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CAMHS won't see you now

Patients should sign a contract to use GP services

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I was sworn and shouted at last week. A patient, who turned up eight minutes late for their appointment, was furious that I would not also see their child in the same appointment. I felt genuinely guilty, and tried to do what I can to meet what was wanted. That evening, having run behind, I was 10 minutes late for the pantomime at our local theatre. I was refused entry, and shown various signs which warned me this would be the case. Do you know what I did? I grumbled a bit, then accepted this with resignation and waited for the interval, having paid for the privilege.

I am a firm believer in two principles that could change the way general practice functions. Firstly, that no other profession could bend further backward to meet the needs of its users. Whether resupplying a lost prescription, seeing a patient who turns up 5 minutes late or dealing with multiple problems in just 10 minutes, we consistently accede to the demands that are put in front of us.

The contract will put the responsibility for health on the patient

Secondly, I believe the public needs to take more responsibility for their health and illness. What should be a few days of rest and time off work becomes a demand for an urgent appointment, antibiotics and a sick note. I find it mystifying how we have come to live in a society where our commitment to our employer is more binding than that to our health. A seven day 8am-8pm GP service is not needed if employers were reasonable and allowed patients to attend daytime appointments.

I propose that practices be allowed to draw up a patient contract, which patients must sign in order to access the health services they need. The contract will put the overall responsibility for health on the patient (where it should be), and give practices more power to manage inappropriate use. General practice has reached breaking point, and we must all bear some of the load.

For the majority of patients who use the service fairly and appropriately, this changes nothing. For those that abuse the system, we accede no more.

  1. If I am late to my appointment, I accept that I will not be seen.
  2. If I lose a prescription or my medication, I will pay an administrative charge for replacement.
  3. If I do not turn up to my appointment, I accept any further appointment will be low priority and seen at a time decided by the practice.
  4. I accept that any verbal or physical abuse to practice staff will result in immediate removal from the practice list.
  5. I accept that I need alter my schedule and work commitments in order to attend a given appointment.

These points are a starter for five, but there are other domains where a patient can agree to use services appropriately which is open to discussion.

Clearly in order to be enforceable such a scheme would need backing from the GMC and other regulatory bodies, however I believe it is needed to improve patient care and facilitate a fundamental shift in who takes care of health. A responsibility that should always be the patient’s.

Dr Danny Chapman is a locum GP in east and south Devon

This blog is part of our ‘Great GP Debate’ season. If you would like to write a blog on how you see the future of general practice, then please email the Editor at

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Readers' comments (9)

  • Healthy Cynic

    I think that this is a logical approach and the idea could certainly be further developed. What about a national Patient Contract?

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  • I agree this is a great ideas. While I like the idea of it applying to all patients nationally, I also think that it would be important that each patient read and sign the agreement themselves

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  • I AGREE FULLY. there should be 3 points for each offence and 9 points which qualify for removal of patient from list . they should be obliged to declare 9 points penalty to new gp. next gp need only 3 points to remove them.

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  • Great idea. We use if for the potentially badly behaved (drug users), but as time and expectations increase should be extended to all.

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  • National Hopeless Service

    Few years ago we all had to have a Patient Charter with similar statements - pile of useless sh*t that was.

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  • Meanwhile, in the rest of the world and in other industries, customers hand over 'money' to 'buy' a service. If they want more they hand over more 'money'.
    Communism leads us to be treated like children and our 'need' judged by others.

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  • I agree Sax. Everyone wants to believe they are our equals. I have 17 years post grad training. When I say"antibiotics are not indicated" why am I meant with Whitney" that's not fair and I know my body".
    I suspect people respect more if they have paid for a service.
    I aka born capitalist, it's purely Darwinaian. Survival of the fittest. If you can't be bothered to get better, hep or indeed educate yourself then the gene pool would be better without you!

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  • Sorry typos
    Whitney- Whiney
    Aka- am a
    Hep- help

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  • Free at point of delivery means to most people it is viewed as being free, and is treated as such. If a deposit was paid on booking an appointment and refunded on attendance (or cancellation in a given time frame) that might also help focus minds.
    On one shift I was sworn at in (I think) 10 or so languages mainly for the crime of not giving antibiotics for viral infections and of course as a Locum to make a fuss might mean I do not get retained again.
    The worst offenders are unlikely to be managed by this - most will have no money and do not mind using various GPs or indeed A&Es. But this could certainly help for the majority.

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