We’re heading into 2018 and things in GP-Land haven’t looked this glum for a while. Demand from patients versus resources available, recruitment/retention issues for GPs, a practice nurse crisis and we have employees ready for retirement but not enough newly qualifieds to take over. Need I go on?

How are we going to improve morale?  How do we, as the PMs, get our workforce to do twice as much work as they’re already doing, for the same money, in the same hours, with the same grateful ‘thanks’ but not much of anything else?  How do we stop our partners from exiting stage left with burn-out and keep them enthused for the job they were trained to do?

Well, we could get rid of all the bureaucracy and red tape – but Jeremy STILL isn’t answering my tweets. So is part of the answer the private online GPs? You know, the ones that advertise via an app on your smartphone or billboards at the bus stop?  Can we/should we be using them more? Should we be directing patients to them because we haven’t got the space?  The answer as far as I’m concerned is a resounding NO and the problem I have with this type of system is the lack of continuity from a record-taking point of view.

If a patient Skypes one of these GP services, for example, or logs on to their web portal for a text conversation, how does the information transfer to their ‘proper’ GP?  What advice is given? How is it recorded?  How do we know what the patient has been advised/prescribed? What if the you-know-what hits the fan and the patient complains to us because something has gone wrong, but we haven’t been given the full picture by these private organisations?

One such company has recently been hitting the press.  The CEO of this company decided on the name Babylon… I’m not sure why they called it Babylon; a city in Mesopotamia apparently, and one which was regarded as full of luxury and corruption. Maybe I’ve just answered my own question! One of the problems I have with Babylon is that they have a list of exclusions of patients that they really don’t want to see, although their advertising may suggest it is perhaps ‘not appropriate’ for them to chat to one of their team – a bunch of highly trained professionals apparently who go through a rigorous recruitment process. Is that why we have no GPs left?!

The list of patients they don’t want to see include those who are pregnant, those who have a safeguarding need, patients with complex mental health conditions, dementia/frailty, those who are at end of life, those with learning difficulties, patients with drug dependency. So basically everyone who needs a doctor!

Wouldn’t it be better to say who their service is more appropriate for? I.e. we only want your call if you are fit, healthy, aged 25 to 40, don’t have a chronic disease such as asthma or diabetes and those who only need a prescription once in a blue moon, perhaps for antibiotics for the STD they picked up at the office Christmas party, those who also suffer tonsillitis, cystitis and/or conjunctivitis. Must have been a ‘helluva’ party!

Whilst I can see that there is a place for a ‘Skype-GP’ – mostly for the commuter who leaves the house at 6.30am to catch a train/join a traffic jam before arriving in Big Cityville, UK to start their highly paid job where they have to work for 12 hours a day (because there’s no point in leaving until after 7.30pm when the roads/trains have eased) and they can’t possibly leave the office to seek medical advice –  it must also be the case that we should be educating employers that if they have staff who need to seek the advice of a doctor, they should be allowed to leave the office for an hour in the day to do this.  I know this would need policing but that’s the employer’s role, not ours.  The non-urgent matters (the medication/BP reviews, the travel vaccinations etc) can be booked in advance allowing the employee to take the appropriate time off work to fit this in or seek the extended hours clinic where they can.  Most of us offer the extended hours sessions now (I know that funding for this is in jeopardy but that’s another argument for another day) and so working patients can be accommodated.

But what’s really important is getting that information into one medical record… easier if the patient carries that with them (perhaps on a credit card sized USB that can be popped into a GP computer for an update – again another argument – another day!) but until that happens, all hell can break loose as information is not forwarded appropriately, or forwarded but not copied into the notes correctly.  It’s fraught with issue and one that I’m not convinced has been thought through properly – and on that note, as it’s nearly Christmas, I’m off to get a pint of Baileys and a box of chocolates – now THAT will improve my morale no end!

Merry Christmas Peeps!

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