Editorial Comment

££ – General Practice Always Under Fire – ££

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Over the last few years the British Press has continued to take a relentless swipe at the NHS and General Practice in particular. Whilst there is no smoke without fire a lot can be blamed on the former Labour government and the 2004 contract.

Now one Labour Peer, Robert Winston thinks that Patients should be charged £200 per annum to see their GP so they ‘learn to appreciate the Patients should be charged £200 to see their GP so they ‘learn to appreciate the NHS’

Curiously, if every patient paid £7 per month a doctors NHS income would remain very similar to what it is now. So to suggest £200 smells of serious profiteering as there is no guarantee that surplus founds would be paid back into the provision of better services. The NHS would still need to fund premises and new initiatives. I recall one doctor in a West Midlands surgery who refused to accept the male head of a household on his list as an NHS patient but did accept that person privately I think at the time for an annual fee of £10. This was 40 years ago. At the time there was nothing to preclude refusing to accept a patient in this way in NHS Regulations. Nowadays even to remove a patient from a list causes quite a stir. Despite Open Lists patients living in nursing homes are shoved form pillar to post.

The idea of charging was only alien to the New NHS for a few years after 1948 – now the dental and ophthalmic service are almost at cost and the pharmaceutical service might soon reach a £10 prescription charge certainly in my lifetime. Hospitals are being asked to levy parking charges more fairly. Those attending outpatient appointments or visiting long term inpatients should never be expected to pay parking charges. Why one wonders have NHS managers not considered the appalling effect car parking charges has on people visiting a hospital and not knowing wht time they would expect to leave the hospital. The NHS has been asked to put this right.

There are still hidden charges already with telephone lines in use that offer a payback to Practices but charge callers higher rates. What evidence is there that the payback to practices is reinvested in the Practice.

The NHS is riddled with charging systems. Nothing is ever free. Nothing paid for comes without consequences. If patient’s paid for consultations, home visits as well as their drugs they would rightly expect a quality service. There would need to be value for money. No waiting a week for an appointment. A proper complaints system would need to be in place. An independent complaints investigation system would need to be in place.

Robert Campbell is a retired Practice Manager offering comments, information and advice to Practice Managers and their staff.

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Editorial Comment

Are Telephone Consultations Ineffective?

Telephone conversations or ‘consultations’

A report published in The Lancet and reported on BBC News questions the effectiveness of telephone consultations in general practice today. In my experience telephone ‘conversations‘ as opposed to ‘telephone consultations’ can be a very useful way for a patient to get a quick answer to a minor problem with their health care. You may have a query about taking your tablets or a reoccurring ailment that simply needs a prescription. The call could be taken by a doctor, a practice nurse or a nurse practitioner and in the overall scheme of things can make the surgery day better organized.

The telephone conversation can save both the patient’s time and the doctor’s time. Many doctors now offer a call back service for minor problems but if you have a new problem not seen by the doctor before this is when the problems start and yes experience does show that a significant number of patients still need to physically see the doctor. This effectively means that there are two contacts are made instead of one costing both more in time and staff involvement. The problem as I see it is that patients do not and cannot be expected to know what is minor, what is major, what is urgent and what is non-urgent. Sometimes reception staff are given some guidelines on how to deal with calls but basically speaking to or seeing personally a health professional is the safest way forward.

Some practices have introduced a system of a doctor vetting all incoming calls requesting an appointment and claim success as a way of managing work. I have also experienced the reluctance of experienced doctors just to handle a patients health care on the telephone.  Obviously there are enquiries from patients that suit the telephone conversation.  But again there are situations where to just take a phone might result in a serious risk to the patient.

Out of Hours services and 111 depend greatly on the expertise of ‘staff’ to elicit enough information from a caller upon which to base an informed and considered decision. Perhaps video calls might be a solution. Access to a patients record might be another solution.

Overall the way in which a service is provided depends on time, the number of doctors, nurses and staff on duty, the number of telephone lines available and the funding to do it. I have always said that there are never no appointments but to provide an effective service needs manpower, resources and adequate funding.

Robert Campbell – Retired GP practice manager

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Robert runs a web site offering information, comment and advice for GP Practice Managers and their staff.