A national conversation: chairing the RCGP Scotland Patient Forum

We have been delighted that the Patient Forum started the year by taking part in some really insightful and meaningful discussions. The purpose of these conversations is to bring together a variety of views from a group of invested patients to help the College better understand the thoughts and experiences of patients in relation to general practice and the broader healthcare ecosystem in Scotland

The Patient Forum recently met to discuss RCGP Scotland's call for a National Conversation between patients, clinicians and policymakers. We were joined in this discussion by Chair-elect of RCGP Scotland Dr Chris Provan and appreciated him listening as well as providing the GP perspective on matters. The Forum was welcoming of the idea for a National Conversation and were especially keen to help improve the mutual understanding of how patients can best access the help, care and support they need at the right place, at the right time. However, the Forum was consistent in expressing the need to ensure that this conversation is meaningful and that the resulting work doesn’t simply get shelved to one side when other deemed Scottish Government priorities arise.

Currently we have a system that can often be demand led rather than needs led, and while there are many factors that have contributed to this, more needs to be done around education to manage public expectations of what general practice can realistically deliver with current resources, and to improve understanding of the use of multi-disciplinary teams and self-management. However, this needs to be accompanied by the improvement of patient pathways. The patient experience must be central to the conversation if it is to be an effective one, and not only of the primary care element of patient treatment. We must not look at general practice in isolation. The interface between primary and secondary care is so important for patients, especially secondary care pathways. All of us must appreciate that we are operating within a system which manages a complex, ageing population with multiple long-term conditions, a reality which poses significant challenges. This reality must be confronted, and all of the facts considered to ensure the success of this conversation. 

Valuing continuity of care

Another benefit of the conversation could include enhancing GP services to think about who is looking after their patients at home and furthering the relationship between general practice and carers. We need acknowledgement and understanding that carers play a pivotal role in society, saving the government millions of pounds while bearing the weight and cost of caring for those they love. It is important that GPs work closely and communicate openly with carers and recognise the value carers place on continuity and on not having to re-tell the patient story on behalf of our loved ones. Carers are often asked to complete numerous forms only for the same questions to be asked from healthcare professionals later. Is this questioning not taking up too much GP time - time that could be better invested? It shouldn’t be a fight to access key services. Carers are often exhausted just doing their day-to-day role along with their other responsibilities, so we need services that are joined up to enable clearly identified pathways. Too often we hear about systems being broken and carers having to access the system at crisis point either for themselves or those they are looking after. The National Conversation could be an excellent place to host these conversations and hear these and other important questions to drive improvements to services and outcomes.

Enabling these discussions to take place in an inviting and open dialogue process could bear real fruit and reverse the erosion of services in Scotland. We cannot know where we are going unless we know where we are, and a national conversation may be the best way for us to collectively take stock of our present situation, challenges and opportunities. I eagerly look forward to listening to the meaningful conversations from this National Conversation and I am confident that the patient forum will have an important role to play in the process.