Is it progressive to reduce us all to same day appointments? Progressive systems reduce inequalities. Regressive systems increase these inequalities. But the “system” concerned is not just the state, but all access to medical care, and if poor standards encourage a certain element to go privately, this increases inequalities. A fair health service, or even a discussion about one seems miles away.. When I know my own practice is busy (no reply for 10 minutes morning and evening) then I ask for a non urgent appointment by post, enclosing a stamped addressed envelope and indicating my preferred time, doctor etc. Will this type of access also be banned in a same day only system? What will I do then? As the Regional Health Services degrade, Wales in particular (the only region where numbers of GPs has fallen – see below) seems to be encouraging a perverse outcome – increased inequality of access and care, in a country rightly proud of its main social hero: Aneurin Bevan. I may be forced to ask for Private Primary Care before long.. This is the result of prolonged rationing by undercapacity.. but enhanced by technology, demographics and an inability to have the honest debate (A dishonest and covert dialogue is all that is happenning at present.. Simon Stevens says he would like to change this.) asked for by Mr Stevens.
MORE than 1m patients are being denied advance appointments in one of the biggest shake-ups of GP practices for decades.
The new system’s supporters say it ensures that patients who really need to see a doctor can do so.
Under the cost-cutting measure, which can save each practice up to £30,000 per GP each year, patients can no longer book an appointment in advance.
They must phone the surgery on the day they wish to see a GP and wait for a doctor to call back to assess the medical problem. The doctor may deal with the problem over the phone or, if a face-to- face consultation is needed, book the patient in for later that day.
In all, 150 GP surgeries serving more than 1.4m patients have switched to the new system, which has been introduced after training and advice by private companies.
It is in response to an increasing GP workload that has meant patients struggle to get an appointment when they want it.
Supporters of the schemes say many patients have welcomed the change because they are guaranteed to see a GP on the same day if they need to or in some cases can fix a future appointment.
Dr Peter Cairns, a GP in an Edinburgh practice, says 80% – 90% of patients are happy with the new system.
He said: “ Patients understand that switching to telephone triage [assessment] frees up capacity. If we do the triage work first, and we have people who we want to see or who want to see us, we have no difficulty bringing them in because we have capacity.”
However, others complain they can no longer book an appointment for a time that suits them. Employees may have to take a day off work because they do not know in advance when the GP will call back or the time their appointment will be.
A mother of two from Hertfordshire said she had changed surgeries after being unable to book an appointment for a non-urgent complaint. The woman, in her thirties, wasoffered a callback from a GP mid-afternoon with the prospect of arranging a consultation for later that day. As the mother had childcare commitments late in the afternoon, this was not practical.
GP leaders are also concerned the system breaks the relationship between a patient and his or her family doctor. Under the new arrangement, the patient cannot book to see a particular doctor or reschedule a follow-up appointment.
Dr Michael Dixon, a Devon GP and chief executive of the NHS Alliance, a primary care organisation, said: “For some practices offering only the same-day service, patients have to see whoever they are booked with and I think that threatens one of the most important aspects of general practice which is to offer personal and continuing care for those patients who need it.”
Dr David Haslam, a Hertfordshire GP, fears the new system marks the end of the family doctor. He said: “The heart of general practice is continuity of care by a familiar doctor, meaning we are familiar with patients without having to spend most of the appointment catching up.”
Dr Des Spence, a GP in Glasgow, says the telephone triage risks medical error. He said: “I was surprised, when I was working in out-of-hours, how often what was thought to be quite a minor condition turned out to be quite a significant one and likewise, things that were thought to be terrible over the phone, turned out to be minor.”
The Royal College of General Practitioners (RCGP) has described the end of advance appointments in many practices as “a very major change”. It says the schemes are needed because “general practice is teetering on the brink” with surgeries overwhelmed , same-day appointments gone by 8.30am and advance appointments booked weeks ahead.
Maureen Baker, chairwoman of the RCGP, said that while some practices had moved to the new system, others in the same area would continue to offer bookings and patients would be able to choose with which to register.
GP Access and Doctor First, two companies that advise surgeries on switching over to the schemes, said that once the GP had called the patient back, the patient could arrange a consultation on another day.
Baker insists, however, that in practice this can only be allowed in a small number of cases because the system relies on GPs having blank diaries.
She said: “The point with these schemes is that you don’t make advance appointments but the people know that if their day off is next Thursday, if they call up next Thursday, they will be seen next Thursday.”