Editorial Comment

NHS General Practice is almost Unrecognisable?

The changes that are taking place in general practice surgeries are making the GP we knew in the fifties and sixties during the first 25 years of the NHS almost unrecognisable.  The surgery premises is no longer a cosy sitting room in a doctors house but a palatial building that is more like an office block or a church than a surgery.

No longer can you turn up to see your own doctor and just sit and wait. The whole attitude of both patients and doctors has changed toward expecting a ‘now’ service and providing an appointment sometime never. Patients expect to telephone a surgery and be offered an appointment with a doctor today. They are not always bothered about seeing their own doctor or the same doctor. Instead the service is driven by what is recorded on the GP Computer Record. Hopefully your treatment and care has been added meticulously by those recording your health care. But is the record of your attendance at an out of hours centre or your flu jab given at your local pharmacy recorded in your GPs notes. Did you get a look of disdain from your GP for going elsewhere?  Have your Lloyd George manual records been transferred and professionally summarised into your computer record? Have all the clinical letters received by the Practice been read and scanned into your notes and has action been taken where it needs to be?

The environment of the surgery is intrusive with pressing queues at the reception. No area to talk in private. Notice boards and leaflet racks galore filled with invites for this and that. The TV screen promotes a healthy lifestyle and your eyes are drawn to the Jayex digital display board to see if its your turn next. If your lucky when you log in at the faceless reception VDU screen you will be told how long you have to wait only to find that you miss the announcement due to an urgent call of nature.

Everyone is friendly and polite almost robotic. You are left feeling that you might have wasted someone’s time. Your surgery visits are now split into consultations with a doctor if you are lucky, a nurse practitioner, an asthma nurse, a diabetic nurse, and a health care assistant on phlebotomy duties. If I want to talk about a specific problem you need to raise it with the right person. I get a text message to remind who I am seeing and I get letter galore invited to this bit screened and that bit monitored. I could paper a wall.

All in all I wonder whether the service is any better. There are too many patients and too few doctors and nurses. The day is only so long yet GP surgery premises remain empty over 14 hours a day and for 62 hours at the weekend.  The lights may still be on but the computers are switched off. My call to ‘111’ results in a 12 mile journey to another town or a visit to a horrible A & E department filled with ‘sad souls’ suffering only from a heavy night out.

What is the solution? Perhaps it’s time to make sure that the service starts to deal with the person and not try to provide a range of services that only some need and not all can benefit from. The kitty is only so big and the cloth needs to be cut to tailor the  best suit.


Editorial Comment

CQC Inspectors comment on Clinical Letters

In one of the latest reports from the Care Quality Commission a Practice is placed into Special Measures for amongst other things not reading and taking action on over 1,200 clinical letters that were up to one year old. Out of hours reports were also not dealt with and a non-clinical member of staff was reviewing clinical letters.

The Report  in my view opens a can of worms for practices and poses questions about who should read and process clinical letters, and how quickly such letters and reports should be read after receipt.

If you take a look at a batch of hospital letters study closely how long it has taken the consultant or clinician to write the letter and then how long it has taken to type before it is received by the practice. How urgent has the letter been treated. There are various ways a Practice can receive clinical letters, on line, by post and by courier and of course by fax. If it is marked urgent or for immediate attention then YES it needs to be dealt either the same day or no later than the next day.

Hospital records are not always very accurate. The GP to whom the latter is addressed may not be the patient’s current GP. The letter might even be sent to the wrong practice.

Taking these problems into account suggests to me that a carte blanche approach to criticizing GPs for not reading clinical mail may not be particularly fair. What is correct is that if a clinical letter is not read at all and important instructions are missed a significant even catastrophic event may have occurred.

Practices need to have open and transparent systems for reading clinical mail and reports. There need to be duty doctors and deputies who are expected to read and action mail either the same day or the next day. Excuses like we are too busy are not good enough.

There are also questions about the point in time a letter is read. Is it before or after scanning. How long is the scanned letter kept before it is destroyed and what checks are carried out to ensure that a clinical letter or report is posted to the correct patient.