Monday, 5 July 2010

I cannot ever get to see my GP, it always takes weeks to get an appointment. Some thoughts: The Party(s) 002.

We continue on from our rant regarding what our patients are repeatedly telling us about their alleged inability to get appointments when it suits them.

Now in the “market” economy, that is the current NHS favoured by all Parties, including the previous one, very few people, and we suspect this includes politicians realise that the vast majority of GPs are what are termed “self employed contractors”. This means that they do not get paid salaries as most employed people do.

Most GPs are no different from any other self employed people for example plumbers, corner shop owners or builders. Now businesses earn money as a result of satisfying the local market and making a profit.

Several of us at ND Central before we became Partners did some locum GP work. What struck us all was the sheer number of different appointment systems in operation at different surgeries that we worked at. These included 5, 7.5, 10 minute appointments or even 20 minute appointments and different ways of delivering them. For example turn up on the day, book in advance, we will only book so many in advance and the rest are drop ins and so on.

You could literally go from one part of a city and see one system of working and a mile up the road there was a completely different one.

So how could this be given that there is an alleged National Health Service in the UK?

Well we are simple here at ND Central and we suspect it was the fact that GPs adapted their provision of appointments to their local population and tried to arrange their workload to meet their local demand and also preserve their health, sanity and resources. We think this may be called being in business and hopefully "the contracted performer's service provision satisfying the local market”. (We love brown smelly NHS speak!).

One of the biggest restrictions to the availability of healthcare in the UK is whichever Party is in control. For it decides it knows better than those grunts on the ground. After all they saw all of those WMDs the world is still looking for and we missed too. But we are just thick GPs not politicians.

For the last 13 years we have had the Za Nu Labour Party who adopted a Soviet top down management style of the NHS and failed to realize that, with the exception of China and North Korea, this had failed the world over.

So how has centralizes Soviet style control reduced the supply of appointments given that NHS expenditure has increased?

Well let us look at the alleged Quality and Outcomes Framework known as QOF which was part of the nGMS (new General Medical Services Contract) contract introduced in 2004. At the start of the nGMS contract the average appointment time for GPs was reckoned to be 7.5 minutes.

The Party, aka Mr Blair and Mr Brown, none of whom had any experience in healthcare, knew better and introduced a huge financial incentive for nGMS GPs to provide 10 minute appointments.

Many practices resisted this initially but, as Tony and Gordon thought that GPs who honour contracts should be paid (less), Tony and Gordon cut GP pay. However, as income started to drop many nGMS GPs started to introduce 10 minute appointments. Not because they were needed but because income was dropping. Money is the fuel of any business.

As a result local experience and knowledge, which had evolved different ways of working to satisfy local need, was replaced by Gord and Tony’s centrally controlled vision of healthcare where all people needed one size of boot.

Size 13 steel capped jackboot. Take it or leave it comrade one size fits all.

So what happened?

We give you a link to a now retired blogger’s thoughts on this and they did this at about the same time as we did and we suspect other GPs did too.

We would have liked linked to another GP blogger’s thoughts, more eloquent and experienced than we but Jobbing Doctor seems to be having a rest. We hope that Jobbing Doctor will return soon as the UK GP blogosphere is impoverished by the absence of someone who can post so well and frequently on a variety of matters GP.

A simple calculation of how many appointments at 5, 7.5 minutes and 10 minutes can fit into an hour (12, 8, 6) reveals the potentials drop per hour in the availability of GP appointments by adopting a centralised approach to GP appointments if you deliver healthcare via five minute appointments and then have to go to ten.

The Party has also introduced many other Soviet means of increasing local GP “efficiency” by denying patients appointments to see GPs.

Think about the 48 hour access target. The 48 hour access target meant that regardless of what your problem was you had a Party given right to see a GP in 48 hours.

Under the old system we used to hold “emergency” surgeries and all patients were given a card telling them that “emergency” appointments were for one problem only. The appointments were all 5 minutes only. Not for follow up appointments, or for repeat prescriptions, or for repeat sick notes or for getting results all of which are PREDICTABLE events unlike genuine illness which is not.

So five minute appointments were replaced by 10 minute ones. A potential 50% reduction in availability of appointments unless you double your working hours. As a result of ten minute appointments it has meant that some of us now spend more time waiting for patients than we do actually seeing them and more importantly we are seeing 6 an hour instead of 12.

So our “emergency” appointments were replaced by 48 hour access appointments which were rapidly used by those incapable of planning their lives and who had nothing better to do then play lotto appointments each day, twice a day, hoping to hit the last digit at the right moment on their phone to get an “emergency” appointment which met the 48 hour target for what was rarely illness.

Of course if an all wise Party cuts the number of appointments, surely it will increase the number of GPs during its tenue? Look what it says here:

“The strong growth rate in the number of practitioners noted last year has continued and the count of GP Providers has also risen, albeit at a slightly lesser rate of 4.6% since last year after a relatively static few years; the 10 year average annual % change is however only 0.3%, up from 27,681 in 1999 to 28,607 as at September 2009.”

By our maths that is a 3.3% increase over 10 years. Compare that with the 100% increase in managers over the same period and 12% increase alone last year.

We calculated that we dropped the number of patients seen in a week per partner by 22% on average and were spending 33% longer per patient over all following the switch to 10 minute appointments.

Another example of financial prudence from the old Party? No wonder Gordon was keen to introduce extended hours for GPs. For even with these we still provide almost 14% fewer appointments than we did before with no increase in GP manpower.

So if you cannot get an appointment think about what we have said and do not blame the receptionists. Remember GPs merely followed orders and gave you the patient what the Party thought you needed.

Praise be to the Party who by increasing appointment lengths to benefit you the patient have in fact made it harder to see GPs. Still there are some who think 20 minutes would be better . . .

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