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Patient journey is a road to nowhere

Patient journey is a road to nowhere

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



Please note, only GPs are permitted to add comments to articles

Mark Howson 15 November, 2023 5:02 pm

I am puzzled by the fact that the number of secondary care doctors has tripled in the last 15 years while the number of GPs has dropped. Yet the “waiting list” problem is a secondary care problem. I am sure they are all working hard and under pressure but the maths makes me wonder what are they all doing?

Pippa Vincent 16 November, 2023 10:32 am

I wonder the same thing, M.
ark. I am also sure they are working hard but, locally at least, they do very little/no follow-up and are no longer seeing patients whom they would have been seeing regularly a decade ago. We refer very little as most of it gets bounced. I do wonder who is in those outpatient clinics

Douglas Callow 16 November, 2023 11:16 am

50% of Consultant time non patient facing

Some Bloke 16 November, 2023 7:51 pm

Waiting lists are not secondary don’t care problem. They simply don’t care. Don’t respond to letters, emails, calls. It is our problem because patients come and see us repeatedly about it.
Reflecting on the thought that if someone asked me if things could get any worse 3-4 years ago, I would have honestly said no.

Darren Tymens 17 November, 2023 12:36 pm

@Mark Howson
It is a productivity issue.
In general, hospitals are well funded and poorly managed whereas general practice is well managed but poorly funded.
Alas, hospitals are in charge of the current system and don’t want to change or evolve as the current system works well for them. They also think they have nothing to learn from us.

Prometheus Unbound 19 November, 2023 2:47 pm

As a GP locum I have worked under 3 different hospital A&G systems.
The best one provides written A&G within an hour or 2, but always the same day and permits 2 way continuing responses. A&G was not compulsory.

This results in seeing a patient at 11am and ringing them back by lunch time with advices from consultant neurologist, endocrinologist, hepatologist, cardiologist. This has avoided loads of clinic appts and long waits. And patients were happy as they got the specialist advice and quickly.

The other A&G system resulted in 1 to 3 month wait for response. Patients then request being reffered at tge start as it gives them a 3m lead on the waiting list.

So A&G can be fantastic foe GPs, hospitals, patients if done properly. It also aided my learning, as I got instant same day specialist and support

Decorum Est 20 November, 2023 5:13 pm

Prometheus Unbound – thank you for that observation. I personally had a very negative opinion of A&G but as you advise us, it can if organised properly be a very effective and appreciated service.