There’s loads of forms before you arrive at Oxford. Room agreements and library contracts to fill in, induction timetables to flick through and bizarre (although upon arriving, incredibly necessary) safe cycling guides to peruse. One that I struggled with, though, was the medical form. It advised students to register with a local GP, pointing out one that was even linked directly with the college. I completely ignored that form. Medical treatment – regular MRIs, consultant’s appointments and blood tests – means that I need to stay registered with my (already overly crowded) GP at home. So, I just skipped that form and temporarily registered with a GP in Oxford instead. But, coming back in Hilary term, now those three months of temporary registration are over, it’s been hard to work out exactly what to do next.
Deregistering with my home GP just isn’t an option. But, after speaking to a doctor in Oxford, it became evident that, due to a lack of funding and medical history, treatment from a GP while unregistered would be very hard to obtain. I was told to go home if I felt unwell so I could receive treatment there. But, if I’m feeling rough enough that I need a GP, I shouldn’t be on a train for a couple of hours to get home, especially considering the likelihood that I could infect others or become more ill during the journey. It’s just not viable as a long-term solution.
So, why can’t students register at a GP both at home and at university? It would be convenient for everyone, disabled or not. Divide the funding proportionately by how many weeks the student is at university, share the medical records, keep an eye on prescriptions and you’re sorted – except it’s not that simple.
Sharing out funding is harder than basic division, intuitive though it is. There would be questions of necessity – should areas with comparatively high numbers of students be given more? Every clinic will claim that they have the largest burden of care – the high pressure university environment and specialist services mean that GPs in university towns can claim to have the higher burden. For Oxford though, home GPs are the standard service for twenty-eight weeks of the year – proportionally, then, they should do more work. Obviously, this will vary hugely on a case-by-case basis – should funding be given on a retrospective basis, then, looking at how GPs are actually used? This would ensure fairness but remove the vital financial buffer of funding from those who then don’t use the GP, leading to an overall worse standard of medical care for all.
There’s also the problem of exclusivity – should it be available only to those receiving treatment at home while also at university? It would help all students, so extend it to them. Then, you could also make a case for those who commute relatively long distances to work – why can’t they be registered at two GPs? It’s hard to decide for whom exactly dual registration would, and should, be put in place.
Bureaucratically, it’s tough too. Who handles referrals? To whom is hospital information sent? Lack of precedent but high interest from students in dual registration means that all of these questions would have to be addressed before any new system was rolled out. Many GPs don’t use the same system for electronic medical records. This lack of one universal scheme creates risk. It could lead to repeated testing, issues with prescribing medication or missing key symptoms. Fundamentally, patient care is limited under a system of dual registration.
Dr Dominique Thompson, while arguing against dual registration, claims that “students can be followed up by the university GP in the holidays by telephone, in person if they wish, and by secure email or even using technologies such as Skype, if the practice uses it”. The key words here are “if the practice uses it” – this creates a postcode lottery based on funding. In areas with high numbers of students, funding is likely to be lower per capita. There are also some services like WebGP or AskMyGP which would provide solutions to some non-urgent queries. However, these are only accessible if your GP surgery has registered to use it, continuing the geographical disparity. “In person if they wish” is also problematic. During the holidays, popping up to Oxford just for a GP appointment isn’t something sick people should “wish” to do. It might be prohibitively expensive or exhausting or there may be other constraints on time.
Furthermore, GPs are supposed to provide treatment to anyone (regardless of their registration status) if it is immediately necessary. But necessity is hard to define in practice. Considering issues of implicit bias means that pain isn’t seen on an objective basis. Marginalised groups who don’t appear in medical textbooks or who are seen as hysterical or having a naturally higher pain tolerance or of wanting drugs for the sake of it don’t receive the same treatment as the heterogenous average. Long term, this can lead to health conditions going untreated – painful for the people and expensive for the NHS.
There isn’t a simple solution to the need for dual registration. Providing it would need to be a long-term process, with questions of funding, filing and convenience. But temporary registration without funding is unfair to overwhelmed GPs, especially in student-dense locations. It’s not going to change any time soon, certainly not within my time at university, and a lack of clear guidance for treating unregistered students means that confusion is likely to continue regardless of dual registration. For now, I’m just going to not get ill – it might be easier than navigating the tangled web of the medical system!