“We get fined if we meet your wishes” – the NHS could be so much better

Liberal Democrats are rightly proud of the fact that the NHS exists and the role of Liberals, especially Beveridge, in its creation.

But I find there is a lot to be concerned about in the way it is run.  From the point of view of a patient I often feel more like a player in an elaborate board game.

When I call my local surgery for an appointment I am invariably told nothing is available for 2 or more weeks.  It’s always longer if I want something early or late to minimise the disruption to work.

But I am always told “if it is urgent we have appointments today.” I typical conversation goes like this:

Me: “I don’t think it’s really urgent. What counts as urgent?”

Surgery: “It is up to you to decide if you are urgent.”

Me: “If I come will I be pushing out someone else who might be more urgent?”

Surgery: “We can’t say.  But if *you* want to say you are *urgent* you can come today.”

Me: “You really can’t fit me in for 2 weeks otherwise?”

Surgery: “But you can come today if you say you are urgent.”

I feel that I am pressured to say I am urgent and am effectively blackmailed. I don’t believe medicine can really categorise people into “must be seen today” and “can wait two weeks”.  It feels like a game and I would not be surprised to learn if there is more payment to the surgery for self-certified “urgent” patients to be seen.

Today I was angered to right about this experience by a call from my local hospital, where the financial motive was admitted to.

I saw my GP two months who said I needed to be referred to hospital.  I heard nothing in that time and the problem has largely cleared up so I was going to leave it.  But today the hospital rang to make an appointment:

Me: “I am a bit surprised it has taken you two months to contact me.”

Hospital: “We’re very busy.”

Me: “Okay but the problem has largely cleared up.  Could we leave it a week or so to see whether I still need the appointment.”

Hospital: “No, we get fined if we don’t see you in a certain time. The only way we could avoid a fine is if I discharge you and you go back to your GP to refer you to use again.”

Me: “But that would use up more resources, wouldn’t it?”

Hospital:  “We have an extra clinic this Saturday and wondered if you want to come in then.”

Me: “When might it be otherwise?”

Hospital: “About 8 weeks.”

Me: “Right. I’ll open my diary.”

Hospital: “Oh, you don’t want this Saturday.  In that case we’ll ring you back.”

Me: “When?”

Hospital: “In about a week, for about 8 weeks time.”

This is bordering on a Monty Python sketch.  There are people who want to talk down the NHS to do away with it. If we don’t improve people’s experience of it those people will have more mileage.

Something has gone wrong.  It has gone particularly wrong when a public service says “we get fined if we meet your wishes.”



* Antony Hook was #2 on the South East European list in 2014, is the English Party's representative on the Federal Executive and produces this sites EU Referendum Roundup.

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  • Steve Comer 30th May '17 - 2:42pm

    I often find if I try to book a routine appointment with my GP a few weeks in advance, then I can’t because that is “too early to book”, but if I leave it until a couple of weeks before the date I want “it’s too late!”………
    I’ve resorted to ringing early several times, then eventually they tell me when the diary for the date I want opens, and I make a note in the diary ring then!
    Even so a waste of my time, and more importantly NHS resources.

  • Have you not seen The Wire?

    If there is a target, then people will do whatever it takes to meet the target: from distorting the service, up to simply denying reality.

    If there is a target for solving 90% of violent crimes, then every instance of a kid being nabbed shoplifting will be classified as a solved violent crime, and any mugging where the perpetrator doesn’t hang around to be cuffed will be classed as a simple robbery.

    In this case, there’s a target that all urgent patients be seen within 24, or 48, or something, hours. So: you keep (almost) all your appointment slots open in case someone urgent turns up, because you can’t afford to have someone urgent turn up and there not be a slot available. And anyone who isn’t urgent has to wait until the next one of your (very few) non-urgent appointments.

  • Lorenzo Cherin 30th May '17 - 3:43pm

    This is what baffles me , experiences such as this are regular , not now only , as the left want us to think , and all the fault of the coalition or the Tories, way back years !

    The fine is all well and good or the reverse , take your pick.

    It’s the notion that you waited two months for the hospital to ring you !

    Very busy, as an excuse?!

    The model of healthcare in this country is uniquely poor in most ways as far as structure and one aspect has nothing to do with the involvement of the private sector .

    We do everything by referal from gp to hospital .

    In most countries whether left or right dominating the debate on delivery, there are specialists on the high street , and several times the number of them , compared to this country.

    That is the problem.

    Too few doctors for too many people. Too much stress for too many patients.It is not the envy of the world and we should stop kidding ourselves it is. It has not been since the seventies !

    It needs much more thyan a penny on taxes !

  • Graham Martin-Royle 30th May '17 - 4:45pm

    With my GP surgery you have to ring on the day to get an appointment, there is no advance booking system. You have to ring as soon as the surgery opens (08.00hrs) and then the reception will get the Dr to ring you back to discuss if you really need to come in. Okay, you do get to see the Dr that day but there are several problems.

    Firstly, the phone number is always engaged as everyone and his dog are all ringing at the same time, clogging up the line. It can take over 1/2hr to get through, at which point I’ve been told to ring back tomorrow as it’s now too late. There is the wasting of both my and the Dr’s time as we go through this rigmarole.

    Then there is the fact that this system takes no account of those of us who work, especially those of us who do shift work. I have to leave home at 04.30hrs when I’m on early shift. Am I supposed to take time off work just to make the appointment? I can’t call when I return from work because “you have to call at 08.00hrs when the surgery opens”! If I’m on late shift I invariably get given an appointment for the afternoon which again means taking time off work (If it’s urgent, fine, if it’s an emergency I’ll call 999, otherwise, for routine appointments I don’t want to lose money by taking time off) or, if I demure I’ll get told to ring again the next day.

    All round, it’s a bloody nightmare that appears to have been put in place more for the convenience of the Dr’s than the patients.

  • When people say they like the NHS but they don’t like how it is run, then what part of it do they actually like? The NHS is a system of running healthcare.

    If it’s just the fact that its free, well ok, but there are plenty of alternative models which have that too, for example in continental Europe.

  • Graham Evans 30th May '17 - 5:11pm

    I think the experience of GP surgeries seem to vary greatly across the country. To some extent my own experience resembles that of Antony though in general I think it is marginally better. However, I do tend to agree with him regarding what happens if you are referred to a hospital. One of the things that surprised me recently was that if you are referred for an X-ray you can usually turn up within 24 hours or so, but if you need an ultrasound scan the booking system can involve an eight week wait. This seems bizarre given the simplicity of ultrasound technology these days.

    However, I’m not sure I agree with the criticism of the GP referral system. Other countries have looked at copying the system because it is a good way of avoiding unnecessary use of specialist services. They have failed to act not because they think the system is bad but simply because of reluctance on the part of voters to embrace change, even though it may well improve the efficiency of health services.

  • Peter Andrews 30th May '17 - 9:07pm

    Our GP surgery runs a drop in clinic every weekday morning. Any patient can come in and wait to be seen. Booked appointments are a separate thing and basically are for people requiring ongoing care, my Mum has a monthly appointment for example and simply books the next one when she is at the surgery for her appointment.

  • Philip Rolle 30th May '17 - 10:23pm

    I think surgeries that won’t offer advance appointments should be named and shamed. It is most frustrating for patients.

  • Ah the scourge of the Key Performance Indicator…. Measuring process instead of outcome, the procurement teams favourite tool to diminish the quality of services by reducing them to a box ticking exercise.

  • Large White Bear 31st May '17 - 9:19am

    Another aspect of this is the weekend closure. My partner has several health conditions and if he is ill at the weekend it means taking him to an ‘out of hours’ service that’s miles away with doctors who don’t know him – or A&E. In both cases, it means long and worrying waits and is less satisfactory than familiar surroundings where he and I are known. Over Christmas and New Year the surgery was shut continuously.

    GPs have very high salaries: why can’t they organise rotas and shift patterns like everyone else? I work in Property management and often have weekend work commitments – and sometimes public holidays. Given the amount of money they receive it doesn’t seem a very big ask.

  • Fundamental to all of this is a shortage of GPs, and the current obsession of presuming that everything except ‘front line services’ is wasteful and should be cut.

    GPs do work ‘out of hours’ on a rota system. Some opt out, but it’s worth remembering that when a qualifying doctor picks their speciality, part of that choice is the sort of hours they want to work, which is also reflected in their pay. Public Health doctors do mainly office hours, but there will always be an on-call rota to deal with a food poisoning outbreak etc. On the other hand, an A&E doctor will routinely be at the actual hospital on a Saturday night, and those on-call will expect to get a phone call.

    We are struggling to fill GP posts to meet the appointments during week days. Many experienced GPs want to retire early, as they’ve had enough, so I say let them work part-time if that’s all they are prepared to do. I don’t think telling new mums that they must return full time, including mandatory night-shifts, falls in line with our family friendly policies.

    That’s not to say that we can’t improve the appointment systems, and encourage GPs to consider that pressing redial for fifteen minutes from 8am only to be told to try again tomorrow, is reasonable for a lot of workers. The whole ‘urgent’ appointment thing has huge potential for abuse, and is plain confusing for those of us who rarely attend our GP, and are mindful that there are people more ill than us. Yet I know people who always ask for an ‘urgent’ appointment, and have no qualms even when it’s blatantly not urgent.

  • Lorenzo Cherin 31st May '17 - 11:35am

    The commentators are putting the gp element of the article at the front of consideration, and almost if, I could , put it this way, ignoring the specialist referral part, which is in my opinion more crucial.

    The one contributor who does , says it is a good model we have , as it saves scarce resources, missing the point completely, specialists should not be scarce at all but many in number and freely available to all who need them.

    Until we as a nation wake up to the need to not just in dire need, buy in foreign doctors but on a massive increase basis, train our own , consultants and make them available closer to home than merely in vast impersonal hospitals, we shall make no progress.

    My wife needed physio , needs it ongoing, referred , with a wait, to the one main hospital catering for over a quarter of a million residents ! On our street there is a private physiotherapist.

    Labour and the Green party want to end private involvement in the NHS .

    Nye Bevan let gps and consultants be contracted at that time as self employed , on the one hand , or at least available for private work on the other hand.

    The left are going backwards and the right are going in the profit making big business direction.

    The answer is vast sums of public money going to a multiplicity of smaller and individual providers of all the necessary services, all joined up and freely available locally and flexibly. A holistic health and care service.Accountable to the patient not only the government , secretary of state or councils.

    There is Liberalism. That is democracy .

  • Trouble with the NHS is everyone has their own idea of how to fix it and too few people are willing to get on with it.

    At least we are promising the 1p income tax with the proceeds for increased NHS funding.

  • David Evershed 31st May '17 - 4:57pm

    I sit on the Patient Participation Group at my GP surgery.

    One of the issues is that over 50% of new doctors are women. Once they have children, understandably many women doctors prefer to be part time and/or to be employed by the GP practice rather than become full partners in the private business.

    Consequently the practice has to employ a large number of part time (non partner)doctors who just work their allotted number of appointments regardless of demand.

    A full time doctor covers about 2,000 patients but a part time doctor seems to cover less than half the number. So with 20,000 patients in the practice we would have 10 full time doctors. But with only six full time doctors we need up to ten part time employee doctors, not just eight.

    Also the turnover of women doctors seems greater as they sometimes move away with their partner’s job and take a career break while they bring up their children. This makes it harder for patients to have the same doctor who is familiar with their complaints and can thus deal with it more speedily or deal with it over the telephone.

    These are just observations, not judgements about gender issues.

  • Richard S: Come on. If I say I think a local Liberal Democrat party is badly run, I don’t mean it ought to be outsourced to a private company or reorganised as a military unit. I mean it’s inefficient and indecisive. I mean within the same broad system, it could be better if the people making decisions knew what they were doing. I’ve had extensive experience of the NHS and social care systems in the last five months as a carer. Much of it was horrendous. Some of the problems were clearly down to underfunding, but much to poor management. In particular, people made decisions in little boxes without considering the implications for other boxes and hence for the patient and the number of boxes is of course enormous, which means even someone pretty well qualified to understand the system like myself often can’t. There was a widespread culture of not communicating either with people allegedly working to the same ends, or with patients or carers. And yes, while targets have achieved some successes they often lead to nonsensical results.

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