PI Brief Update

Understanding GPs: Struggling to Cope - Dr Mark Burgin

07/02/20. Dr. Mark Burgin BM BCh (oxon) MRCGP explains in the third of a series how the Triple Aim and ignorance of biopsychosocial progress is harming patients and the NHS.

In earlier articles I have discussed how a management framework which promises the impossible has grown to dominate health care thinking.

In this article I examine the harm caused to those affected by out of touch guidelines, targets and micromanagement.

GPs are burning out, patients do not have time to tell their story and secondary care has to treat the illnesses that could have been prevented.

The heroes of this story are the patients who despite difficulties with getting an appointment and seeing burned out GPs continue to trust their doctors.

Patients

Patients have the best understanding of what a failing health service looks like as they sit and wait to be ‘fobbed off’ by another doctor.

They know that they need an individualised treatment that addresses their problems whether biological, psychological or social.

Their health deteriorates until they are forced to attend A & E as an emergency when they cannot cope anymore.

Failure of prevention is substantially more expensive and leads to worse results which is a lose-lose situation for patients and taxpayers.

The 10-Minute Consultation

The GP consultation has been extended from 6 minutes, to 7.5 then 10 minutes and some are advocating 15 or 20 minutes as a way of solving the crisis.

The problem is not the time needed to use the Biopsychosocial model (BPSM) and find an effective strategy, it is what else has been put into the consultation.

When the GP is inputting data, managing risk factors and giving unwanted advice about smoking or obesity they are not listening to the patient.

It is difficult to modify a patient’s psychosocial risk factors whilst the computer is competing for attention however much time the GP has.

Burnout

General Practice is the best job in medicine as continuity of care and holistic (BPSM) follow up permits GPs a unique window on the world.

Although it is more difficult to recognise whose life you have saved as a GP than in secondary care the reward from biopsychosocial progress is more constant.

Complexity and high workload were managed with the BPSM, as guidelines at best are right 70% of the time GPs know they will make more mistakes

In the past 10-20% of GPs were burned out but now the figures are closer to 50% and would be higher if they were not leaving.

Increasing Costs And Increasing Illness

The public (and politicians) believe that if more is spent on healthcare the result will be healthier life and greater life expectancy.

GPs know that some of the most effective interventions (e.g. immunisation) are cheap and some of the least effective (in terms of QALYs) are very expensive.

In the long-term Biopsychosocial Progress saves money by preventing illness and complications thus reducing the costs in secondary care.

As managers make it more difficult for GPs to use the BPSM which is cheap and effective the population will become sicker and need more secondary care.

Conclusions

By some measures General Practice is in crisis as the GP workforce continues to fall putting pressure on secondary care and life expectancy.

Leaders of the profession have generally denied that there is a link between decreased access to primary care and increased use of secondary care.

I believe that the problem is not primarily underinvestment in primary care but the toxic effects of a management model that sounds too good to be true.

The answer is to accept that GPs are experts in complexity and value biopsychosocial progress as a target that understands GPs.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register and audits medical expert reports.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

GMC 2019 The state of medical education and practice in the UK: the workforce report

Burgin 2020 Understanding GPs: Biopsychosocial Progress. www.pibriefupdate.com

Burgin 2020 Understanding GPs: The Triple Aim as a Management Tool. www.pibriefupdate.com

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