Columnist Dr Copperfield regrets that GPs are forced to collude in the deception that patients will actually get a hospital appointment
There we were stuck in a waiting room packed with other disgruntled patients, more than an hour beyond the designated orthopaedic appointment time for my wife’s dodgy hip, when I realised that, according to the NHS constitution, I was entitled to scream, ‘I know my rights, I pay my taxes, something must be done!’
So I did just that. Which was stupid, because I’d forgotten we were in a private hospital. But it was clear affirmation of recent stories about a huge rise in the use of private healthcare by patients despairing at the state of the NHS.
As if I didn’t already know. After all, when we GPs now ‘‘‘‘refer’’’’ a patient under the NHS, we fully realise that we’re either a) colluding with secondary care in the deception that they will actually get an appointment when in fact they’re simply put in a holding pattern while admin waits for slots to be ‘released’, or b) entering into the interminable and tedious ‘oh yes I can/oh no you can’t’ pantomime that is A&G.
No wonder we now routinely and gently introduce the concept of the private appointment when suggesting referral – and by ‘gently’ I mean explaining that this is the only way to guarantee being seen.
But this is just the start of what is hilariously called ‘the patient journey’. Even if patients do enter the system, they’re soon stuck within it. And the old methods of writing to expedite appointments or diverting the patient to PALS are a waste of time because letters are ignored and phones are unanswered, respectively. These days, the NHS kicks the can of referral so far down the road that I’m no longer sure what road it is, nor whether there’s actually a can.
And what happens if the patient does miraculously receive an appointment? Something like this, which was recounted to me yesterday. He will find his MS follow-up slot repeatedly postponed. When one is finally honoured, he will receive finger-wagging text reminders in the week before, warning him how a DNA would be a waste of precious NHS time. He will arrive, punctually, to be told that the appointment has been cancelled and that he’s not received the cancellation letter because it was only sent that day. And they’ll see him in six months. Next!
This genuinely made me question whether the zero tolerance policy for abuse to NHS staff needs reconsideration.
The solution to this horrendous appointment crisis requires dramatic action, aimed at both supply and demand. The latter is a long-term fix that needs the headspace for radical ideas, which we won’t have unless the supply side, aka the backlog, is sorted.
This really does need urgent attention, and not just for the sake of patients. Medical students, trainees and young doctors are watching with glassy-eyed disbelief as they see us GPs spend entire surgeries fighting unwinnable battles on behalf of desperate and bewildered patients let down by secondary care. This future workforce is a huge part of the solution to our problems, but those problems are already crushing the enthusiasm out of them. Who wants to train 10 years for a role with zero medicine, 100% admin, and less than zero % job satisfaction?
Enough. I know my rights! I pay my taxes!! Something must be done!!!
Dr Copperfield is a GP in Essex. Read more of his blogs here