19/04/2023. For once I think Labour leader Starmer’s latest campaign (about failing GP services) is a strong one. I’m fed up with the difficulty of seeing a GP in this country – an appointment in seven days time seems to be considered acceptable! It is not. When I lived in Belgium I could usually go see my GP on the same day.
https://www.telegraph.co.uk/politics/2023/04/18/the-nhs-is-broken-declares-keir-starmer-labour/
In fact that used to be the case in the UK also. So what has changed? What I see in recent years are fewer and larger purpose-built surgeries with more staff, rather than the smaller, often more local and pleasanter converted home. The smaller, more patient-friendly neighbourhood GP outfits that were around until 10 years ago have disappeared. Both government and NHS dogma are responsible for this ‘improved efficiency’, and in doing so have brought about the delays and the mess we find ourselves in now.
Of course we know that the improved efficiencies were about saving money, and certain present government ministers were directly involved in those decisions. But what government and health planners failed to see is that the larger the organisation in the form of the modern GP surgery, the more inherent are the inefficiencies. The benefits of scale in terms of infrastructure become outweighed by the rising needs of an ageing population, often for quite simple remedies and advice.
When a surgery is one or two GPs in a home, then the support staff are also fewer in number and correspondingly more loyal. Decisions can also be made more quickly with a smaller and flatter organisational hierarchy. The total cost of the GP service may be higher, but forcing more patients to visit A&E because of delays can be more costly still, especially if those delays result in a need for more comprehensive treatment.
I’m probably seeing this through slightly rose-hued spectacles, because the GPs of my youth didn’t have to make vast reams of notes on each patient and enter them into a national network. But then they probably didn’t need to – when you knew your family GP personally and he or she knew you, they could make recommendations for further follow-up more immediately.
And it’s true that because most of my Belgian medical history was on paper, it hasn’t made it through to my NHS file here. So 30 years of personal medical history, probably including some key health moments, are not included in my NHS file. An issue for my personal cradle-to-grave coverage I guess.
So we cannot go backwards to a health service without computers. Having your personal medical file available for all to see on the NHS network is, despite the privacy concerns, for most people a good thing. It can save time and reduce the likelihood of errors. Certainly no-one thinks twice about it on the continent.
So more note taking per patient is perhaps inevitable. The tricky part for the NHS is to be able to provide the long-term health support that people expect, without the inefficiency and muddle that seems to characterise certain GP surgeries. I don’t want to see a stranger every time I visit my local doctor – the fact that I often do these days makes me not want to visit the GP surgery at all.
Is the NHS broken? I don’t think so. It certainly performed marvellously during the initial Covid pandemics; many staff went above and beyond to care for patients at a very difficult time. I lost family and friends during this period, so I can claim some knowledge.
But do GP services need reforming? Yes, I think that is true. As the front line for NHS support to the people of this country, GP surgeries need to be accessible both easily and immediately. The fact that they are often not so these days means that something has to change. And probably the most obvious answer is that we need more of them.
© Philip Hunt 2023
