RESEARCH into extending the length of GP appointments has exposed the battle doctors face dealing with complex problems in 10 minute slots.
The report, which involved family doctors keeping diaries, followed a pioneering project in a deprived part of Glasgow which has allowed the GPs to spend as long as 45 minutes with deeply troubled patients.
Visiting housebound patients who had not been seen for sometime, supporting cancer sufferers who had suddenly found their condition was terminal and writing a letter about a missing child were among the jobs the doctors were able to carry out in the extra time.
Early signs also pointed to the patients spending less time in hospital as a result.
One GP, who described being able to follow-up on problems better and give patients more say about their treatment because they were less rushed, commented: “Otherwise I often just find myself superficially dealing with things and not following up on them or assuming that someone else should be dealing with it.”
Another doctor said the project had given them a sense of control, adding: “Otherwise we are constantly fire fighting.”
The new approach is being carried out at Govan Health Centre, which serves one of the most deprived communities in the country. Since April 2015, supported with Scottish Government funding, two locums have come into the practice.
This has freed a number of GPs once a week to schedule longer appointments with patients and meet a range of other professionals including social workers to discuss how best to look after the most vulnerable.
Earlier this year Professor Graham Watt, an expert in general practice at Glasgow University, led a study which monitored how the GPs were using their extra time by asking the 15 doctors involved to keep diaries. Their notes, kept over two weeks, shine a light on the spectrum of desperate need which they see on a daily basis.
One consultation raised serious concerns about the safety of two children, whose mother was seeking medication and said she had been threatened.
A home visit to a housebound patient with mental health problems found the house was not secure. A lone carer having suicidal thoughts, a patient who had not been out of their house for several years, many frail elderly patients nearing crisis and many people juggling addictions are also described.
Dr John Montgomery, one of the pioneers behind the project along with manager Vince McGarry, said: “Because we have been doing this for so long we have almost become immune to it. This is what we have to deal with. It was almost a shock to sit back and read it – you think is that really what we are having to manage?”
One of the aims of the project is to help reduce the number of patients who are taken into accident and emergency by better care planning and anticipation of their needs.
During the two week monitoring period one doctor reviewed the records of 12 dementia patients who had not been seen for a year and decided eight needed appointments.
Another GP said: “I simply would not have had the time to try to properly review these patients and try to avoid A&E attendances without this extra time.”
Dr Montgomery said there were early signs that the number of patients going to hospital had dipped since the new system began. He also indicated it had improved job satisfaction for the doctors, saying they had attracted new staff and a similar way of working – being rolled out in other deprived areas – had drawn six new young medical staff.
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