To serve the public, eh?

Almost all GPs do not want their own practice to open seven days a week, a poll of 15,000 doctors has found.

Plans for 7 day access to GPs are the key Conservative manifesto health pledge, along with improved hospital services at weekends.

But the British Medical Association (BMA) survey found that 94 per cent of family doctors do not want their own surgery to offer seven day opening.

Can you say producer capture?

62 thoughts on “To serve the public, eh?”

  1. Is there any real benefit to a GP being open 7 days a week? It’s just going to mean some GPs working Sundays and having Fridays off, others working Saturday and having Mondays off. You’re not creating more capacity, you’re just spreading the capacity around (and increasing the cost of receptionists and things like software support).

    OK, we might prefer them to work Saturdays and Sundays, in which case, close them Monday and Tuesdays.

    (the real answer is scrapping GPs and turning most doctors into specialists, but you’ll have people getting wistful about Dr Findlay if you do).

  2. Could it be that too many of the doctors are part-timers? So if there was a rota for working outside “normal” hours in order to provide full evening and week-end cover the full-time partners, who comprise a minority of all GPs but would be the only ones expected to provide out-of-hours cover, would have to work more than the 48 hours per week limit.
    I notice that, as usual, all the photographs in the article are of females. Before I moved here I was served by a two-person practice with one male and one female GP. The two split surgery hours and had an out-of-hours number to call in emergencies, to which the male doctor responded. [No, I do not know what happened when he went away on holiday, partly because no-one ever mentioned him being away on holiday: sad guy, but a good doctor.]

  3. It’s always hard to get professionals to work weekends. Banks have only fairly recently started opening at weekends, and that’s in no small part thanks to the de-skilling of bank teller work.

  4. The Stigler asks “Is there any real benefit to a GP being open 7 days a week?” My answer is that it’s not just Mondays to Fridays that people fall ill.

    I went into my doctor’s surgery a year ago with a seriously irregular heart beat. They told me there was no doctor available. So I asked what they’d like me to do: drop dead perhaps? As it happens the local hospital A&E was 20 minutes walk away, so I walked there.

    No doctor available at your local surgery can be a problem!!!

  5. “It’s always hard to get professionals to work weekends”

    Depends what sort of professionals. I don’t imagine corporate finance lawyers get very far if they tell the boss “sorry, playing golf on Sunday, can that wait until Monday?”

  6. Every other area of society in the last 30 years has moved to a virtual 24/7 basis. Shops are open 24/7. Petrol stations are open 24/7. Banks may not be open 24/7, but their services are, via ATMs and now internet banking. Pubs are open to all hours of the night, and all weekends. Oddly enough whenever the customer has been able to determine when services are offered by spending his or her money with a service provider that provides the service at the time they want, the market has tended towards extended business hours.

    I’ll now wait for lost_nurse to come along and tell us that patients don’t want a 24/7 NHS, that there’s no demand for it whatsoever, and we should ignore anyone who says otherwise because they just want us to have an American healthcare system with the poor dying in ditches.

  7. There is another good reason for not opening at weekends. People still get ill, and GP’s are still required.

    However, weekend cover is a relatively ungenerous part of the GP contract. That’s why no one will do it. The gap is partly filled by the NHS paying eye-popping weekend cover rates. It is not uncommon for European doctors to stay put in, say Germany, but fly in for the weekend.

    Opening at the weekend would drasrically reduce the pay on offer.

  8. Ralph,

    “The Stigler asks “Is there any real benefit to a GP being open 7 days a week?” My answer is that it’s not just Mondays to Fridays that people fall ill.”

    Sure, and people also get sick at 3am. Are we going to provide GP cover for that, or do we use things like A&E for those services?

    There are things that need sorting straight away and things that can wait. In the case of an irregular heartbeat, I’d go straight to A&E rather than wasting my time talking to a doctor who has few of the diagnostic or surgical facilities of a hospital and will probably send you to A&E. There is zero chance that A&E will say “sorry, we can’t help you, but your GP can”.

  9. Jim,
    > Every other area of society in the last 30 years has moved to a virtual 24/7 basis.

    Take a walk through the City of London or Canary Wharf this weekend, then come back and tell me how much of our society is 24/7.

  10. @Andrew M:

    Fair point, but the IT teams will all be working 24/7 to keep the banks up and running. It’s just that they keep them hidden in the basement of some industrial estate in Swindon.

    And the top guys will still be working all weekend on their laptops, just at home.

  11. Doctors have been persuaded that they are national treasures rather than professionals, deserving of having their mouths stuffed with gold as well as the security and comfort enjoyed by senior civil servants. End result. Forty years ago, from first year med school onward, you knew the hours would be long and antisocial.

  12. Jim,

    “Every other area of society in the last 30 years has moved to a virtual 24/7 basis. Shops are open 24/7. Petrol stations are open 24/7. Banks may not be open 24/7, but their services are, via ATMs and now internet banking.”

    And healthcare isn’t? A&E isn’t open 24/7? OK, that does mean you can’t get your passport form authorised at 3am, but that can wait.

    Banks won’t open you an account at 3am. Rigby and Peller don’t do fittings at 2am. In most cases, 24/7 is about the fact that cost is small. Call centres do 24/7 service because the midnight to 6am shift has hardly any calls and requires hardly any people. And that could be done because you can apply large, telephone call centres to things like banking.

    You can’t do that with healthcare. A doctor has to look at the odd growth on your neck, maybe X-Ray it etc etc. It’s completely impractical. And if you want to manage the workload properly, you put a number of doctors in one place, a hospital.

  13. I’ll now wait for lost_nurse to come along and tell us that patients don’t want a 24/7 NHS

    You can wait on. I work in the 24/7 bit of the NHS.

    I’m not an apologist for how NuLav screwed up weekend OOH cover, or how it has been further mangled by this government… perhaps you could examine how extant reform allows “diverse providers” to simply pass the buck to acute care.

    And if you want to manage the workload properly, you put a number of doctors in one place, a hospital.

    Exactly.

  14. My point is that lots of privately provided services are now available 24/7, and GPS have not only failed to keep anywhere near up with that, but in fact have gone backwards from what they used to do. I’m not suggesting your GP surgery be open at 3am, but I am suggesting they have a proper 24 hour emergency care system, just like they managed to provide 40-50 years ago. My grandfather was a GP, he was in partnership with one other doctor, between them they provided a 24/7 care service for their patients. My grandmother would take the out of hours calls, and my grandfather would make emergency visits at all hours of day and night. But then he started doctoring in the 30s, when patients were private and you had to provide a good service, or they’d take their money elsewhere, the idea of good service was ingrained in his way of working. GPs today are just your bog standard bolshy trade unionists, demanding more and more pay for less and less work, all the while protecting their knowledge like some medieval guild of old.

    Its high time the medical monopoly was broken. Most GPs have f*ck all knowledge anyway – a lot of people know more about their ailments nowadays than the GP does, thanks to the internet. A decent computer program could out diagnose a GP most of the time I reckon.

  15. @ GlenDorran
    “Depends what sort of professionals.”
    Precisely! Until I was well over forty I never imagined GPs not covering emergencies at weekends. Sure, Ken played hockey on Saturdays in the winter for my father’s team until both were well over fifty, but emergencies were covered with a back-up if the on-call docxtor was already answering another call. That is what professionalism means.
    I have this anecdote of the CEO of my principal client going back to the office a couple of hours after his last train home and finding the report that I had emailed earlier that morning, having told one of his clients at about 7.30 pm “we can’t publish first thing because the office is closed by now and it has to be published via the office”, and formatting it before getting into his sleeping bag on the office floor so that it did, despite my disbelief, go out first thing.

  16. @john77

    Yes, I’ve got similar experiences of all night sessions to get client work finished.

    And I’ll resist retelling my anecdote about my vet’s out of hours service.

    One other piece of anecdata: look at the obituaries column of any local newspaper. They consistently have glowing stories of the local GP who dedicated his life to his community, visiting patients at all hours, knowing all families by name. Those days are long gone for many many reasons, but modern GPs just don’t appear to have the same view of their job as a “calling” as they had in the past.

  17. But then he started doctoring in the 30s

    After leaving the Army, and prior to returning to hospital medicine, my dad did a long spell as a GP in ruralshire. At weekends, he would sometimes borrow the Landrover from the neighbouring farm – there are still practices like that, but they are finding it harder to survive. The ’12 HaSC Act has greatly facilitated the rise of the GP conglomerate.

    In part, NuLav wrecked OOH cover because they thought it could be done cheaper (take a bow, Serco in Cornwall), combined with a gift-horse offer to GPs. It set out the foundations for Virgincare et al, and their current loss-leading expansion. And here we are today.

  18. I sneeze in threes

    I’d wager men are less likely to see a GP if the appointment is inconvenient for their work, so a weekend option would help with that.

    I think a woman is put off less because throughout their life they expect to see a GP more regularly, e.g smears, childbirth, fainting due to trigger words etc

    Possibly the first hour of each days appointments should be reserved for the employed if weekends are not feasible. Also earlier starts and later finishes would help.

  19. @lost-nurse
    You don’t need a hospital. Three (or four while preparing for the retirement of the senior/oldest partner) guys and one lady were quite adequate.

  20. You don’t need a hospital.

    Not for the stuff that gets inappropriately referred & buck-passed, no. But there is much that (rightly) concerns the public about emergency care at the weekend – and that will end often up at A&E, however good the local GP, and whatever the route in.

    “Front-of-house” GPs in/near acute care are a good idea, IMO.

  21. So, you are worried by something, you’d normally go to the GP but as it is the weekend you go to A&E as instructed.

    Four hours later they chuck you out ‘coz it was trivial and suddenly you are clogging up A&E, because the public are expected to have sufficient medical knowledge to self-diagnose and not bother the professionals and wait instead until Monday, when of course you can book an appointment for three weeks hence.

  22. @The Stigler

    ‘You can’t do that with healthcare. A doctor has to look at the odd growth on your neck, maybe X-Ray it etc etc. ‘

    A friend of mine is currently in hospital on a long term basis being treated for something quite serious. He was woken at 2am the other day and taken for a chest x-ray.

    (He wasn’t massively pleased about the 24 hour nature of it all, but it dd mean he got his chest x-ray.)

  23. bloke (not) in spain

    I find some of the comments above….amusing.
    I have run a client facing business providing a service customers relied on.. Whilst I wouldn’t have been expecting to be fielding 3 am calls – that’s what emergency call out services are for – I was still available 7 days a week. And if my customers needed weekend attention, they got weekend attention. it’s what they paid for.
    But then, I do consider myself to be a proper professional.

  24. “It’s always hard to get professionals to work weekends”

    I must have been doing it wrong.

  25. @ b(n)is
    I have a strict policy that I shall not work (as in paid work, as distinct from cooking Christmas Dinner or Sunday lunch) on Good Friday, Easter Day or Christmas Day. Apart from that, I *prefer* not to work on Sunday but Jesus quoted the Torah to justify healing someone on the Sabbath so why should anyone stop doctors working at weekends?

  26. @ dearieme
    Fifty years ago, one of the (many) differences between Oxford and certain “tertiary education establishments” was that we didn’t even notice artificial “Bank Holidays” since we were not a bank: missing one-eighth of the lectures scheduled for Monays in exam terms would have damaged our education.
    So, no, you have been doing it right – the others have been doing it wrong.

  27. A friend of mine has been diagnosed with cancer. He has to have radiotherapy every day for seven weeks.

    Except weekends of course…

    Running a health service that works five days a week is pretty third world.

    And don’t even get me grossing up the annual NHS budget by 7/5…

  28. In which countries are GP surgeries (or their equivalent) generally open seven days a week?

    I don’t know the answer to that, but I do know that France, usually held up here as an example, isn’t one of them. If you need to see a doctor at the weekend, you use an out-of-hours service, much as in the UK.

  29. They’re not doing it themselves, they’re going to the Russians
    to do the same thing. If you think you’ve forgotten some of the
    rules, it would not hurt to take a glance of the rules and
    instructions. There is also a trend of many college students running up debts on sports betting.

  30. He has to have radiotherapy every day for seven weeks…Running a health service that works five days a week is pretty third world.

    Or to quote the US National Cancer Institute, “Most people get external beam radiation therapy once a day, 5 days a week, Monday through Friday.”

  31. I wouldn’t be surprised if your body fancies a couple of days off after five days of radiotherapy.

    So glad I don’t have to worry about clients or bosses or political bullshit or anything really.

  32. bloke (not) in spain

    “In which countries are GP surgeries (or their equivalent) generally open seven days a week?”
    My one, for a start. if I need a doctor, I get a doctor. if the surgery isn’t open, they open it. Nowhere in the insurance policy does it say it’s a 5 day week service.

  33. “we didn’t even notice artificial “Bank Holidays” since we were not a bank”: that’s nothing. When I was at Edinburgh the university ignored Easter Monday.

    It did, however, honour Victoria Day, which sounds sweet until you realise that it tended to fall in the gap between lectures ending and the year-end examinations starting.

  34. From a purely logistical aspect unless there are more Doctors and Nurses it will not work. There has to be a cost implication as well even if staff were not paid premium rates for weekends , nights etc ……….in winter heating on all hours and lighting etc. Costs could be reduced by centralising a number of surgeries for out of hours treatment …..but that’s what we have at present with walkin centres and GP units at local hospitals. As normal with the Tories all spin no substance and no thought before opening their mouths.

  35. …if the surgeon isn’t open, they open it…
    But the Tory proposal is for “routine appointments, seven days a week”, not just opening in emergency.

  36. In which countries are GP surgeries (or their equivalent) generally open seven days a week?

    Like B(n)iS, mine too. It’s in my insurance policy and it works. Too difficult for Brits I suppose.

  37. Are GPs really there to treat the really sick. Mostly they are there to fill in forms , fend of junkies and drunks, deal with armchair experts. The real disease is seen by ‘real’ doctors surely.
    Good on the GPs to get organised. Having nights off is good. The telephone is a terrible birth controller at night.
    I remember being called out 11PM ( many years ago) and being met at the house door by the husband who said of his wife -” tell this bitch she hasn’t got a headache”
    It gives you a warm feeling.

  38. So Much for Subtlety

    john malpas – “Are GPs really there to treat the really sick. Mostly they are there to fill in forms , fend of junkies and drunks, deal with armchair experts. The real disease is seen by ‘real’ doctors surely.”

    This is one of the problems with GPs. They don’t have much to do any more. When I were a lad, GPs still did everything – delivering babies, minor surgery, the lot. Now they hand out antibiotics and if they don’t work, send them to see a specialist. But the system has not caught up with that change yet. We still train and pay GPs as if they do real medicine.

    We are moving away from the traditional GP practice anyway. Increasingly GPs are female. They will want to work in larger practices. What the government thinks we need is something better suited to their needs – small mini-hospitals in effect. Large clinics with a staff of 20 to 30 “health practitioners”. That way, the female doctors can work more social hours and still pick up their children from school. And there are enough to provide 7 day a week care.

    OK. Fair enough I suppose. But we should go the whole way. The lines between nurses and doctors are blurring. We ought to give GPs much shorter and cheaper courses. If you do a medical degree it ought to be an expectation that you will specialise and work in a proper hospital. If you want to give flu shots, you do a nursing degree and gain some experience and qualifications as you go.

  39. SMFS,

    “We ought to give GPs much shorter and cheaper courses. If you do a medical degree it ought to be an expectation that you will specialise and work in a proper hospital. If you want to give flu shots, you do a nursing degree and gain some experience and qualifications as you go.”

    The whole thing with GPs, I suspect, was originally about proximity. If you lived in Auchtermuchty in the pre-war era , you needed someone with medical training around because you couldn’t easily get to town. Someone who could sort most stuff out. It makes no sense today. Everyone can get to a hospital or be transported to one in a non-emergency situation and are better off with paramedics in an emergency one.

    GPs are now little more than gatekeepers to antibiotics and specialists. If you go from “stuff pharmacists and nurses don’t know/do” to “stuff referred to specialists” it’s a small gap now. I had a lump, and went to my GP and he referred me for more tests. He served no purpose at all, except as gatekeeper. In a sensible world, I’d have gone to hospital and walked into the ultrasound centre and asked them to take a look. it’s not like GPs are even cheap gatekeepers. The woman who did my ultrasound seemed to be more like a senior nurse.

  40. The glories of the NHS; us colonials without “the NHS” can only look on and marvel, enviously, at the UK’s health system.

    Oh, what I would give for a 5 hour queue at A&E on a Sunday; instead I must make do with popping in to my GP’s surgery and being seen to within 10 minutes. OK, so it costs me $60 (including the weekend surcharge) but I get $45 of that back with my $1 a day insurance.

    My son’s fever gets much worse at 9pm on a Sunday evening … OK, I’ll pop into the 24/7 surgery 5 mins further up the road – and who can load up the boy’s medical records to see how he was diagnosed and what he was given by the GP earlier that day. Cost – $nil as he is under 7.

    It really is terrible out in the colonies; your envy of the world is truly the healthcare gold standard.

  41. Let’s face it, this is not about emergencies, it’s about convenience. We want to be able to go to the doctor’s without taking time off work. Completely legitimate, but not an emergency.

    Of course, if doctors were allowed to choose their hours and fix their prices accordingly, we would probably be prepared to pay more for ‘out of hours’ appointments. But I suspect that they aren’t allowed, so I completely understand them resisting.

    And the comment about about “every other service moving to 24/7” is completely irrelevant: you also have a 24/7 ‘virtual’ medical service, it’s called the internet 🙂

  42. bloke (not) in spain

    I don’t think you get this, PaulB.

    “…if the surgeon isn’t open, they open it…
    But the Tory proposal is for “routine appointments, seven days a week”, not just opening in emergency.”

    My GP’s surgery doesn’t do “routine appointments”. It just does appointments. If there was a demand for them to open at 3 o’clock Sunday morning to do flu jabs that’s what they’d do. Or lose the trade to a surgery that did.
    Non-routine appointments would be when the medics fly out to me in a helicopter. It says so in the insurance policy.

  43. I’ve missed the thread, but just as a general point getting a face to face consultation with my GP is like trying to get an audience with the Pope, except more difficult. Local newsagents sell “Congratulations on your GP appointment” cards.

  44. bloke (not) in spain

    And what KJ needs to get his head around is there is more to costs than the cost of medical personnel.

    “From a purely logistical aspect unless there are more Doctors and Nurses it will not work. There has to be a cost implication as well even if staff were not paid premium rates for weekends , nights etc ……….in winter heating on all hours and lighting etc. Costs could be reduced by centralising a number of surgeries for out of hours treatment …..but that’s what we have at present with walkin centres and GP units at local hospitals.”

    But not a single mention that the people needing treatment are also wage earners & whilst they’re waiting to be treated for whatever’s wrong with them they’re likely losing earnings. Which often add up to considerably more than the wage bill of the people treating them

  45. B(n)is,

    But a lot of them won’t be. You’ll be after an old lady who could call in anytime but decides she’d rather go on Sunday (one of my annoyances is waiting behind people who have got all day, who could see the GP at 11 instead of 9).

    If we had variable pricing, you’d solve this problem. £10 for a weekend GP appointment. But that would count as heresy because reasons.

  46. Stig,

    > Is there any real benefit to a GP being open 7 days a week?

    Yes, massively. I hope you don’t have to find this one out the hard way.

    Simple example, which crops up regularly in my life. There are only two antibiotics which work on my wife, who has bad lungs and is prone to chest infections. She also needs a large dose. Her GPs know this. And, indeed, it’s in her notes. Plus she knows, and tells any doctor she needs a prescription from. The GPs who work the out-of-hours coverage, however, refuse to believe it, because of course they know better, and always give her a prescription for either antiobiotics which are known not to work on her (but are cheaper) or too small a dose, or both. Using that prescription simply increases the resistance of the bacteria in her body — you know, exactly why doctors are always warning us not to misuse antibiotics — and prolongs her illness. So she no longer goes, instead putting up with a chest infection geting worse while waiting for the next available office-hours appointment.

    > Sure, and people also get sick at 3am. Are we going to provide GP cover for that, or do we use things like A&E for those services?

    I think you’re labouring under a misapprehension here. We already do use GP cover for that. The trouble is that out-of-hours GP coverage is shite, not that it doesn’t exist.

    > There is zero chance that A&E will say “sorry, we can’t help you, but your GP can”.

    There is a very high chance, though, that you’ll have to wait a ridiculous amount of time at A&E. My wife, due to her various complications, gets put straight to the top of the queue by triage every time. Still not unusual to sit in A&E for twelve hours overnight. I dread to think how long someone with something relatively minor might have to stay there. It makes sense, surely, for a GP service to deal with the more routine things so that the people who are dealing with car crashes don’t have to.

    > There are things that need sorting straight away and things that can wait.

    Due to my work, I am only in the country at weekends. If I need to see a GP, I have to have an argument on the phone with the sub-standard out-of-hours service, explaining that it’s not an emergency, but it’s my only opportunity to see a doctor, and I’m quite willing to bring a book to the waiting room and wait for hours while they see more important cases. They still sometimes refuse. So, what, I should go to A&E for a sinus infection that just needs some antibiotics? And the staff there will thank me for helping them to optimise the NHS’s workflow, will they? Will they fuck.

    A lot of people in the UK are on a fifth of what GPs make and have to work shifts. I’ve worked awkward shifts at least half my working life. I have no sympathy with these overpaid prima donnas.

    Andrew,

    > Banks have only fairly recently started opening at weekends, and that’s in no small part thanks to the de-skilling of bank teller work.

    Banks aren’t quite comparable to GPs here. Apart from a bit of admin, when a GP isn’t open to patients, they’re not working. When banks aren’t open to customers, thousands of staff are working behind the scenes to keep the systems running.

    > Take a walk through the City of London or Canary Wharf this weekend, then come back and tell me how much of our society is 24/7.

    That’s because (a) they let us dial in from home, and (b) the banks switch operations to other countries. It’s not because they stop working. I worked five years of night shift for RBS. A load of my colleagues simply moved to New York when the bank switched to follow-the-Sun coverage.

    Doctors happen to do a job that can’t be offshored. I’m pretty sure they knew that when they picked their career, though.

  47. I’ve missed the thread, but just as a general point getting a face to face consultation with my GP is like trying to get an audience with the Pope, except more difficult. Local newsagents sell “Congratulations on your GP appointment” cards.

    This.

    This was my experience last time I had reason to see a GP, which was some time ago but I gather it hasn’t improved since.

    I’d had a medical for a private health insurance policy (burn the heretic!) which involved a blood test. Some days later I was informed the results were available with the doctor. At the time I was working with a company mainly based in the USA, so my working hours were more mid-Atlantic – I’d start around midday, and work until 9-10pm. I’d get out of bed around 10am.

    So I wake up, and call the surgery to book an appointment to see my results. “Sorry,” says the receptionist, “we’re fully booked for today.” “OK,” I say, “how about tomorrow?” “Full too.” “Fine, it’s not an emergency at all, how about next week sometime?” “No, we don’t book anything in advance, you’ll just have to phone up in the morning to get a slot.”

    Tried several days, same answer. I never did find out those results.

  48. Why we need better GP coverage:
    My 2yr old son had diarrhea from Sunday morning. Nasty nappies in a youngster are hardly unusual, so we just let him be. However, by Tuesday morning, he was not getting better (actually worse, since he started throwing-up too).
    But, this was early on a weekday, so I tried to call our local surgery. Our surgery is closed on a Tuesday morning, but I had assumed that after a 4 day Easter weekend, they might decide to work…
    Stupid thought, obviously. The surgery was closed and that was that.
    So we went to A&E.

  49. bloke (not) in spain

    @The Stig
    “But a lot of them won’t be. (appointments – cost to customer of) You’ll be after an old lady who could call in anytime but decides she’d rather go on Sunday (one of my annoyances is waiting behind people who have got all day, who could see the GP at 11 instead of 9).”

    But that’s not your priority to decide. It’s the old lady’s. if she’s the one paying the medical bill/insurance.

    It’s always the trouble with discussing the availability of medical attention with those suffering under the blight of the NHS. There’s so many points of view that are based around the principal there’s a limited amount of health care which must be rationed out by some table of priorities. WTF should they be? You don’t go on a waiting list to see a plumber. And there’s absolutely not the slightest difference between a doctor & a plumber. Apart from a doctor probably won’t hack fixing your ball cock.

  50. My wife and I use the GPs services a lot. As we work with post office and couriers the appointments have to be based around either later afternoon or early morning. The time we are free is Saturday afternoon to Sunday evening. The GPs surgery of course is closed then.

  51. I must just be lucky. Can always get a GP appointment the next day, not that I need one very often.

    @S2 – I appreciate this isn’t a total solution, but re the antibiotics can’t you get some sort of letter from your GP for your wife to produce if she sees someone not acquainted with the particularity of her condition?

  52. “It’s always the trouble with discussing the availability of medical attention with those suffering under the blight of the NHS. There’s so many points of view that are based around the principal there’s a limited amount of health care which must be rationed out by some table of priorities. WTF should they be? You don’t go on a waiting list to see a plumber. And there’s absolutely not the slightest difference between a doctor & a plumber. Apart from a doctor probably won’t hack fixing your ball cock.”

    Absolutely spot on. It needs to be drummed into doctors that they are just another service provider, not (as they seem to think) gods that we should bow and scrape in front of, and be pathetically grateful that they deign to grant us an audience 3 weeks hence.

  53. > can’t you get some sort of letter from your GP for your wife to produce if she sees someone not acquainted with the particularity of her condition?

    They’re already ignoring her medical notes. There are more details. For instance, she has a long history of getting severe chest infections that can’t be detected with a stethoscope, so her GPs trust her to self-diagnose since she’s so familiar with the sensation. The out-of-hours GPs insist that, if they can’t hear it with a stethoscope, there is no infection. Again, all in her notes. Again, all ignored. Makes you wonder what the point of medical notes is, really.

    As I commented on another NHS thread recently (and Lost Nurse agreed), the person in charge of your healthcare is the person standing nearest you, and they will routinely overrule anyone not in the same room at the same time.

  54. I can get one on Friday too – our local surgery is open Saturday mornings.

    But I take that point generally. I was really responding to people who were bemoaning the fact that they couldn’t get an appointment on a weekday other than Friday.

    Re your wife, I suppose doctors get a lot of patients who *know* they need antibiotics and whose medical notes show they have needed them before. The fact that your wife is probably right is scant consolation I suppose.

  55. There are two methods of getting an appointment at my surgery:

    1) Keep re-dialing until you get through (from 9.00am)
    2) Go and queue outside until they open, along with the shuffling elderly, the pregnant and so on. With luck you can make an appointment, then come back later.

    It’s like the internet never happened.

  56. > Keep re-dialing until you get through (from 9.00am)

    Yup, mine too. Forget the Internet — could they not even implement a proper phone queue?

    Back on the general point of why this is necessary, what strikes me as really stupid is that your GP is assigned based on where you live. For most people, that’s not where they work. If we could go to a GP near our work, we wouldn’t need to take half a day off, and the GPs’ refusal to work weekends wouldn’t be such a problem.

  57. GP’s haven’t refused to work weekends, they’re just incentivised not to.

    With the new contract, weekend work became a separate service that, if provided, allowed an additional payment. The problem really was the massive increase in the basic salary. So, the choice became something like this:

    Old terms: 65k, inclsuive of anti-social hours

    New terms: 100k for 9am-3.30pm, or 110k if providing weekend cover.

    I know what I would have done.

  58. S2,

    “Simple example, which crops up regularly in my life. There are only two antibiotics which work on my wife, who has bad lungs and is prone to chest infections. She also needs a large dose. Her GPs know this. And, indeed, it’s in her notes. Plus she knows, and tells any doctor she needs a prescription from. The GPs who work the out-of-hours coverage, however, refuse to believe it, because of course they know better, and always give her a prescription for either antiobiotics which are known not to work on her (but are cheaper) or too small a dose, or both. ”

    And if you get 7 day week GPs, are you going to be seeing the same few GPs, or lots of locums with the same problem?

    “There is a very high chance, though, that you’ll have to wait a ridiculous amount of time at A&E.”

    Sure, but what if we took the GP resources and put them in A&E or walk-in centres? You’ve still got the same capacity.

    “Due to my work, I am only in the country at weekends. If I need to see a GP, I have to have an argument on the phone with the sub-standard out-of-hours service, explaining that it’s not an emergency, but it’s my only opportunity to see a doctor, and I’m quite willing to bring a book to the waiting room and wait for hours while they see more important cases. They still sometimes refuse. So, what, I should go to A&E for a sinus infection that just needs some antibiotics? And the staff there will thank me for helping them to optimise the NHS’s workflow, will they? Will they fuck.”

    Well, yes, that would make more sense.

    “A lot of people in the UK are on a fifth of what GPs make and have to work shifts. I’ve worked awkward shifts at least half my working life. I have no sympathy with these overpaid prima donnas.”

    I’m not disagreeing with that. Most of them are body mechanics and should be paid accordingly. The whole thing needs a massive shake-up with better information systems and stronger discipline against bad doctors. I’ve personally diagnosed what an ENT couldn’t, and found that working through the interactions of various parts of the human body aren’t really that complicated. The TMJ is certainly less complicated than a Telco’s billing system.

    And the lack of email or any sort of post-2000 tech really grinds my gears. My tiny dental practice manages all of this. All notes are on the computer. Reminders are sent by SMS about appointments. I can email to request an appointment and I get a call back the next day. Of course, I can fire them at a moment’s notice.

  59. b(n)is,

    “But that’s not your priority to decide. It’s the old lady’s. if she’s the one paying the medical bill/insurance.”

    I’m not deciding priority. I’m saying that price is the best mechanism for dealing with different demands for different time periods, whether we’re talking gyms, hotels, restaurants or cinemas. Most non-working people are flexible on when they can go to the GP. Many working people would spend a small amount for a convenient appointment (e.g. morning, evening or weekends).

  60. bloke (not) in spain

    Oh, I’d fully agree with you, Mr Stig. Price is a good way of dealing with different demands. But you’re starting with the UK medical profession here. Idle money grabbing f*****s to a man/woman. Before you trusted them with that you’d have to get them used to the idea it isn’t a 9-5 Monday to Friday job. Or they’ll use it as an excuse to rob you blind

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