Q: Let’s start off with a hot topic at the moment. The NHS is stretched and struggling. What are your concerns regarding this and how did we get to this point?
HJ: The NHS has been underfunded by successive governments for several years. Also, we’ve already got so much admirable efficiency in the service compared to other industries but there is no spare capacity such as resources and beds. All it needs is an epidemic of flu or a bad winter and we go over the tipping point and are in a real crisis. It’s not just in emergency care, it’s in general practice and social care, too. We’ve got patients in hospital who could be looked after in social care but we haven’t got the beds. That’s why we’ve got people waiting in ambulances to be admitted and others lying in corridors to be treated as well but ultimately, they’re being treated without the dignity and respect that they deserve. It’s a problem that’s been ignored despite protests from various Royal Colleges for many years and it’s only getting worse at the moment because GPs are retiring early and young doctors are not choosing to go into the profession. There are many GP surgeries closing down without being replaced. That means more people go to hospital increasing the pressure further on hospitals. Staff are doing their utmost to keep their heads above water but they’re struggling and morale is at rock bottom.
Q: How has the state of general practice changed since you started out?
HJ: In my early days as a GP, we still had personal lists. We don’t deliver babies that grow old with us anymore, neither do we carry out minor surgical procedures or do many house calls and it’s a shame. GPs now tend to sit in a surgery looking at a computer and seeing a conveyor belt of people with medical problems. So much of the excitement and challenge of general practice has gone. I think that’s one thing that’s changed for doctors. There are doctors who have special interests but it’s becoming harder to be a GP with a special interest, such as infertility, rheumatology and heart disease. General practice has changed and now I see they’re talking about more consultations being carried out virtually on Skype and things…but you can’t do a cervical smear by Skype and you can’t examine somebody’s enlarged spleen or lymph glands online. For me, we’re getting further and further away from the doctor you go and see and talk to about your concerns. It’s not entirely satisfactory and it may be the future, but it’s not a future that I embrace as a doctor that wants to get things done properly.
Q: So it really is about getting more GPs into the profession…
HJ: Absolutely. I just had a thought yesterday as I went to get my hair cut. There are eight hairdressers in my town; it’s a little town, by the way. And there’s one GP surgery. Everyone can get their appointment today if they want to get their hair cut…but if you want to see a doctor when you’re worried, you might have to wait three or four days. What’s important is that we have to readdress this balance of supply and demand. People are always going to have medical problems and the NHS should be able to be on top of people’s medical complaints quickly and urgently to sort them out. The more patients have to wait, the higher the chances of something being harder to treat.
Q: What are some things we can do as patients to ease the burden on GPs?
HJ: I think all of us need to take more responsibility for our own health; that’s the first step. If we look around, we have 67 percent of the adult male population either overweight or obese. As well as 57 percent of the adult female population and 30 percent of children aged two to 15. This is a massive problem that is stirring up all sorts of issues for the future. While we make poor choices about our diet and amount of exercise we do, we are becoming a fatter and sicker society. We can change that by making decisions today and teaching our children what’s healthy and what isn’t. The government and food and drink industry can do a great deal more. It’s scandalous that they’re advertising sugar and sugary products to the population—they don’t need it, although they crave it. That’s something that can change. The second thing that can change is for people to learn how the system works best. Yes, if it’s a minor ailment, pharmacists are well placed to advise and then GPs can be consulted with. But you need to use the system well, you need to be patient, get your appointment, prioritise what your problems are and don’t be tempted to take three children with you and ask for them to all be seen at the same time. Follow your GP’s advice; don’t take medication that you don’t need and don’t pressure the doctor for antibiotics that you don’t need. We all need to be more responsible and part of that responsibility is to appreciate how hard doctors and nurses work. I would like to see more stringent punishment for people who abuse staff, who punch nurses and who are violent toward medical staff. There’s something everyone can do. We can also lobby our ministers and say: ‘Look after the NHS, it’s one of the precious jewels we have in this country and we need to protect and preserve it.’
Q: Using the system well is definitely important. What NHS services do you wish patients used more or took more advantage of?
HJ: I wish they took more advantage of mental health services and services that can help them with weight loss. The trouble is that mental health services are incredibly stretched. We need more mental health services and resources and people getting involved. We need to break the stigma of mental health. Of course, with the obesity and diabetes epidemic we need people to vigorously tell more people to do more exercise and make better food choices. We need to put pressure on councillors and ministers to stop so many fast food shops from opening up on high streets and replace them with delicatessens and greengrocers.
Q: GPs are stretched for time. A 10-minute consultation is not long enough for patients to have a proper conversation with their doctor. What steps can patients take to make the most out of their appointment?
HJ: They can write down what the nature of the problem is and bring with them a diary of what the problem is, when it started and what
makes it better or worse. It makes it easier for the doctor if he knows exactly what the problem is. In a way, it’s like the patient helps the doctor with the investigation rather than the patient coming in and having a vague idea of what’s wrong. It saves time.
Q: What is your biggest health worry and concern for the younger generation?
HJ: Mental health. I’m extremely concerned that there is so much use of technology and it’s killing communication amongst young people. I meet a lot of young people who find it difficult to hold eye contact and find it difficult to describe their feelings. Young people who don’t have any real friends, only have virtual friends at the end of a phone or an iPad. The inability to mix with others physically is of real concern. It’s fuelling a mental health crisis, fuelling bullying online, lowering self-esteem and pushing individuals to become withdrawn and isolated. I’m horrified at how unfit some of the younger generation are—they’d rather watch sport on TV instead of participating in it. At that age, why would you change to live the life of someone incapable of movement and miss out on the excitement of physical activity?
Q: What about for the older generation?
HJ: The older generation has lived through quite a lot of hardship in their life. They are better placed to keep things in perspective. They may become isolated and withdrawn through no fault of their own but if you give them the opportunity to communicate, they’re interesting and good at it. They have increasingly complex medical needs as they get older, but these days most of those conditions are fairly manageable. People living into their 90s and later can enjoy a pretty good quality of life right up until the end. Even 20 years ago, people were living with chronic problems and not having a very good time during the last decade of their life. Now they can still enjoy it. That’s something that’s encouraging, but we need to deal with the isolation issue. We need to make sure the elderly are looked after by society, as they deserve to be.
Q: Are there any health-related New Year’s resolutions you think everyone should have?
HJ: Definitely. 2018 should be the year people think about what they’re eating. Asking themselves: ‘How much sugar is in this, how much fat is in this, how much nutrition is in this and how much am I drinking? Can I look after myself better by making some better food choices?’ Engaging in new hobbies and pastimes that make them physically more active. Whether it’s getting a dog and walking every day, signing up to a marathon, a day in the garden, or the 3 Peaks Challenge or the great north swim. This is something you can do with friends and have a fantastic time while getting fitter. When people get moderately fit they look back and think: ‘I can’t believe how awful I felt a year ago. I’m so pleased I’m in this place.’ But it does take discipline.
Q: In your opinion, what’s the biggest silent killer affecting our nation?
HJ: There are a few, but I guess high blood pressure would be one. Hypertension, hypercholesterolemia—abnormal blood fats that people won’t know about until it’s too late. Obesity and diabetes…of course. There are probably half a million people with undiagnosed diabetes whose health is deteriorating as we speak. There are millions of people with obesity which will cause not just psychological problems but physical problems such as heart disease, stroke and diabetes. Five percent of cancers are linked to obesity. These are some of the ‘silent’ things going on unnoticed but that have a significant impact on our health.
Q: Do you have a health mantra you’d like to share with readers?
HJ: My own health mantra is exercise over medication. I would much rather prescribe somebody a course of exercises and physical activity than any drug. Medication should be a last resort—lifestyle adjustment should be the first. But so few people are willing to do it. With back pain, for example, millions of people suffer from back pain. Rather than taking medication for pain relief and having epidurals and surgeries, just enroll on a Pilates course and spend 20 minutes a day doing some specialist exercises. It’s amazing how many people can overcome their problems with a little bit of self-discipline.
Q: What are the five key priorities for living a longer and healthier life?
HJ: Regular exercise is at the top of the list and healthy diet a close number two. Love and laughter are really important and that’s number three. Never take life too seriously. We get bogged down in the little minutia of things that irritate us but, actually, in the great scheme of things, they are not important. People get sidetracked and angry about the little things. Don’t get angry. Change things but don’t bother getting angry. Being nice to people, having a laugh and having fun with people is very therapeutic. Love and laughter…that’s a big number three. Four would be giving something back. Be generous to people, including strangers. Be warm and friendly. Treating people as we ourselves want to be treated. That can give people a good inner glow and make them feel good about themselves. Number five for living a longer and healthier life, I think, is probably spending more time with nature. It sounds a bit lame, it sounds a bit Californian, and I don’t mean ‘hug a tree’. Get out into the fresh air and turn your face to the sun sometimes. Get away from the smog of the city and go and do some hiking and walking. Go look at the sea and the mountains and remember we are part of a bigger universe. It is something that is good for our spirit. That in itself keeps us feeling young at heart.
Q: Are there any key health check-ups and screenings that you think people should be doing every year?
HJ: I think everybody should know what their blood pressure is, everyone should know what their cholesterol level is. Everyone should check their BMI. But even better than their BMI, the simpler thing is their height-to-waist ratio. If your waist measurement is less than half your height, you’re fine—it’s as simple as that. You’ve got to have a urine check for sugar; you should also have an eye check every couple of years, and your hearing checked after the age of 45. You should also, after the age of 60, have a prostate check if you’re a man. For women, regular cervical smears and if they are over 50, get a mammography. Of course, people should be aware of the common symptoms of common cancers and report to their GP when they’ve got any concerns.