How much time do GPs spend on issues other than health? asks a poll of GPs by Citizens Advice. The answer is a lot.
Almost a fifth of consultation time is spent on “non-health” matters. Nine out of 10 of the GPs polled said patients had raised issues about personal relationship problems in the past month.
About three-quarters of them said patients had talked about housing, unemployment, work or benefits problems. This workload apparently “translates to an implied cost” of nearly £400m to the health service.
Citizens Advice says that four in five of the polled GPs refer patients to an advice agency in the community, asking ask whether new ways of meeting this “non-health” demand could contribute to the £22bn “efficiency savings the NHS needs to achieve in this parliament”.
This strikes me as a rather crude attention-grabbing ploy by Citizens Advice. They do a great job, provide good advice, are a valuable resource and do dovetail well with other agencies, including GPs, in trying to help individuals. But what on earth is “non-health” about emotional problems, work pressures or stresses caused by living conditions?
If nine out of 10 of the polled GPs said patients raised emotional issues in the past month, what are the other 10% doing? It is impossible to be a GP for a morning without hearing about the emotional and socioeconomic factors that are affecting patients’ health.
If a whole month goes by without a GP hearing “non-health” issues, they’re either in denial or not fit to practice. This distinction between “health” and “non-health” matters is a false dichotomy; there is no health problem or solution that does not include, to a greater or lesser extent, consideration of how a person is feeling, what they do, who they live with and what conditions they live in. It is never a waste of time to find out some background. Medicine can’t operate in a vacuum.
And who says the NHS “needs” to achieve £22bn worth of efficiency savings in this parliament? The figure comes from NHS England’s projection that savings of £30bn are needed over and above inflation by 2020. £8bn is to be funded by taxpayers and £22bn by “increased productivity”.
So is the idea here that GPs will help the great leap forward by interrupting patients when they start crying? By handing them a tissue and a Citizens Advice card and pushing them out the door?
Of course integrated care is a good idea. Social and health services need to work better together, especially in cases of complex need. Voluntary agencies that support, lobby and act as advocates for individuals play a vital role. Organisations like the mental health charity Mind often complement the work that GP and primary care teams do in helping people who are struggling with mental health problems.
But it is a dystopic view of healthcare that says that GPs should be discouraged from doing “non-health” work so as to boost productivity. It seems a huge step backwards to see a person as being just a symptom to be efficiently fixed rather than the sum of their myriad complicated parts. Because tinkering with broken parts, rather than trying to make the whole function, doesn’t work, isn’t right and doesn’t even save money in the long run.
