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………

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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.

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