Struggling GPs are as much of a problem for the NHS as A&E

BY David Waywell   /  8 August 2018

The problem with my mother is that she bends in all the wrong places. I realised this as I tried to jam her right leg into the rear seat of a taxi van as the driver did his utmost to twist her left hip in an anticlockwise direction in order to coax her spine around a doorframe sharpened like Damascus steel.

‘We’re doing it!’ cried the driver who could have passed for Ed Sheeran’s stunt double.

From her inverted horizontal position, my mother agreed with Ed. Her agreement came in the form of a piercing scream that the designers of this “mobility friendly” taxi van hadn’t taken into account when they’d chosen the sound system. For ten long seconds, the sound of Queen’s “Bohemian Rhapsody” was completely drowned out. I hate “Bohemian Rhapsody” so part of me wasn’t complaining. The other part of me was concerned with the muscle I’d just pulled in my back.

This was the culmination of one of the hardest weeks of my life and I’m only able to write about it now thanks to the Gods of Caffeine and Codeine. Yet how I found myself in this situation began some months ago when my mother made the mistake of telling her GP about her knee pain…

It wasn’t terrible knee pain but it was enough for her to seek help. The GP immediately sent her for an X-Ray. “Very mild osteoarthritis,” they said with reassuring confidence once the results came back. They prescribed Ibuprofen and sent her to a physio who suggested she balance on one leg, wiggle her ankles, and, most of all, keep walking on the knee because arthritis responds to activity.

And walk on it she did until the activity made the knee worse. In fact, it made it a lot worse. Another GP decided the answer was stronger painkillers. This was followed, a long agonizing month later, by yet another GP (we’re plagued by a constant succession of locums at our local practice) deciding that even stronger painkillers should mask the pain that was now so severe that my mother could barely walk more than a few feet unaided.

“Are you sure this is arthritis?” I’d ask each GP who I would never see again. “It seems more like a meniscus tear or a problem with a ligament…”

They all smiled at me as they do when faced by a fool who clearly doesn’t understand knees and had spent a few too many hours on the internet doing research.

“Mild arthritis,” they said, pointing to the X-ray which seemed to show a healthy thickness of cartilage in the knee joint.

Surprisingly, my mother’s optician was the first medical professional to question if it really was arthritis.

“Osteoarthritis shouldn’t be this painful!” he said as we both tried to lift her from the chair after a routine eye exam.

About a week later, we had to call the emergency doctor. This time she was stuck in her own armchair after her knee had made a noise like Mount Doom splitting open due to Hobbit fatigue. The rota Doctor examined, prodded, and poked the area (surprisingly the first to have done so despite months of asking and the only one to have checked for Baker’s Cyst) and immediately diagnosed a seriously buggered up knee. That, of course, wasn’t his professional diagnosis but he did say he would write to the GP and recommend that the knee have an MRI with some urgency.

Naturally, given that urgency, the GP just sent my mother back to the physio and the physio, in turn, could only work from the official diagnosis of arthritis. That meant more standing on one leg, more wiggling her ankles, and more keeping the leg mobile because, as you know, arthritis responds to activity…

This went on for eight months before, a fortnight ago, we realised we were facing a real knee crisis. We decided to pawn the family cat in order to pay for the MRI that the GP was still refusing to authorise in the form of a referral to a knee specialist. Last Wednesday, the result came back. The MRI revealed not one, not two, but three meniscus tears in the knee. The knee was probably more tear than knee. Not that the diagnosis helped my mother. So traumatic was the ordeal of going for the scan that she couldn’t get out of bed. Nor could she the next day. Nor the day after that… Soon she’d been immobile for so long that she developed an infection which, last Thursday, made her see dragons.

We rang 999 and she spent the night in hospital, taking antibiotics, and recovering her senses as I underwent emergency surgery on a wallet that ruptured trying to cover the costs of installing a stairlift. It did mean, however, that my mother could leave hospital. That was when we faced the non-trivial matter of finding a mobility friendly taxi and how I came to find myself wrestling her into the back of a taxi van with Ed Sheeran’s stunt double.

None of which really explains the kind of week I had or the weeks that went before it. It does, however, show a little of how the NHS works and how it fails.

I have always been unapologetically supportive of the NHS. My father worked in it all his life, which makes its failure to give proper care to his widow all the more disappointing. In many areas, the service is second to none, especially when it comes to critical care. Yet the stories I repeatedly hear, often told to me by ambulance crews, are of a service that is fundamentally broken at the GP level. Because of a serially misdiagnosed (and overprescribed) knee problem, my mother went from an active woman of senior years to a woman being pushed around in a wheelchair and then in hospital because of an infection caused by her lack of mobility. Nearly all of that needn’t have happened.

This is, however, the story of too much of the NHS, especially in small towns where care feels like an afterthought. This is the reality of the GP system which struggles to offer continuity of care given the prevalent use of locums. The new Patient Access system was meant to list the names of doctors in any surgery so you might arrange to see the same doctor. Now the system lists them as “Doctor A” or “Doctor B”.  All that’s missing is Noel Edmonds to squeal with delight when you make the wrong choice. The result is an over-reliance on pain medication and GPs who have some phobia about touching patients or diagnosing anything that doesn’t show up on blood tests or X-Rays. They treat minor complaints with indifference, serious complaints with mild concern, and by the time the problem has escalated, they no longer care because they’ve already moved on. By then the matter is in the hands of overstretched ambulance crews or staff at the equally stretched hospitals.

None of this will be new to people working inside the NHS nor, for that matter, those of you who use the NHS with any regularity outside London (where I’m told care is better). Last year, a doctor, Max Pemberton, wrote a blistering piece for The Spectator, arguing that “the NHS as we know it is dying” and that “it’s no longer a matter of if it will collapse, but when.” It’s a grim diagnosis and I suspect that Pemberton is right when he says that “root problem is political: a systematic refusal by all parties to acknowledge the problem”. Arguments on both sides run quickly into ideological absolutes. Pragmatism, which should be the byword of the NHS, seems to have no place in the debates. Yet sitting in the hospital last week, I saw a system that wasn’t so much failing as existing in a state of complete imbalance.

Promises to expand services, invest in technology, and build new hospitals are largely political gambits. What we need is a zero tolerance policy towards minor ailments like New York City once had a zero policy attitude towards crime. The Sugar Tax felt like a holistic start to achieving just that but, really, efforts are wasted if funding doesn’t address the fundamentals. If the roots are rotten, you don’t expect a tree to survive. In the case of the NHS, the taproot is that which connects patients with doctors. If we don’t solve the problem of continuity of care, the results will be felt throughout the system. As it is, the GP system is failing and not just my mother’s knee.