Scarcely a week goes by without some report from a prestigious think-tank or official inquiry pronouncing that GPs are “ideally placed” to tackle some pressing social problem. The scope of millennial primary health care is expanding at a dizzying rate. It already stretches from childhood obesity, through teenage pregnancy to dementia and terminal care. Doctors’ surgeries are expected to treat drug and alcohol dependency, and take on responsibility for child protection, while screening for domestic violence and elder abuse.
Given the rising scale of expectations placed on GPs, it is not surprising to find that various inquiries also find them deficient in satisfying the new demands – or indeed in fulfilling their traditional responsibilities, such as in relation to the health care needs of people with learning disabilities or mental health problems. The familiar solution to this paradox is to propose more training for GPs to raise their awareness of their new areas of responsibility and to provide them with the “skills, attitudes and values” for modern medical practice.
The notion that GPs can resolve societal problems that have evaded solutions in the realm of social policy and criminal justice is illusory. It reflects the wider loss of authority in contemporary society that is reflected in the trend for ”outsourcing” responsibility, from the nation state to supranational bodies, from government to non-governmental organisations, from politicians to bureaucrats, from executives to consultants, from parents to professionals.
Because nurses and GPs are rated highly in public opinion surveys, politicians and social services authorities (not to mention lawyers, the police and journalists) – who rank low in public esteem – believe that they can pass on their tarnished burdens to doctors’ surgeries. But why should people trained in dealing with the ills of the body be considered capable of solving all the ills of society?
Having recently attended training in child protection and the prevention of teenage pregnancy, I can confirm that this is useful in familiarising GPs with current jargon and fashionable dogma in these areas. Whereas medical practice has a solid foundation in scientific medicine, this sort of training seems to lack any basis in theory or practice (it is certainly exempt from the demands of evidence-based practice).
Though training provides an escape from frontline work and a steady income for a growing body of teachers and consultants in the worlds of health and social care, and it may provide a brief respite from the surgery for beleaguered doctors and nurses, it will have little impact on day-to-day clinical work.
The danger of loading more and more responsibilities – and increasingly unrealistic expectations – on general practice, is not only that GPs will fail to meet them, but that they will be incapacitated in carrying out their traditional functions. If GPs assume a more intrusive and authoritarian role in relation to their patients, they are likely to find that their fragile prestige will rapidly crumble and that their capacity to heal is correspondingly diminished.
Doctors are ideally placed to diagnose and treat illness and disease. Everything else is social work.
Dr Michael Fitzpatrick is a GP in the London Borough of Hackney