Dr Katie Musgrave compares the veterinary system to general practice to reflect on the systematic replacement of GPs
My best friend from primary school was the daughter of a vet. I loved visiting her house: she had a tank of terrapins in her bedroom; her family kept chickens; and they had multiple dogs and cats. One of my most vivid childhood memories involves sleeping in a small bed with around half a dozen tiny kittens.
The relevance of this story to general practice is that my friend’s mother – an eccentric and highly intelligent woman – was later suspended from veterinary practice, for allowing nurses to administer vaccines to animals at her surgery. She had felt it reasonable to train up her nurses, delegating this easy and low risk procedure from vets.
However, the British Veterinary Association (BVA) disagrees: ‘The first vaccination consultation usually provides an opportunity for a thorough examination of the animal and early identification of any underlying conditions (e.g. heart murmur), There are also a number of other considerations discussed with the owner at the first vaccination appointment […]
‘For these reasons, we do not support registered veterinary nurses (RVNs) being permitted to prescribe first vaccinations, even with increased training.’
It’s startling how differently the NHS approaches the delegation of human healthcare. The BVA states: ‘There is a potential risk to animal health and welfare if the animal does not receive regular health assessments, which may be an unintended consequence of booster vaccinations being prescribed by RVNs.’
Yes, you read that right. It is considered too risky for veterinary nurses to deliver routine annual vaccines, because the animal would forgo the opportunity to be seen and examined by a fully qualified vet.
Yet, here we are in the NHS, witnessing the introduction of physician associates: the newest member of the healthcare team, with variable levels of experience, only a two year degree, and an unspecified scope of practice. For years now, we have had nurse prescribers, paramedics, physios, and pharmacists seeing undifferentiated patients in UK general practice. Perhaps the plan is eventually to drive GPs extinct.
As a GP, I am all too aware of my limitations; I have been a doctor for 14 years, and in general practice for over a decade. Yet, I frequently learn new things, or discover areas where I could have been practising more safely (my unknown unknowns). Seeing undifferentiated patients is complex and challenging. Sifting the wheat from the chaff, and spotting the red flag or pertinent unexpected blood result, is high risk and difficult work.
There are no shortcuts: GPs need their degree-level medical training, junior doctor hospital experience, followed by years of training in general practice. The concerns raised by the BVA can be applied to general practice. There is clearly a potential risk to human health if a patient does not receive regular medical assessments (especially when they present with symptoms), which is a consequence of care being delivered by non-medical staff.
The stark difference in the standards applied to delivering veterinary care and medical care in the UK is remarkable. Even more troubling, is the trend towards non-medical staff replacing GPs is most commonly seen in the most deprived areas. Over time, this will inevitably increase health inequalities, worsening health outcomes and life expectancy for the poorest in our society. It will also place more pressure on our already floundering health system, as inappropriate prescribing, tests, referrals, and admissions take place.
It may feel as if the diversification of healthcare workers is unavoidable, as GPs cannot be retained – but this has been a political choice. The NHS is not retaining its GPs. We are emigrating, retiring, retraining and minimising our clinical sessions due to our poor working conditions. In addition, we now even have the spectacle of unemployed locums, and newly qualified GPs unable to find work. Yet ARRS funding is ring-fenced, to specifically prevent it being used to recruit more doctors. Replacing GPs with less qualified staff is clearly a strategy of NHS leaders and politicians. They are trying to deliver a bargain-basement, all-you-can-eat, substandard, NHS buffet; and hoping we (and the public) won’t notice.
Our leaders continue to give lip-service supporting the NHS, while diminishing the standard of care delivered; rather than have the necessary conversations with the public about how it might be possible to fund and deliver a safe, sustainable, universal health care system.
It’s true what they say: you wouldn’t treat an animal like this.
Dr Katie Musgrave is a GP in Devon
I think animals get better care in the UK than humans in the curent NHS. Even though the owner do have to pay for it!
Vets charge an absolute fortune – last time my cat went he got an antibiotic, a steroid and a worming tablet – Now that’s covering quite a few bases for an obvious UTI – and yes I did treat it with a sample (Back in the day when you got these as a freebie from a drugs rep!)
I think it is more to do with profit generation than the pet’s long term health, an innocent murmur needing lifelong monitoring comes to mind. A bit like the chiropractic free check-up that is anything up. And as much use as the regular checkup in our patient population.
Obviously doctors should charge more !
Funny thing is that I am not authorised to give annual flu jabs unless I have been on the update course each year; and yet nobody does a full physical before giving the jabs these days. I am not sure people would find it appropriate to have to fully strip off and have a physical instead of just presenting their upper arms?
A good comparative and accurate analysis.
You will be looking forward to Labour’s Lord Darzi’s next pontifications on the NHS, most likely more smoke and mirrors and an exercise in a ‘perception of reality’.
Apparently, it all going to be new stuff – and yet, there’s Darzi’s 2018 “The Lord Darzi Review of Health and Care” (Institute of Public Policy Research).
The article has it all completely correct. Reality exists. It’s out there. It’s a thing. Realty – that is. People who know, well they know. You don’t need to be a brain surgeon. It isn’t rocket science. It’s general practice. Anyone who’s been doing general practice, real day to day, seeing patient after patient after patient, general practice, as an actual risk carrying GP, will know. But despite this. Despite reality being there, freely available to those who could be bothered to find it, reality is being ignored. We are following a fools path to ruin. It seems unstoppable. Like so many things over the last few decades in this country. Everything, seemingly, has to be made crap. It has to be like this. There is no reason. It just all has to be crap. We cant afford anything good. Everything has to he crap. Except (weirdly) for a few exceptional folk..who we cant afford to loose. Thats just the way it is.
KM I like your description of the value of what we GPs do. Our complex decision making is emergent in nature (as in its philosophical definition). NHS managers/NHSE only employ reductionist principles and so we are where we are. How can you explain to those unwilling to listen? And now the coders working for billionaire AI corporates no doubt will further the illusion that a computer program can do what we do. More money for the wealthy 1%. Hopefully GPs don’t become a historical footnote (like the golden toad).
For the Vets its just an excuse to charge more. Different model completely.. bit like comparing apples and oranges
Money is the lubricant that prevents the machine from seizing. This one needs chucking to the tip and replacing with a newer/cleaner model.
Users of Veterinary care have choices; freedom to choose different insurance plans with different insurers; the freedom to choose from any Vet who is prepared to see them.
Compare and contrast with the NHS; a small fortune in tax with no choice whatsoever; and take it or leave it, be grateful for anything the NHS chooses to offer as treatment.
Upselling opportunity. Would your cat with the possible heart murmur like an echo and an AVR?
Simply proves that we care more about our pets, and are prepared to pay for them, than government cares about us