Will GPs and the real world ever coincide?

As the NHS begins to transform into a private institution, we can only expect conditions to get worse


I very nearly pulled my knickers down in Boots the other day. I know; me a grown woman, Brownie leader and mother of four. Outrageous. Why was I tempted to do such a thing? Because I had a sort of mark, all right a bloody great big horrible ruby red thing adorning my otherwise beautiful bottom.

I had attacked it with Savlon. And Kiehl’s Crème de Corps. Both stratagems were useless. So I decided I needed chemical assistance to zap it, not least because of the looming Hackney Half Marathon.

It was impeding my training! So, I thought, I will show it to the pharmacist at Boots. Because I simply could not be arsed (pun intended) to go to my GP. It is just not worth it.

This is not because I live miles away from the nearest practice (I don’t). Or because the practice is tiny and only has one doctor (it doesn’t). It is because getting an appointment there is akin to winning a round of Cranium, a devilish board game which goes on for hours, and during which you have to be able to spell, draw, sing, calculate and sculpt things from clay.

To win a morning appointment at my north London practice, one must ring the surgery at 8.00. Not 8.01. Or even 8.00.25. By then, all the slots for appointments will be full. You must call at 0800 hrs.

What you must do is get the Speaking Clock lined up, with the pips going as you press the final digit on your number. You and everyone else, that is.

If the morning is full, you can’t then book an afternoon slot, oh no. As the unsmiling, nail-filing receptionist wearily informs you, afternoon appointments can only be booked at 14.00, at which point, you must go through the whole rigmarole again.

What if you are in a meeting, or a working lunch, and can only call at 14.30? Too bad. If you don’t call at 14.00 precisely, there will be nothing for you that day, and so you will be back on the 0800 reveille tomorrow.

And so it goes on. Unless, God forfend, that you have a spot on your bum, or worse, on a Thursday. For the practise is closed on Thursday afternoons. Why? Who knows. Nobody is ill on Thursday afternoons, presumably. Let’s not mention weekends.

This appears to be the pattern across the country. Yesterday, it was reported that a quarter of surgeries in the UK are closed for at least one half-day during the week. Presumably doctors and practice nurses simply cross their fingers on that day.

What happens if you have a child with meningitis? Or toothache? Or you need to have a repeat prescription for the Pill? A&E is not the answer – indeed, hospitals are driven to distraction by patients clogging up their waiting rooms who they consider should be sorted out by GPs.

I am not normally given to attacking the NHS. I practically grew up in a hospital. Both of my parents are (retired) NHS doctors. I know GPs work terrifically hard. My clever brother Richard is one. A brilliant one, too. He does home visits and night calls, cares about his patients deeply, and is a trouper.

But I am afraid that the system on the whole now has the unmistakable air of a private institution, not a public service.

You will do as we say. We are running our practice, which is now a profit-making enterprise, not a taxpayer-funded set up, You will ring us at 0800 even if it is inconvenient for you.

Even if you are vomiting at that particular time. Even if you are getting breakfast for your small children. Because there is no slack in the system, and the system fills up by 0801, says the receptionist. Well, if there is no slack, why are you closed on Thursday afternoons?

An inadvertently hilarious website entitled Top Tips for a Profitable Practice, written to address some of these problems, seems to me to sum up the entire malaise.

Be friendly! Be helpful! Not because you are doing a worthwhile, important vocational job, but because you won’t make as much money.

“Freeing up the receptionist to meet and greet and respond to patients face to face is key,” it trills. “Being busy on the telephone … before speaking to patients will potentially lose the business customers and the income they attract.”

Customers? Income? How did we get to this place, and please can somebody show us the way out of it?

Postscript: following self diagnosis via Google and some very scary websites, plus liberal application of Anthisan my rear end is once more back to its former glory.

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