Firstly I would like to apologise for my 12 month absence and try to redeem myself. The reason, in part, for my silence, has been my own personal paradigm shift.
The pattern so deeply established of working as a GP trainee in a city recently dubbed as the “least peaceful major urban centre in the UK” has changed unrecognisably. The funny thing about this is that the city’s citizens do as much to perpetuate these false stereotypes as those who’ve never been. The city’s old reputation as a hard town was probably once justified. Now, however, it’s like the city’s old warehouses that have been gutted and converted into artists’ residences – the shell remains, but the rough heart is gone.
A couple of months ago myself, Surgical Dad, Bella and Big Son left this glorious city and headed 418 miles due South. We have exchanged urban for rural, hilly landscape for lunar, cold with warmth, and the perpetual risk of rain to that of finding wild ponies, deer and boar on the roads at any given time.
So the move, passing my exams and ditching my title of longest serving trainee for member of the Royal College of General Practitioners has resulted in many others aspects of my life being left on hold for a quite frightening length of time.
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With five months to go before the referendum that could lead to Scotland leaving the UK, healthcare is already devolved. I am aware on a daily basis of the differences between the NHS and the public healthcare systems.
One of the first differences I noticed was the distinct lack of pharmacies operating the Minor Ailment Scheme. The scheme that offers medication free of charge on the NHS, for those who don’t pay prescription charges, for a number of problems from nappy rash, threadworm, diarrhoea, conjunctivitis…. etc. A pharmacist would offer advice on the conditions and where appropriate suggest medical review. It was a fantastic service, it offered patients ease of access and treatment, it offered doctors more appointment availability. I am yet to find a chemist locally who offers this although I understand from the NHS website they may exist.
This brings me on to the hotly debated prescription charges. On the one hand is the group who feels that paying their £104 for an annual prescription pre-payment certificate is a small price for their bisoprolol, ramipril, aspirin, clopidogrel and statin immediately post-angioplasty which saved their life. On the other hand is the group erked by having to pay for their life-long thyroxine script when their partner doesn’t pay for their life-long insulin one. Why should some chronic illnesses be charged and not others? The other day I saw a man whose psoriasis had flared up due to acute tonsillitis – he could only afford one prescription…… Whilst seeing these patients I constantly have on my mind the fact that north of the border the individual doesn’t pay for anything. Of course they do really, but they don’t knowingly count out the pennies.
Cervical screening may not be the only screening programme with age differences in the UK but it has gained much attention in light of this recently. I notice the difference when 24 year old girls come in complaining of post-coital bleeding. In Scotland they would have had 2 smears already, but no routine HPV testing. I feel screening needs demystifying, it is often proffered by the press for those who are symptomatic and patients then come in to GP surgeries expecting such. Screening is just that, to screen asymptomatic individuals, to look for changes which could become problematic if not treated. Those with symptoms need appropriately investigated, channeling them back through the screening programme is not the right choice for them, regardless of age.
At work my smart card has now come through meaning I can now offer Choose and Book to my patients. This is an entirely new concept to me. Sitting with the patient who needs an orthopaedic referral and offering them the hospital, date and time of their appointment to suit their preference and convenience. As they close the door behind them their appointment is booked. This is a triumph in patient choice! Yes sci-gateway, the integrated e-referral scheme in Scotland worked well but hospital choice was governed by postcode and protocol. The two schemes together would reign supreme though, now there’s a thought.
On a personal level both myself and Surgical Dad have found our defence union premiums doubled as we crossed the border. The reason, “people seem more litigious than they were, much more so in England” says MDDUS Mr Dickson. Our risk of having a claim made against us increased 3-fold during the journey despite our practice remaining unchanged and arguably better for our breadth of experience.
And so in 418 miles we have gained and we have lost but the focus has always been on the journey and not the destination.