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Cuba’s healthcare lesson
• FOLLOWING a number of recent articles in the New Journal regarding privatisation and polyclinics in Camden, I am writing with my concerns as a GP working in the area,
I am concerned that Healthcare for London’s and Camden Primary Care Trust’s current plans for polyclinics in the borough place access to technology above access to a person.
The overwhelming majority of medical consultations are between patient and GP, and only a minority of them lead to investigations.
Most of our healthcare needs are in the last few years of our life because if we don’t die in old age we are likely to be sick.
Age and illness limit our mobility. So does a child in a buggy.
When mobility becomes a problem, patients change, reluctantly, from the GP that they have always known to a nearer practice. Larger units, however marvellous the facilities, do not compensate for being further away.
If we are old or chronically ill or dying or afraid, we value the continuity of care which general practice has traditionally given. When you are alone with pain and fear, the personal relationship is more important than anything.
Continuity of care is particularly important for those with impaired ability to express themselves in English, whether because they are foreign or intellectually impaired. Continuity facilitates the establishment of understanding, both linguistic and philosophical, and trust and confidence.
Regrettably, the disempowered do not feature in focus groups or work for the Department of Health, and so, though lip service is paid to preserving continuity of care, the proposed actions threaten to destroy it.
Moving services like X-ray to the community will be costly, due to duplication of services and the need to employ radiographers (already a scarce resource) and staff to report the images 24 hours a day.
The problem for GPs and their patients is less the journey to a hospital X-ray department than the delays in getting the report to the GP, which in local hospitals often takes several weeks.
Other hospitals, Milton Keynes General, for example, have overcome this through technology.
The term polyclinic is too loaded with myth. Polyclinics are associated with the Soviet Union, generally negatively, and with Cuba, generally positively. However, it was because the polyclinic system failed to provide effective family and preventive care that Cuba in 1984 started its family doctor system.
I hope that the apparent advantage of the proposed changes will be weighed against the clear and serious disbenefits.
JUDITH HARVEY
Sessional GP, Camden
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