Wednesday, 1 July 2009

Where have all the ill patients gone?

We at ND Central had a crap day last Friday. We have spent more time waiting than we have working a clear benefit of Gordon (the MoreOn)’s NHS “reforms” for General Practice.

If we had actually spent our whole day working, we could have seen and dealt with all our patients in it in just over 3 hours rather than the long drawn out, agonisingly boring wait for patients that stretched it out and took almost 9 hours to finish.

This morning we worked from 09.00-11.30hrs and spent an hour and ten minutes seeing patients. The rest of the time we spent waiting for patients to arrive (1 hour twenty minutes). If you cannot see a doctor read on to work out why. The Fat Controller’s influence is all pervasive in healthcare as it is in our increasingly affluent economy over which he presides.

In amongst this morning’s waiting, sorry work, was a patient who brought their child in and proceeded to moan about how they and their family could not get a same day appointment at a GP Practice in the English NHS and had to go to A&E to be seen straight away. They felt that this was wrong (as they paid a lot of tax to the Fat Controller) and also they asked about any local private GPs (of which there are hundreds in our affluent neck of the woods).

They contrasted their experience to that in Southern Ireland and in Europe where they have had to pay to see GPs but could always get same day appointments. The law of supply and demand at work, perchance?

We know from the A&E discharge summary that the patient had a GP treatable condition but due to Party reforms and a “World Class” Commissioning PCT, they cannot get a GP appointment. But the Fat Controller rewards local idiots for their incompetence and they and he think they are doing a good job. Neither ever talks to patients so they know better than do we.

We then sorted out visits for the whole of the practice on our own that weren’t needed and then signed 350 urgent repeat prescriptions before moving on to minor administrative queries and problems that did not involve any direct patient contact.
This afternoon on an emergency appointment list we saw 17 patients in 1.5 hours in the only time in the week we don’t do a Gordon or centrally dictated surgery.

Amazingly, this non Party prescribed system works well, but when you leave work people are staring daggers at you for seeing sometimes 8 patients in the 20 minutes plus they are waiting to see a doctor doing 10 minute Gordon appointments.

In a whole day no one had any illness that was life threatening.

4 out of the afternoon “open access” (to meet the 48 hour Gordon access target) wanted (non) urgent blood results.

Another 4 had booked into get a Party prescribed (Gordon) annual medication review for a (non) urgent annually needed hay fever treatment

4 came back to ask for repeat sick notes which they knew they would need when they got the first one but they did not book an appointment at that time.

Oh yes and one patient did not show (but we still had to wait 10 minutes just in case they did).

So most of the same day (urgent) Gordon appointments were for things that did not need to be seen within 48 hours or even that week based on MEDICAL priority or need but Gordon knows best as he never went to medical school.

We used to use this “something for the weekend surgery” as “emergency” only appointments to try to see acute illness but now they are open to whatever crap wants to come in thanks to Gordon and Tony. And it does and in doing so blocks illness.

What used to be an “emergency” surgery has now become a “I can’t be bothered (to plan my life) surgery but as it is free I will (ab)use it”. Our reception staff have noticed that there is a hard core of patients that always (ab)use these surgeries which occur twice daily every working day. Some patients will use the afternoon surgery if they are unhappy that they didn’t get want they wanted in the morning and worse than this even the next days surgeries as well.

Where has all the illness gone? We know it is there but we are not seeing it.

This worries us.

A former comrade at arms who works in the other front line of NHS care, Accident and Emergency medicine, noted that their workload at night went up by 20% in the first year of the new GP contract. It has got worse since our comrade tells us as if people can’t get an appointment with their GP they go straight to A&E. They are seeing less Accident and Emergency medicine but more general practice “because I can’t see my GP”.

At practice based commissioning meetings the local Thickerrazi tells us that A&E attendances are going up and they want us to stop people going there to reduce costs. Is this were all the illness is going?

We know not but, if you see almost 30% less patients then you used due to Party reforms then, if illness is distributed randomly, it will take you longer to see it. Maybe that is why we are seeing less illness because we are now seeing less patients and taking longer to do so in order to meet government targets?

Of course illness could be struggling into the extended hours surgery that Gordon thought was a good idea. All those early morning surgeries for busy commuting pensioners and children and the Saturday mornings where often a third don’t turn up as they are busy sleeping off their intensive health promotion Friday night workouts (8 pints, a curry and a glassing). Is this where all the illness has gone?

We doubt it as all of these are pre booked appointments so no acute illness. The extra surgeries do not make up the appointments lost by the Party’s insistence that all consultations should be 10 minutes long, comrade. Still the Fat Controller thinks our staffs’ weekends should be disrupted to try and keep him in power. (We like true socialists who look after the workers, comrades).

Could it have gone to NHS (re)Direct? We don’t think so as a third of their workload is bounced back to GPs or A&Es so we should eventually see some of it?

Could it have done to the Darzi centres or rather the Equitable Access centres or whatever other name is currently applied to the squandering of finite NHS resources on the private sector regardless of need?

We don’t know as yet but our patients are not leaving in huge wildebeest like droves to join these expensive white elephants so it is just possible they may be seeing all the ill patients we are not?

We drove past a GP Walk In centre in one of the largest cities locally yesterday at 17.00hrs and saw one patient in the waiting room when ours would be full. That is one more than we have seen the last 3 times we have driven past it.

Might illness have gone to other Walk In (get nothing done and then see your GP) centers?

Same logic as here as with NHS (re)Direct.

So where has all the illness gone?

Praise be to the Party for reducing illness by its health policies. Make GPs do less, spend more time waiting than working, and then blame them when patients moan.

Anyone else struggling to see illness or is this phenomena peculiar to the ever over affluent North? More pork scratchings and chips anyone?

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