At the end of last month we wrote about a presentation given to councillors by our local Primary Care Trust.
One GP read the item and has sent us the following , very illuminating review of how things are working out in practice. It’s well worth reading!
We should add that this doctor does not work in the South East Essex area, so the comments do not specifically apply to our local primary care trust. We do know who the doctor is, but this person would like to stay anonymous, and we fully understand that. We are very grateful to “Dr X” for writing in such detail.
1- OUT OF HOURS CARE (6.30pm – 8am weekdays and all weekend)
With the new government GP contract, a few years ago, the government took away out of hours care from GP’s (all weekend and from 6.30pm – 8am on weekdays) and this is now mostly provided by private agencies contracted by the PCT’s. So Andrew Pike is responsible for the out of hours provision for this area, although this is contracted out. The PCT would have seen tenders from lots of different agencies, I am sure cost plays a big part in the decision making process. My personal view (in our area) is that the out of hours provision of care is extremely poor. Only one or two out of hours centres, requiring people to travel quite some distance and really only for absolute emergencies. That’s why someone with earache, for example, would be considered low priority and either be advised to wait for their own GP or travel miles to see someone over night. It would be interesting to see the numbers, but my guess would be that there may be only one doctor in the centre and one visiting for a very large area that this PCT cover. This obviously saves money but means that provision of care is very poor. In my area by the time the patient manages to be seen by their GP the next morning they are generally pretty cross!
I regularly come across cases that I feel should have been seen and assessed the night before. I had a call last week by someone in extreme back pain from 7pm the previous night. He had rung the out of hours service 3 times over night and when he eventually did speak to a doctor at 6am was told he may as well now wait until his own surgery opened at 8am! So you can imagine his frustrations when he got through to me at 8.30 am to discover I had a full surgery and wouldn’t be able to get out to him until 11.30am! Actually I did go out to him during the morning and gave him some well needed painkillers but at the cost of my own surgery running very late! How irritating when a decent out of hours service could have offered him some pain relief over night.
People are also frequently advised just to go to A+E and really could have been dealt with by a GP, terminally ill patients or housebound confused elderly patients for whom a trip to hospital is quite traumatic and certainly places huge unnecessary demands on A+E. These few cases are not going to show up in audit figures but at an individual level have a big impact.
I am not criticising the doctors, nurses and paramedics involved in out of hours, just the resourcing of the service.
2 – INFORMATION SHARING
Poor communication happens due to the above out of hours split in provision and people being seen in a variety of different settings over night. The other reason for poor communication is the horrendous information technology within the NHS.Electronic notes transfer rarely works and the famous “spine” really isn’t up and running despite millions spent on it.
In the past I have found that when the out of hours care was provided in small GP co-operatives (a group of GP’s sharing the out of hours care) communication was much better as the GP’s had a responsibility to inform their colleagues
3 – POLYCLINICS
Polyclinics may be good if it really is better provision and an additional service to existing practices. My feeling is it may well not be the case and once the new polyclinics are established the exisiting surgeries will then be closed down.
The clinic planned for Rawreth may well be a polyclinic, possibly run by private providers and possibly with a plan that a lot of GP’s are eventually moved in down there instead of being central.
This if it happens it will end up being a huge centre with outpatients, minor surgery, physio etc as well as traditional GP facilities. Possibly even encorporating out of hours care too.
4 – PROVIDING OTHER SERVICES
The NHS has become more obsessed in saving money than providing good health care. The statistics really don’t mean very much in my opinion! I am a reasonably young GP partner and I have seen the out of hours care deteriorate in the last 9 years quite significantly. Things like waiting times, which fit nicely in to figures for statistics, have improved greatly which is a good thing, but at a much greater cost to individual care.
GP surgeries are small businesses, the GP’s are therefore funded for specific services they provide. The PCT will not fund GP’s to provide nurses to do blood tests. Our PCT said they would provide a contract for us to do it, but the money didn’t even cover the cost of the nurses salary let alone the other overheads! This doesn’t sit comfortably with me as I became a GP to diagnose and treat patients not to decide on care based on money. However, we are a small business currently finanically struggling like never before and therefore these decisions unfortunately do have to be made. The reality is we do offer blood tests from time to time when the patient would really struggle to get anywhere else but we do it because we care!
Primary care has changed quite a bit over the last few years, patients leave hospital often only a day or two after an operation. There are Admission Advoidance Teams who try and keep people out of hospital and far more is expected to be looked after by GP’s in the community rather than sending people to a hospital consultant. I agree in principle with most of these changes, most of us would prefer to avoid being in hospital. However, these changes mean that something else has to give. Making time for home visits and having time to really get to know patients is what is being slowly ebbed away. Cramming patients in to 10 minute appointments, with their list of ten questions (because they have been trying to get an appointment for weeks) and trying to adequately cover everything proves very stressful. Then being asked to book them their hospital appointment online (rarely fast), prescribe from the PCT directed Low Cost Drugs List and give them their Government Patient Survey to see what they think of the whirlwind appointment!!
I agree GP’s need to be accountable and efficient and move with what patients now need within the new NHS. I am very keen though that these new services come with proper funding to ensure we don’t lose the precious service of having your own GP who knows you rather than a stranger in a polyclinic 20 miles away from where you live.
I am aware this has been a therapeutic ramble for me but I hope it has helped in your questions!
Our thinking has become quite distorted as far as the provision of public services are concerned. Stafford Hospital, for instance, was able to achieve foundation status by reaching its financial targets – while patients died and staff were sacked to save money. Similarly, the director of Children’s Services in Haringey was able to say that her staff had done everything they should have (i.e. they had ticked all the boxes) – despite the fact that baby P had died.
No one wants to abandon accountability and prudence – but it’s time the providers of public services were allowed to get back to the basic question: what can I do to promote this person’s best interests?
I would like to share with you an experience that a close member of my family had this weekend .They live in Rayleigh and have two young children . The youngest ran a very high temperature in the evening, they rang nhs direct who advised the out of hours doctor should be contacted .They were given two alternatives either Southend Hospital or Basildon Hospital ,having experienced Southend on a previous occasion , they went to Basildon .There, they were directed to what transpired to be the inpatients mental health ward .There were two “heavies” on the locked door .They were able to see the doctor inside ,there appeared to be other children waiting to see the doctor,whilst all around them there were patients trying to get out or disrobe themselves. Does not seem a very suitable environment for out of hours with sick children .My other daughter who is a sister at Broomfield Hospital was shocked and questioned why the out patients department could not have been used for this facility .Not only was it potentially frightening for the children it was disturbing for the inpatients .Is this the normal provision for Basildon or was there a good reason ?
After using Southends out of hours surgery last weekend, I have to say what an appalling lack of facilities there are to treat sick children when surgeries are closed. Our little girl had been un-well on Saturday, as any mum would do I watched her all day and night, but by Sunday decided that her condition was not a common cold, flu virus and rang the emergency doctor, after giving very precise and detailed descriptions of her condition as they then appeared, rash, temperature, etc I was given the alternative of either Southend or Basildon for an appointment some two hours later!!! (glad looking at Alistirs comments I chose Southend) when we got there, no doctor was on duty, they were late arriving, some 20 mins late which meant the first appointment was late being seen, this coupled with the fact that the second appointment was a well known out of hours frequent visitor who still managed to get an appointment despite being so well know to staff there were on first name terms, we were finally seen over an hour after arriving. By this time we had sat in a waiting room with a number of very poorly looking people, including a young baby and toddler, I sympathised so much with the parents, a very unwell child should not have to travel for 15-20 minutes to see a doctor only to have to wait another hour when they get there,(some faced even longer waits) thankfully for us, the care our daughter received once seen was brilliant and a diagnosis was given straight away, Scarlet Fever, a highly contagious illness that is notifiable by law to the relevant Gov services and needs urgent treatment with antibiotics, great for everyone else who sat in the waiting area with us, they were all unwell to start with (apart from the frequent visitor who got told to see her own gp the next day and then stood and had an argument with the receptionist) as they were all put at risk, I know how contagious it is, I now have it, so for anyone with a brain who reads this from the PCT, why or why can you not make a gp available to make home visits where warranted, the details I gave about my daughter, the rash, the sunburn look, temp etc should all of set alarm bells ringing, but they didn’t, no separate waiting rooms are available so more illness is spread through these totally unfit facilities that are being provided for out of hours care, something needs to change, why can’t gp’s go back to being responsible for their own patients 24/7 365 days a year, yet another wise Government decision that is backed up!!!!
Hayley – I agree 100 percent with what you say.
I also know that in places like Russia (where we were told their medicine was rubbish), their polyclinics have three separate entrances /reception areas – one for adults, one for healthy children, and one for sick children.
I’m sure the Rawreth contingent of Onlinefocus readers will all want to send their best wishes to the two of you – do you need any shopping or anything?
Many thanks Chris, thankfully I have had my Mum on hand who has been brilliant, and we now seem to have turned the corner thanks to the anitibiotics!!!!