Dr Mary McCarthy: Standard appointment not enough for patients with complex conditions

People are queuing by the reception desk, and now that we have an automatic check-in system some people walk straight through to the overcrowded waiting room – a constant reminder that general practice is overwhelmed by rising patient demand, particularly from an ageing society.

As people are living longer and survival rates for diseases such as cancer are improving, people are living with life-long conditions, and have increasingly complex medical needs.

The standard 10-minute appointment for these patients is simply not enough, and in other European countries consultation times are about 30 minutes. But increasing the time available for all our patients will have yet another severe knock-on effect of more delays in getting an appointment.

Thankfully, my next patient who suffers from diabetes – a complex and long-term condition – has booked a double appointment, giving me enough time to really listen to him and other investigations and explain what should happen next.

The diagnosis of diabetes often comes as a shock though patients with a family history of diabetes may be aware of the symptoms of tiredness, thirst and increased frequency of passing urine. It affects patients in many ways – it may impact on insurance, on driving and it certainly affects their lifestyle.

They have a steep learning curve as they take in the importance of keeping blood sugars level and near-normal and the fact that, in some cases, they may have to test their own blood and alter the dose of their medication depending on the result.

They need to make sure their diet is low in sugar and fat and high in fibre and that they keep physically active if at all possible.

They have to get used to check-ups every six months or so with various blood tests, have their blood pressure checked and once a year get a sort of MOT with photographs of the back of their eyes and examination of circulation and sensation in their feet.

It used to be that all diabetics were seen in a hospital diabetic clinic, but now in Shropshire about 80 per cent of diabetic patients are seen by their general practitioner.

We desperately want to provide the best possible care for our growing number of patients, and to allow more services to move from secondary care to primary care, but with the increasing demand and diminishing resources we need long-standing investment in general practice – as called for by the British Medical Association – so we can deliver the care our patients deserve.

• Dr Mary McCarthy is chair of the local medical committee and represents Shropshire, North Staffordshire and South Staffordshire on the General Practitioners Committee of the BMA. She has worked at Belvidere Surgery in Shrewsbury for more than 20 years.