Practicing Medicine in Britain

Apr 08, 2015 at 12:54 pm by steve

Sippu Momin, MD at Stonehenge.

(No, they don’t prescribe tea)

America’s healthcare system landed at the bottom of a list of 11 industrialized countries last year. The report, the fifth one produced by the Washington-based Commonwealth Fund in the last ten years, evaluated the systems based on quality, efficiency, access to care, equity, and healthy lives. In each report, the U.S. has fallen last, even as more countries were added. In this latest ranking, Britain’s National Health Service (NHS) topped the list.

One of America’s downfalls was expense. The U.S. spent $8,508 per person on healthcare in 2011 compared to $3,406 by England.

“We do a lot of prevention in England; not as much acute care as here in America. That’s because of the government rationing the money,” says Sippu Momin, MD, who practiced medicine in England for eight years, 18 months of which she served as a general practitioner (GP), the equivalent of a U.S. primary care physician. She came to Birmingham in 2013, and recently joined UAB as a researcher.

In England, GPs receive a specific amount of money per year for each person in their care. “It’s very limited money, so we’re more focused on prevention so it does not get into a stage where it requires a lot of money,” Momin says. “Here there is a lot of scope for money to be used.”

The allowance doled out by the NHS has to cover overhead as well, such as receptionists or secretaries. But it increases per person for those with certain conditions, such as diabetes.

Salaries for physicians, Momin says, run the same throughout the country. In America, specialists earn higher reimbursements than primary care physicians because procedures garner higher fees. But in Britain, GPs make more, and U.S. healthcare is following their example.

“General practitioners take on a lot of responsibility in England and are quite wealthy,” she says. A healthier patient population reaps financial rewards for the GP. “For instance, they can get more money if they have less smokers or less patients with asthma,” Momin says. Access to more incentives combined with the GP’s heavier patient load means GPs can earn more than specialists.

“We rarely send patients to specialists,” Momin says. She treated entire generations of each family from pregnancy to death, with specialists like obstetricians, rarely utilized. “I got to know their family finances, their social background, and to understand them as a whole rather than just a child who comes to me, like a pediatrician.”

Expectant mothers see their general practitioner, not their gynecologist. “When they got pregnant, I would do the paperwork and then hand them off to a midwife team,” Momin says, adding that the physicians then received regular midwifery reports. They only saw an OB/GYN if complications arose.

“After delivery, the general practitioner does the post-natal check and the baby check. If they have a urinary infection or a child gets chickenpox, they come to us. We only use pediatricians if there’s a complication,” Momin says.

The focus on prevention in England gets a substantial boost from a nationwide network of wellness and cessation clinics as part of the government’s healthcare system. According to the NHR, studies show smokers are four times more likely to quit successfully with their help. Their Stop Smoking Service includes advisers, support groups, stop-smoking medicines, and nicotine replacement therapies, like patches; all free.

The same concept also holds with nationwide clinics for sexually transmitted diseases, diabetes, contraception, and alcohol cessation. No referral is needed to access the clinics. Patients can work with their general practitioner as well. “We don’t just say, ‘Go to the clinic. Bye bye’,” Momin says. “We call back to know where they are. And if they need motivation, we give it. If I need to see you every week to keep motivating you, I do.”

Schools in Britain even report obese children to their GP. “The school nurse writes to the practice and then we write to the parents to come see us,” Momin says. “Then we talk to them so the child does not get diabetes.” She regularly gave talks at elementary schools about how to choose healthy drinks and food.

“We’re like hawks on asthma,” Momin adds. GPs take a lot of time explaining to patients how their asthma gets triggered and when and how to take the medications. “We tell them when to call for help before they get into a seizure, and we have to see them at least twice a year,” she says. GPs also make sure vulnerable populations, like asthma and diabetic patients, get flu vaccines.

“We work prevention at the ground level in England,” Momin says. “It is not like it is very hard work, but it is taking responsibility and talking about it all.”

The Commonwealth Fund report did find American healthcare topping other countries in some areas, such as breast cancer survival, whereas Britain bottomed out on serious cancer treatments. “America has established a research-based, high-tech medicine,” Momin says. “And that creates good opportunities.”





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