The producer interest talking

Most people do not want GP appointments at weekends – and the very idea of being able to see your doctor any day is “very wasteful”, the head of the British Medical Association has said.

Sounds very like those arguments from a couple of decades ago about Sunday opening for supermarkets, doesn’t it?

And not quite the way it worked out, either.

It’s really very simple. We’re paying your wages you fuckers so be there and be open when we want you.

32 thoughts on “The producer interest talking”

  1. Turn them all into proper private businesses that depend on customers through the door spending their own money, then they can open when they please.

  2. A lot of professional services aren’t open on Sundays. Private dentists mostly work Monday to Friday. It’s even hard to find a garage to service your car on a Sunday. The most common situation is Saturday morning opening, and that seems to be sufficient.

    There is however a real shortage of GPs. Making them open on Sundays instead of Tuesdays isn’t going to solve that problem. Funding more places to study medicine in the first place would. As would relaxing the qualifications required – do they really need seven years’ training now that we have Dr Google?

  3. I know – and here’s a really mad idea – let’s give it a try. Have GP surgeries open at weekends for a year or so and see if people do want appointments.

    The BMA can be such wankers.

  4. But it’s not actually going to improve things. We have a limited supply of GPs, so if you have a GP working Sunday, that’s a GP that isn’t working on say, Monday.

    Plus, you’ve now introduced other costs. You now need 7 day cover for receptionists that you didn’t before.

    The answer is getting rid of most GPs and having earlier specialisation. You know what hurts, so go and see someone who specialises in that thing rather than having GPs trying a few things with their limited knowledge before giving up and sending you to a specialist. We already accept direct specialization for teeth, eyes, sexual health, so why not ears, feet and stomachs?

  5. The vast bulk of appointments are taken by very young children and the elderly, two groups unlikely to benefit from 7 day service. I suspect just Saturday mornings would suffice to keep working age people satisfied.

    The real motivation is likely to be giving people an alternative to A&E particularly arty weekends, some so many patients there don’t really need it. Wonder if it’d be cheaper just to install a hospital-based GP into the A&E triage system, though.

  6. “We have a limited supply of GPs, so if you have a GP working Sunday, that’s a GP that isn’t working on say, Monday.”
    So what? If you’ve seen the doctor on Sunday, you don’t need to see the doctor on Monday. So he doesn’t need to be available to be seen.

  7. “Plus, you’ve now introduced other costs. You now need 7 day cover for receptionists that you didn’t before.”
    It’s always this presumption, in the health service, the people out in the waiting room have nothing better to do than sit around waiting to see a health professional. What about their costs? The value of their time?

  8. Bloke in North Dorset

    Jim: “Turn them all into proper private businesses that depend on customers through the door spending their own money, then they can open when they please.”

    Even if we set them up as private businesses some stupid politician would stuff their mouths with gold.

    Blair tried paying by results. I had a mate who was a Practice Manager for a large GP practice and he figured out how to game the system. The Senior Partner made £600k that year and even the lowest partner made £150k. My mate got a £50 bonus.

  9. bis,

    Yes. And that then means that if I want to see my GP on a Monday, I can’t. This is just shuffling the capacity. Instead of there being 3 GPs on for 5 days, you’ll have 2 GPs on for 7 days. You’ve also now got to pay a couple of receptionists overtime for a weekend.

  10. >Most people do not want GP appointments at weekends – and the very idea of being able to see your doctor any day is “very wasteful”, the head of the British Medical Association has said.

    There speaks someone who can afford private healthcare and hasn’t had to suffer the horror of the NHS weekend appointment system. Because you can in fact get an ’emergency’ appointment at weekends in the UK. I don’t mean A&E. I mean for things that can’t wait until Monday, but aren’t quite bad enough Monday. Like a pretty sick child.

    You go to a horrible place along with hundreds of other sick people, and you wait around all day or all night with kids who are going out of their minds with boredom, and then after what seems like hundreds of hours you see a hopeless foreign doctor who is completely useless and misdiagnoses you. Afterwards you pray you never get sick on a weekend again. But of course your kids always get sick on Friday evening.

  11. ISTM the most likely reason is that patients aren’t aware that their GP’s surgery was open at the weekend.

    Of course, GP’s will object, and practices will need to merge, but sometimes cheese needs to be moved.

  12. Bloke in North Dorset

    Talking of producer interests according to this week’s Economist prison-guard unions in the USA sponsored some of the bills that led to more and longer prison sentences.

  13. @Tim Almond
    ” bis…
    You’ve also now got to pay a couple of receptionists overtime for a weekend.”

    Sp f*****g what! Peanuts. What do you reckon my time’s worth, during the week?

  14. BMA is a dr organisation not a customer organisation.
    To see GP during week we have to shut the warehouse for a couple of hours or open much later in the morning.
    Weekend we have the walk in centre – quickest there I have had is 2 hours – usually quicker to head to A&E who operate a non emergency service too. Actually probably 90% of our weekend visits to A&E end up using that service.

  15. @ Martin Davies
    This what gets me. There’s people provide vital, high value services. Hanging around at the beck & call of some mouth breather in a white coat & stethoscope & a glorified checkout operator.
    Fucked priorities.

  16. bis,

    “Sp f*****g what! Peanuts. What do you reckon my time’s worth, during the week?”

    I don’t know. What is your time worth? What’s your point exactly? That GPs should work weekends so that you can go and see a GP on a Saturday? What about the people who would rather go and see their GP on a Friday rather than on a Saturday, who are now more likely to have to go to the GP on a Saturday because Friday capacity has been reduced?

  17. “What’s your point exactly?”
    That most of us, provide services, do so to suit our customers’ needs. Or they go to someone who will. But most of us haven’t got a restrictive trade organisation batting for us.

  18. bis,

    “That most of us, provide services, do so to suit our customers’ needs. Or they go to someone who will. But most of us haven’t got a restrictive trade organisation batting for us.”

    But this is a shared socialised service, this GP thing. It should serve people across the board. I’d like a GP to be open at 10pm. Therefore, according to you, they should be open at 10pm for my convenience and all the taxpayers should pay for that service, in the same way that they should be open on weekends to suit you.

    The private sector has a simple way of dealing with this which is that people pay a premium for convenience. If I want my shopping delivered on a Saturday, or in the evening, it costs more than in the daytime because that’s the peak of demand. They don’t deliver at all at 3am because the cost of having the service up at that time for the number of people who want it isn’t worth it. I’m sure if I gave Ocado enough money, they’d make an exception, though.

    I’d be in favour of that for GP appointments. I paid £15 to Sainsbury’s privately for a flu jab on a Saturday morning because I didn’t want to take a half-day off to see a GP at 3pm. But if my GP charged me £10 for a 5pm appointment on a weekday instead, I might have taken them up on it. But no-one will go near premium appointments politically, because of the whole “the NHS should be free” talk.

  19. @Tim Arnold
    Let’s actually think about this from a cost effective point of view. For those of us who work, seeing a doctor, during working hours, is costing somebody. If you don’t lose wages, yourself, your employer’s paying.
    So let’s say you go sit in a waiting room for an hour – to see a doctor for ten minutes. And you’ve lost an hour, both sides of that waiting hour, because the sh***f***ed health system insists the doctor who’ll see you has to be in the area where you live, not where you work.
    So you get the value of 10 minutes of the cost of a doctor at the cost of three hours of what you’re worth.
    Cost effective?

  20. Single-payer legal care.

    All of the restrictions we put on doctors, we should first try out on lawyers/solicitors/barristers. Because there’s not one lawyer who does anything worth more than minimum wage.

    (I’ll let you figure out how many of the above sentences are fully serious.)

  21. After “where you work” should have added “And they only work office hours” to add insult to injury.

  22. Thing I’ve always thought about lawyers is, Ted, if you shout for a lawyer, about ten come running. And if you shout for a plumber, you may have to wait a week.
    Might say something about the relative scarcity of lawyers & plumbers & how hard it might be to become either.

  23. Bloke in North Dorset

    Bis,
    “Fucked priorities.”

    Fucked incentives.

    TimA

    “I’d be in favour of that for GP appointments. I paid £15 to Sainsbury’s privately for a flu jab on a Saturday morning because I didn’t want to take a half-day off to see a GP at 3pm. But if my GP charged me £10 for a 5pm appointment on a weekday instead, I might have taken them up on it. But no-one will go near premium appointments politically, because of the whole “the NHS should be free” talk.”

    I don’t know if they still do, or are even allowed to, but at one time GPs offered private out of hours services. They still charge for inoculations so I don’t see why they couldn’t charge for OOH flu jabs.

  24. …the sh***f***ed health system insists the doctor who’ll see you has to be in the area where you live, not where you work….
    That’s been fixed now. You can register wherever best suits you.

    We’re paying your wages … so be there and be open when we want you.
    That’s fair. But if the wage is determined by the balanced of supply and demand, making the conditions more onerous will reduce supply, unless you increase the wage.

  25. Bloke in North Dorset

    Slightly off topic but a few years ago I had privately paid for extracorporeal shock wave lithotripsy for kidney stones at a Reading NHS Hospital in the evenings. I thought it was best of both worlds, the NHS didn’t have expensive capital equipment lying around and I got treated when it suited me.

  26. Weekend appointments, I’m all for it, BUT, I can’t get an appointment anyway for three weeks, in an emergency it is the walk in centre five miles away or a day at A&E.
    Yet my “medical centre” is almost empty on at least three afternoona a week, why , because out of eight doctors at the practice five are part time, and a friend in North London whose good practice merged with others into another “medical centre” now can’t get an appointment as seven out of eight doctors have gone part time.
    Chances of weekend appointments are nil.
    Oh and a sign at my practice says appointments are now available up to seven on Friday evenings, which is fascinating.

  27. bis,

    “So let’s say you go sit in a waiting room for an hour – to see a doctor for ten minutes. And you’ve lost an hour, both sides of that waiting hour, because the sh***f***ed health system insists the doctor who’ll see you has to be in the area where you live, not where you work.

    So you get the value of 10 minutes of the cost of a doctor at the cost of three hours of what you’re worth.

    Cost effective?”

    But you’re looking at it from your perspective as someone who lives an hour from where you work. Lots of people don’t. For them, a weekday appointment isn’t so much of a problem, and it leaves their weekends free. When I worked in my home town, I could turn around an appointment in half an hour (and yes, having to see the GP in your town is stupid). By extending opening to 7 days, I’d be less likely to get that weekday appointment as the capacity is spread wider and would lose time I value at weekends, so would be less valuable for me.

    But the system is an antique that fitted 1920s market towns before the age of the car. I don’t need a GP within walking or cycling distance. I can easily go by car or bus to a hospital and have an appointment where a nurse asks me what the problem is and directs me straight to someone who spends all day on my sort of symptoms because he’s seen my symptoms all day. So, I’m not going back because his diagnosis didn’t work. Basically, a walk-in centre, but with appointments. And with their patient diary linked to real-time updates, so if things are running late, I can leave later (not rocket science).

  28. @Tim Almond
    “But you’re looking at it from your perspective as someone who lives an hour from where you work. ”
    Well of course I am. ‘Coz it’s my bloody experience. Your experience is different? Good luck for you.
    People have different needs. Makes sense, providing difference solutions, match those needs.
    Here’s a novel solution. It can’t be hard to train doctors. Like lawyers & accountants, there’s so many of ’em. Let’s have twice as many doctors, pay them half as much.
    Then we can all see a doctor when it suits us.
    Markets, isn’t it?

  29. Bloke in Costa Rica

    I work Monday to Friday. I do not work Saturday and Sunday. Therefore if I want to see a doctor it is best he be available on the weekend. The thing is, here in CR I can pay a doctor out of pocket to see him at my convenience and thus, mirabile dictu, there are doctors working on weekends.

  30. Central planning of NHS services working well it seems.
    What about charging for Med School places, allow the Uni’s to keep the dough so they can train as many as they can manage.
    Allow GP’s to set up whereever they want,take whoever they want,charge what they want and work whenever they want because it’s not our business. They just don’t get any govt dough.
    Allow the same for hospitals.
    Basically get the government out of the Health service and see where that gets us….

  31. BIS,

    > It’s always this presumption, in the health service, the people out in the waiting room have nothing better to do than sit around waiting to see a health professional. What about their costs? The value of their time?

    Exactly.

    The comparison of the price of the NHS with other countries’ health systems never takes into account the cost to the economy of making people take half a day off work instead of an hour to see a doctor, or the cost to them and their productivity of waiting in crippling pain for vital surgery for a year instead of a fortnight. Because fuck the patients.

    This is what really strikes me, though:

    Most people do not want GP appointments at weekends

    Yeah, and? Most people don’t want insulin, either, because most people aren’t diabetic. Most people don’t need to see an oncologist or a haematologist. Most people don’t need cataract treatment. So let’s not do any of those things, right?

    I thought the whole point of the NHS was… well, the opposite of this attitude. What happened to “To each according to his need”, eh?

    Tim A,

    > What about the people who would rather go and see their GP on a Friday rather than on a Saturday, who are now more likely to have to go to the GP on a Saturday because Friday capacity has been reduced?

    Most people work Monday to Friday. So most people who see a doctor Monday to Friday are taking time off work to do so. Obviously.

    You could test your theory by going to your local supermarket at midday on Saturday and four o’clock on a Wednesday and looking at how crowded it is. Now you know when people are free to go do stuff because they’re not at work. No, really.

    > The private sector has a simple way of dealing with this which is that people pay a premium for convenience. If I want my shopping delivered on a Saturday, or in the evening, it costs more than in the daytime because that’s the peak of demand. They don’t deliver at all at 3am because the cost of having the service up at that time for the number of people who want it isn’t worth it.

    Delivery is a very limited example, which might correlate to home visits from GPs. If we look at when stores are actually open, that seems a better analogy to when GPs are open. And we see that the shops that are open longer, more convenient hours are the cheaper ones. I can go get cheap high-quality food at Tesco at 10pm, or much more expensive food from a high-street shop that insists on shutting no later than 6. And if I do need to shop at 3pm, there’s a not-quite-so-local Tesco up the road that’s open 24 hours. When I lived in Glasgow, my local Asda was open 24 hours. Leaving evenings aside and just concentrating on weekends, which is the point being argued by the BMA here, try suggesting to a shop-owner that they should be shut on Saturdays. They’d think you were barmy. So what’s your point?

    Cal,

    > You go to a horrible place along with hundreds of other sick people, and you wait around all day or all night with kids who are going out of their minds with boredom, and then after what seems like hundreds of hours you see a hopeless foreign doctor who is completely useless and misdiagnoses you. Afterwards you pray you never get sick on a weekend again. But of course your kids always get sick on Friday evening.

    This. Only without the foreign. I have found competence and incompetence to be spread quite evenly between nationalities in the NHS. As I’ve said before, the main problem is that you’re seeing someone who hasn’t even skim-read your notes. Because Heaven forfend they should be available to a doctor. So they give you antibiotics that your doctor knows don’t work on you. And you inform them of that, but they do it anyway, because who’s going to believe some fucking patient?

    My wife has bad lungs. There are only two antibiotics that work on her. When she gets an infection, she needs those antibiotics urgently, in a large dose. The NHS has repeatedly proven that it is systemically incapable of providing that very simple service at weekends. This is a serious problem.

    And Tim A, who keeps going on about costs, should consider that the cost of treating a serious infection that has had two extra days to take hold is far greater than the cost of treating a relatively minor infection caught early.

    BIS,

    > the sh***f***ed health system insists the doctor who’ll see you has to be in the area where you live, not where you work.

    And this too. Multiply that by living in NI and working in London.

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