Some tips to avoid waiting to see your doctor……. but it is going to get worse, and more expensive whatever.

A relative had to call the doctor for a urine infection. It was painful, they had a fever, and yet no treatment was available without an appointment, and a sample of urine for culture. The urine was lost, and they went privately because there was “no other way” to get treatment! This cost time, energy and £65, but to the English Health Service it has cost another disillusioned taxpayer. Stories abound about poor access, delayed investigations, and subsequently poor outcomes. The shortage of doctors has been predicted for more than a decade, and the poor manpower planning that has led to those doctors we do have being “part time” is understandable for all of us close to the profession and the service. Disillusion is not confined to the public, but is endemic in the caring professions…. hence early retirement and emigration, and changes of career. Poorer parts of the UK will be more affected, as when there is undersupply doctors will choose to work in more affluent areas with better schooling and infrastructure. These areas will also have more people prepared to pay for the private option. Just as dentistry has “gone private”, so Primary Care (G.P.) is facing the exact opposite of the National, fair, mutual service(s) that Aneurin Bevan enabled in 1948. We are bringing back fear, rather than replacing it.

Some tips to avoid waiting to see your doctor…….

Write your symptoms down on headed paper and deliver it ( by relative if necessary ) as the doctor will have to read the letter, have it scanned into your notes, and act on it accordingly. The envelope should be addressed to your preferred or normal doctor, but make it clear that any doctor will be adequate. If you think it urgent mark the envelope as such, but be aware that GPs have been excused form being an emergency service. ( A true emergency, as defined by the state(s) and not by the patients, needs a 999 call, and attending A&E. ) Verbal messages over the phone are not recorded in a standardised manner, so recording is different in each practice. Emails either direct to a practice, or from receptionists receiving messages, are not necessarily copied into notes.  Access is going to get worse, and more expensive whatever: there are just not enough doctors for the next 15 years..

The “ideal” concept, as originally envisaged has died. We have to ration health care, so better that rationing is overt rather than covert. It must be universal for big expensive services such as cancer care, and heart surgery, but it may have to be local (post coded) for smaller items and services which are not expensive or life threatening. My personal preference is for means tested health care in the same way as we have means tested social care. This would allow combining budgets without internal argument. All that remains is for the press and the politicians to reach this conclusion. The bad news is that this will take decades, and many deaths.

The prospect of a “telephone app” doctor does not convince me at all. Advertisements in London have small print saying that, to access this service, you will need to re-register. The old adage of History, Examination and Investigation is being replaced by History, Investigation and then possible examination but by a different doctor. I predict: No continuity of care. No trust. Waste by over investigating, and then by litigation costs. What better incentives to go privately if you can afford it? What better way to destroy the health services by making them unofficially “two tier”?

Sarah Baxter reports that: “Doctors are quitting and surgeries are threatened. Services need radical reform” in the Times 11th December 2018.

Scary news. More than 350 GP practices may close next year and millions of patients face a three-week wait to see their doctor. To be frank I thought everybody in Britain, like me, was already obliged to book an appointment three weeks in advance. So whenever my children, say, need prompt attention for an ailment that might be serious but probably isn’t, I send them to one of those private walk-in clinics for £65 that you can find around the back of central London railway stations.

Not everybody has that opportunity, but I felt ashamed about running to the A&E after my son was prescribed a couple of Nurofen for a neck injury on the football pitch that turned out to be nothing. Equally, I’m not prepared to wait three weeks for an examination. I did try to change surgeries, but was told by a nearby GP practice that its situation was far worse……….

My NHS clinic is Theresa May‘s ideal – if only I could see a GP (The original Times article)

Correspondence:

Sir, You report that, in the past year, 9.3 per cent of patients waited more than three weeks for an appointment (“Millions of patients face three-week wait for GP”, Dec 7). While it is undeniable that there are serious resource shortages at GP practices, there is much that patients can do to improve the performance of their GP service. In my local practice, patients fail to turn up to 5 per cent of booked appointments without giving prior notification. During the course of 12 months this wastes 50 per cent of the time of one whole doctor.

In the case of minor ailments, patients who agree to accept an appointment with a clinical nurse or agree to visit a pharmacy directly can improve the availability of doctors for more urgent appointments.
Richard Harvey
Oakham, Leics

Sir, Tony Blair made two big errors in his dealings with primary care: allowing GPs to opt out of 24-hour care and interfering with appointment systems that practices had fine-tuned to meet the needs of their patient population. As a result of being embarrassed on national television in a Q&A session with voters, he introduced a “one fits all” system incentivising practices to deal with all requests for an appointment within 48 hours. The only way this could be achieved was for practices not to allow booking in advance so the appointment book was empty at the start of each day. This created the rush hour at 8.15am and a lucky 30 got an appointment.

Any service where demand outweighs supply inevitably has a pinch point and in this scenario the bottleneck is at about two to three days. Urgent cases can still be seen on the same day and chronic conditions can wait a couple of weeks with no detriment to the patient. Illnesses such as sore throats, viral illnesses, diarrhoea and vomiting, etc get better without the need to be seen at all.
Dr Andrew Cairns
Petersfield, Hants

Sir, Maybe the delays in being able to see a doctor are not caused by, as you report, “the chronic shortage of GPs”. Out of the seven GPs in my doctor’s practice, six only work part time.
Douglas Stuart
Guildford, Surrey

Sir, It is not just general practice that is under enormous strain; patients across the country are also struggling to access NHS dentistry. More than half of NHS dental practices are closed to new patients and some people face a 90-mile round trip to get to their nearest surgery.

As chief executive of the largest provider of NHS dentistry in the UK, I see first-hand the acute shortage of NHS dentists, particularly in remote areas, and the impact this has on patients. The government urgently needs to train more dentists and, most importantly, allow high-quality clinicians from around the world access to work in the UK.
Tom Riall
Chief executive, mydentist

Sir I am lucky enough to be registered with a GP practice in west London which operates a system that ensures that medical advice can be easily accessed. Each weekday morning and four weekday afternoons a walk-in clinic is on offer where, as often as not, a patient is able to see the doctor of their choice without too long a wait. As well as this facility, an appointment — perhaps for a lengthier consultation — can be arranged using the phone, sometimes subject to a week’s delay. If this busy practice can achieve such a service, then why are not all practices aiming for such a system?
Sheila Keating
London W2

Image result for two tier service cartoonWorkload pressures and the GP shortage forcing practices … to close

GP surgery closures ‘will see 3 million patients lose out in the next year’ 

 

 

This entry was posted in A Personal View, General Practitioners, Post Code Lottery, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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