22nd September 2017

I have decided to start using dates instead of a day count. My research is sporadic, some days I’m just not up for it. And anyway, I keep losing count!

Yesterday I was quite excited. I watched a video about the German Healthcare system. I have not corroborated the facts yet, but I found some similarities and a few differences. The point that intrigued me most was that the German General Practice system has a maximum patient limit. It also scored very highly on patients getting appointments either the same day or the next day.

I hate making appointments to see my GP.

The phone lines open at 8.30 am.  Everybody tries to phone as soon as the practice is open for business because everyone knows that everybody else is doing the same thing and they need to be quick to get an appointment. Then the line is constantly engaged because everyone is phoning……

When you get a ringtone (oh joy) it doesn’t necessarily mean you will get to speak to someone. Sometimes you just have to wait for the phone to be answered (the poor receptionist is trying to answer the phone and help patients who are in the surgery and get medical notes for the doctor….etc), or you might get put through to another receptionist who tells you that your call is on hold, please wait.

Eventually, you speak to someone. They offer available times, take your details and you’re in. Or not. “Sorry, there are no appointments for today, phone again at 8.30 tomorrow”. WHAT??!!

I can’t decide which is worse. Going through this when you are also trying to get ready for work or maybe are on speakerphone and automatic redial because you’re driving to work, or you’re at home with small children who are refusing to eat breakfast; or going through this when you are crippled with anxiety, not sleeping properly and have hauled yourself out of bed because you need to phone at a specific time. In all cases anxiety levels are bound to be high. Tempers will flare. You may start shouting at the receptionist because you are so frustrated and have lots of more important things to do and don’t have time for this but need to see a doctor. Today. You wouldn’t be phoning otherwise.

How do receptionists stay sane in this environment?

Writing this has given me an idea. (And I’ve noticed that I have deviated from my main point a little.) In my surgery, if you get told to phone again the next day, there is no guarantee that after going through the same process the next day you will be given an appointment. My idea is that a system be created to give priority to people who have phoned previously. This might get complicated and involve urgency ratings (because there have to be appointments available each day). I haven’t thought it through yet.

This is why I either don’t make the appointment at all (I’m fine, really, I don’t need to go) or if I’m desperate I use the electronic appointment system. (I have been using the electronic repeat prescription services for a few years now because getting an appointment to see a doctor to say I need more tablets was way too stressful – I suffer from anxiety). Electronic appointments are much easier, but there are only advance bookings, and sometimes advance means a few weeks away.

I think you can safely say that I don’t like the system as it is.

So in Germany a practice has a maximum number of patients. This initially excited me because the easy access to appointments appeared to be a direct consequence.

Looking in to how it would work over here, I’m not so sure now. We have a GP system where we are free to register with whichever practice we think suits us best. The practice is legally bound to accept your registration unless there are reasonable grounds not to, which must be explained. I like this, freedom of choice. This is to help people who want a GP nearer to the place they work, someone who has moved but wants to keep their family GP, or someone who feels they are not getting their needs met at their current practice.

But this freedom of choice means that practices can get oversubscribed. Which is why I can never get an appointment and when I do I have to regularly wait half an hour after the appointment time to actually get seen. And this must also have a huge impact on doctors and nurses and receptionists……..

Do we need more doctors for the growing population? Where will they come from? How long will it take to get them trained? Who is going to pay for them?

The Royal College of General Practitioners (the body which regulates family doctors in the UK) produced a report on patient access in 2015. It has some interesting arguments and can be downloaded here.