Adrian Hamilton: I'd rather see my own doctor, please

If a GP won't take responsibility for you, who in the whole system will?
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The Independent Online

It has been six months since my doctor retired from the inner London surgery where I am registered. So I asked to whom I was being re-assigned. "I'm afraid we haven't got round to it yet, I think," he said, before adding: "Anyhow, we're rather moving away from that now."

Precisely so. Ministers cheerfully talk about choice and how the new front line of the health service is to be the doctor's surgery. The modernised NHS, they declare, is going to be a world of efficiency and immediacy, a land of super-surgeries, immediate appointments, rapid testing and consumer control.

What they don't say is that it is also becoming a world where no one is finally responsible for you, where the GP you see is no longer "your" doctor, but the one that is available, a processor of your symptoms by quick reference to your file on the screen.

That may suit some patients. When you are young it doesn't really matter who you see at the surgery: you've fallen off your bike, got kicked in a rugby match, gone down with a fever, feel pain in your stomach. Your past, your health profile, is not important. What you want is instant attention and a ready cure.

But once you start developing a history and once you start to get older, the value – indeed, the need – of seeing a doctor who knows your case increases by the visit. At the very least, it saves you having to go through once again all the details of your past record, the fact you had rheumatism as a child, or a miscarriage or the delicacies of mental problems. And, at best, it improves the chance of getting a diagnosis that takes into account your peculiar condition.

It is easy enough to see what the health bodies are up to. In a political climate obsessed with targets, the name of the game in the NHS is "outcomes". Conversations with a doctor have become dominated by talk of averages and statistics. Symptoms, pills and diagnosis are all reduced to a statistical norm of side-effects for this pill, normal readings for your age, the likelihood of symptoms arising from this condition or that. Numbers are what matter, not people, as much as to funnel them through the system in minimum time as to meet their individual need.

This suits not just the system but the doctors too. Leaving aside the question of whether the remuneration package for doctors has been over-generous (it probably has but envy is a corrosive emotion) the effect has been a noticeable tightening of doctor's hours. The more the doctor is paid for readily achievable outcomes, the less incentive there is to put in extra hours. That is particularly so where there are married couples in a practice – as in mine – where the partners can now organise their working hours to suit their parental needs. Even if you are assigned a doctor, an appointments system that prevents you booking slots more than a fortnight ahead makes it extremely difficult to arrange time for reviews.

It is fine for the providers. It might even help improve the outcome statistics. But it is not fine for the patients. The old doctor-patient relationship may have been cumbersome, inefficient in managerial terms. But it did answer to the needs of the patient in what, for many, is the most specific and personal part of their lives. If a doctor doesn't take responsibility for you, who in the whole system is responsible?

a.hamilton@independent.co.uk

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