What is an Excellent Service?

There was a time when GP practices were expected to provide a service that was convenient to patients. Yet in some quarters I now read that patients may have to wait three days not two for repeat prescriptions when it is actually possible to issue repeat prescriptions in hours not days. I also read that patients wanting to be seen today may have to be challenged by a health professional to justify their request and that this ‘service’ will be CCG wide.

What then happened to putting patients first or the customer is always right. In recent months I have had the privilege of attending a large hospital where the doctors are thorough, the information is solid and tine is spent explaining what is a worrying  procedure at the best of times. The nurses too spend time with patients, give support and are always available later on the telephone to provide additional support.  When someone is ill, it can be life threatening, a patient does not want to be overly questioned and challenged other than by the medic they want to see.

Always some health professionals are better than others at putting patients at ease, giving injections and treatment without causing hurt or harm. Some health professionals are better at talking on the same level as patients. It does not hurt to show kindness and sympathy. Patients can be worried, frightened and actually feel very ill although on the surface it may not be obvious. A trained professional should be able to elicit this, not someone who’s only purpose is to prevent that patient from being seen today.

So when you are planning and managing your services always thing of how you would like to be dealt with and expect no less for the patients you provide a service for. Think twice before cutting services to fit the cloth. A health service should be a little more than that.







NHS Phrases No longer in Use?

As the NHS and general practice continue to change and develop just like Britains lost railways there are phrases like railway lines in use say 20/30 years ago that are no longer in common use or whose relevance is no longer significant.

Convenience to Patients

GPs were once encouraged to provide appointments that were ‘convenient to patients’. This meant that appointments should be available throughout the working day. Whilst so called regular appointments might need to be at times when patients are not at work or at school, patients ought to expect to attend an urgent appointment at any time of the day. I recall one mother complaining that she had been offered an urgent appointment for her child at 8:45am – she said it was not convenient as she was taking her children to school. I assumed that the child’s health was less important than taking the child to school. Now is that a reasonable view of convenience!

Reasonably Spread Over the Working Week

The phrase ‘reasonably spread over the working week’ related to the spread of sessions Monday to Friday at a time when few GPs worked part time.  Many doctors still take a half day and close at lunchtimes. The half day has a long history that goes back to the Shops Act of 1911, which introduced the early closing day.  Nowadays many doctors work less than five days a week, although there is now some weekend working and sessions starting before 8.00am and booking appointments after 6.30pm.  In a patients eyes, however, is an appointment to see a practice nurse, a nurse practitioner or a health care assistant an adequate replacement for not seeing a GP? The Governments drive to have a seven day week seems to have lost steam  as the argument for weekend working is not convincing unless you work in an A & E Department of course.  If we are to have weekend working do we still need half day or lunch time closing?

Immediately Neccessary Treatment

There was an obligation written into the General Medical Services Regulations  that doctors should prescribe whatever medicines or drugs that were required for the treatment and care of a patient. Now you might be expected to buy over the counter medicines. I assume from this that the painkillers written up for me after a recent operation were actually not required, despite my pain and discomfort.  The serious question that arises is whether hospitals are failing to issue discharge medication and therefore cost shifting occurs, which instead of passing to the general practice is now passing to the patient. Something has gone off the rails!

Temporary Residents

Are we moving away from the principles of being able to obtain treatment and care when on holiday or away from home somewhere in the U.K.?  Practices receive little income for ‘temporary residents’ these days and I suspect that the rigeramole of completing forms, seeing patients and getting little recompense is leading to finding ways of cheating the system. New technology, fax machines and electronic prescribing systems are brought into play so that patients can pick up their treatment needs from a holiday location pharmacy without the intervention of a tourist town GP.  The problem comes with patients who have gone abroad and forgotten their medicines. Again what happened to the days when it took six weeks to sail to Australia and drugs would be provided for the journey. These days a temporary GP might give you one weeks supply if you are lucky and your own GP might limit you to 28 days.

Personal Medical Services

I often wondered what was meant by ‘personal’ medical services. The words ‘family practitioner services’ have fallen out of use. This had been an attempt by the government in the early 70’s to rename the local GP services that might become more familiar.  But ‘family practitioner’ was replaced by ‘family health’ and ‘primary care’ came to the forefront. What does that say about ‘family’? My take on personal medical services was a desire to provide services on a personal basis, that there be a continuity of care between the practitioner and the patient and that patients could become used to seeing a named and preferred doctor! Fine principles but are they now defunct and why?

Trusts, Foundations, Federations and Clinical Commissioning Groups

More titles, more paint for sign boards, more new headed paper. When will it end.  But what do patients make of all these primary care organisations. Do they know what they do. And there’s more with Urgent Care Centres, Walk in centres, and Minor Injury Units. Oh and there’s your local pharmacist. Now busy talking to patients instead of dispensing drugs. Can you see a points failure coming up fast. Is there going to be a disastrous train crash? Is the NHS going off the rails?

To be continued………


Excuses not to collect charges from foreign tourists

Can you actually believe the extent to which NHS managers and clinicians argue that it’s not their job to collect charges from foreign tourists seeking free emergency or non emergency treatment. Many years ago in the 1970’s I came across a GP practice in the West Midlands that charged £25 per annum to register as a private patient the head of a household. The practice would not accept that person as an NHS patient. Working in a Family Practitioner Committee at the time we studied NHS Regulations very carefully in an attempt to find how this loophole. We could not find a law that had been broken and the practise continued.

It seems strange that hospitals in particular either cannot or do not apply a similar principle. Collect a charge when the patient / tourist crosses the threshold. I was surprised to hear this morning that in the U.K there is no law that requires foreign tourists visiting the U.K. To take out a medical insurance. I don’t know about you but I find this ridiculous. I have an annual insurance which covered me on my Christmas trip to Cuba but if I had reached the age of 70 I would have had to pay another £70 on top of my £120. I took my insurance documents with me and although I was quite ill whilst away – I was waiting for an operation – thankfully apart from buying strong painkillers I did not need a medical intervention.

The tourist from Nigeria who was flying from continent to continent heavily pregnant has used up to 6 hospital beds for over five months at a cost of £500,000. Whilst considering it an abuse of our NHS who will pay, answer you and me. In recent years the whole attitude of the NHS has changed toward not charging and freely accepting all comers into our NHS. We must be the laughing stock of the world. I felt sorry for the man with his credit card machine trying to squeeze the last penny out of occupants of a hospital bed. The whole should be dealt with before the patient crosses the threshold. Perhaps border guards should be checking for health insurance rather than hospital staff ask how long have you lived here.



The Prime Minister wants GPs to provide a 7 day service

How many times have we heard from the Conservative Government the call to General Practice to provide a seven day 8am til 8pm service. But is it possible? I for one do not want to wait 6 hours to see a doctor is an A&E but could my GP have helped me. On a recent occasion for me the answer would have been no, apart from referring me to see a colectoral surgeon urgently.

Yes, if there is a demand for a seven day service get it provided and provided quickly. It’s not a question of looking for premises. The NHS already pays GPs for surgery premises 365 days a year. But it’s the GP manpower that arguably is lacking. Why? In my view there are plenty of GPs. The problem is they are working part time. Few work full time. Whilst there may well be legitimate reasons for working less than 5 days a week there will be even louder and stronger arguments not to work over 7 days.

But it is not valid to work a four day week just because you want to. It is not valid to work one or two days a week so that a GP can lead a CCG. Family reasons are often cited as a reason to go part time and in these days of equality it would be difficult to argue against it. But in my view all part time working should be approved by NHS England. Admission to the Performers List should be for an agreed time commitment. I know too many GPs who have just taken it upon themselves to work a four day week without any real solid reason. The consequences of part time working has been the use of expensive locums.

All in all someone somewhere needs to take control again – stop unreasonable and unexplained part time working and stop the employment of locums, unless there are exceptional reasons, such as sickness or maternity leave absence or a singlehanded doctor needing a break.