Doctors at the heart of their community

Nov 23 2007 by Audrey Barton, The Journal

Doctors in Northumberland have voiced their fears for patient care amid cuts brought in to save money by Northumberland Care Trust. Audrey Barton spent a day shadowing Ashington GP Jane Lothian to see what really goes on during a typical doctor’s day.

IT IS 8am and Dr Jane Lothian is already making phone calls to patients at their homes from Seaton Park Medical Group in Ashington.

She listens carefully to the patient’s symptoms, reassures, prescribes medication, and, if necessary, arranges a home visit. All in a quick and friendly phone call lasting just minutes.

Surgery begins at 8.30am and a steady stream of patients passes through the family doctor’s office to be seen. By 10am she has time to take the quick break she has scheduled in to talk to me about her job.

Seaton Park Medical Group is the largest in the county, treating 20,000 patients as a result of a merger of Seaton Hurst, Newbiggin and Seaton Park practices in July.

The 49-year-old explains how the practice is busier than ever as there is a shift from treating patients in hospital to caring for them closer to home in the community.

Patients with long-term chronic conditions such as diabetes or chronic obstructive pulmonary disease can now be managed by their doctor and practice nurses in primary care.

“People who just five years ago I would have referred to hospital are now routinely managed in the community,” said Dr Lothian.

“In some areas there are extensive hospital departments but in Northumberland we manage about nine out of 10 people with diabetes without them going to hospital.

“We are expected to do more complex work in a surgery than the senior consultants and clinicians who taught me medicine.”

In recent weeks Dr Lothian saw a woman who was suffering gynaecological problems and discussed whether there was a need for her to go back to hospital for treatment.

“We decided she would prefer to be looked after at the surgery rather than going back to hospital. I absolutely agree with treating patients at home. If someone wants to stay at home it is absolutely crucial.”

Hospital admission can be traumatic and worrying for the elderly and brings with it a risk of infection.

“It is still a belief among the elderly that if you go into hospital and it is serious, you might not come out. With a lot of these people there is strong family support around here and so they want to stay at home.

“That is what we want to achieve. It is a team working together, not just a GP.”

I leave her office to make way for more patients before we set off for a home visit to an elderly patient Dr Lothian is concerned about. The lady’s daughter called the surgery worried about her mother’s leg which has discolouration and is causing her pain.

Dr Lothian wants to pay her a visit to rule out serious conditions such as deep vein thrombosis, artery blockage or heart failure.

When we arrive at the Ashington home, it is clear Dr Lothian knows her patient well. Not just her, but her whole family.

“Some of the doctors have worked here 25 years, I have been here for close to a decade. We know all the family history. I know this woman’s husband has had a knee replacement, I know her daughter. I am able to come in and hopefully know what is wrong.”

Dr Lothian diagnoses an infection and prescribes antibiotics. Now we are on our way to an administration meeting of the partners during the practice lunch hour when the surgery is closed. The partners are angry about plans by Birmingham Primary Care Trust to run doctors’ services under a “McDonalds-style franchise” by private-sector companies with no experience in health. Some of the Seaton Park partners believe it would be a massive tragedy for patients and would lead to mass standardisation as surgeries would not be aware of family history and there would be no continuity of care.

Nationally the idea has been condemned by a member of the British Medical Association as peddling junk healthcare.

The GPs also hold lunch-time education meetings every week to keep their knowledge and skills up to date. They discuss new developments in treatments for illnesses and guidelines.

The thirst for knowledge to deal with more complex cases in the community is fed through the click of a button.

With patient records going paperless and being stored on computers, and online systems such as Choose and Book offering patients a choice of hospitals where they wish to be treated, the computer is the doctor’s new medical bible.

Through one click of the mouse, doctors have access to Department of Health information and guidelines, medical sites, statutory regulations and management guidelines to enable them to treat patients in primary care. Northumberland doctors’ concerns for their ability to maintain patient care amid a raft of cuts are have been well documented in The Journal.

But GPs themselves across the country have come in for national criticism for their salaries which are reportedly as high as £250,000.

But Dr Lothian, a GP of 26 years, is exasperated at the suggestion of earnings that high.

“I would love to see who earns £250,000. I think realistically we are looking at just over a third of that. That wouldn’t be unusual for somewhere like this.

“I don’t think I could put in more hours doing the job I do. GPs are doing more work in the community and the income is coming down each year.

“We have been making efficiency cuts of the value of inflation for two years.

“I am a working mother with two children, who, by the way, don’t go to private school. My husband is a house husband which makes it possible for me to do this job.”

We return to the practice for afternoon surgery, and another round of phone calls, home visits and patient consultations.

Dr Lothian finally leaves for home just before 8pm, with a couple more visits between her and getting to see her 10 and 12-year-old children, and an armful of paper work to do after dinner.