There are 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 it 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!
