Abuse of the system, or by the system

I was speaking at the Lincs Practice Managers’ conference on Friday and started chatting over breakfast with another hotel guest, about each other’s work.  Neil (not his real name) was passing through on his way back to Harrogate (real name).

Neil went straight into describing his dreadful recent neck and back pain, when he hadn’t been able to see his own GP for 7 days.  Try as he might every day at 8.30, he’d be told “You are number 17 in the queue” and then find no appointments left.  He was in agony, couldn’t sleep.  I absolutely hate to hear this so common story, it drives my passion to do something about it.

Listening to GPs we hear endlessly about patients who abuse the system with trivial demands.  We can’t eliminate the problem, but when we have asked GPs to audit their consultations in real time (n>25,000), we’ve found they judge overall just 3% as “should have been self care”.  This number doesn’t change when access is easy.

Yet a real time audit in reception (n=40,000) shows that 12% of patients asking to see a GP are told, “Sorry, nothing left”.  A rough calculation says those abusing the system are outnumbered 4 to 1 by those abused BY the system - such as Neil.  Compassion, the word of the day in our touchy feely NHS, is not a sympathetic smile, it is simply saying yes to a patient in need.

Turning up the volume on the moanometer won’t do.  We can and we must change the system.

Neil wanted to test askmyGP to see how it could help.  Starting from “back pain” he did a simple questionnaire, which turned out to be 36 one click answers, taking 6 mins 37 seconds (patients are happy to spend their own time if it’s productive).  Take a look at the history he produced here.  GPs, bearing in mind you would normally have the existing patient record, please decide the first action you would take to help Neil.

How many seconds did it take to make that decision?  Compare with the 7 days of agony it took Neil to get in front of his GP.

Dr Sara Cowell

Founder, Chief Executive
Dot Community Health Ltd

PS Back pain is the second most common presenting symptom through askmyGP.  But in a very deprived practice, depression tops the list.  Our poster with Wester Hailes “Smarter access improves clinical care” at the RCGP last week explains.

PPS If you’re not a GP, this blog on What do GPs do all day is worth a read on how things have changed.  We need to get back the essence and put GPs in better control of their day.

One response to “Abuse of the system, or by the system”

  1. Chris Frith says:

    My decision would be I need to ask questions to rule out red flags for cord compression or to differentiate between sciatica and facet joint pain. Shame these were not in the questions.

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