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Independents' Day

We need to tell the time wasters to bugger off

Dr Katie Musgrave

Legend has it that once upon a time, a GP in South Devon got so frustrated with his patients that he stormed into the waiting room bellowing ‘If you’re not seriously ill, I want you to leave my surgery immediately!'

You can imagine the response in the present day. Smartphones would be seized. Teenagers would be weeping in the corner. The footage would go viral. All over the country, we’d hear horrified commentators lambasting the doctor’s insensitivity, like ‘How could he ask the poor, innocent patients to leave him alone?’

But, don’t we, in our heart of hearts, regularly share this doctor’s frustration? I’ve been a GP trainee for a few years now. Among many presentations of unwell patients, I regularly see a plethora of totally insignificant problems, that should never get anywhere near a doctor. I’d hazard a guess that on a given day, fewer than half of my patients will have a genuine medical need. 

The others present with a range of minutiae, fairly implausible-sounding health anxieties, or social problems (which I’m ill-placed to help with).

Sorting through these patients, and establishing that they don’t actually need to see a doctor, is a tiring and complicated business, especially as amongst them will occasionally lie an unexpected cancer diagnosis, or a heart attack you didn’t see coming.

Recent examples include the patient who came in worried that her toenails were stained yellow after she removed her nail varnish, and another who asked if I could offer advice on hair dye to cover her greys.

A particular highlight was a 30-something-year-old man who asked if I would mind squeezing a spot on his back that he couldn’t reach. He didn’t know who else to ask… We all have examples of such consultations.

I fear I’ll find that little old lady dead in the corner

These stories might be amusing, if it wasn’t also true that many genuinely ill people now struggle to get a GP appointment

Waiting times are so long in many places that patients are undoubtedly coming to harm, or inappropriately using A&E services

I remember a day when, running behind in my surgery, I had a delightful older lady wander in, clutching her chest. She’d been quietly having a myocardial infarction in the waiting room, while I was busy dealing with a teenager who’d been having tantrums over his PlayStation. This isn’t a joke. Those who need our help are left suffering for our lack of action.

The founding principle of the NHS of being free at the point of access has been so abused that we desperately need to address the situation.

Too many now believe that the NHS is worthless - on hand to jump at their every whim. A very small fee, for taxpayers who could afford it, might go some way in encouraging people to think twice before consulting their doctor.

Perhaps this fee would be charged at both GP surgeries and A&E departments. It wouldn’t be the end of the world - we don’t view prescription charges as threatening Nye Bevan’s principles in founding the NHS.

Likewise, a small financial disincentive to working age adults might encourage them to appropriately value their GP’s time. If patients sought advice from a family member or read NHS Choices instead of booking an unnecessary GP appointment, we might regain the capacity to manage those patients who are in genuine need of medical care. 

After all, free at the point of use is worthless if those who need the service can’t access it.

I genuinely fear that if someone doesn’t go into the waiting room and have a stern word with the patients, before long, I’ll find that little old lady dead in the corner.

Dr Katie Musgrave is a GP trainee in Plymouth and quality improvement fellow for the South West

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Readers' comments (72)

  • Our esteemed leaders have debated this and rejected it in the recent past:


    Never mind what the GPs on the front line think. In addition it’s not a political easy vote winner so unlikely to ever come to fruition. I’m afraid the only way you will be able to escape this is to emigrate.

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  • Cobblers

    Katie, just wait. A domino will fall probably in some coastal town and GP will fail.

    Faced with minimal primary care the government will relax access to FP10s and NHS secondary care and private GPs will take off.

    The Alt Left option would be to make all GPs salaried which will be underwhelming seeing how few will remain.

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  • Maybe you’re in the wrong job.....

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  • There is actually no need to fight or be too principled. When it turns private, nobody will be labelled "time wasters". Doctors here are programmed to fight their patients due to the system and when the complaint comes there is no support. The famous last words:"It's your clinical decision." We are in a way in the service industry and it all boils down to money. We/they get what we/they pay for.

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  • I expect the fee would be set with so many exemptions and caveats that like prescription charges; less than 1 in 6 are paid for and the consultation rate for those with prescription charge exemptions far exceeds 5/6th of consultations. So no reduction in dross but a big increase in 'entitlement' :-(

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  • Good to see Katie that at the stage of trainee you have worked out the ills of the system. Sadly, no government would introduce such a system due to it being political suicide.

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  • Bob Hodges

    We at the Gloucestershire LMC have repeated submitted motions to conferences about a nominal access charge. Hoever, during debate these motions are shouted down by the usual suspects who seems to have a religious regards for things being free at the point of access, even where this demonstably inflicts intolerable pressures on their colleagues around the country.

    However, there is no other equivalent country on Earth where primary care is absolutely free and unlimited in theory, and there are also no European countries (America is different obviously) were people without money are denied care.

    I reckon £3 is enough. If its too high, then certain people will act like they've just bought themselves a spa experience day.£3 is a roughly 10% contribution to the cost of provision in recgonition of the value of the resource being accessed.

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  • Personally I would be glad to get a case of yellow nails after lacquer use- it would allow some catch up time and a pause in the relentless onslaught of the work. Tell the patient- "Look up resorcinol".Job done.

    The other factor to bear in mind is that its easier for a qualified doctor to assess something as not serious than it is for someone in the position of not knowing; such uncertainty is anathema for most cognizing persons and raises the possibility that it implies something potentially bad, and berating them for their ignorance should merit a pause for a little self-reflection.

    I don't think Ideas, Concerns, Expectations alone is enough, but can enhance ones clinical prowess if afforded the role it serves.

    There are no easy answers.

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  • "Sadly, no government would introduce such a system due to it being political suicide."

    - Yes, the change has to come from the top. But as Friedman says, its not about electing the 'right' person, it's about "establishing a political climate of opinion which will make it politically profitable for the wrong people to do the right thing. Unless it is politically profitable for the wrong people to do the right thing, the right people will not do the right thing either, or if they try, they will shortly be out of office." Therefore, the battle is in the hearts/minds of the public. Simply put, its about demonstrating to the socialists/communists that they are so clearly wrong about big state and centralised planning.

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  • I suspect a ‘very small fee ‘ will encourage those who can afford it to feel entitled to bring their cosmetic minutiae to us ,after all they’re paying for it, and it will be cheaper than a hairdresser or footcare practitioner appointment.

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