An excess of access

GPs cannot bend space-time to create new appointments, says Dr Copperfield

As a declaration of war against her GP, who happened to be me, it was really quite impressive. She came in clutching, in one hand, the Daily Mail, and in the other, a complaint form. ‘Nice to see a GP face to face at last, do you know how long I’ve waited for this appointment?’ she said, with a look that combined the sneer of someone convinced I’ve had my feet up for the past couple of years and the indignation of the stoic who has endured her pain for as long as is humanly reasonable.

And, to be fair, it was a nasty ingrowing toenail.

But the case did highlight that the finger of blame for GP access issues remains pointed in completely the wrong direction. And no wonder. We already have the glorious QOF ‘quality improvement’ domain of ‘Optimising Access to General Practice’, in which, to Optimise Access to 37 QOF points, we have to ‘demonstrate continuous quality improvement’ on improving access and participate in ‘network activity to regularly share and discuss learning… on optimising access’. Which we’ll all make up on the basis that,  a) no one ever actually reads the feedback templates and, b) the time could be better spent, ironically, seeing patients.

Then there’s the recently introduced publication of league tables on GP waiting times and F2F appointments. This, of course, is all about transparency and opportunities to improve and not at all about keeping editors well stocked with anti-GP headline fodder and providing patients with the rage to kick us in the nuts.

And, finally, we now have NHS England’s attempts to modify our five-year contract by incorporating a new QOF ‘access marker’ and an IIF ‘Capacity and Support Indicator’ to include a target for appointments within two weeks.

Which suggests that, in the same way the folks at NHSE don’t seem to get the concept of ‘fixed’ in ‘fixed contract’, they don’t seem to understand the concept of ‘laws’ in ‘laws of physics’. 

We GPs cannot bend space-time to create new appointments but as long as NHSE continues to churn out these initiatives to suggest we can, everyone – hospitals, patients, media – will be misled into thinking that access failure is our fault. 

And that’s without addressing the other obvious issue of the NHS generally falling to bits with the result that even if we could solve GP access, there would be little benefit for the 10% of patients needing onward referral – they would simply swap a primary care bottleneck for a secondary care one.

Look, NHSE, the issues around access are not related to our laziness, lack of motivation, stupidity, reluctance to innovate, inability to ‘work smartly’ or ‘at scale’ etc etc, so they will not be solved by the addition of spurious new domains or indicators, or by publishing league tables. The problems are caused by – and I can hardly stop myself yawning as I write this – a lack of clinicians and too much work. 

So please stop thinking up these moronic initiatives/inducements/quasi solutions that imply general practice is to blame.

If you do continue to insist this is a problem I can solve, then I may have to innovate, discuss and disseminate with the PCN my radical idea for a new pre-appointment online questionnaire for patients, to screen out unnecessary consultations. 

And the first question it asks will be, ‘What newspaper do you read?’

Dr Copperfield is a GP in Essex. Read more of his blogs here