Editorial Comment

Face to Mouth Consultations 2021

Covid has brought with it a continuing state of concern about what is safe to do. No matter what measures we take to keep safe, we can still catch the awful disease. The news media has made great play on the fact that only around 50% of GP Practices have returned to normal running. Yet for many months now NHS Dentists have been seeing patients face to mouth. To be fair, dentists are still not using the full range of their equipment.

Again to be fair, the very nature of how general medical practice is provided has changed dramatically since the start of Covid. The world of GP Surgeries has moved on from basic appointments systems as we now have ‘triage’, ‘Signposting’, extended hours, Nurse practitioners who can prescribe, online prescriptions, video calls, text messages and emails. Practices now have elaborate web sites, some very good, easy to read and simple to follow, whilst others so complicated you need a degree in technology to navigate them. Oh! Then there are Care Navigators. Who are they and what do they do? What on Earth happened to the ‘dragon’ receptionist!

Going back to the early days of the NHS, Patients would simply turn up at a Surgery, sit and wait and be seen. Complaints were at a very low level. This was until in the 1970s, when appointments systems became more common and the Government of the day encouraged patients to make complaints and even set up Community Health Councils to help them. Inevitably complaints became more common, and perhaps to add insult to injury patients were given a Charter (of rights). They now have an NHS Constitution.

Moving to the 1990s, the General Practice Fundholding Initiative brought with it an attempt to emphasise that GPs were the gatekeepers to the NHS. They were the first point of call for patients. The idea then was that the funding for whatever treatment and care that was needed would follow the patient. But over the past 20 years the way NHS services are commissioned has changed and developed and is going to change again in 2022. Perhaps, it has reached a state of total confusion.

It has to be said that with the complexity of general practice, the formation of primary care networks and the reduction in the number of GPs, the provision of general practice is no longer as simple, if it ever was, and straightforward. There are now practice not personal GP lists of patients. Patients are unlikely to consistently see the same doctor. In fact, after 6:30pm patients may well see a doctor from another practice and at the other doctors surgery. Many Practices employ part-time doctors and patients may see a nurse practitioner rather than a GP. This is not a criticism but a fact. It is a different model of general practice maybe still in its infancy which may require a different type of Management and monitoring. It also needs to be promoted more positively.

Where does this monitoring start? I go back to the point about general practice being the first port of call and the gatekeeper to the rest of the NHS. Sadly, this fact has been diluted by such developments as ‘111’ and the NHS web site. We now have a variety of Covid and NHS apps as well as contact systems like MyGP. Many GP Practices have long elongated introductory messages on their telephone systems, with some making the seriously negative pronouncement that there are ‘no appointments today’. Perhaps it’s those telephone messages that need monitoring!

In my view, there does need to be a change in approach in general practice. There is such a variety of ways available to Practices to enable them to provide high quality services, that it cannot be acceptable for any Practice to declare that there are ‘no appointments available’. Similarly, it has never been acceptable for patients to have to wait, days if not weeks to see a doctor (of their choice). Practices need to be clear about what services are available, without delay. Patients need to understand that their treatment and care can be provided in different ways and different types of clinician. Nothing should be said that puts patients off asking for help.

So rather than grumbling about poor funding, my view is that Practices should look very carefully at the way they offer and promote their services. Rather than say there are no appointments available today take a more positive view and say that it is the aim of the Practice to try to help each patient who contacts the Practice a service today, but patients need to understand that the service may be provided by a range of clinicians employed or engaged by the Practice.

Robert Campbell – October 2021


Robert Campbell

By Robert Campbell<br><img src="" alt="Robert Campbell" class="avatar" width='50' height='50'/>

Started work writing medical cards in 1966 at Staffordshire Executive Council. Have worked at Inner London Executive Council, Hertfordshire Executive Council, Lambeth Southwark and Lewisham FPC, Birmingham FPC, Dudley FPC and Wakefield FPC and Family Health Services Authority. I was seconded to the NHS Appeals Unit and have worked as a full time GP practice manager since 1992 until 2010. I was also an AMSPAR trainer at Park Lane College, Leeds. Now I work as a freelance author.