NHS changes – how much power do GPs need, anyway?

This might be controversial but it occurred to me that ‘comedy’ David Cameron and Andrew Lansley have been pinning much of their hopes for the Health and Social Care Bill on a perception that local doctors – GPs in their parlance – are best-suited to direct where spending on healthcare actually goes.

I’m not convinced that’s true. Why are people at the entry-level of the NHS being acclaimed as experts?

I suffer from a condition known as cluster headaches. Every couple of years, I get fast-onset, extremely painful one-sided migraine headaches at a rate of four or more every day, for a period lasting up to three months. It’s a rare condition – only around 50,000 people in the UK get it, which means very little research has been carried out.

When I went to my local doctors’ surgery with it, the GP I saw thought it was just a severe headache and told me to take some aspirin.

Aspirin won’t touch cluster headaches. By the time the drug takes effect, the headache is far too well-entrenched for it to make any difference at all. If I had accepted that doctor’s advice as being the best, most expert diagnosis available, I would have condemned myself to spending a quarter of a year in agony, every two years.

Instead, I went back, got properly diagnosed, and was put on injections of a substance that costs something like £25 a shot – which also raises questions about how much GPs will be willing to spend on a patient when they hold the budget.

Mrs Mike has a condition whereby the intervertebral discs – the shock absorbers between vertebrae – at the bottom of her spine have disappeared. There is an operation available on the NHS that would replace these discs with artificial ones, but this was never mentioned to her and I only found out by typing ‘intervertebral discs’ into the search box on the NHS website. Now, there might be a good reason for keeping this from her, but I doubt it.

Now these examples could be shot down by any critic as anecdotal, but there is evidence that this sort of thing is widespread.

Dr Phil Hammond, speaking on the Radio 4 show Heresy, tells us: “If you go to Dr Google, or his friend Professor Wikipedia, you have a 58 per cent chance of getting it right. Doctors are marginally ahead at about 75 per cent.”

And they tend to look up your ailment on the Internet as well! “Doctors use search engines too; it’s quite common for doctors to use Google,” said Dr Hammond on the same show. “If you look at their computer screen, you’ll actually see them typing… I had a mate who was a pain specialist… and he was teaching a junior doctor and a women came in who had Wartenberg’s Neuritis. He was looking at his notes before she came in and said to his junior doctor, ‘Look, I’ve never heard of this; let’s look it up on Wikipedia.’ They look it up, they make notes, and this woman walks in and says, ‘I’m terribly sorry; I was waiting outside and I heard you say to your junior doctor, you’ve never heard of Wartenberg’s Neuritis, you were going to look it up on Wikipedia. I thought I ought to warn you – I’m the person who wrote the entry.”

So we should not be hailing GPs as the experts who need to have control of NHS budgets. They’re not the experts. The experts are the consultants, surgeons or whoever, to whom they pass you if they find they can’t write a prescription to get rid of you.

The Bill must be scrapped. If we let the Tories make fools of us, it may be the last thing we do.

4 thoughts on “NHS changes – how much power do GPs need, anyway?

  1. gracie

    Mike, the reason why you were advised to take aspirin for cluster headaches (a form of migraine) is because aspirin has been shown to be effective on them, there are a few preparations that contain aspirin mixed with other medicines that have been found to be effective. Unfortunately the problem with aspirin (for many) is that it often causes irritation and bleeding of the gut which prevents the person from taking it.
    There is a preparation called sumatriptan (Imigran) it comes in tablet form or subcutaneous injection (to be self administered).

    People suffering from migraines need to understand that basic analgesics such as paracetamol and aspirin do work (or would work) in the majority of cases for people suffering migraine headaches HOWEVER, the reason why they do not in many cases is because studies have shown that when people get a migraine headache their gut often fails to absorb oral medication properly, which is why normal remedies do not help them and this is why Imigran can be obtained in injection form too. So if people are taking oral Imigran and not gaining relief they should ask their doctor about it in injection form.

  2. gracie

    I would like to add to doctors and nurse practitioners who look up on Google or Wiki, that where they differ from Joe of Joanne Public, they can differentiate the information they read and apply it because of their medical knowledge, so don’t be too worried if your doctor does look something up, we all have to learn and a good doctor or nurse never thinks they know enough, they always want to learn more.

  3. Mike Sivier

    I’m sorry to report that the reason I was advised to take aspirin was misdiagnosis (although, in fairness, this doctor was coming to it completely blind and so was I). No orally-administered treatment is effective on cluster headaches. They start far too quickly and the pain is far too great. They aren’t called “suicidal headaches” for nothing! They are much, much more painful than ordinary migraines or any other type of headache. I’ve had migraines, too; I know.
    I had to go back and see a different doctor, who put me onto Imigran injections. The trouble with those is that you only get to have two injections per day; after that I have to hoof it to the hospital for oxygen therapy which is hit-and-miss.
    The point of the article is that GPs are the entry point to the NHS – the bottom rung of the ladder. This is not to play down their importance because in the vast majority of cases, they will be able to find a treatment that is quick and cost-effective. But they do make mistakes and they don’t know everything there is to know about medicine. I’m not arguing that they should, but it’s because they don’t know it all and can get it wrong that I don’t think they should control as much of the health service’s finances as Cameron and Lansley are offering them.
    And for Comedy David and Lansley to suggest that they are the best possible people to be entrusted with such responsibility is farcical.

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