Service in the surgery

Most of us can no longer afford medical cover, so how do we deal with the vagaries of the NHS? First, find a good GP, says Harvey Jones

THE SEARCH for decent health cover can lead to a dilemma. The NHS seems plagued with rising waiting lists and hospitals in crisis, yet the private medical insurance alternative is getting increasingly expensive.

Latest NHS figures show that between September and December 1997 the number of people waiting between one year and 17 months for hospital admission increased by more than 18 per cent. Nearly 1,000 people had waited longer than the Patient's Charter guarantee of a maximum wait of 18 months. These lists are to be blitzed with pounds 375m of funding but the queues will be hard to shorten.

The private sector should be booming, but its growth is being stifled by steeply rising costs. Some analysts have predicted that private medical insurance premiums will increase by an average 6 or 7 per cent this year. George Connelly, health insurance intermediary at Health Care Matters, says this is a conservative estimate. "I would not be surprised if some premiums increased by double that figure," he says. Only one in 10 people now has private cover, and many of these are covered by subsidised company schemes.

The rest of us have to make sure we are getting the best out of the NHS. Governments have tried to make the NHS more patient-friendly in recent years, and a rewritten Patient's Charter setting out our rights and responsibilities is due in July.

You can take positive action to try to ensure you get the best NHS care. Your first port of call will almost always be a GP. The GP is the all- important gatekeeper who can direct you to a range of secondary care services. It's vital to pick a good GP if you are sticking with the NHS.

If you aren't happy with the care you get at the moment you can choose a new GP, says Stephanie Ellis, honorary secretary of the Patients' Association. "Patients are free to change GP, but few realise this. They fear they will have to explain why they moved to their new doctor, and may be branded a troublemaker."

To change practice you do not have to tell your current GP. Contact your health authority or community health council, or visit your local post office or library to get a list of practices. It may not always be possible to join the practice of your choice as its lists may be full or you may live outside its catchment area.

Deciding what makes a good GP practice is difficult. Word of mouth is a good start. Your local community health council will also guide you, although staff cannot recommend a particular practice.

Some forward-looking practices have set their own standards of service, and these may prove good criteria to compare against your own practice. The ideal surgery should usually be able to offer routine appointments within three days and urgent appointments on the same day. If the practice has an appointment system the GP or nurse should generally see you within 20 minutes of appointment time. You should look for referrals to be made within one week and repeat prescriptions issued within 48 hours. All this may go out of the window during, say, a flu epidemic, but it is a useful benchmark.

Check whether their services match your particular needs. Most practices offer services such as contraceptive advice and fitting, child health surveillance, maternity, obstetrics and minor surgery. Many practices will also run specialist clinics. A typical list includes antenatal care, well woman, blood pressure and asthma and diabetes clinics.

In addition, you may find some of the more innovative practices offering dietary, counselling and psychotherapy clinics, depending on the interests of the partners. A growing number offer access to alternative and complementary medicine. If these services interest you it might be worth seeking out an appropriate practice. A practice leaflet sets out all the services.

Some patients prefer to see a female GP, and, with the number of women entering general practice rising rapidly, most group practices now include at least one female partner.

A visit to the surgery may also help you decide whether to join the practice list. All GP surgeries are obliged to have the basics including a properly equipped treatment room and minor surgery room, patient privacy for consultations and examinations, adequate waiting areas and disabled access.

"There are no easy measures for judging a good practice," says Mr Ellis. "A surgery may be clean but not have the latest wallpaper because the GPs have spent their resources in other ways. However, positive signs may be toys for younger children, information on hospital services or where to go if you wish to complain."

The average GP has just less than 2,000 patients to look after, so you cannot expect a luxury service. However, warning signs of a poor surgery may include few extra services, rude staff and doctors and a scruffy waiting room.

When joining a new practice you have the right to be offered a basic health check, and can have a health check from your current GP if you have not consulted for three years. Your GP is responsible for ensuring that 24-hour medical cover is available when necessary, although she or he does not have to supply it personally. You also have the right to be referred to a consultant acceptable to you when your GP thinks it necessary, and to be referred for a second opinion if your GP agrees it's desirable. "You're pretty much in the hands of your GP when it comes to hospital referral," says Mr Ellis.

"But if you go with clear ideas of what you want, including the hospital you would like to be treated in and local waiting list times, you may get more from your GP. Your local community health council will have information on waiting list times."

q Harvey Jones is editor of 'Financial Pulse' magazine.