I am a GP, just in from work (8.40pm) after a day at my surgery. Just a normal day, not a late night. And no, I am not a martyr to the NHS. I am just trying to make sure that all my patients are seen, all my correspondence from hospital colleagues is dealt with, all my results are read and filed, all my letters written, all reports I have been asked to do (which are not strictly part of my NHS work, but there is no one else to do them) are completed. Actually, I did not do the last bit. That will have to wait until the weekend, in my own time. Am I smiling now? No, I am seething with rage at Mary Dejevsky’s hatchet job on general practice (Most of us just want a GP appointment and a friendly smile at reception, 19 November).
We get the health service we pay for. In fact, according to international studies, we get more than that: we get extremely good value for our taxes. In GPs we get, in the main, highly skilled and highly motivated people who continue to give all they can despite a fall in their income in real terms of 16%, despite a fall in the proportion of the total NHS income that goes to general practice of a similar amount, despite demands for instant access, telephone appointments and email service, and despite an ever-more-complex and ageing population to care for. We need a real debate on what we want from our health service, and how it is going to paid for. What we don’t need is being told how to do our job when we are more aware than anyone else of the shortcomings of general practice.
Dr Robert Bennett
Oxford
• I was a GP partner until I left at the age of 53. My wife was a GP partner until she left at the age of 49. The stresses of trying to cope with ever-increasing demand with ever-tighter finances proved intolerable. Most receptionists are polite and professional but cannot create additional appointments with clinicians who already have a full workload from the moment they arrive at work to the moment they leave. I would suggest Mary Dejevesky arranges to spend time observing the situation in a medical practice. If she is then able to offer constructive criticism, I am sure it would be welcomed.
Dr Paul Cassidy
Huddersfield
• I read with interest Mary Dejevsky’s column on the difficulties of getting an appointment with “your” GP. Although prior to the 2004 contract individual GP partners were responsible for a registered list of patients, the new contract gave the practice responsibility for a registered population. There has always been a tension between access, continuity and cost. Over the last 10 years, with the shift towards a consumer society, demand for instant access has been greater than for continuity, eroding the central relationship of a patient with a GP. This has been particularly true of the more vocal majority, often with less need, resulting in political moves to incentivise practices to provide quicker access at the expense of those who need continuity of care. Relationship continuity with your GP is important for patient experience, and evidence shows outcomes are improved, particularly in those with complex needs, but in addition it enhances doctor resilience, much needed at a time of workforce crisis with fewer than 25% of new graduates choosing general practice.
In my own practice we have always prioritised continuity and all patients have a named GP. In order to continue to prioritise continuity but still manage increasing demand for access, as well as an increasingly part-time workforce, we have introduced small teams so that if the patient’s named GP is not available the patient sees only one or two other GPs.
GPs have worked out for themselves what is needed, but much is subject to the whims of our political masters, out of our control. The politicians are recognising the importance of continuity, hence the introduction of a named GP for over 75s, and from April 2015, for every patient. I welcome wholeheartedly a return to placing continuity at the heart of primary care, but there will continue to be a tension between access and continuity unless more resources, both in term of money and GPs, are found.
Dr Naureen Bhatti
London
• Mary Dejevsky has misunderstood the information that the Care Quality Commission has published for every NHS GP practice in England. She discovered that a local practice’s “overall score was a presentable five out of six”. For each GP practice, the CQC combines 38 indicators into an overall score. It then uses this to assign a practice into one of six priority bands for inspection. Band 1 is the highest risk and Band 6 the lowest. A practice’s priority band for inspection isn’t an “overall score” and shouldn’t be interpreted as such.
Dr Alex May
Manchester
• I must be lucky where in live, in a Merseyside village: I can nearly always get an appointment on the day I call (if I phone at 8:30am), the staff are pleasant, and I have no problem with repeat prescriptions. But for those who aren’t so lucky, aren’t they being defrauded? GPs are paid per head, so if a practice reaches a situation where it can’t offer an appointment, the GPs need to work longer shifts. It’s as simple as that.
David Garner
Southport, Lancashire
• Like Mary Dejevsky’s husband, I have a long-term condition – and yes, continuity does matter. Yet it can take two to three weeks to obtain an appointment with the doctor with whom I am registered. If I don’t care for that, I can join the telephone free-for-all on the dot of 8am to obtain an appointment with a newly employed salaried doctor I have never heard of. Even this has taken, on one occasion, almost 20 minutes of constantly re-dialling.
My wife has to work abroad for her company from Monday to Thursday, so Friday is her only opportunity for an appointment. She was recently offered one four weeks in advance – and not even with the doctor of her choice.Why should we be denied adequate healthcare because of the failings of our local GP practice?
Rob Stubbs
Wirral, Merseyside
• Perhaps Mary Dejevsky should just change her doctor. My local practice cannot be the only one where one can see the doctor of choice, phone for an appointment whenever convenient, discuss possibilities with a practice nurse or a friendly, knowledgeable, smiling receptionist. Any matters of practice that cause problems can be discussed at a patient participation group. It is great. Don’t damn all GP surgeries because of your personal bad experience: find a new practice.
Corinne Haynes
Nottingham
