At a friend’s surgery a number of things were conspiring to restrict the appointment availability. One part time doctor had gone off on maternity leave, a partner was on sabbatical, they were trying to recruit an additional nurse and they had just switched to a new computer system as the old one was about to become obsolete.*
As a result the receptionists and doctors were having to constantly apologise for the lack of availability or routine appointments. There were posters and messages on WellTV in the waiting room.
I couldn’t help saying to him, “Well why don’t you send out a letter, or put up a poster for your patients saying something like, ‘Thank you to our valued customers, patients for putting up with us through this difficult time. By way of thanks we would like to offer you a free appointment with your doctor of choice. To claim your free appointment simply call or speak to reception and use the bonus phrase, “Yes, I really feel that I need to be seen today”’, or whatever?”
He looked at me, and I winked mischievously.
On a serious note, the current deal that the British public have with access to general practice is amazingly good. It is taken for granted that one can speak or see a doctor at your own GP surgery, free of charge, at almost any time during the working week. There are ways around every appointment system and GPs are aware of the patients that can make it suit them.
The fundamental problem with having access to general practice free at the point of delivery is that it has the potential to lead to infinite demand. This in turn leads to rationing, whether it is called rationing or efficiency savings. Access is in fact the gateway, or bottleneck, between demand and healthcare services.
Bizarrely, the government response to rising demand is not to commission research to investigate why demand is so high and how it can be managed, but to foment consumerism in healthcare and match access to demand. The logical conclusion to be drawn from this is that infinite demand will lead to infinitely easy access – not just 12 hours per day, seven days a week, but 24 hours a day, every day of the year via face-to-face consultations, telephone, text, email and Skype.
At present access is a flimsy gate held in place with rusty nails in rotten wood. In order to preserve British general practice in some functional form, then either demand has to managed and curtailed or a stronger, more robust gate is needed.
This is imperative. And yet none of the political parties in the UK are bold enough – or even see the need – to manage demand for healthcare.
Society must support GPs to find and implement solutions.
*this situation is fictional