GP patients have to be seen

The NHS has been in the news a lot recently. Big changes are afoot, and about time too. While I am very aware that it is blasphemy to say so, the NHS no longer works well in many areas, and needs to change. It's a constantly evolving being and the way it is managed needs to evolve along with it. Unfortunately this hasn't happened.

I think some of the new proposals are very sensible. Surely if anyone is going to know where money is most needed and best spent it is the GPs on the front line? I hope this plan works and I welcome it.

There is another idea being touted, however, that I don't think is sensible. In fact, it makes me very concerned indeed. The Government is planning to offer patients email consultations with GPs. People will be able to directly email their GP through a new Communicator tool, part of the secure personal health organiser website originally set up to allow patients to view their records online. Remember what a disaster the NHS IT system was to set up? Doesn't bode well, does it?

It's a move the Government claims will improve access to primary care. The word to pick up on is "access". It may well be improving access but it is certainly not improving care. It may possibly work for issuing repeat prescriptions to those with chronic but well managed conditions, or getting results from home test kits such as blood sugar or BP, to update records, but beyond this? No chance.

There is a very good reason why tradition has dictated that doctors bother to see their patients in person, to talk to them, ask them salient questions and maybe even lay on a hand. It's because patients are not generally very good at telling you what is wrong with them. They need help, and it is not always what they say that gives you the answer. Being able to see them, to read their body language and hear the tone of their voice are vital parts in diagnosis. I'll give you an example: chest pain. "Dear doc, I have pain in my chest, comes and goes, maybe a bit goes to my left arm as well. Should I be worried?"

Chest pain can have many causes, heart attack being one, acid reflux another, but it could also be a simple chest infection or even depression manifesting as a pain. Never could this be worked out from an email without either much back-and-forth correspondence (taking up at least as much time as a face-to- face consultation) or a very informed, educated and impartial patient relating the exact relevant symptoms correctly. It won't happen.

I have had good personal experience of this long before any pilot schemes were tried out. Since my TV shows have aired I have been inundated on a regular basis with emails from people all over the world wanting help, advice and diagnoses. I can confidently say that few are easily or quickly answerable, and few give enough information for any sort of useful reply to be given other than "Better go and see your doctor".

Given that the public is spending £2 billion a week on the health service I think it a very sad state of affairs for medicine if a face-to-face appointment with a GP becomes not a right but a luxury.

Cash for eggs: there are so many issues

Fertility and its management is always an emotive subject that polarises opinion. The views of the public are currently being sought on surrogacy - in the spotlight again following Nicole Kidman's announcement that her second daughter was carried this way - as well as the use of donor eggs and sperm to enable infertile couples to have a baby. More ethical issues are being explored, including whether close relatives should donate eggs or sperm to each other, and if it is acceptable for a baby to be born, through egg donation, to a woman who is also its grandmother.

The debate follows a high court ruling that may have opened the way for surrogate mothers to be paid, a practice which had been banned. If the public concede, then women could be set to receive thousands of pounds for donating their eggs. Currently, British clinics are banned from paying for eggs and sperm directly but can pay up to £250 in expenses - which hasn't exactly filled potential donors with a desire to go through with the process of donation.

The problem with the "cash for eggs" proposal will not be with the well-meaning majority but the unscrupulous few, who will lure in women by making egg donation seem like an easy way to earn money - without any explanation of what actually is involved. Worrying, too, is the possibility of "designer genes" being offered to couples prepared to pay exorbitant fees for the perfect combination of brains and beauty; the higher your exam marks and the better your bone structure, the more your eggs could be worth.

I'm not sure money is the main issue, however. While it's mainly the small amount of cash currently offered to donors that has been blamed for the shortage of eggs, I suspect a greater problem is the recent change in UK law which requires the identity of sperm or egg donors to be revealed to their children - the idea of a load of "surprise" children showing up years after donation undoubtedly puts off many would-be donors.

Maybe the issue is being looked at from the wrong angle, in London at least. The stats for maternal age show that in the UK London has the lowest number of births per 1,000 women aged 25 to 29, and the highest birth rate for women aged 35 to 39. This implies London women are leaving pregnancy until much later, a known risk for fertility issues and the need for donor eggs or even surrogacy. Many have argued that more should be done to cure infertility and to encourage women to have children when they are young and their eggs are still in good condition, instead of worrying about turning body parts into tradable commodities.

Flu is a threat but simple measures can keep it at bay

Last year I wrote rather scathingly about the panic surrounding the predicted flu epidemic that never was. This year I'm going to be more cautious as I feel things have changed. Flu is back but this time it affects a new demographic of hitherto unaffected people, which could have profound implications on our future approach to managing flu.

The number of flu victims has been rising steadily, which isn't unusual, but these victims are mainly professional, young middle-aged and middle-class, which is. What is worrying some virologists is the newly proposed theory that these current unlikely flu victims are stricken down because last year's flu jab may have made them more vulnerable to this year's attack by the H1N1 swine flu virus.

As it has been estimated that a serious outbreak of flu could kill 65,000 people in Britain and, according to one study, could knock out nearly 40 per cent of all health professionals — doctors, nurses and paramedics — in the first 10 days then this theory, if true, is a disaster. Already swine flu is spreading faster in the UK than in Europe, and the figures are likely to climb even more steeply now that we are back at school and work and mingling with each other again.

But we have had vaccine scare stories frequently in the past and few have been legitimate. In fact many have been very damaging, like the MMR scare.

This is still very much a theory, totally unproven, so I would advise everyone, whatever age or state of health, still to have a flu jab this year, as it will help reduce the chances of a pandemic that could kill far more than the vaccine will ever adversely affect.

This year I have also seen more chest infections in my clinic, always with the same story: “It started off as a bit of a cold, then developed into something much worse, doctor.” Viral illnesses and flu can be common precursors to pneumonias so getting your flu jab will help stop this. Not smoking, a healthy diet, and getting plenty of exercise and rest will too. If you seem to be regularly affected ask your GP about pneumococcal pneumonia vaccine. It's effective in 80 per cent of healthy adults and helps high-risk groups lower their odds of getting pneumonia.

Finally, given the chances of catching flu this year seem so much greater, consider taking antiviral drugs if you do get ill. The side effects can be dreadful but they can make illness milder and last for a shorter duration.