No one wants to wait. Unfortunately, last year over 25 million people waited a week or more to see their GP. Everyone agrees this is too long. But the parties are divided over how to make things better.
How many patients does a GP see? GPs work in sessions; each session is three hours long. A normal working day comprises two sessions. At 10 minutes a patient, you see 36 patients a day: 180 patients a week, excluding extras. The “hole” in the middle of the day – charitably referred to among hospital doctors as the “three-hour lunch break” – is your time to dictate referral letters, sign prescriptions, fill out forms, read letters from hospitals, check results, and phone patients and their families. This is also when you do your home visits. You hope for one visit, rather than four; though three near each other will trump two at opposing ends of the one-way system. You want the 96-year-old you’re visiting to be well enough not to need a series of complicated interventions, and oriented enough to open the door. What you don’t want, as with my last visit of my last job, is to find your patient dying in front of you. Death, as my boss at the time observed, does make you incredibly late.
It is true that increasing numbers of GPs work part-time, seeing only around 90 patients a week (although five or six sessions can easily expand to fill 40 hours once you factor in the associated administration and visits: the part-time label may be slightly misplaced). This is often cited as a contributing factor to the access crisis; but no one is offering to pay for all the part-time doctors to take up full-time posts. The minister for care and support, Norman Lamb, thinks IT is the answer. “It’s very difficult for people with busy lives to get appointments with GPs so let’s just get smarter with the use of technology,” he suggested in a recent interview that was received unfondly by doctors (“Thank God for that, some genuine vision at last!” said a colleague, “If only I knew how to use the email!”).
The surgeries have tried to finesse how they arrange things, with mixed success. About a third of practices have ditched advance booking in favour of “phone up on the day”; this means you might get in under 48 hours if you can phone quickly enough, as the appointment slots will all be empty, at least until 8.34am when they’ll all be full. The system enrages patients (as it would anyone who has had to make 30 phone calls in five minutes in order not to get an appointment). And it makes no attempt to evaluate clinical need – cancer will be seen at 11am, whereas the sore toe with automatic redial gets the 9am slot. But attempts to triage – for example, by having a GP speak to everyone on the phone before offering appointments – are killingly time-consuming, taking up a whole doctor per morning or afternoon, and also nearly kill the doctor doing them. Triage typically allocates five minutes or less per call, so a session means speaking to 72 unwell, irritated patients and trying to make a complex and potentially risky assessment for each. The patients aren’t keen, either.
You can tinker with appointments; you can extend opening hours; but you can’t make honey without bees, even if all the bees are really good at Gmail. You need enough staff: doctors, nurses, healthcare assistants, midwives, secretaries, receptionists and managers. General practice carries out 90 per cent of patient contacts. It receives less than 9 per cent of the NHS budget. We value it cheap.
Sophie Harrison is a hospital doctor in South Yorkshire. This column appears fortnightly