New Horizons

I may be a little tardy in my response to The White Paper but I like to think that it's because I have been carefully assessing the situation before I state my position. In reality, it has just taken me an awfully long time to get round to reading it (thank goodness for summaries...).

My reaction to the government's big shake up has been mixed. It started with irritation that such huge responsibility was being handed to GP's without a hint of consultation with us first. That inevitably lead to terror - we are not managers, how on earth could we cope with what enormous PCTs have dealt with up until now (with much complaining from us about how bad a job they were doing of course)?

But the truth is we asked for this. When we grumbled about big funding decisions being made by suits and not doctors, when we've complained bitterly about new systems forced on us by managers, when we've just wasted yet another consultation ticking boxes of no discernible use. So now we've got what we wanted and the question is, can we handle it?

In a word, yes.

We'll have to work together and cooperate like never before and yes, we will need help with managing the books, but let's not forget that we are being handed an incredible opportunity here to transform our NHS. No longer will we have to put up with systems that don't work (bye bye choose and book), or have to accept second rate services. We can change them.

Of course there are threats as well: what happens if the money runs out (many PCTs found themselves in this scenario, so it's pretty likely to happen to GP consortia too)? How do we achieve the balance between being both advocates for our patients but also the purse holders? How will we ensure that we can work together without squabbling about individual practices' needs? What about practices who let the side down?

To me however, the potential for good outweighs the bad, and it's up to us to make sure this is so. We've got time to put forward our opinions and ideas to help shape the detail of these plans, so let's get involved and seize this opportunity. This change is coming whether we like it or not, don't let's be dragged kicking and screaming.

Why do we do it?

Like many other medical bloggers, I was invited to read 'Sick Notes' - the recently published book by GP columnist Dr Tony Copperfield (of Pulse fame). I hadn't planned on reviewing it, and I'm not going to, but I have brought it up because it has left me asking big questions about my career choice.

The book is hysterical, I really mean that. I laughed out loud on several occasions, and was often to be found chuckling in a corner, book in hand. It's funny because it is unbelievably true to life. In each ridiculous scenario that he describes I can see myself, every absurdity he mentions I too have seen. In some ways it is comforting to know that there are others who share my GP-related pain. On the other hand, hearing all of this from a GP nearing the end of his career when I am just at the start of mine, does make me feel a little hopeless.

The stark realisation is that if this book is anything to go by, things are not likely to get any better. I am always going to be plagued by patient's lists, always going to be caught out by the 'oh there's just one more thing doctor', always going to long for the last patient of the morning and the promise of lunch and a coffee, desperately hoping that no home visit requests come up.

There is one chapter called 'Things I really like about General Practice'. It's two pages long.

Loneliness

In a drive to be ever more organised when it comes to completing our QOF tasks by April, this week has been a 'Vulnerable Elderly' review week. These reviews involve long consultations with endless questions about hearing problems, mobility, hygiene problems (I never quite know how to ask about this one?) and to finish, the dreaded mini mental state examination.

As a quick aside, can I just say how much I loathe the mini mental test. If the patient is completely coherent, asking what year it is, what country we're in and to follow ridiculous commands involving fingers, ears and nose is just embarrassing. Many are offended, many just think you're wasting their time. If on the other hand the patient suffers from a degree of dementia and can't answer the questions, watching their embarrassment is even worse. All in all a hideous experience.

There is however, one question that I dread asking even more than I dread the mini mental test. It's this:

"During the last month, have you often been bothered by feeling down, depressed, or hopeless"

It's part of the depression screening, and the tragically high number of positive responses provides the basis of many a disheartening conversation. For some, these feelings stem from financial problems, family disagreements or the loss of a loved one. For the majority they are simply due to loneliness. Those without local friends or family, too frail now to make the journeys they once used to.

One patient told me that he insisted on going to the supermarket every single day, because so often the brief conversations with checkout staff provided his only human interaction. Another mused that she had simply lived too long, her husband and all of her friends having died before her. She could only give me her cleaner's name as her next of kin.

So they score a positive on my depression screening, but what of that? Should I give them antidepressants? I can't see how that would help. Psychological therapy? Somehow I don't think so. I've tried to get patients such as these involved in day centres or community activities, but I find that many are simply unable and some too proud.

It's hard to know how I can help and now I too am feeling down, depressed and hopeless...