That’s the bit which is within our gift to address. We don’t need to draw out long knives and stab colleagues in the back. Most medics are savvy enough to see the mire of problems before them might manifest as dissonance with medical colleagues but it is in fact orchestrated centrally. And that’s where cohesive vitriol should be placed, rather than at the door of our colleagues. In my corner, thankfully, that’s the case. GPs and Consultants and the PCT do really seem to get along pretty well.

All of the media talk about nationalized health plans has me nervous. I foresee some hard times for both doctors and patients if government drones are given the power of HMO’s and PPO’s.

As I’ve said before, I’ve never had much of an issue with my GP, nor do I know anyone who has, so maybe it’s a local thing.

Niceladydoctor, great post as usual – I have to admit I find this privatisation by stealth terrifying. All is well in the NHS, comrades!

depends where you live
depends whether you have a decent GP
depends whether you have travelled enough and have the education to spot crap service

just because people are “vocal” doesnt make them wrong

and we have the english attitude where folk like my mother will wax lyrical about how great the doctor is, while at the same time winge to me about inability to get to see them, its a generational thing, never winges to the doc cos in her eyes the docs are gods

other folk i know left to die by the nhs still to their dying day thank the nurses and docs, because they just dont know what treatment options they would have had elsewhere, that their treatment has been limited by lack of surgeons and much more, crying shame

the nhs only reacts to folk who make a fuss, folk like me who never make a fuss to the docs or receptionists are always let down

Where are all these disaffected patients who can’t see their doctor? er going private in london normally in my case when im in that much trouble ive pretty much given up on nhs GPs

ive lived around the world (as lisa stansfield would say) and i can honestly say the UK is the only country where Ive ever waited days to see a doc, the only country with dirt obvious for all to see, the only country where violent police prisoners sit next to the most vulnerable

the nhs is failing

sorry im a bit short of time right now

I’m glad you are able to concede that the traditional model works well for many patients. I think it has the potential to work well for all patients but you may disagree on that one.

Regarding choice you do make a good point. I think increasing choice is no bad things as you’re right, some patients do have a valid grip about access. However as I’m sure you know, the government’s own survey – designed to show that the public wanted more choice – did show that over 80% were quite happy with their GP and access to their GP. I think that would suggest that while a minority agree with you, the majority, who tend to be the less vocal about these things, are happy with the status quo.

The thing is the patients who really need us to be there during the daytime are the patients less likely to be making a fuss. My surgeries are full of patients who do need to see doctors. There are some “malingerers” it’s true, but most of my patients (I’d say 80% plus) are the elderly, people who can’t work, young children and their young parents, and the disabled. They need me to be there during the daytime as that’s when they’re about. And moreover, they need ME. They don’t want to be repeating their life story to a new doctor every time; they rely on the fact that I know them their circumstances, in some cases I know all about other members of their family. And as time moves on this relationship deepens. It’s vital and is the heart of general practice.

You may be interested to hear that my practice offers extended hours. Our Saturday morning surgeries are not as you might expect full of patients who can’t see us during the week. Our Sayturday morning surgeries are either not full at all, or they are a mixture of all of our usual patients who could if they wanted see us in the week. Where are all these disaffected patients who can’t see their doctor? In fact like most surgeries we can offer a routine appointment to anyone who asks for one, within two working days of them calling. In most cases that is adequate time to arrange time off work (as you’d do if you were seeing your solicitor or dentist), for others we have some advanced access appointments. This works and we know it works because our patients tell us that it does (in surveys that the governement has asked us to complete).

I’m not dogmatic about the general practice or the NHS as a whole being a totally public entity, indeed in my most cynical moments I would say that in its current form it cannot survive. There are some problems with “choice” and “market forces”, however. Firstly, market forces. I would suggest that market forces cannot and should not apply to healthcare as it is not by its nature a profitable enterprise. It doesn’t generate money so “market forces” don’t apply in the same way. The way that they could work is for some kind of system whereby the traditional GP model (which does work, I think, for most) is protected from the risks of a purely market led system. how that might work, I don’t know. Any suggestions?

Regarding other countries: I think you’re right and you’re wrong. The UK does fall behind some other developed countries when it comes to some important conditions – cancer survival being one. But you’d be wrong to deny that the general practice model works well with the limited funds available to us. Spending per head on health care remains below the European average and well below the US (this http://www.marketwatch.com/news/story/us-health-system-earns-d/story.aspx?guid=%7BC8565FAD-46D7-46AD-9FF4-7CE58DF41B47%7D&dist=msr_2 is an interesting article).

I think a big problem (and a political and ethical hot potato) is that market forces/GCSE economics will tell you that if you make something free, demand is potentially infinite. We live in a country where older people remember having to pay the doctor so they ask of the NHS only what they feel that they need. Younger patients have grown up with the NHS; it doesn’t occur to them that every attendance costs money. That means that GPs are trapped in an unwinnable situation: on the one hand trying to do the best thing by the patient, on the other constantly aware that they have to keep within a budget. GP consultations are exceptionally good value for money – the cost per consultation is £14 pounds.

In terms of the comparison with other countries, I’d point you towards the results of an international poll commissioned this year, and summarised nicely here: http://www.marketwatch.com/news/story/americans-rate-us-health-care-system/story.aspx?guid=%7B86F29D04%2DFC2D%2D466F%2DADF6%2D2435468CE406%7D&dist=morenews
You will see that over the world there are countries with different health care systems but the one with the system that is most based on market forces has the unhappiest patients (or should that be customers?) – the US.

but the symptoms of poor GP service FROM THE PATIENT POINT OF VIEW are there for all to see who look hard enough

good family docs and their relationship with their patients had many noble and good elements

the reality for many patients is that they have a rubbish GP, an arrogant GP receptionist, and no real ability to choose another GP

the system should self optimise if patients were given real choice, GPs could innovate and compete (offer different hours etc), and let the norms of the free market solve many of the issues, and bring in the extra cash to implement

the status quo of many GP waiting rooms being full of the same old malingerers while the genuine needy cases struggle to get an appointment etc, its all out of step

and as much as I know there are many great docs in the UK, standards here even from the most basic laymans view are very significantly sub the rest of the developed world, and as Brits travel more they believe the nhs proganda less and less