WHERE TO GET HELP: PRIMARY HEALTH CARE SERVICES

The general practitioner (GP) is usually the focal point of these community-based services. GPs are moving away from the old-style single-handed practice to more group work, often involving a number of doctors based in a health centre. These centers then become the base for the other primary health care workers and a focal point in the community. GPs are self-employed but come under the authority of the local Family Health Services Agency (FHSA). Government reforms of the NHS have encouraged certain GPs to become fund-holders. This implies a larger degree of financial autonomy and is only granted if the GPs concerned wish to apply, if their financial and patient base is big enough, and if they can demonstrate an understanding and competence of financial and management matters. It does mean that within certain restrictions the GP practice can operate more independently in a variety of ways (with the idea of benefiting the customers, i.e. patients). Running one’s own budget can improve services (the government’s intention). People have been worried however that patients seen as expensive would be deemed undesirable to fund-holding practices and either asked to find new GPs or get a less expensive service provision. There appears to be very little evidence of this but in cases of concern the patient or carer can contact the local FHSA to discuss the matter further in confidence (if discussing the issue with the GP fails to resolve the issue).
Until recently general practice was not seen as a very attractive career prospect unless working in a prosperous country area. This has now changed with new regulations requiring GPs to be specially trained. This usually takes the form of a 3 year vocational scheme, undertaken a year after qualifying and involving training in numerous specialties (children, the elderly, psychiatry etc.) A year is then spent in general practice under supervision. Many areas run organized schemes, while some doctors make their own. Increasingly many young doctors are being trained and then choose to remain in inner city areas improving the standard of health care to the population (often poor and with a high percentage of old people).
The government changes have also meant that GPs are being asked to meet certain targets (e.g. a certain number of children immunized) before full payment is given. This is meant to improve the overall standard of care. In addition, the government has insisted on the offer of an over-75 yearly screening programme. This means that every person over 75 must at least be offered a visit to check certain things: weight, blood pressure, hearing, eyesight, etc. Many GPs feel this is not a good use of their time as the pick-up rate is considered to be low. Many delegate this duty to the practice nurse and many practices do not follow up on the initial refusers.
The situation is complex and certainly not many new problems are uncovered if the government guidelines are strictly adhered to. GPs, however, are now in a position to widen the scope of the health check and include other services which may be of benefit, e.g. assessing levels of disability, depression, the possibility of abuse, etc. Good GP practices tend to offer good services, and as it is now easier to shop around and change GP, elderly customers should try and be more critical of the services on offer.
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