Who is she? Katherine Murphy, of the Patients Association.
In the misplaced need to supposedly provide "balance" to every article, she provides a handy soundbite to any journalist that asks.
Don't get me wrong, we need people like Katherine and her organisation to stand up for patients, especially when a system has failed. There is some great work from the organisation which has undoubtedly helped improve services.
But I often find myself, as an actual healthcare worker, wondering if she exists in some sort of parallel universe where everything is perfect, resources are unlimited, and no-one is responsible for their own actions. She rarely compliments, and is freely criticising in her approach, often taking individual situations and extrapolating them, as well as generalising and not taking into context the entire situation at hand.
It's easy to throw out soundbites like "GPs are crap and there should be 24/7 immediate access" without actually stating how that is achievable.
In case you think I'm being melodramatic... here is her direct quote in the Daily Mail:
"Patients should have access to GP services 24/7 and the GP should be the first point of contact for anyone who requires healthcare."I don't think this is something unreasonable to strive for, but within the same article she also states:
"There is no continuity of care out of hours, and this is the danger to patients when the service isn’t provided by their GP but by private contractors."So how on Earth does she propose a system should then run? Should all GPs be personally available, all the time (as in 24 hours a day, 7 days a week, 365 days a year)?
As a doctor, or indeed, an NHS worker, I cannot simply say what I want to the press. For one, I'm bound by the Duties of a Doctor, to "not bring the profession into disrepute":
"Never abuse your patients' trust in you or the public's trust in the profession."And, for some, speaking out can prove a career- or life-ending move:
http://www.telegraph.co.uk/news/health/news/10397842/Whistleblower-doctors-punished-by-mafia-code.html
http://www.ajustnhs.com/case-histories-of-victimised-nhs-staff/
Doctors are bound by codes of conduct that make it hard to defend what they do, especially when facing attack from someone with no such code of conduct. It's an unfair playing field, where one side can say whatever they like, whether backed up with plans/evidence/statistics, but the other can't. It doesn't help that the professional organisations (such as the BMA or RCGP) who could, aren't often invited to give a soundbite, or when they do, fail to actively engage the audience as well as Katherine does.
So here is today's article that has led to me writing this blog:
Worried parents 'put pressure on A&E' BBC 29/04/2015
Let's take Katherine's quote in this article shall we?
I'm going to examine this in more detail...
But Katherine Murphy, chief executive of the charity the Patient's Association, said there also needed to be better access to GPs.
She said: "It can be frightening for children to end up in A&E. They might be better cared for in the community in many cases.
"But very often parents take their children to A&E because they can't get access to their GPs.
"They know they won't be turned away from A&E and won't need to wait days for an appointment.
"We need better access. And there needs to be more awareness raised of services such as minor injury units."
"It can be frightening for children to end up in A&E. They might be better cared for in the community in many cases."
I agree. Children with minor illness should be kept away from health care if they don't need it, especially a busy A&E department.
"But very often parents take their children to A&E because they can't get access to their GPs."
I'll provide a recent source (the Kings Fund, about as independent, impartial and trustworthy as you can get), as Katherine doesn't, that suggests that actually most A&E attendance is within working hours, and that available evidence doesn't suggest GP access is the cause of problems with A&E waiting times.
If Katherine is allowed, then I'll give some anecdotal "evidence" too, both as a GP and A&E doctor. I've yet to come across a practice that doesn't respond in some way to a request for an on-the day appointment that same day (whether by telephone or clinic appointment) for children under 2, and often under 5s too. By the same token, I've dealt with triage call for an "urgent" appointment, only to have my suggestion that I see the child within 30 minutes rejected as "inconvenient".
When in A&E, we would often be told "there were no GP appointments" by parents, only to find the GP quite willing to see the child when we asked.
"They know they won't be turned away from A&E and won't need to wait days for an appointment."
As I've said, seeing ill children is a priority for GPs, as failure to spot serious illness is hardly likely to lead to anyone, including the GP, being happy. The trouble comes when the definition of seriousness is left so vague. Is a minor bang to the head, leaving no bruise "urgent"? Should parents try some paracetamol and a cuddle, or should they call the GP, or should they attend A&E?
In response to demand, many GPs operate a triage system (just like A&E), in order to prioritise the patients needing seeing sooner, meaning that some have to wait. It may not be convenient for everyone, all of the time, but then the politically-unspoken commodity in the NHS is patient's time. Rather than higher taxes, or a pay-as-you-go system that would allow for more access, and quicker access, we use patient's time to keep healthcare accessible for all.
So if you have to wait days for an appointment, I'm sorry on behalf of the NHS, but know that it's because someone somewhere has to wait to allow that ill child to be seen quickly. It's not perfect, but it's probably the best we can expect as a public that funds the NHS as we do.
"We need better access. And there needs to be more awareness raised of services such as minor injury units."
No. This should read "We want better access". As review over and over again shows, the NHS is one of the most efficient systems in the world, despite the much-trumpeted access "problem". If it were truly detrimental to wait, then how come the outcomes remain so good?
Do we need more awareness of minor injury units? I would argue that we need more awareness of when and where to access health care, if it is needed:
I think the one question not answered here though is just how many of those anxious parents needed to see either a GP or the NHS at all.
Community care includes parents and guardians providing simple First Aid, trying over-the-counter medicines and reassurance. Successive media campaigns have driven an idea that every cut or bruise needs to be dressed by a nurse in an A&E, every tiny bump to a head a full neurological assessment or a "scan", and every cough or sore throat a thorough "check-up" within hours of onset.
Parents are anxious because we've created a narrative that every minor illness may just be the one in a million that is serious. So what are they to do? No wonder they head to A&E worried about their child.
Research this week shows how potentially harmful this may turn out to be:
Parents 'may pass anxiety on to their children'
http://www.nhs.uk/news/2015/04April/Pages/Parents-may-pass-anxiety-on-to-their-children.aspx
We need to re-instill confidence in our population about how to manage their own illnesses, accept a degree of personal risk and responsibility, and to use the finite NHS resource with consideration for all that need to access it.
Like most problems, its important to look at the cause and not the effect when trying to generate a solution.
And that is why I struggle to empathise with Katherine Murphy, for rather than support a way of tackling the root problems, she jumps to conclusions, which make great soundbites, but perhaps ironically, do little to actually help the patients she purports to be an advocate for.
