UK-Japan GP Network - Review by Yuko Ota, 3rd year GP trainee

Thanks to Dr. Maham Stanyon and her connection with the UK-Japan GP Network, I was delighted to visit Imperial Primary Care Department in April. As a Japanese GP trainee being exposed to primary care in the UK, every single day was filled with surprise and I would like to share some of my thoughts on your newsletter.

Abington Medical Centre/Crown Street Surgery

This was my first occasion to visit UK surgeries and I was amazed by how differently we work as GPs in the UK and in Japan. I was very impressed by how GPs in the UK act as strict gatekeepers working “under pressure not to refer” and how the flow of all the patients is tightly controlled under appointment systems. This is totally different from Japan where patients have choices to visit GPs or any specialty clinics any time without making an appointment. I imagine that being in charge of thousands of patients at each surgery must be an enormous workload for all the GPs in the UK but I could see that this is made possible by; 1) having several GPs working at each surgery (in Japan there are usually one or two GPs seeing around thirty to fifty patients in one session); 2) other professionals such as nurses and pharmacists see patients independently (in Japan only doctors are allowed to prescribe); 3) systems that allow GPs to work within the surgery for as much as possible, such as telephone consultations, texting patients and electronic prescriptions (all of which we do not have in Japan); 4) as depicted by most GPs’ first question to their patients “What have you tried so far?”,  patients are well educated to use over-the-counter medications and other remedies before visiting GPs (in Japan, visiting a GP is usually the patients’ first action presumably because of easy accessibility and expensive OTC medications).  

Cultures regarding home visits also differ greatly between the UK and Japan. I was surprised to know that home visits by GPs are offered to very limited patients in the UK, and how district nurses and foreign caregivers(!!) are involved in the care of patients with terminal illnesses. In Japan, mainly because of its rapidly ageing society with 27.3% of population being above 65 years old, and many of the frail elderly live on their own or together as a couple both with dementia, we as GPs and the Japanese national health insurance system prefer to offer regular home visits for immobile patients, regardless of their disease severity. It surely increases our workload, but personally, I find home visits very tempting as each patient house is like a treasure house filled with clues I can appreciate with five senses to imagine the patient’s life history and gain further holistic understanding.

Primary care education at Imperial

I enjoyed attending VTS with GP trainees and really appreciated their comments on my presentation “GPs in Japan”. CFMD Tokyo, the programme I belong, also holds regular meetings like VTS but only on monthly basis. Meeting colleagues from the training programme and sharing information every week must be very encouraging and helpful for the trainees to keep up their motivation!

Undergraduate education at Imperial was another great surprise. I was especially impressed by the performance of Year 5 students at mini PACES, where they all performed like skilled GPs tackling complex patients. I strongly felt that in the UK, training to become a GP does not start upon entering a GP training programme but in fact from the very early stage of a medical school, which was also apparent from the case presentation given by a student at Crown Street surgery and Dr. Mountjoy’s innovative dermatology class.

Research on “Social isolation and Loneliness”

Thanks to Dr. Gnani, I really enjoyed working on the project on “social isolation and loneliness” since it is a big issue we frequently encounter in Japanese society too. The literature search techniques I had acquired during my stay has now become very helpful in daily practice. Until very recently, I have never been interested in becoming an academic GP, but now it has definitely become one of my future career choices!

I truly enjoyed collaborating with GPs (including future ones!) from different stages throughout my visit. And lastly, I would like to mention how I was impressed everyday by the idea of “equality” on which all of your work as GPs or educators is based on. Just as depicted by the spirit of eCOP, I could feel that there was equality among everyone, not only between working professionals but it seemed that even patients and GPs stood on equal grounds (one interesting example I noticed was how GPs are dressed in their casual clothes at surgeries, unlike how we wrap ourselves with scrubs or white coats in Japan that could possibly lead to emotional barriers for patients). Surely there were a lot for me to learn from the Primary Care in the UK (far more than I can put in 500 words)!  Thank you very much to those who allowed me to be part of your great teams during my visit and I wish to see you again, hopefully in Japan!

Yuko Ota, MD

3^rd year GP trainee

Centre for Family Medicine Development (CFMD), Seikyo Ukima Clinic Tokyo