If we can’t access GPs, do we really have a health service at all?

by Kevin Meagher

As I sit here nursing a nasty chest infection that I can’t seem to shake off, the crisis in the NHS is brought home to me all too clearly. I can’t get an appointment to see my GP before the end of next week, begging the question that if I cannot access basic healthcare at the point of need, do we in fact have a National Health Service in any meaningful sense at all?

As Shadow Health Secretary Andy Burnham has pointed out, the slump in service standards “is more marked in general practice than anywhere else in the NHS: in 2009/10, four out of five people said they saw a GP within 48 hours; now it is just two in five.”

And it’s set to get worse. A recent poll of GPs suggests average waiting times for a basic appointment are going to stretch to 13 days by next April. Apparently, I should have had the forethought to make an appointment after the first cough.

In response, the government’s NHS Choices website (“Your health, your choices”) suggests that people like me should “consider the alternatives” before bothering their GP. Thankfully, this is just a range of staggeringly inane and nannying ‘advice’ rather than an invitation to seek out a consultation with the village wise woman or medicine man.

Instead of seeing the doctor, “[t]he pharmacist behind the counter at your local chemist may be able to give you the help you need, so you won’t have to spend time waiting for an appointment.” Discussing your medical history within earshot of the queue in Boots certainly offers an interesting approach to patient confidentiality.

If, however, you feel compelled to seek out the kind of informed medical support that we pay our taxes to access when we are ill, the advice is not to forget your manners, especially to the support staff. “Be polite to receptionists. They are busy people who often have to deal with unhappy patients. Being polite to them will encourage them to help you.”

What is the corollary of this extraordinary statement? Patients are not busy people and if some receptionist does not consider a patient to be sufficiently ‘polite’ they will not help them?

If, after navigating past the pharmacist and a touchy receptionist you are fortunate enough to actually sit in front of a GP, you are urged to: “Be clear about what you want the doctor to do, such as refer you to a specialist or prescribe a different medication. Be assertive if you need to, but always be polite.”

So not only are patients expected to know when they are going to be ill in order to book an appointment, they are supposed to know what treatment they require when they get one. This is the beginning of the Googlification of medicine. (As for being assertive and polite, well that sounds a bit like pulling off smart-casual).

This government stands accused of starving the GP system of vital funding, ensuring that problems simply bubble up elsewhere. But the last Labour government doesn’t get off the hook. Its decision to award GPs a 58 per cent pay rise while allowing them to opt-out of providing out-of-hours cover saw ministers stuff their mouths with gold and hope for the best. (In short, a classic New Labour public service reform, where ministers didn’t have the bottle to stand up to powerful vested interests).

As a result, the provision of out-of-hours care is a patchwork of assorted odd-ends, although the NHS Choices website feels able to boast that: “GP services are available 24 hours a day. Outside normal surgery hours you can still phone the GP surgery, but you’ll usually be directed to an out-of-hours service if there is one [my italics].” So that’s clear: you can see a GP anytime you like, as long as there is one.

Rather than blandishments, we need a GP system that treats people quickly, working on the assumption that hypochondriacs and health tourists aside, most people only visit the doctor sparingly. This part of the system needs to respond effectively so it can manage demand on more acute (and expensive) areas of the system like A&E. It goes without saying that it can hardly do this if it takes patients a fortnight to get a first appointment with their GP.

As well as funding, it also means politicians standing up to GPs who have been able to build a system that too readily operates in their interests. Weekend and evening opening should now be the norm rather than the exception.

As for me, I guess I’m reduced to crowdsourcing a solution to my chesty cough with my fellow snifflers and hackers at the counter in Boots.

Kevin Meagher is associate editor of Uncut

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3 Responses to “If we can’t access GPs, do we really have a health service at all?”

  1. Bishop says:

    These discussions just amaze me. Even when Labour was in power it took five days to get an appointment and now it’s five weeks – and that’s only if you are prepared to see any Doctor. Where do you people live that you complain about a few days wait?

  2. Tafia says:

    Up here on Anglesey in North Wales if the surgery triage nurse deems it urgent you are seen that day but the most you’ll have to wait is 3-4 working days. And my Srgery is open till 8 at night and is shortly to start saturday surgeries as well.

  3. Astonished says:

    Really astonished to read this. I had to do a double take to make sure it wasn’t Melanie Phillips in the Mail. Where to begin? Firstly No…we don’t have a health service if we can’t access GPs. But really…don’t we need a more informed analysis of why this is happening up and down the UK?
    First not getting an appointment before the end of the week. Really? Most practices will see people (or at least triage them) the same day I’d someone feels it’s urgent. If they don’t ..isn’t a few days quite reasonable? Perhaps it’s the ‘chest infection’ which often means a cough that only a few years ago Someone wouldn’t have demanded healthcare for. Wonder why primary care is overwhelmed?
    Then the snipes on politeness requests and low paid receptionists. I promise you….a morning in the real front line of the NHS would have you singing their praises.
    And then the snipe at ‘out of hours’. Unless I’m badly mistaken, every citizen in the UK has access to a GP OOH service….24/7/365…no exceptions. But hey…why let facts… Of course you may be given advice and you’ll certainly only get to see a GP or a nurse if it’s really necessary OOH…but we run OOH on a shoestring. What do you expect?
    And finally the attack on GPs. The old snipe of massive pay rises for less work. But what really happened was a quality target scheme which was entirely separate from the contracting out of OOH which GPs actually payed for (yes, really, it doesn’t get reported much). But if GPs are such fat cats as getting 59% pay rises…(what should they be paid for their workload?)…and not seeing enough people, it seems strange that GP is now engulfed by the biggest recruitment crisis in years. Odd that.
    Really we have grossly underfunded primary care for years and foisted ridiculous schemes that swallow up GPs time. Attitudes have changed from a GP paternalism attitude to an entitled and often aggressive selfishness from a significant minority of users, to an extent exemplified by the piece above. At its best, partnership working May rescue the NHS…with mutual respect between users and staff. You may not like it but we have to return to self care for minor ailments (or please tell me how we fund insatiable demand). the only hope for the NHS is a fairly urgent re calibration of the proportion spent on the NHS frontline….general practice. We have been seduced by flashing blue light glamour instead of the real solid work that goes on in GP.
    Most of all, we need more health workers involved in politics…many are working too hard to do so, but, my goodness, look what spectacularly ill informed comment results when they don’t get involved.
    The NHS will be killed by political opponents but it may also be killed by views like this. The NHS belongs to the people and it’s up to us to save it… We need a much more reasoned discussion.

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