Back in the early 90s, a large number of our patients were the wives and children of men in the Navy.  Indeed, the local Rowner Estate had been built in the 1960s by the MOD for these young Naval families.  With their husbands away at sea, and their families far away, the ‘Navy wives’ had little or no family support with their children, though there was often support from their peers.  We were very aware of this lack of support for the young mums from their own mothers, and accepted that there was a lower threshold for calling on us as a result.

I was reminded of this by a recent letter in The Times:

Fri 12th October, Letters to the Editor:
GRANDMA TRIAGE
Sir, There may be an even more radical solution than asking nurses to fill in for GPs (letters, Oct 10 & 11). When faced with a similar dilemma in hospital, I often quote a paper from 20 years ago showing that, in families, the involvement of a grandmother significantly reduced the likelihood of attendance for minor problems. The clear inference being that a grandmother’s common sense and experience were all that was required much of the time.

A kindly grandmother sitting at the triage desk could undoubtedly manage many of the patients, and there might even be enough doctors and nurses to look after the rest.
Anthony Cohn
Consultant paediatrician, Watford General Hospital

Here is the original paper from the BMJ:

https://core.ac.uk/download/pdf/1670636.pdf

So, could Grandma save the NHS?   I fear that the Grandmas of today are somewhat different to those of the 1990’s, who were born and raised before the NHS was founded. They and their parents were a product of a time when access to healthcare was at a cost, and self-reliance therefore a necessity.  The attitude “Don’t bother the Doctor” was the norm.  No-one can deny the huge benefits of ‘free healthcare at the point of access’ – the mantra of the NHS, which has made the NHS the most valued institution in the UK.  However, one unforeseen consequence of such free access, is a progressive deskilling of successive generations.

Over the last two decades, successive governments have prioritised access, and fostered – if not encouraged – a consumerist approach.  They have used access targets in primary and secondary care, waiting time targets in A&E, Gordon Brown’s Extended Hours, and now the latest expansion of GP services: GPEA (GP Extended Access).   Already stretched services are expected to stretch even further.

“I don’t want to bother the Doctor” is a rarely-heard refrain now, and restricted to the very elderly.  Thankfully, “It’s my right” is also rarely said (though perhaps more often thought), but there is no denying that patient/public expectations have increased hugely over the last two decades.

Grandmas of today, both individually and collectively, have such an important role in their families and society.  Despite what I have said about the change in experience and expectations, and the deskilling of more recent generations in the management of minor illness, some could certainly provide an effective triage service for minor illness.

So, there you are Messrs. Hunt and Hancock: with a little smoke and mirrors, you can hide the unrealistic promise of 5000 more GPs by 2020, and build a workforce of Grandmas to ‘man’ 111, Same Day Access Services, and A&E Triage …

… sorted!