Dr Copperfield is fed up with the dizzying circus that is accessing care in the NHS, and the position in which it leaves GPs
So proud of the NHS this week. And I’m sure you were, too, when you heard the widely reported story of how superbly the service dealt with a patient in Telford seeking an appointment with her GP. Her surgery was fully booked, so she was signposted to 111, who called paramedics, who advised she needed a GP appointment, which they booked. That’s how patient pathways work. That’s seamless care. That’s a user journey that could only have been bettered if that final GP appointment had been unavailable, resulting in a return ticket via 111 and another ambulance. That would have been the value-for-money scenic route.
Of course, going round in circles is not limited to accessing the NHS. Once inside, the process is just as dizzying. Hence my new, severely depressed patient this week, who has gone from psychiatric pillar to post with involvement from 111 option 2, First Response Team, Mental Health Crisis Team, the Urgent Care Department, A&E, a half-way house sanctuary and an admissions-avoidance team. Everyone, in fact, except an actual psychiatrist. His mental health may be not better, but he’s at least got to know the area.
And I find the same when I’m trying to access care for patients myself. For example, when confronted by the acute-on-chronic elderly care crisis known technically as ‘gone off her legs’, I have a bewildering number of choices. There’s the urgent elderly care helpline. A frailty clinic (actual). A frailty clinic (virtual). An urgent community response team. An emergency response team. The community nursing service. An acute visiting service. And so on.
Somehow, at some point, someone thought it would be a great idea to deconstruct NHS services into tiny silos. These give a semblance of specific and appropriate care, but the reality is the opposite. Because the characteristics they share include inaccessibility, facelessness, obstructive and ever-changing referral criteria, a predilection for screening, assessing and signposting over actually treating, and an inability or unwillingness to communicate with the other cogs in the machine. And, most of all, a complete aversion to ‘owning the problem’: once patients are sucked into this vortex, there is no way of knowing who, if anyone, is making, or willing to make, definitive management decisions.
Except, of course, those sat in the middle of this dysfunctional merry-go-round: that’s us GPs, who are left to make sense of it all.
Welcome to our great NHS! I say welcome, but actually, you might just want to walk around it a few times and go home.
Dr Tony Copperfield is a GP in Essex
Currently on that merry-go-round with an elderly father, 4 failed discharges later, nobody ‘owning the problems’, everyone is “just a messenger”, invisible social worker making decisions excluding the patient and his family, and not contactable….going round and round….Deep joy
That Telford scenario is exactly what you get when you insist that the GP surgery has to ringfence a proportion of it’s avaiable consultation time to be only bookable by 111, and not allow GP Receptionists to use it up for urgent patients who contact them direct – sometimes leaving the ‘111-only’ slots completely unused at the end of the day, whilst direct contact patients are unable to book !
Traditional GP services can do so much better when flexibility is allowed. I have not yet heard final outcome, but yestereve hopefully avoided a patient being ambulanced to AE at 18:20 following a collapse, when, following suitable assessment, in absence of anyone being able to get to any community pharmacy before their respective closing times within a 90-minute radius, suitable medication was deliverd by the daytime doctor on their way home after work, from Surgery stock. (Hoping AMR does not foil outcome!)
Exactly so TC about the deconstructed and overmanaged NHS and the horrors it now visits on some patients caught in its maze. The thing that pisses me off though is that there’s an assumption that the public sector is automatically bureaucratic (fragmented and siloed) – but it doesn’t have to be so – it’s been made that way by those who’d like to see it finished off. Isn’t it funny that a fundamentalist article of faith in the economic theory of the privatising pirates (I mean from Blair’s Labour to the Tory incumbents) is deregulation and independence for private enterprise.
Yet they never extend the same to our prime national asset the NHS which is over-regulated and micromanaged by politicians and managers who have no idea about virtuous care.
Yes Tony I’ve seen one of my flock being sent on a ludicrous circular journey, quite literally via a hospital 60 miles distant only to be told to re-approach his GP with his original problem, which took me 10 minutes to sort out, but 8 hours after he first accessed the system. This sort of patient pathway is dreamed up by ignorant arseholes who are too thick to know they are so, who think this is good patient care. Reading Labour’s plans gives me no hope either. More apps, more tech, more pathways, more bullshit. I would say Fuck The Tories but it seems I may have to widen my attack.
Dr No more like a plague on both your houses.There lobby groups in the shadows pulling the strings of the puppets and influencing policy for profit.
Small point, but I can advise, we don’t allow NHS 111 to book directly. They’re too rubbish and unsafe to trust that. Our Duty Doc will scrutinize their nonsense and I am happy to defend our position every time this happens.
Outside merry go round mess as expected