Hate to say this, but you’ve lost me Ed.

Ed Milliband says “I just want to make the system work better.”  I don’t doubt the good intentions, but Labour’s pledge of a 48 hour maximum wait to see a GP is hollow.

Let me spell out how to make it look like no patient waits more than 48 hours:

1.  Set the clinical system to release all appointments at 48 hours.

2.  When patients call for the appointments, fill them up.

3.  When they are all full, tell patients to call again tomorrow.

Job done, Labour target satisfied.  But why are patients dissatisfied?

1.  Any appointments bookable more than 48 hours in advance will not contribute to hitting the target, so would make it harder to meet Ed’s pledge, for which they will be punished.  It’s now impossible to book ahead more than 48 hours, and if you want a particular doctor (nearly half of patients do), you are stuck because he or she may not have availability in that period.  Continuity takes a dive.

2.  Because everyone knows there’s a shortage of appointments, everyone calls when lines open at 8:00 on the dot.  The practice has no way to afford the lines and employ the receptionists to deal with the spike in demand, so everyone waits.  They wait until either they are lucky and get an appointment, or not and are told that all slots are gone, call again tomorrow.  Please note that they are given out on the basis of luck, not clinical priority.  Patient safety takes a dive.

3.  Today, around 12% of patients asking for a doctor are told to call back tomorrow.  The target will increase that number, wasting time for patients and receptionistss, increasing complaints and therefore bureaucracy.  Do you think Ed Milliband can force doctors to take all comers?  He can’t.  They won’t.  The “advanced access” programme tried bribing them to do so at great cost, and failed.  Efficiency takes a dive.

Ed says this has all been carefully thought out.  He’s putting £100m into general practice, by saving on bureaucracy elsewhere (politicians of all stripes promise these savings, and they all fail).  So why £100m?  It’s a round figure.  It’s twice what Dave is spending on his GP Challenge Fund.  It’s enough to pay for less than one tenth of a GP consultation for everyone in England.  But given an average of 4 visits each per year, that’s about 2.5%.  If there’s a crisis in general practice, it simply doesn’t add up.

Understand how general practice works as a system, understand what motivates the players, look at the perverse outcomes of your 48 hour target, and start again.

Dr Sara Cowell    (PS I care about access and continuity too, and there’s a better way.)



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