IT is a popular misconception that general practitioners are employees of the National Health Service. They are not. A GP is a private practitioner who enters into a contractual agreement with the local health board to provide patient services. They do not receive a fixed salary. They are paid on a per capita basis, that is, for each patient under their care, they receive a fee: the more patients they have, the more they are paid.

The by-product of this is the more patients per practice, the less time per patient in the surgery. It is my view that the number of patients per surgery should be capped to provide a longer consultation time. Differences in remuneration can be made up by government or negotiated by mutual consent.

READ MORE: ‘Sajid Javid is wrong to back GP fees’, says Scots doctor

Change of course would be would be resisted, as general practitioners are noted for being rather conservative. As trainee NHS administrators we were told that the planned transfer of GP surgeries to modern health centres was not hampered by technical or building matters, but by fierce resistance to relocation. Again, it must be asked whether the present medical model pertaining to GPs is appropriate to patients’ needs.

Longer consultation times would certainly lead to better-informed decisions. GPs are trained in symptomology – that is, they view the patient as a bundle of symptoms rather than a whole person. Now don’t get me wrong, doctors can do wonderful things, but there is little social interaction during a GP consultation. Emotional considerations, eg how to cope with serious illness or mental health issues, are often ignored. On two separate occasions, GPs advised me to Google my health concerns!

The sum total of a visit to a surgery is mostly a prescription. Now, many of these drugs work, but psychopharmacology is not without its critics. Psychotherapy and some parts of psychiatry have largely been replaced by psychopharmacology. It cannot be stressed enough that the relationship between the GP and the pharmaceutical industry is a controversial one. It is estimated that most people over 50 are on four drug regimes per day. These people are regarded as “healthy”. Drugs are prescribed. The NHS could save millions of pounds if patients told their GPs that they were no longer taking medication, rather than stocking their shelves with unused pills!

READ MORE: King Charles' 'warm spaces' will be seen as 'token PR stunt'

Since the advent of the repeat prescription many people are on medication longer than they need to be. A medication review is supposed to be carried out every year and to my knowledge this is rarely with the patient present. It should be added that very few GPs in Scotland have the General Practitioner Certificate, which for some reason is not compulsory, unlike Scottish Social Services Council registration for carers and support workers.

I also find it ironic that GP waiting rooms are virtually empty while hospital emergency departments are full. Community medicine specialists now treat you for illnesses you don’t have! For example, you might have a heart attack by the time you are 60 and this is what you must do, followed by a list of lifestyle changes. Doesn’t being told you have a 13% risk of having a heart attack by the age of 66 really mean you have an 87% chance of not having a heart attack?

Very often preventative medicine is inconsistent. People’s behaviours are influenced by community health theories for a five-year period. If the correlation and causal factors are disproved, the experiment ceases. How many new cases of misdiagnosis can we expect in the next few years, due to the normalisation of GP telephone appointments?

My analysis is not a attack on the GP or his profession, but on the bureaucracy, the suitability of the medical model and the relationship with the pharmaceutical industry. Addressing these problems will not be easy. Max Weber, the German sociologist, said in 1907, “Once embedded in an organisation, bureaucracy is the most difficult social structure to remove.” More information on the above can be found in The Divided Self by RD Laing and Limits to Medicine by Ivan Illich. In broader terms, an interesting question is, to what extent are professions in Scotland accountable and to whom?

WJ Graham
East Kilbride