Tristan Cork: We need to be able to call on our doctor 24/7
Doctors sometimes need to remember who pays their wages, argues Tristan Cork...
In exactly a month’s time, the biggest change in 60 years of the NHS will happen, whether doctors, nurses and patients are ready or not.
There are many different aspects and controversies surrounding the NHS Reform Act, and not a week goes by when Prime Minister’s Questions don’t resound to yet another fear being raised about increasing privatisation.
Only this week, one question had David Cameron crying out in frustration: “What is there to be afraid of?!” when asked about claims that doctors were being forced to put the services they offer out to competitive tendering.
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In truth, much of this is already happening, and there is a case to argue – as Mr Cameron surely will – that if the founding principle of the NHS remains, that it is free at the point of deliver to whoever needs it whenever they need it, and of good quality, then who is delivering it and how doesn’t matter that much to the average patient.
It used to be the case that your local doctor would come out at all hours of the day and night. This was when the West was all green fields and everyone did everything by hand, and the doctor was your doctor from the cradle to the grave and would visit you in bed, nod sagely and all would be right with the world.
Demands on doctors have increased hugely – the population has boomed, for one – and whereas people would only turn up at the surgery for an appointment if they actually thought they were dying, now they are there if they sneeze twice in the same hour.
I exaggerate, of course, but the long and the short of it is that doctors found the old way of doing things meant they wouldn’t, actually, have a life of their own.
So under the last Labour Government they signed a deal with Messrs Blair and Brown that if they were to go ahead with the last lot of reforms from the last lot of politicians in power, they would want a great deal more money to be doctors and do a great deal less work. The doctors, mostly, won.
So the act of providing a GP service when your doctor’s surgery wasn’t actually open has gradually been separated from the act of providing a GP service when it is. It has, for some inexplicable reason, become a commodity to put out to hire. Your regular doctor doesn’t want to work past 7pm – none of the ten in your super surgery do – so effectively the NHS, and now they themselves, pay a private company to provide it. They in turn pay doctors to visit people, but wisely think it’s probably best if they filter the calls they get.
The NHS Direct service and your doctors’ out-of-hours service are soon to merge, if they haven’t already where you live in the West, with a new 111 number, instead of 999. Almost everyone knows not to dial 999 if you’ve got a bit of a temperature. 999 is for when you’re having a heart attack, been run over or have half your arm hanging off thanks to a DIY or threshing machine accident, and even then a lot of farmers I know would probably be weighing up their ability to drive to the hospital: “Would it be quicker? How would I change gear?”
But the 111 service appears designed to fail miserably. Having a private company means they have to make a profit. Making a profit means they will do the minimum they have to, to meet the standards of service required, and still take the money from the doctors who are paying them to do their job for them at night and at weekends.
So far under the new arrangements, there is a shortage of doctors, clearly. There is also a poor excuse for a call-handling system, where non-medical people merely go through a rigid set of questions – at least with the much-criticised NHS Direct service, you had a good chance of speaking to an actual trained nurse.
So for the likes of Gill Green, for whom the pain caused by her cancer became too much, she had to wait six hours for a doctor, while she entertained two paramedics who were friendly and helpful, but utterly the wrong medical professionals she needed. Ambulances and paramedics are for first aid and taking people to hospital in a hurry.
As an asthmatic I have had cause to call what passes for an out-of-hours GP service, mainly when my inhaler runs out.
It’s my fault I know, but all I need is a fresh inhaler, and the doctors’ is closed. I don’t need an ambulance or a paramedic to take me to hospital – that would cost far more money than a local doctor arriving promptly and handing one over, telling me to call again if it doesn’t do the trick.
Instead I get through to a person in Southampton, or wherever, asking me about my medical history, and taking five attempts to spell the name of my hometown correctly as I wheeze down the phone. Why is it that if you are taken ill at the weekend you are far more likely to die than if the same thing happens during office hours? I begin to get some idea…
A friend of mine works for a mobile phone network company. Many an evening he is “on call”, speeding off to a problem somewhere. Another friend is a firefighter, with a pager charged up most evenings. Another friend is a vet at a practice covering roughly the same area as the doctors’ surgery. I wouldn’t guess at the numbers, but there’s probably more cows and horses in this corner of north Wiltshire than there are people and the vets practice cares for them all. One or two of them are always on call – heading off into the night to tend to a sick horse or a troublesome calving.
Sure, animal care is all private – the vet sends a bill or has an agreed contract with a farmer. But then, taxpayers like me and everyone else pays hundreds of pounds in National Insurance for the NHS and pay the doctors’ wages. We have a contract too, you know.
So doctors, you are, on the whole, brilliant. You combine the patience of saints with the expertise of years of training and experience.
But the system in place at the moment simply is not good enough. If one good thing can come out of giving doctors the power to commission their own services then hopefully it will be that they start thinking of returning to doing their own jobs themselves again – and that means around the clock.