Zara Aziz: Skill mix may seem a good idea, but the reality is rather different

Apparently one in four GP appointments are potentially avoidable. It makes for a good headline and something to talk about with Betty when she attends yet again for her bunion.

'You know David Cameron said this yesterday,' I look sombrely at the bunion in question.

'I've been saying this for years Doctor! Half your waiting room is coughing. A bit of Lemsip is all they need - time wasters!’ she shakes her head vehemently.

The PM cited a report by the NHS Alliance and Primary Care Foundation, which found that greater integration could cut the number of GP appointments needed, in his party conference speech. Innovative practices should be using allied health staff such as nurses, pharmacists or physician assistants to meet patient demand and become more efficient.

I all sounds good in practice, but the reality is different. For starters, the NHS is as short of nurses as we are GPs. Our practice already employs several nurses, nurse practitioners, a pharmacist and HCAs. This does not seem to check demand for GP appointments. The more you provide the more you need - balancing demand with capacity remains difficult as ever.

There are a multitude of reasons for this: as practice numbers fall we are seeing a rise in list sizes; patients with comorbidities are living longer and add in austerity cuts and social problems, and it makes for increased medical complexity.

Then there is perceived need culture which is in great part fuelled by politicians out for a quick vote, or by inept risk averse organisations set up by same politicians. Take 111 for instance. I try to get my head round their letter that lists the problem as ‘dental pain’ and the bizarre advice as ‘attend emergency department within two hours!’

And what of the constant quest for efficiency that the government talks of which adds in increasing risk to patients and GPs as well as adding time pressures and stress?

The government could start with adequately funding all that it recommends five days of the week before moving on to its more ambitious plans. What is the point of feigned realism ‘we know GPs are overworked, burnt out, depressed etc etc' but let’s give them even more work from secondary care, social prescribing and seven day opening?

  • Dr Aziz is a GP partner in Bristol

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