The essence of medicine

I recently worked back in the UK for 6 months on a ‘reverse sabbatical’ from Australia. A few things had changed since I left in 2013 which made me quite anxious, and added a few challenges to my locuming job.

The most notable change on locuming back in the UK was that far more happens electronically now in the NHS, such as ordering scans, bloods or printing forms. I didn’t have a clue how to do things and the secretaries got a lot of tasks from me. QoF had a few changes too which I struggled to get my head around. But to be honest, I always found keeping up with QoF difficult!

Another stark difference from Australian medicine was doing home visits again. On the whole, I actually quite enjoy home visits as a locum. I am glad I’m not a partner though who has to screen the requests because some were definitely requested for the patient’s convenience, rather than clinical need. Routine visits are not offered in Australia and usually have a charge attached to them. So relatives or friends usually bring people to the surgery for routine appointments. This seems to happen less in the UK because everyone knows the doctor will visit on request.

Another difference I noticed was an increase in the number of adverts for private medical companies. I joined one such company, GPDQ in London, whilst I was over and did a session as an ‘Uber Doctor’. This was my first session a private GP in the UK and although I was quite nervous, it was great. I visited the patient’s house, they were charged on the time I spent with them and I was surprised at how much the patient was willing to pay for this! But being a private doctor didn’t change my practice. I still acted in the same way that I would do in the NHS. I assessed, gave my diagnosis, came up with an agreeable management plan, then said goodbye, with option for follow-up.

[Tweet "...essence of medicine is the same everywhere, it's the system...that demands the learning curve."]

I faced the same issues when I first moved to Australia. I needed to learn a new computer system, and how to bill for your time with patients, understanding private vs government referrals and so forth. Clinically through, apart from needing to brush up a bit on my skin cancer knowledge, things were the same. Having done a variety of jobs now, what I have found is that the essence of medicine is the same everywhere, it is the system around us that demands the learning curve.


This article first appeared in the February edition of The Sessional GP magazine.

1 Response

  1. Jessica Richards
    I beg to differ. The longer you work in a private setting compared to the NHS the more you change. I have worked in both Oz and UK. The lack of rationing and the high rate of private health cover in Oz allows excessive referral to secondary care with over investigation and treatment and excessive use of new more expensive therapies. The failure to enforce patient registration in Oz means they can seek health care with multiple providers leading to overservicing and significant drug misuse. Home visits have changed enormously in availability over the last 20 years and like every other aspect of service provision in the NHS, depend upon GPs acting as gatekeepers of the Budget available and best practise. This is not the case for Australian GPs who can pick and choose which aspects of best practise they follow according to how well it is remunerated and patients will vote with their feet if they do not receive what they want.

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