Alan Stout has worked in general practice in East Belfast over the last 12 years and is also involved in the area’s out-of-hours service. He tells agendaNi about the pressures of serving an ageing population with high expectations.
How did you become interested in medicine?
I have always had an exposure and interest in medicine, coming from a medical family. My father was a consultant in old age and was also Dean of Queen’s Medical School for many years, so I had interest and inspiration all around me. I was also lucky to spend just enough time off the rugby field to allow me to achieve the grades to get into Queen’s.
How have you seen the profession change over the years?
The profession, and in particular general practice is changing rapidly, some for the good and some change that does and will provide plenty of challenges over the coming years.
The biggest positive change I have seen over the past number of years is the increasing computerisation of patient records, which helps with record keeping, confidentiality and continuity for patients. The introduction of the electronic care record in Northern Ireland also helps GPs access hospital notes and records which can be very useful on occasions and for management decisions. We do have to be careful that these electronic records are properly used, though, and do not lead to problems of their own.
The other biggest change I have seen has been the ever-increasing demand for access and for services. This is partly due to the increasing elderly population with complex and multiple care needs, but is also driven by societal changes and a desire to have everything immediately.
It constantly astounds me that some patients will contact me at 8.30am having woken up with a sore throat or other minor illness. So much of what takes up our time these days does not have to have seen a GP, and there needs to be sustained education and promotion of self-care. The difficulty is that this demand then reduces accessibility and capacity for those patients who really do need to see a GP. Couple this with an impending workforce crisis and a reluctance to invest in primary care and the next few years will be very challenging for every practice and every GP.
What are the most enjoyable and challenging aspects of the job?
I still find the patient contact and the ability to genuinely help people as the most enjoyable aspect and also a privilege. It does become frustrating when paperwork and administration starts to impact on this, and this is becoming more and more of a problem. I think all GPs respect and recognise the need for regulation and the importance of quality and safety, but this needs to be sensible and proportionate and it is a constant challenge to ensure that this is the case.
We are also lucky in Northern Ireland to have a very strong general practice committee, which is well supported by the local BMA office. It is always enjoyable and inspiring to work with my colleagues and my peers, and a common aim of continuing to improve and develop general practice.
ICPs, in my experience, have been very positive. The ability to get clinicians, other healthcare professionals and the community sector together to review, plan and design new services is very welcome. The common aim and the common desire to do what is best for patients is very encouraging, and the ICPs now need to be given the autonomy, the ability and the accountability to implement these changes. Too much change, improvement and innovation is still held back by bureaucracy in the Health Service and this needs to change rapidly.
What one policy would make the greatest difference to public health?
The most important public health policy is undoubtedly the sustained promotion of self-care and appropriate use of services. It is the increasing demand that is strangling all parts of the Health Service at the moment. By way of an example, we have a consultation rate in Northern Ireland roughly double that of the Republic of Ireland, and yet our levels of illness, morbidity and mortality are almost the same.
This implies that the Northern Ireland tax-payer is paying for twice as many consultations as we need. The main implication for this is freeing the capacity of GPs to deal with patients who really need seen, need care and need the continuity that general practice is so good at. This is going to become even more important with the increasingly elderly population.
How do you relax outside work?
I have three young children so my time outside of work is just as busy, but very enjoyable. There is nothing better than a Friday night at Ravenhill watching Ulster play rugby, and often a Saturday morning by the side of the pitch at Sullivan Upper. I still try to play golf as much as possible. I am lucky in that my 13-year old son is also a very keen (and a very good) golfer, and we can have some great matches and trips together.