Fighting the covid legacy
It is still the case that only a handful of medics working within the NHS feel free to speak out publicly. We have written about the reasons for this previously.
A GP contacted HART last week, describing some of what they are currently witnessing. Boots on the ground reports are extremely informative for a confused public. We invite other medics and clinicians to share their experiences. Anonymity would be assured.
Currently, many patients really struggle to get a GP appointment. In my practice we do our utmost to ensure very good access and our patients regularly comment that they are very pleased to be able to be seen the same day or the next day. However, many surgeries routinely have waiting times of 2-3 weeks for GP appointments and even then patients may only be offered a telephone appointment instead of face to face care.
Patients in acute need inevitably end up going to A&E. They are then told it is an inappropriate use of A&E. I would ask what other choice they have if they cannot access their GP service for weeks on end? There are practices in our area that still have their surgery doors locked and patients have to have telephone triage before being ‘allowed’ into the building. There is no reasonable explanation as to why this is the case. One is reminded of the Milton Friedman saying – “Nothing is so permanent as a temporary government program”.
Masks are still hit and miss. Hardly anyone wears them in our shared health centre, which includes 3 GP practices and various community services. However, I personally know other practices that still insist staff and patients wear them. Currently I believe our local hospital is not asking people to wear them. The fact that this is inconsistent across services speaks volumes. They are far from benign and it is appalling, given the dearth of evidence, that anyone in the medical arena is still championing their use.
In-patients are regularly being made to have PCR tests. I can infer that a patient has been admitted as an in-patient when I receive a PCR result. I cannot remember when there was last a positive result, and again, it is unclear why this costly and flawed procedure is still being used.
The main problem facing the NHS now is waiting times. My surgeries are filled with patients who have already been referred and are waiting for hospital appointments. The patient rings the hospital to chase their appointment and is told that the waiting list is 50/60/80 weeks long. The only way to be seen sooner is to go back to the GP and ask the GP to expedite it. Where appropriate, I then duly send another letter, but the hospital triages it back down to ‘routine’ status and we are no further on. More time wasted at both points of service. As one consultant gastroenterologist said to me recently “there is no such thing as an urgent referral any more”.
I work in an area where people are relatively well off and many are choosing to pay privately instead. That is not to say they are wealthy people, but they feel that the service is so poor that it is worth dipping into their savings to improve their quality of life. They would rather pay than spend a year or more on a waiting list. However, there are plenty of people for whom this just isn’t an option.
When the patient has finally been seen, the consultant tells them they want them to start some new medication but it takes their secretary 6 weeks or more to type the letter, by which time the patient in question has rung the surgery multiple times chasing up the new prescription. Why is this still being done in this way? In a world where we are told tech is ‘shaping a better future’, surely the physician in question could devise a system to issue a prescription there and then?
Examples of system failure
It is not unheard of for a patient to be referred with a routine problem, such as a hernia or gallstones, only to spend so long on the waiting list that the problem escalates and they ultimately require emergency surgery. This not only exposes the patient to more risk but is also more costly for the health service.
Another issue is inefficiency. Often a patient is sent an appointment letter and on the same day receives another letter cancelling the appointment and telling them not to call up as they will be sent a new appointment in due course. The new appointment fails to materialise so they book a GP appointment to chase it up. A common scenario is a patient has to rearrange their out-patient appointment or hospital investigation because of other commitments. If they do this once, that is acceptable; if they try to do it twice they are told a flat no. They are discharged back to the GP to be re-referred, not only wasting time and resources but also meaning the patient ends up back at the bottom of the waiting list. I often send test results with my referral letter but these are not passed onto the treating clinician who then repeats the investigations. More wasted resources.
Rejected Patient Referrals
More and more of my referrals are rejected by the hospital. Any number of excuses is given not to have to see the patient. It is like a culture that is bred into NHS staff to bat away anything you can. I have had experience of our local surgical unit refusing to accept referrals for suspected appendicitis because the patient is young and female therefore the problem “must” be gynaecological. Standard referral forms are changed on a whim and if the current version is not used the referral is rejected, even though all the same information is contained within it. Referring 16 and 17 year olds is particularly fraught as paediatric services often cease accepting patients at 16 but adult services only accept patients aged over 18.
This account could of course go on for many more pages, but hopefully this highlights the woeful state of ‘our’ NHS today. The system is not working. When state healthcare is on its knees like this, people die. It needs a complete rethink, and more ‘management’ is not the answer.