Two for the price of one

He's back. Frank, fearless and funny, our 'anonymous' senior physician, previously featured in Bedside Manor, turns his attentions to the latest changes in primary care.

A leading supermarket chain recently established an in house "see your GP on aisle number 20". Apparently you can queue in the express lane with 10 symptoms or less.

Not such a bad idea, most people over the age of 50 have enough long term medical conditions to bang up quite a few Loyalty Card points. 

In truth GPs have been running an efficient budget service for a very long time. When an entire family pops into the surgery headed by Mum or Dad on a single appointment, it is very difficult to say, "Bugger off until next week". General Practitioners do a great deal more than buy one see one free. The latest fracas with the government shows all the pain commercialisation of health services can cause when it comes to delivering those services.

Many, many years ago I once did a locum for a single handed practice. This family doctor aged 60 years had served his rural community for all his professional life 24 hours a day, 365 days per year.

I called to tell him one of his patients relatives had called our practice asking for a visit but was not sure if he was on call. "I'm always on (expletive) call. All my patients know this. Who made the call?" he replied. I gave him the details of the telephone request.

"Ah, yes. I know him well. Call an ambulance. If you wish I will meet you at his home. There is no number at the end of the lane. Watch out for the dogs, they will bite your (expletive) part of your (expletive) anatomy off. Don't (expletive) around. These people are genuine."

Frankly, I can't imagine an equivalent service based on telephone responses such as "Press one for further information, press two for booklets on private medicine, press three for the government's position on the GP enhanced hours crisis, press four to be contacted by a private contractor with unbelievable prices for funeral services."

All lipstick and no spanners

Going to your average pharmacy you might be confused. Here we have amongst the very best educated and trained health professionals yet to Joe Public (and sometimes to Jo Public too), pharmacists are a very convenient means of filling very small brown plastic bottles with pills.

Men it appears not only have a poor opinion of GPs when it comes to booking visits but they also see pharmacists as all lipsticks and no spanners. In short as Terry Maguire, big cheese of the Royal Pharmaceutical Society says, "men don't particularly value chemists shops for other than something for the weekend."

Well, times are about to change not least because there is a clatter of medicines about to go POM to P (that is, they'll be available from a pharmacy wihout prescription). Serious drugs are about to hit the common market. Remember how we got it wrong over Ranitidine? So think about treatments for BPH or for that matter erectile dysfunction.

Is there a safe way to get treatments across to men who traditionally don't use pharmacy services? Perhaps they should buy their medicines online and risk getting chalk dust or worse, missing out on definitive a diagnosis. At present optometrists pick up most undiagnosed diabetes in men. This is at least eight years too late to make any kind of difference. 

Making better use of highly trained health professionals within primary care as distinct from General Practice might not be such a bad idea, getting two for the price of one can make sense so long as it is not yet another politician with undiagnosed expenses.