J Meirion Thomas has a familiar but worthwhile TCW piece on the marked decline of the GP service here in the UK.
The damaging decline of NHS general practice
GENERAL practice has been in accelerating decline for more than a decade, and no significant effort has been made to arrest the process. Not by any of the responsible arms of government who also foot the bill on behalf of the taxpayer, and least of all by the hierarchy of the GP profession who seem oblivious to the decay they are overseeing.
Family practice was once a cornerstone of the welfare state and a source of reassurance and confidence for the public. I have been astonished by the complacency with which millions of people tolerate waiting for a month or more for a GP appointment and even then, possibly virtually. Unless, rather than seeing a doctor, they are offered an earlier appointment with a practice nurse, a pharmacist, a physiotherapist or a paramedic. Worst of all, in some practices by a Physician’s Assistant, who is not a doctor although patients may not be aware of this.
If a solicitor or an accountant treated clients in this way, their practice would fail, but GPs have a guaranteed income irrespective of performance. Of course, some GPs do their best to maintain standards but it is equally true that there is no incentive to provide a better service than some of their colleagues.
Nobody in the UK is likely to be unfamiliar with the serious nature of the decline, but the whole piece is well worth reading as a reminder that none of our major political parties has any interest in arresting it. If past performance is any guide, then the decline is likely to become worse.
The death knell for general practice was rung in 2004 with a fatal decision negotiated between the British Medical Association and the then Labour government. GPs would work office hours only and have no responsibility for providing out-of-hours services to patients: not at night, at weekends or bank holidays. In return, GPs would be expected to ‘improve access to medical services for patients’. Did that happen? At the time, GP friends of mine could not believe the windfall benefits of the new contract. Surely this change amounted to an abdication of vocational responsibility?
The pandemic was another fatal blow for patient services. In April 2020, NHS England enforced a ‘remote total triage’ model for general practice to protect their staff from the virus. All consultations would be virtual. There was nothing similar for A&E staff who bore the risks and workload consequences. Because virtual consultation was so convenient for GPs, it was continued after the pandemic and is now part of regular practice.
6 comments:
I'm not one for saying "I told you so", but local experience supports all he wrote. Also, I stick to my opinion that the notional health service is a top-heavy self-serving bureaucracy which has been allowed or instructed to forget the reason for its existence and its consumption of so much taxpayers' money.
Pieces like this are useful, not least because they encourage the public to reflect on their experiences and ask whether the ongoing adulation of the NHS is justified. Does anyone actually think that the denizens of the local "Health Centre" are actually trying to help us? It's looking more and more like a simple racket.
Senora O'Blene has had the attendance of paramedics twice in the last few months, and their skills were excellent! She was carted off to AandE on both occasions and straight away was seen by a doctor, then a consultant. On the first occasion, we even had a pre-paramedic visit her to 'get the ball rolling'! (She'd had a couple of falls with complications).
I think we're just lucky being in an area where we have several doctors, and appointments are never far beyond a couple of days, with emergencies on a same-day basis. I'm sure this wouldn't be the same in large towns and cities, and to think that doctors in those places just aren't around out of office hours is very worrying.
Jannie - I expect it has been allowed to forget the reason for its existence, although having a major political party always rooting for it has made the decline inevitable.
Sam - yes it is looking more and more like a simple racket. The proliferation of rackets seems to be behind a more general decline in trust.
Scrobs - my impression is that it's very patchy and there are numerous anecdotes to highlight the good or the bad, but the bad can be very bad indeed. Various international measures do suggest that NHS performance is generally poor or mediocre.
Sorry I am late to this, as some know I have had an all in view of the NS in the last year or so and have seen close up the good the bad and the ugly.
Yet still the organisation keeps amazing all and sundry with it's ridiculous demands, we need more staff, despite being the biggest employer in Europe, we need more money, in fact they get a figure in the top half of developed countries despite claiming they are starved of finance.
Yet the other day while in the surgery, yes I managed to get an appointment for the wife, I was left staring at the TV above the reception area informing all and sundry how they can self diagnose use less of everything and generally save the NHS.
It finished with two messages aimed at immigrants and non nationals, telling them they can still avail themselves of NHS sevices and sign on here, it finished with having no documentation was not a problem as you can still sign on here.
Incredible that a surgery is the gateway to free NHS treatment to those who arrive illegally and have never paid a sous into the system, and they wonder why they need more of everything, time to tear the NHS as it stands down and start again.
Wiggia - I agree, time to tear the NHS down and start again. I suppose we may as well self diagnose because GPs mostly seem to act as a route to specialists of one kind or another. Assuming you can get hold of one.
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