GP Shadowing in North Wales

Written by Jenny Randerson AM and published in Western Mail on Mon 18th Dec 2006

Western Mail Article By Jenny Randerson AM

Earlier this year I wrote to every GP practice in Wales to find out how the new GP contract has changed their working lives. One of the most detailed responses came from Dr. Peter Saul in Wrexham who said that to really understand, I should spend a day shadowing his work. So on a cold and windy Thursday morning in early December I met up with Peter in Wrexham.

I spent a busy and fascinating day with him starting at the health centre in Rhos which is one of the two places where his practice operates. Peter spent the morning seeing patients and with their permission, I was allowed to sit in on some of the consultations. What struck me most was the length of time he had to spend referring to computerised records - checking patient history, current medication and the results of hospital tests.

I also had the chance to talk to a community nurse, health visitor and the Practice Manager. Peter's practice offers a wide range of well co-ordinated additional services in line with the vision Welsh Liberal Democrats have of more care being offered in the community. They used to offer a counselling service but that is no longer funded by the LHB. This is an example of an issue which was raised by many GPs responding to my recent GP survey. The Labour Assembly Government has a vision for the expansion of primary care but faced with waiting time targets many LHBs are forced into cutting primary care services in order to balance the books.

One service offered by Peter's practice is for the care of addicts and detoxification. In many parts of Wales this service is offered by dedicated voluntary organisations but one of the GPs in Peter's practice has specific expertise in this field and has taken on the role there. This is an interesting example of the increasing specialisation we need to see among GPs.

My chat with the Practice Manager illustrated clearly how the new GP contract is working on the ground. GPs have to reach certain targets on the management of higher risk patients and illness prevention to maximise the amount they are paid. So for instance the practice is well aware of how many patients they have given the annual flu jab and how many more they need to see in order to reach their target. When I was there the pressure was on to encourage more patients to take up the offer and the GPs were being reminded to raise the issue during consultations. They are also well aware of how they are doing against the average in the number of patients on anti-depressants - in this case, the target is to reduce the numbers involved.

During the afternoon of my visit I saw the 'specialist GP' in operation as Peter held an allergy clinic in a hospital in Chester. In an afternoon with 14 appointments, he saw 3 new patients - all children showing signs of allergic reactions to everyday foods such as nuts and eggs. As well as diagnosing the allergy he gave comprehensive advice to their parents on diet and medication.

In Wrexham the cross border issue is important, Peter's practice often refers patients to hospitals in Chester as waiting times are shorter there. That is of benefit to his patients but not a sign that we are catching up with England. Peter also said that in England there are more obvious controls and checks on doctors. Indeed, that afternoon the hospital was auditing appointments to see if he was running on time.

My day shadowing a GP reminded me how dedicated the people who work in our health service are. It showed me their passion to make things better, and the frustration they feel when politicians fail to give them the tools to get the job done. We owe it to them, as much as to patients, to remove the barriers, remove the frustrations, and let the people who care, do what needs to be done.

Jenny Randerson's GP Report is available at http://www.welshlibdems.org.uk/documents/061127GPSurveyReport.doc