Friday, 10 April 2009

Queues GPs

We had a discussion today about an item on a BBC local news station about queues forming at a GPs surgery in one of the more Southern reaches of Northernshire that one of the team here at ND Central had spotted and past around.

The video can be seen on this link but what was interesting was the fact that several members of the team were worried as the TV program concerned had asked viewers to email in their experiences and they were worried that someone might grass us up even though we do not have this situation, as yet, on our own home turf.

We got thinking as to how this situation had arisen and how the news item had someone from the local BMA towing the Party line.

If you can bear with us and follow this through we hope we can explain how such a situation has arisen as a result of the new Soviet style NHS system of Big Gordon knows best.

Prior to the introduction of the 2004 New General Medical Services (nGMS) contract there was no specified minimum consultation time. Practices had adapted consultation times and availability to best cope with local demand.

In areas of well ordered and well informed patients you would probably have had longish consultation slots with extra spare slots to fit in genuine emergencies. In areas that differ from this you may have had a drop in and wait system in the morning to accommodate high numbers of minor but quick to deal with problems e.g. the urgent sick note, 2 minutes in and out.

There were all sorts of different ways of seeing and dealing with patients that local practice’s had evolved to deal with local demand and refined and adapted according to changes.
But then came along Comrades Tony and Gordon who given their collective experience of healthcare came up with the nGMS contract. They thought that 10 minutes was the correct Soviet length of time for a consultation and that all patients should be able to see a GP within 48 hours.

If GPs did not tick these 2 boxes then they would be heavily penalized financially. So in well over doctored, affluent areas this was not a problem as they were probably doing this anyway.

However, in less affluent areas that were under doctored areas, this caused a problem. As most of what presents here is relatively simple it does not need 10 minutes to deal with and so you cope with high numbers by short consultation times.

One of us at ND did a stint as a locum GP and remembers seeing 50 patients in an inner city deprived area on a drop in basis when there would have normally been 2 GPs on their own and spending 5 hours to do so or 6 minutes per patient.

At ten minutes per patient that would have been 8 hours 20 minutes followed by visits and paperwork and that was just the morning surgery.

Now Gordon and Tony, who are both holier than all others bar Mugabe, were not pleased following the introduction of the nGMS contract that GPs did honour by doing all that was required so costing them dear which they had not allowed for.

So Gord and Tony did then start reducing how much they paid GPs and as a result some GPs incomes went down from the alleged £ 250,000 a year we all earn (but not as a pension).

This happened at ND Central where we resisted the 10 minute appointment scam until we realized that the only way we could preserve Practice income, which is used to pay our staff, run the Practice as well as pay ourselves the £250,000 that we don’t get was that we had to introduce 10 minute appointments.

So after 2 years of the nGMS contract we introduced a 10 minute appointment system for the second time as the first time it failed disastrously as we tried to keep existing appointment numbers up and found we were doing nothing but appointments. The second time we reduced the number of appointments to enable us to do other things in the day. The well establish Dr Crippen seems to be going through the same process and his thoughts are here post "Things can only get better ,comrade" and we like the graphic 3 April 2009.

The system we employed was that any patient could ring at 08.30 or 12.00hrs to get a same day appointment for any problem (urgent or not) to ensure that Gord and Tony were happy we have 48 hour access. These same day appointments disappear within 4 minutes sometimes as little as 2. We have 10 minute appointments (where we used to have 5 minutes) but we have less appointments than we had before. Previously only emergencies were allowed to book same day appointments now anyone can book with anything.

So what happens? Certain patients with non urgent conditions and nothing else to do with their disorganised lives realize that that they can access a GP the same day and so they book appointments for trivial non urgent conditions and block the same day slots from those with more urgent problems.
Sometimes we as GPs see patients that need review after a day or two to see the evolution of an illness to check it is not our worse case scenario and as a result we ask people to book into a same day appointment but tell them to come to the surgery (and not ring) just before 08.30/12.00hrs to guarantee an appointment.

This is what happens in relatively affluent areas but the same will happen in less affluent areas. People will discover that, rather than ring the surgery and get the engaged tone because they were a millisecond too late hitting the last key on the phone, they are more likely to be seen on the same day if they go in person and ask for an appointment so stopping a receptionist answering the phone.

Now the BBC and the Government do not realize that patients are not always directed by the Big Brother screen in their home much to the disappointment of the Party who seek to control people but they also speak to each other. So if someone finds a way to get seen quicker they tell their mates who tell their mates and so on.

Next thing you know is that people desperate for an appointment will start to queue, rather than phone, and know that the earlier you get there the more likely you are to get an appointment. Remember appointment numbers are likely to have gone down in order to meet the 10 minute target.

Then disgusted of Dinnington using her mobile phone steps in and it is highly likely that disgusted of Dinnington voted Labour but it is of course the GP’s fault as he was merely following Party diktat.

So a simple “it is disgusting story” has a relatively simple explanation and an equally unaccountable group of idiots that are responsible for its creation.

Praise be to the Party for their “if it isn’t bust, break it” healthcare policies. They work so well to make things better?

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