator’ will see you now. When your number is called, please speak to your GP’s receptionist, who is taking an ‘enhanced role’ in ‘active signposting’.
Those peculiar euphemisms were coined by NHS England this year as part of the so-called General Practice Forward View, a scheme to cut the workload on overstretched GPs. When the language of George Orwell’s 1984 seeps into the National Health Service, we should all be afraid.
In plain English, as a shocking investigation by the Mail revealed yesterday, 60 per cent of GP surgeries are now screening patients at the reception desk.
Staff without proper medical training are determining who is and is not sick enough to merit an appointment with a general practitioner.
It is true that GPs are under tremendous pressure. But using receptionists to assess how unwell someone is — a skill known as triage — is not the solution. It’s a wonky sticking plaster, hastily applied. It’s cost-cutting dressed up as efficiency.
It is true that GPs are under tremendous pressure. But using receptionists to assess how unwell someone is — a skill known as triage — is not the solution, writes DR MAX PEMBERTON (stock image)
Frankly, there is no way a receptionist without the benefit of years at medical school can hope to understand a complex health issue, let alone advise patients reliably, effectively and safely on whether or not they need to be seen by a GP.
If a patient tells a ‘care navigator’ they have chest pains, for example, it will be impossible for the receptionist to know if this is a heart attack requiring emergency action or indigestion that could be solved with an antacid.
Sure, there will be some cases that are obvious — ones in which unmistakeably a GP’s experience and knowledge is required. But some of the most deadly conditions can be masked by apparently benign, innocuous symptoms.
All but the most trained eyes will miss cases that need urgent medical attention — and the inevitable result will be unnecessary deaths.
Every doctor has a story about a brush with tragedy, when a life was saved by little more than a hunch, a niggling feeling.
This comes from years of experience; it cannot be taught. And it’s precisely these cases that a receptionist will miss.
What’s more, it’s not as if those on the front desk don’t already have enough to do. Already, simply getting through to the surgery on the phone can be a challenge for patients.
Far from being like kindly Sherpas, helping us to pick our way through the labyrinthine NHS treatment pathways, receptionists will act more like a big boulder blocking the path to the GP’s door — obstinately refusing to budge and impossible to get round.
Their role will be to dissuade patients from making what are deemed ‘avoidable appointments’.
I know who will suffer, and it enrages me. It will be the elderly, the vulnerable, the mentally ill.
It’s these groups who often feel they don’t want to bother a GP; who don’t feel entitled, who might be anxious or nervous and feel under pressure not to be pushy. They won’t be able to communicate their problems effectively to an officious or harassed receptionist in the space of a few seconds.
It won’t be the articulate and educated ‘worried well’ who are discouraged from insisting on an appointment. They will argue back, know their rights and demand to be seen.
Rather than weeding out those who are actually misusing the NHS, ‘care navigators’ will simply pick off those who are unable to assert themselves — the ones who are easiest to bat away.
Yet these are often the patients who most need to be seen.
To make this awful situation worse, a report this week revealed that more than a million women in England do not have access to a regular female GP.
Despite the fact that 51 per cent of doctors in general practice nationwide are female, more than 600 surgeries employ only male doctors. That’s almost a tenth of the practices across the country.
All but the most trained eyes will miss cases that need urgent medical attention — and the inevitable result will be unnecessary deaths, writes DR MAX PEMBERTON (stock image)
As a result, tens of thousands of women who would greatly prefer to see a female GP are denied that right. Many of these patients will be elderly and feel embarrassed at the idea of discussing their health problems with a man.
Others may have religious beliefs that prevent them being examined by someone of the opposite sex. Others still may have been victims of sexual assault and prefer to see a doctor of their own gender. It’s likely that, rather than go through such an excruciating ordeal, some will stay away from the surgery altogether.
The report also showed that many women were made to feel like troublemakers when they pleaded to see a female GP.
Ironically, though, one of the factors placing pressure on the NHS is the increasing number of female doctors overall. In a society that still tacitly expects women to undertake a disproportionately large role in childcare, GPs who are also mothers frequently have no option but to work part-time.
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This week: You sweat less
The glands in our armpits appear to perspire less as we get older. In a study, researchers measured how much two groups of women sweated as they walked faster and faster uphill on a treadmill in a hot room.
The women had similar weights, heights and fitness levels, however the older women sweated less. Some 14 per cent less sweat was collected from the 52 to 62-year-olds compared with the 20 to 30-year-olds.
The Pennsylvania State University researchers said sweat glands may become less sensitive with age. But this doesn’t mean deodorants can be economised on. The amount of 2-nonenal, a sweat chemical with an ‘unpleasant greasy, grassy odour’, rises after the age of 40.
A casual observer might expect that the shortage of GPs will soon be sorted out by their soaring salaries. On paper, pay has rocketed since the last Labour government introduced the notorious ‘GP contracts’, which introduced out-of-hours payments for calls that were previously done as routine.
That proved a PR disaster for their relationship with patients, who began to see them as mercenary and not interested in their care — a view that has subsequently been exploited and manipulated by politicians.
It certainly seems that British doctors are high earners, not only in comparison to the average British worker’s wage but also when measured against their counterparts in almost every industrial society in the world.
Typically, partners in general practice earn more than £115,000 for full-time work. That seems extraordinary when you take into account the fact that nurses’ pay starts at £24,000.
But the truth is that for the vast majority of jobbing GPs, a six-figure salary is a fantasy. The high-earning partners who own the GP surgery are more akin to business people.
Most GPs are salaried and work for the surgery rather than owning it, and their average salary for working full-time is between £65,000 and £80,000.
Not a bad wage, but that does require an average working week of about 60 hours. Small wonder that more and more doctors now opt to work part-time.
Too many are at breaking point, responsible for an ever-increasing number of patients. At one practice in Maidstone, Kent, a single GP is responsible for upwards of 11,000 patients. That’s insane.
Given all that, you might think it would be a good idea to train as many people as possible within the NHS — including receptionists — to triage patients and ease that pressure
But the truth is there is no easy fix — and using receptionists to screen patients only underscores how the NHS desperately needs more doctors.
The Prime Minister has pledged that the NHS will hire an additional 6,000 GPs. Well, forgive me if I’m sceptical, but five years ago David Cameron promised to bring in 5,000 more doctors — and since then, the number has in fact fallen, from 28,631 to 26,958.
I’m not a GP. I work at a hospital in mental health care and I’ve had several GPs themselves referred to me as patients because they simply couldn’t cope any more.
While many of them work part-time in theory, the reality is they put in so many extra, unpaid hours that they are effectively full-time.
We won’t be able to attract the extra doctors we need until we start to value them properly again — not just by paying for the hours they work but by respecting their dedication, learning and experience.
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