Monday 11 August 2014

Do We Really Have A Health Service At All?

Kevin Meagher writes:

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.

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