At the 2017 annual primary care conference Professor Helen Stokes-Lampard addressed attendees with a powerful message in her Chair’s Address, reminding us of the core values and reasons we love general practice. It proved that despite all the politics, paper work and QOF targets, you can still be the practitioner that you want to be, in providing ‘Enid-shaped care’. Even though “it has never been tougher’, there is a positive vision for the future of general practice and everyone has a part to play in this.
“I want to give great care. Enid shaped care…” – Professor Helen Stokes-Lampard
Who is Enid? Helen described the heart-warming and familiar story of Enid – “you will all recognise her in your own surgeries; your own communities; your own lives”. An 84 yr old lady with well-controlled hypertension, type 2 diabetes and osteoarthritis. “Enid has kind eyes, a warm smile and always ‘dresses up’ to come and see us at the surgery”. Last year, she lost Brian, her husband of 62 yrs. They were best friends and always attended the surgery together. “But now he is gone, she is living alone and society is a bit uncomfortable about Enid – an ageing widow who’s just a bit frail”. Enid starts coming to the surgery more often, and is sometimes snappy. It is quickly clear that Enid’s main problem not medical but loneliness.
“So, I didn’t follow the rules. I chatted to her, I listened. I did what all good GPs do – I saw the world through Enid’s eyes for our precious few minutes together“. I prioritised what Enid wanted over QOF, over NICE, and over the CCG guidelines – after all, they are only guidelines. Sometimes I offered advice about a new class, group, or a charity that I thought might suit her, might benefit her health and wellbeing. I gave her permission to miss Brian – permission to move on with her own life. Permission to carve out a new normal.
And then in the final moments of our encounter, I do turn to the screenI update her record as accurately as I can…[on] the computer – in its well-intentioned but binary way – is telling me I should be doing”
Enid-shaped care is holistic; it is what every GP wants to provide. Social isolation and loneliness are as much of an issue, as any chronic condition. If we want to provide patient-centred care, Enid must be at the forefront of our mind. The impact of loneliness to GP and secondary care services must not be underestimated. There, of course, is debate as to whose responsibility this type of care is. Some larger practices may have additional services available to them to help these patients, but many don’t. At the moment, it is not always possible to deliver this type of care with limited human and physical resources available to us. Yet, if something is so significantly affecting our patients well-being do we not have a duty to help where we can? This is someone who is seen everyday all around the country, and the vision is that with increased support from the Government funding that this may, and should be, possible for all patients. Enid-shaped care encapsulates the core values at the heart of General Practice.
“So, let me take you back to Enid
I am not her friend, I am not her daughter, I am not her counsellor.
But I am her doctor
During our moments together in consultations, Enid is the focus of my professional world
She knows I will do everything I can to get the right outcomes for her.
That may not be longer life – that may not be the medication or treatment recommended by clinical guidelines, or my computer
But it will be Enid-shaped care
This is what we should aspire to
This should be the future of general practice – Enid shaped care…”
Read the transcript of the speech here: http://www.rcgp.org.uk/news/2017/october/helens-annual-conference-speech.aspx