GP appointments lottery requires radical surgery – Bill Carmichael

DURING a routine eye test a few weeks back the optician squinted at the image she had taken of the inside of my eyeball and said: “I don’t like the look of those blood vessels. You had better get your blood pressure checked.”

The availability of GP appointments continues to prompt national debate.

No problem, I thought, I pass the doctor’s surgery on my walk home, so I’ll just pop in and make an appointment. No such luck – there’s a large notice pinned to the door stating that you can’t make an appointment in person and you must telephone or use the website.

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I tried the telephone number half a dozen times and it was engaged. My surgery is part of a large, national conglomerate and I had to navigate the national website before finding my local practice.

The availability of GP appointments continues to prompt national debate.

I consider myself computer savvy but I found the website confusing and difficult to use. Heaven knows how those unfamiliar with computers manage.

It turns out I could request a call back from a doctor, or a video consultation, but to see someone in person I had to ring the constantly engaged number.

I felt perfectly fit, and I didn’t really need to see a doctor. A 10-minute appointment with the practice nurse would be enough. As far as I know, there is no way of checking my blood pressure remotely.

The availability of GP appointments continues to prompt national debate.

Eventually, after several emails where I explained this numerous times, I was given an appointment with the nurse. Thankfully everything was tickety-boo – 120 over 80, if you are interested in the details.

According to my neighbours, my experience was not unusual. They told me to get an in-person appointment you have to ring on the dot at 8am, when all the lines are likely to be engaged because everyone else is ringing at the same time. By 8.05 all the available appointments are fully booked, and if you have not been lucky you have to try again the next day. You can’t book in advance.

I asked what happens if you are really ill? Then you have to go to the A&E department at the local hospital, I was told.

This seems like a totally crazy system to me, and is it any wonder that hospitals are under intolerable pressure? This week, for example, the College of Paramedics warned that lives are being put at risk because ambulances carrying desperately ill people are queuing up for hours outside overwhelmed A&E departments.

I am not blaming GPs and their receptionists, who are no doubt doing their best in exacting circumstances, but the system seems to be designed to make it as difficult as possible for patients to actually see a doctor.

One major contributing problem is there is a national shortage of GPs, and this is especially acute in deprived areas. In prosperous places such as Oxfordshire there are 1,688 patients per doctor, or West Suffolk with 1,731 per doctor.

Compare that with poorer areas, such as Hull (2,761 per doctor) or Calderdale (2,606 per doctor).

In short, the places with the worst health problems have the fewest doctors.

This at least partly explains the large disparities in health and life expectancy in the UK, with people in poor areas dying as much as 10 years earlier than those in wealthier locations.

Now a new study released by the Social Market Foundation think-tank this week has proposed a radical solution to try to even things up.

Written by John Gooderham, a former senior official in the Department of Health, it suggests that GPs should be barred from taking up jobs in wealthy areas, and directed to work in deprived regions in an effort to “level up” health inequalities.

Mr Gooderham says that practices that want to create new GP jobs would have to apply for approval from a new regulator, the Office for Equitable Distribution of GPs, or Ofedge.

Ofedge could veto new appointments if it judged there were enough doctors in the area. New GP posts would only be allowed in those areas in the greatest need of more doctors.

I have some reservations. At first glance this seems an overly bureaucratic solution to the problem. Do we really need yet another regulator?

And there is an element of compulsion with the state effectively telling doctors where they can and can’t work, which I don’t like.

But if levelling up means anything, it has to tackle growing health inequalities. So perhaps such a radical idea merits serious consideration.

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