Wednesday, May 15, 2013
At around 3pm on Sunday a member of our family was taken ill. So my wife rang the local surgery and was told to bring her in immediately. I drove them both to the clinic and by 5pm we were all back home. The ailing patient had been seen by an expert practitioner, the illness diagnosed, treatment administered and a course of pills prescribed. Not long after we got back, we received an email from the very efficient receptionist to check everything was OK and to inform us that the patient's records had been updated.
Now, you may be asking: is this a fantasy? Were we overseas at the weekend, or had we entered a time-warp to another era? No, this was Britain - but the patient was our cat. As we loaded her basket into the car, it struck us that her chances of getting to see a vet at the weekend were greater than ours of consulting a GP. Had I or my wife been taken ill on Sunday afternoon, we would have had to ring the new non-emergency 111 number to speak to someone unable to make a proper diagnosis, since they could not have seen us, and who probably wouldn't have had the required expertise in any case.
The 111 number is proving a disaster, with an increasing number of callers giving up in frustration at their inability to get through. Had one of us been really sick, then presumably an out-of-hours doctor could have been contacted, though providers are finding it hard to recruit GPs to do these shifts and are using nurses instead. A drop-in clinic might have been an option, though I am not aware of one near our home.
Almost certainly, we would have ended up at the local hospital's casualty department, waiting for ages with all the others for whom A&E has become the out-of-hours replacement for the GP's surgery. As David Prior, head of the Care Quality Commission, said last week, the pressure on hospital A&E services has now reached crisis point. We are always being told that the NHS is "the envy of the world", a claim that hasn't been true for years. But it has come to something when our pets are likely to get better, and certainly more personal, treatment in the evenings and weekends than their owners. It's even easier to get an appointment during the day.
Yes, I know this comparison is simplistic: there are obviously many differences between caring for animals and humans. One is that we had to pay for the cat's treatment, but we are insured and will get the money back. Apart from a relatively small "excess" the cost was reasonable. However, the principle of providing out-of-hours availability is the same, so why can't our GPs organise themselves the same way as vets do? Why is it that when every other profession or industry is expected to work at weekends, doctors don't? Had we gone to our big south London surgery on Sunday, it would have been closed.
The A&E fiasco is the predictable (indeed it was predicted) outcome of the GP contract that took effect nearly 10 years ago, compounded by EU restrictions on the working hours of junior doctors and a target-obsessed approach to health-care provision. At the weekend, it was revealed that ambulances with patients on board are being fined up to £1,000 for waiting outside overcrowded casualty departments. Presumably, while these ambulances are tied up, fewer are available to attend what might be a life-threatening emergency.
Meanwhile, primary care is in the throes of a structural upheaval; and while ministers hope this will result in GP practices extending their opening hours, many doctors are resisting. They argue that what people really want is better access during normal working hours, but this is simply not true.
Figures compiled by the Department of Health last year indicated that the vast majority of patients were unhappy with the opening hours of their GP surgeries. We have the worst possible combination, therefore, of long waits for routine appointments but limited opening hours. It is a health-care system that is not responsive to the needs of patients but set up for the convenience of its practitioners.
Which brings me back to our cat. We need to move to a health service that allows people to pay for primary care and take out insurance to cover the cost, but our politicians refuse to contemplate this prospect because they are wedded to a structure that has essentially remained unchanged for 60 years.
The problems in the NHS stem from a variety of sources, such as a growing elderly population. But its difficulties are also caused by the fact that it is a state monopoly funded through direct taxation. This has been an article of faith for every political party since 1948, but while everyone knows it doesn't work any more, governments will not even think about doing things differently.
The Conservatives fear being accused of privatising the NHS and of creating a two-tier health system. Labour would rather have sub-standard care for the many than see some pay for better care. They think the answer is more state spending, yet in recent years, as the NHS budget has risen inexorably, its bureaucracy has swollen, cottage hospitals have closed, A&E centres have become chaotic, trust deficits have increased, superbugs have spread and primary care has declined.
Other similarly advanced countries, such as Germany and France with their social insurance schemes, provide much better health care at all levels because they can respond more easily to changes in demand. Could such an approach work here? Just ask our cat.
(Author: Philip Johnston Source: telegraph.co.uk)
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