Health Check: 'GPs have met targets by pushing patients around'

Have you seen your GP lately? More than 95 per cent of practices are now said to be offering appointments within the Government target of 48 hours. I put my practice to the test by calling up for an early morning appointment.

Have you seen your GP lately? More than 95 per cent of practices are now said to be offering appointments within the Government target of 48 hours. I put my practice to the test by calling up for an early morning appointment.

I was told I could come in that morning and wait. But the problem was not urgent and I preferred a time to suit me. There was a pause and some sighing from the receptionist before she offered me 9.15am on a day five weeks ahead.

I laughed. The problem was not that non-urgent, I said. She responded, politely, that the practice was always striving to improve services for patients. We compromised on a date 10 days ahead, but with a GP registrar (a trainee), rather than my own doctor.

Not getting prompt attention from the family doctor used to be one of the chief complaints of patients. Recognising the extent of public dissatisfaction, the Government imposed the 48-hour target for patients to be seen by either a doctor or a nurse.

The British Medical Association insisted the target was impossible to meet with existing manpower and demanded an extra 10,000 GPs. Yet here we are, a few years later and the target has been largely met.

However, it has been achieved at a cost. Some practices decided that, if the Government was going to push them around then they would push their patients around. They abandoned all appointments in favour of open-access surgeries where patients would have to queue.

Ministers were infuriated by this, and demanded that doctors offer patients the choice of waiting in the surgery or an appointment. But what kind of choice is it if the appointment is in five weeks?

There is a broader lesson from this story. The new GP contract, introduced last April, which provides for a whopping 33-per-cent rise in doctors' earnings over three years, is based on a payment-by-results system designed to cut the burden of heart disease and nine other chronic conditions. It has been hailed by foreign commentators as the "boldest attempt to improve the quality of primary care anywhere in the world". But there is a major omission. Nowhere does it reflect the traditional role of the doctor as advocate for the patient. Those features of the relationship that patients have always valued - continuity of care and personal care - are not incentivised.

The result could be an increasingly fragmented and impersonal GP system. A hint of this comes from the decision by the vast bulk of GPs to opt out of night work, leaving it to GP-deputising services. Is there any profession in history that has willingly given up its monopoly of care in this way? As new organisations move in to provide GP cover at night, using nurses and medical auxiliaries, they will undoubtedly have their eye on providing daytime services too. If they can offer appointments at times convenient to patients, then I am one customer on whose interest they can depend.

* The elderly man with Alzheimer's disease abandoned at Oldchurch hospital in Essex last week has highlighted the desperate situation faced by many carers. We have been looking for someone to live in and look after an elderly relative and turned to The Lady, a publication I last consulted 20 years ago for an au pair. The big change since then is that most advertisers are looking for carers for the old, rather than the young.

We placed an ad and were astonished at the response. In two days we received more than 100 calls from a range of nationalities, including a fair sprinkling of middle-class Brits seeking a rent-free home. We finally chose a lovely Lithuanian woman who seemed to have the right mix of caring skills and intellectual engagement.

But the experience left me wondering about the impact of an ageing population and escalating rents. There is an army of people out there who are only too happy to provide care in return for a roof over their heads.