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Around the access merry-go-round we go

Around the access merry-go-round we go

Columnist Dr Shaba Nabi relates how a family crisis brought home to her the realities of trying to access timely care in a broken NHS

We all know we’ve been stumbling around this fairground for a while. You know – the one where patients are passed from pillar to post in an effort to manage the systemic issue of insufficient capacity. We have all experienced the mix of empathy and helplessness as they bounce between general practice, community pharmacy, 111 and then back to general practice again. Patients are appalled and blame us, we know it’s rubbish but can do nothing, and the rusty carousel goes round and round.

But a recent personal experience, when I found myself walking in a patient’s shoes, showed me how truly broken things are. 

It was a rainy Sunday morning when my kids persuaded me to take them indoor climbing. They are proficient climbers, so I was happy for them to get on with it while I caught up with work in the café. But when they came out, I took one look at my 12-year-old daughter and knew she had broken her elbow. 

I drove her to a heaving minor injuries unit, to be told there was a five-hour wait with no guarantee of being seen before it closed. As it was approaching lunchtime I decided to drive home, give my daughter a bite to eat and pain relief, and then go to another unit nearer home. On arrival, we found that unit was closed because it could not cope with the demand. It was heartbreaking to see my resilient daughter crying in pain when told she could not be seen. 

There was no option to register her name in a queue and the reasons were obvious – they were relying on a large proportion of patients to return the next day, or never return because they were better. This made me reflect on the challenges of offering everyone in general practice an appointment at first contact. The main reason we don’t do it is that we’re relying on a significant number going elsewhere for care. Even with this undesirable but natural attrition, we still can’t cope with demand. 

Back to my daughter. We returned home and waited… and waited. Thankfully the minor injuries unit re-opened that evening and my daughter was treated quickly and compassionately. But what about parents who can’t or won’t wait? Where are the safeguards to ensure we are protecting the most vulnerable children when our system is failing to provide the basics of urgent care? 

The system as it stands is imploding because of soaring demand and there is nothing curtailing this. Many health commentators have antibodies against any sort of co-payment, but I can’t help comparing my incredibly good-value dental review at £23.80 with the £25 I spend on a haircut. 

I have previously written about the widening health inequalities for young people in the mental health space, but these inequalities are now permeating every part of the NHS. It is universally understood that a well-funded NHS that values its staff enough to retain them is the gold standard for healthcare delivery. But when that’s not forthcoming, do we rigidly adhere to our ethical values and see inequalities widen every year? Or do we allow an element of cognitive dissonance for the greater good, so that the most vulnerable in our society can gain timely access to high-quality NHS care? 

My passion for reducing health inequalities is greater than my adherence to any political ideal, so I may be open to a different way of doing things. After all, the outcome is the most important, and not necessarily how we get there. 

The other option is to look on helplessly and wait for the access merry-go-round to stop once again at our door.

Dr Shaba Nabi is a GP trainer in Bristol. Read more of her blogs here



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

John Graham Munro 6 June, 2023 2:05 pm

Many patients, even without medical problems are often asked ”Have you seen your G.P?

Lise Hertel 6 June, 2023 5:47 pm

You speak from a platform of huge privilege. £23.80 for a check up? Cheap for you but for literally millions of people in the UK, totally unafffordable we need free dental care at the point of contact, but that has already been privatised by stealth, leaving people to DIY their dental problems and suffer in agony- this is what you are advocating for in your article, but for ALL of healthcare.
If you want to go into private health care, then do it. Take out private health insurance for your family and use it. You can afford it obviously. Its what the government wants and you have said you don’t mind compromising your beliefs. Its there now, there’s a few just for doctors and their families.
But don’t advocate it for everyone else.
I read the article hoping that it would be about the challenge for clincally vulnerable people and their loved ones to access even the most simple level of care now that Public Health – and society – have given up on us. Millions of us are not even allowed Covid vaccinations anymore, never mind even the simplest help, such as N95 masks, clean air, HCWs wearing masks etc. So every time we have to access care, we run the risk of a level 3 pathogen, that kills 300 people a week in the UK and disables many more.

Hello My name is 7 June, 2023 8:39 am

You’re right Shaba, this situation would not be accepted in other developed countries. Why do we wring our hands and put up with it?

Ian King 7 June, 2023 9:37 am

Very laudable Lise. Fully agree the rhetoric but that is all it is. System is broken. It works for no one. There aren’t enough GPs. There aren’t enough other colleagues able or willing to take on responsibility for managing trivial problems which means the ones needing to be seen aren’t seen. Until those able to authorise change are prepared to be honest with the public about what GPs can reasonably achieve with current resources,
nothing will change.

Decorum Est 7 June, 2023 12:49 pm

Well said Ian King!

Prometheus Unbound 7 June, 2023 1:04 pm

I agree with the comments.
I see people with terrible dental abscesses that cannot afford a dentist.
I see people that cannot afford the £9.65 for the medicafions I prescribe.

Charging for A&E or for GP visits is moving the healthcare access gate into the top 10% only. It will reduce the queue but at what physical cost for the remaining 90%?
France tried charging 20 euros for GP access and abandoned it…

Centreground Centreground 7 June, 2023 1:51 pm

PCNs /Clinical directors have significantly widened health inequalities by diverting resources away from NHS core practices undertaking the work to staff who spend 3 to 6 times the amount of time to deal with a patient than the previous roles and often effectively cost 2 to 3 times the amount a GP or nurse would have cost.
Clinical Directors are having a laugh in return for the huge payments they receive for doing little or no work and many in our area hop from one PCN board meeting, to an ICB meeting to an LMC meeting to a Clinical lead meeting and barely see the GP practices they are supposed to be helping.
A scandalous waste of resources from the NHS to PCN and this requires urgent action to stop PCNs and protect the NHS with resources going directly back to practices doing the work and able to make their own decisions.

Dr No 8 June, 2023 2:13 pm

Spot on Centreground, it’s all bullshit managerialism when what we need is more unhypothecated funding and fewer unevidenced targets. Will they listen? No. Because they think we’re like them, driven by self interest and profit. As said elsewhere, Fuck the Tories.