Getting a doctor’s appointment is becoming more and more of a challenge. Whether it means explaining in detail to a non-qualified receptionist who triages requests, or having to grapple with an inflexible online booking system, or having to join a phone queue at 8am exactly, or even filling in an online form just to be put in another triage queue – the processes seem designed to make you think it’s not worth it. They are particularly trying for anyone who is elderly, sick or in pain, or who has a chronic medical condition, and these, after all, take up a large proportion of appointments.
During the pandemic we got used to phone and video consultations, but we all knew these were not the most effective way to make a diagnosis, and there is plenty of anecdotal evidence that serious conditions were missed. It may still make sense for a doctor to hold an initial remote conversation, but only if an in-person appointment can be made speedily if needed.
But the delays in getting appointments is very real. Years ago no-one would have been offered a GP appointment in two weeks’ time for a new condition, and yet that is what is happening now.
Ed Davey is announcing plans to give us all the legal right to see a GP within a week (or 24 hours if urgent). It is certainly an indicator of the stresses within the NHS if a week’s delay is seen as an improvement. He has unearthed data which shows that 25% of people in some areas have to wait over two weeks for an appointment. This is in the context of the two week target for suspected cancer cases to be seen by a specialist, where the clock only starts once someone has actually seen their GP. That wait could be doubled if they can’t get a GP appointment immediately.
The proposal is that this right would be enshrined in law, thus putting a duty on the Government to ensure that it happens. Of course, it can only be achieved if the recruitment and retention of GPs is improved, and that requires action at the highest level.
So watch out for the announcement in Ed’s major speech at the weekend – designed to replace the missed Conference speech. Ahead of that he has said:
Far too many people are struggling to get a GP appointment when they need one, leaving them waiting anxiously for the care they deserve.
This can lead to missed or delayed diagnoses, or people turning in desperation to our overstretched A&E departments instead.
Patients are suffering from years of neglect under the Conservatives, who have repeatedly broken their promise to recruit more GPs.
Liberal Democrats would guarantee people a right to a GP appointment within one week, or within 24 hours if they are in urgent need. This would reduce pressure on our hospitals and paramedics, saving crucial time and money elsewhere in the NHS.
* Mary Reid is a contributing editor on Lib Dem Voice. She was a councillor in Kingston upon Thames, where she is still very active with the local party, and is the Hon President of Kingston Lib Dems.
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29 Comments
I think the idea of a legal right to see a GP within a week is daft. How would you enforce it?
This is like announcing 40 new hospitals and assuming it is done.
This is what I would term as ‘opposition policy’. I can’t believe a government would bring in policy which creates issues for itself and takes staff members attention away from difficulties NHS is currently having in order to battle court cases, but it’s something voters will want on the face of it.
But this isn’t calling for a vote on fracking when government of the day is powder keg waiting to explode, this is the UK’s health system. I will wait for details before final judgement.
I am pretty appalled by this “policy”. Without a solid plan about how to make this attainable we are just echoing the populist right by shouting at a struggling health service.
This seems to be echoing the comments Sajid Javid made when he was Health Secretary. We are surely more constructive and imaginative than him.
A family member of mine is a GP and I am frankly embarrassed that we are part of the political voices stigmatising them. When we should be supporting him.
This policy is crass and unimaginative and not a great reflection on Ed Davey’s leadership.
I think it’s a great policy and should be part of a wider approach of putting user rights at the heart of healthcare.
GPs might be against it but I feel that sometimes what they say goes unchallenged.
The only issue is that I don’t remember the Lib Dems raising the issue of remote appointments being inadequate during the pandemic.
In Mary’s OP it states:
“Of course, it can only be achieved if the recruitment and retention of GPs is improved, and that requires action at the highest level.”
Isn’t that the real problem? Not enough GPs? Especially in some areas – Blackpool was featured in the news today as a town with big problems of GP shortages.
Surely it’s better that people can see their GP within a reasonable time limit because if they can’t they’re likely to go to A&E – which doesn’t solve any of our NHS problems – it just moves them elsewhere in the NHS.
I note also refers to seeing a GP within a week – maybe that might not necessarily be one’s named GP…?
I’m not saying that I think this proposal is a done and dusted great one – not unless/until I can be convinced that it is part of addressing a SMART objective – that unwell people can be seen, diagnosed and if necessary treated within a timescale appropriate to the ailment.
Personally I would’t mind an initial visit to a practice nurse appropriately trained to deal with minor ailments and to get the GP straight away if doubtful about the diagnosis or certain that it’s urgent.
Thank goodness all these other sensible people have already said what I was going to say. The bleeding’ obvious – it’s not that GPs are finding it inconvenient to meet patients and headed out for long lunches before doing a couple of Zooms, it’s that there JUST ARENT ENOUGH OF THEM and anyone reading the papers for the last 10 years would be familiar with repeated warnings that GPS are ageing, leaving the profession in ways that will make the service unsustainable by, er, the 2020s. This is Kindergarten politics – surely we can do better.
“This is Kindergarten politics – surely we can do better.”
Exactly Martin. Well done for saying like it is.
We are addressing the symptoms, not the condition with this fake rights based approach.
If this is the best we can do then we deserve to stay at 5% in the polls.
Zachary Adam Parker and Martin Pierce – I think you have misunderstood the proposal. It does not criticise GPs in any way, indeed it is sympathetic towards the pressures they are under.
What this policy does is to shift the responsibility for providing adequate health care from the NHS and from GP practices firmly on to the Government. A legal right means that the Government is at fault if it does not provide the resources to meet it. It is different from a target imposed from above on the NHS without resources following.
‘During the pandemic we got used to phone and video consultations, but we all knew these were not the most effective way to make a diagnosis, and there is plenty of anecdotal evidence that serious conditions were missed.’ I don’t agree. I got a phone consultation during lockdown at an hour’s notice, sent the GP a photo of my condition, got a prompt and accurate diagnosis and a suitable prescription. It’s true serious conditions can get missed but that can happen with in-person consultations. Anyway, 7 days is too long and making it a legal requirement is a job-creation scheme for lawyers, not doctors. Technology can and has reduced pressure on GP resources.
But @Mary Reid the point that concerns me is that if “friendly to us” people are misunderstanding the proposal put the way it is, so is anyone else looking to have a go. Sadly we are in a world of soundbites, and quick flick through, not carefully reading proposals and considering just how it will work well.
As for what @MarkFrankel says, afraid we have had more than our fair share of appointments in the last year in this house, but the phone consultations or even just use of e-consult have worked well for us in either getting a prescription given or advice, or a quick appointment made.
As for length of waiting time, it clearly needs to be tackled, but it does all depend on urgency for the patient and balancing that with wish to see a particular doctor. In the past month I have had a wait of over 3 weeks because I wanted to discuss the result of a scan with the dr who referred me, and that was fine by me. But was seen the same day about a terrible cough. It isn’t as simple as “appt within 7 days”.
Having had a pancreatic infection in the past, I would not have lasted 7 days.
There is serious illnesses still, its degrading and against the rules of compassion we live by.
I can’t quite believe in today’s world why this is allowed to happen.
Who thought this was a great idea? It sends out all the wrong messages. The fact that it has been “misunderstood” says it all. It panders to those who want to scapegoat GPs and divert us away from the real issue. 12 Years of Tory underfunding.
I don’t care that it was not supposed to criticise GPs. That’s how it comes across. Drop it for all our sakes, before even more damage is done to our reputation.
I wasn’t going to comment as I didn’t want to rain on what’s clearly supposed to be a big policy launch, but I see others have got there first – this is motherhood and apple pie, and the worst of what the Government have done in the past 6 years. Announce catchy slogans with no mechanisms to achieve them, and expect people to be impressed, or that you have a deliverable plan if you were in power.
What if I’m a GP with 100 slots and 120 people demanding one? How does this being the Government’s fault change anything or help anyone? Will you be encouraged to take legal action against the Gvt if you can’t get your appointment in 7 days? How long is that supposed to take, or make things any better?
The grown up version would be to take the Jeremy Hunt amendment to the Health Bill, on the NHS producing a staffing need plan each year, and put a responsibilty on Gvt to aim towards this. Clinical staff take years in expensive training and you can’t substitute others in (and the raising of the ethical argument about importing from abroad is one of the few positives of Brexit.) so how can you plug gaps?
I reckon if this emerging Lib Dem policy was implemented, you’d end up with pre-screening questionnaires, and patients refused access to GPs, so that all cases with merit met the deadlines. Without extra appointments, it’s just a call for rationing. I hope it gets dropped.
@tpfkar
As I pointed out earlier – the OP stated:-
“Of course, it can only be achieved if the recruitment and retention of GPs is improved, and that requires action at the highest level.”
Did you actually read the OP?
If this policy came in, you woud probably end up with those who are seen within 1 or 2 days at the present not being seen until after 6 days. How is that an improvement?
Proposals like this just make me sigh with despair. It’s your legal right to see a GP in a given timeframe. So what if you can’t? Sue the NHS? Put the doctor in prison? This is the worst type of left wing thinking: ‘Solving’ scarcity by changing the law to abolish it. Food too expensive? Easy, just change the law and make it cheap. Oh dear, now there’s empty shelves in the shops… but there might just be something under the counter for favoured customers at the right price.
Most of the comments seem to completely miss the point – We are not seen as a Party of Government, more as an Alternative Opposition or a Campaign Group/Thinktank. The odds against our being in Government in the next Decade are astronomical & if we were it would be as a Junior Partner in a Labour-led Coalition.
This proposal has one purpose – to get us Media attention. I would have thought it would have a good chance of doing that, we will know in a few days anyway.
@ Paul Barker. If your first paragraph is correct, then what on earth is the point ?
As a retired GP I find this very disappointing. The reality is that if you have an urgent problem AND you can get past the receptionist ( big AND) GP s will see you on the same day. When the Blair government brought in the 48 hour rule we all moaned, it was chaos for a while and then it sorted itself out. Two things are needed
1. Clinicians should triage all calls. 2. All GP practices should be walk in alongside booked appointments. ( this also worked well in the Blair years , at least the one I worked in did!)
To achieve this we need more health care and physician assistants to take on routine work and of course more nurses and doctors . The latter will take time of course but some things can be done now. The Tories. Hold start by taking the NHS seriously and providing the investment it needs
This policy is getting a lot of flak on here, but given the genuine sense from a lot of the public that the system isn’t working properly (along with other things since Covid lockdown disruption), some top down directive to return things to pre-Covid operations isn’t such a terrible thing
The NHS is large, clunky and inefficient (I’ve worked in it as a doctor) and it’s rare for things to improve by themselves. Blair’s 4 hour rule for A&E (be treated/discharged/admitted) did improve the service, not least because it forced a total rethink of how A&E was organised, resulting in a streamlined process, more organised clinical management, decentralisation of roles and responsibilities away from scare medical personnel and into the hands of readily available and still perfectly competent non-medical personnel, and a shift in working culture. Sure there was gaming of the process (as there always will be) but the overall outcome was positive so this sort of measure could be a step in the right direction
@Mary, yes and no. This sort of policy puts the onus on individual GPs to deliver on the target (as the onus for A&E targets fell on NHS Trust). Before giving more resources (throwing money at things rarely solves problems by itself), GPs need to try and get creative with the resources they already have
The one downside to these sort of managerial and target directives is they favour very large and multi-practice chains, and further the decline of family and single GP practices.
@Meg Thomas
Very helpful to have a pro in this discussion.
Does ‘clinician’ include nurse and if so do they need any special qualifications to do the triaging?
Difficulty getting past receptionist – does this mean they need more appropriate training or what?
@James Pugh
“GPs need to try and get creative with the resources they already have”
But it appears the number of working GPs has been declining. Isn’t there a limit on just how creative the ones still working can be?
“further the decline of family and single GP practices.”
Some areas – rural – might love to have any kind of GP practice on their patch.
@nonconformistradical
“””But it appears the number of working GPs has been declining. Isn’t there a limit on just how creative the ones still working can be?”””
One of the (many) inbuilt and engrained inefficiencies in the NHS is the range and volume of of tasks done by doctors. Tasks that really don’t need that level of clinical training or knowledge and could be done by Nurse Practitioners, Nurses, Physician’s Assistants, Managers, Administrators and Paramedic type people
Doctors from overseas are often amazed at the level of simple, menial or plain drudge work that is a doctors’ responsibility here. Admittedly this problem is far worse in hospitals than in Primary Care, but there is scope to look at how GP practices are run (especially since all GP practices are private contractors so there will be significantly variation and things to learn from)
“More doctors” or “more money” isn’t necessarily the solution
So we’re now taking clinical decision making as a Lib Dem power are we. It’s a nonsense proposal, dard I say it a populist one (in the bad definition of that word) and demonstrates to anyone with an understanding of healthcare that we don’t know what we’re talking about.
The U.K. has a healthcare workforce shortage, across all professions. Without a proper plan, for each devolved nation and supported by one at the U.K. level, for stabilising and growing the workforce, proposals like these are empty gestures. Allied to that is the vexed question of whether everyone who wants to see a GP actually needs to see one, or would be better seeing a nurse, or an AHP, who can diagnose many conditions and for advanced practitioner prescribe and refer.
This seems like a proposal made to capture a moment without thinking about the forces that have created that moment. A bit like how we’ve create many of our GE manifestos in the past. Rather than how we create new policy, through working groups that look at a range of evidence and possible solutions.
The one thing we know, through lots and lots of evidence, is that in health and social care, such targets usually come with unintended and often contrary consequences.
As others have said, this policy sounds aspirational and while I’m sure some thought has been given on how to get there, without emphasis on those steps it comes across as unrealistic. I’m wary of the impact of any legal obligation. The Scottish Government set a series of legally binding targets for the Scottish NHS, but they are routinely missed with no consequence.
The right to see a GP within 7 days is fine, though presumably this doesn’t place an obligation, so people could still book appointments well in advance if more appropriate, and I think that should be a specified, because right now I can only get an appointment with my GP on the day (if I’m lucky in the morning lottery) or exactly one week later (also requires luck in the morning lottery). If I could book ahead for two weeks on Tuesday for something less urgent, it would be a vast improvement.
The emphasis on in person appointments feels like it’s pandering to complaints on letters pages of the right-wing papers, not clinical need. Yes, there are times when in person appointments are better, but many times when it’s not, and policies that perpetuate the impression that telephone or online consultations are always inferior is going to get in the way of reducing overall waiting times.
On top of the GPs problems there is also the associated problem of the shortage of pharmacists, if my area is typical of the whole country pharmacies are closing in worrying numbers through lack of staff making it more and more difficult for patients to acquire their much needed prescriptions, it seems our much loved NHS is in real trouble?
I find it surprising how rare both triage-gated and multi-tiered health services are.
Meg Thomas alludes to what is involved, namely having people with clinical skills fielding calls. However, it requires more than this, also needs tiered provision and people to have awareness.
In my area we have a “community hospital”, it has walk-in accident and outpatients departments. So the GP’s clinician will decide whether the patient is going to be best served by seeing the GP (so arrange appointment) or going to the Community hospital and seeing a relevant expert and having X-rays etc. and thus avoiding the delays inherent in GP referral and effectively wasting a GP’s appointment slot. Additionally, it means the patient gets a better diagnosis earlier and doesn’t add load on to the local hospital’s ambulance served A&E.
So to me, having some legal right to see my GP within n days, doesn’t really give me any benefit. However, improving public transport (bus service) and so making access to the community hospital easier will give benefits.
This policy really is rather silly. I saw my doctor last week, six weeks after I made the appointment, which was not an urgent one. I mentioned the delay to her and she explained why it took so long. She had substantial leave owing to her which she would lose if she didn’t take it. Some of the other doctors in the practice had children and it was half term. Covid was also doing the rounds again. I know it’s difficult for Ed Davey to hit the headlines, but it’s not sensible to try to do it with unrealistic ideas dreamt up from somewhere.
@David Blake
What appears to be being proposed is a right i.e. an entitlement. But is there any obligation on the patient to insist on exercising their right if the situation isn’t sufficiently urgent? I’ve just been in a similar situation as you with GP being on leave although I only have to wait a couple of weeks or so (which is fine by me).
Is your practice a one GP practice or are there other GPs?