Doctor who?

When is the last time you got a house call from your doctor?

If you’re old enough, you’ve seen it on TV – e.g. Peak Practice (Dr Jack: ‘I’ll just pop over the moor and see how Mrs Bassenthwaite’s headache is doing’) or even Dr Finlay’s Casebook (Dr F: ‘And while I’m here I may as well take a look at your cat.’)

Now, not only does the GP not come to you, it’s getting hard to contact the GP for an appointment.

A couple of days ago, a doctor advised my wife (via telephone, of course) to have this and that checked. So she called the group practice, and a recorded message said that there were no appointments left for that day and – well, that was that.

So she went online and found the practice website. There was a long rigmarole (mustn’t scream, mustn’t throw laptop) of registering, plus password and memorable check-word. Finally, she was shepherded through to a page promisingly called Patient Access. This asked what the patient wanted, and the enquiry box wouldn’t recognise the various messages she typed in; but there was also a list below of available services, which if you were incautious you might request – but which were private and mostly fee-charging. How does an NHS GP practice lead to this? How many patients, some elderly, some perhaps not good readers or speaking English as a second language, might walk into this spider’s web?

All we wanted was an appointment with the GP or practice nurse! You can phone/email your dentist (at least, we can – in fact, just got a same-day morning slot today!*) – but not your doctor?

Okay, frustration threshold crossed, time for ‘action directe’; she went next morning in person to the Centre. After standing in line behind someone with a complicated query, she got to the front and was told ‘you can’t come in to book an appointment, you have to do it online.’ (Because Covid? There were only a few people in the waiting room and she was wearing a mask.) Oh, and what if you don’t have a smartphone or a working computer?

There are, of course, no email addresses to reach the practice manager, admin staff or individual doctors.

Back to Hewlett-Packard, Microsoft and internet grief. Somehow the practice site led us onto a different link, Engage Consult aka engage.gp, and by dint of not answering most of the questions and ignoring hints to call 999 or 111 we got to the point where we could ask for a call-back; which came by text the following day, with an appointment - for 10 days hence.

Why all this complication and delay? Even now, the average GP has fewer than 2,100 patients https://www.pulsetoday.co.uk/news/workload/number-of-registered-patients-per-gp-rises-to-almost-2100/ , as compared with MPs who have on average 73,000-plus constituents, though admittedly the latter manage by ignoring many of us altogether. Also, where MPs are paid c. £82,000 plus expenses, the average GP in England and Wales earns £98,000 https://www.dailymail.co.uk/news/article-9356701/NHS-GP-earning-700-000-year-one-hundreds-earning-Prime-Minister.html ; I make that £1.12 per constituent p.a. versus £47 p.a. per patient.

Is it, perhaps, something to do with the way that doctors, like police and politicians, have gone from a bottom-up model of working, to top-down? Modern GP work is a business (it always was, but more consciously so now) and patients are profit centres who can be made more productive by having mass screenings and vaccinations rolled out to them, like the aorta scan (part of a large program) they made me have some years ago. For this kind of thing, you get contacted by letter, email, telephone; you get assigned provisional dates and venues; you get reminders.

‘Contact your personal physician’ – really, that’s so last century. It’s not personal any more; not ‘your doctor.’

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* i.e. last Friday