The Times leads today with the not-very-exciting headline that people go to their GP too often with minor complaints. The "story" is based on a letter in the paper signed by a host of signatories who have set up the Self Care Campaign. The chief executive of Diabetes UK is among the leading lights of the group.
The signatories, who include some very eminent and sensible doctors, are publishing a manifesto saying that people should be encouraged to manage their minor ailments on their own and not visit the GP with them.
They have produced a report based on an analysis by IMS Health. IMS Health's website says "virtually every major pharmaceutical and biotechnology company is a client of IMS", while the report is funded by the Proprietary Association of Great Britain, which represents manufacturers of over-the-counter medicines.
The aim is to discourage people going to the GP so they will look after themselves when they have a self-limiting illness. Nothing wrong with that. But nowhere in the worthy-sounding letter to the Times, or its front-page article, does it mention that this is an agenda driven by a trade organisation representing international drug companies that want to sell you cough and cold remedies over the counter.
The upshot of the Self Care Campaign report is that:
• In 2009, 18% of visits to the GP were deemed to be for "minor ailments", a steady rise since 1987 when only 10% were characterised as minor.
• These common minor ailments now account for a fifth of visits to the GP.
• They cost £2bn a year.
• Nearly half of these visits were by 16- to 59-year-olds, not the young or elderly.
• In 2007, there were 51.4 million GP visits for a minor ailment alone, and 90% of those people came away with a prescription.
But here are a few thoughts.
In my experience as a GP, there is almost always a good reason that brings someone to see me. If a person only presents the minor ailment, it may be that they don't feel comfortable enough to talk about the real reason they came, like depression. Our cancer survival rates lag behind the rest of Europe in some key areas. People's reluctance to present their symptoms to the GP is cited as a significant cause.
One person's "minor" is another's "major". A cough is usually minor and self-limiting, but is also a key feature of TB and lung cancer. The public can be told that a cough lasting more than six weeks needs investigation, but the sudden onset of a severe cough in someone who never gets one and has no other features suggestive of a viral illness, may require immediate attention.
Older people often preface any visit to the GP with the words, "Sorry to bother you." There is still a culture that our health service, paid for by tax payers, bestows care as a beneficent gesture rather than providing an efficient, customer-friendly service. That's why going to the GP is rarely as satisfactory as going to John Lewis.
A visit with a "minor" ailment provides the chance to have your blood pressure checked, be reminded that a cervical smear is due or be offered help to quit smoking. Most preventive health measures in primary care are carried out in this opportunistic way. The health (and cost) benefits of preventing smoking-related disease or treating high blood pressure to prevent heart disease or a stroke, need to be offset against the savings made by telling people to stop "bothering" their GP.
People are not stupid. If they go to their GP once with a self-limiting viral cold and are told they don't need antibiotics, they won't bother to go the next time they have the same symptoms. GPs need to stop treating minor illnesses inappropriately. There is no need for a national pamphlet campaign with patronising advice about buying over-the-counter remedies and staying warm.
