Research by the Patients Association reveals significant dissatisfaction with weekend and overnight community medical care & advice services. A separate survey found 80%of patients lacked confidence in NHS out-of-hours services if they had a potentially urgent medical problem. Half were dissatisfied with their experience of out-of-hours care in the previous two years, and over two-thirds would not feel confident using walk-in centre’s or NHS Direct.
The NHS service in the UK historically relied on the concept of family doctors (GP’s) to look after the non critical and chronic care needs of the public. They provided a holistic service ensuring an ethical interface with tertiary (hospital) care. Their close knowledge of the patients in their care (also their own community) meant that their diagnostic skills were sharpened.
The system has changed hugely in the last 50 years from a local GP who was effectively on call for large portions of the working week & beyond. The landscape of single GP’s changed to small practices sharing the burden. Over the last couple of decades this has moved further into large practices of GP’s working in a more collaborative manner to try & achieve patient satisfaction & better work-life balances for the Dr’s. Collaborative systems began to provide cover for out of hours (OOH) work. About a decade ago the system changed further and primary care co-operatives were born & OOH care ceased to be the responsibility of the GP’s and was transferred to a separate organisations, staffed by GP’s working shift, usually on site close to the local A&E. Hence, the concept of continuous GP care has gone adding another layer of burocracy into the strained NHS system. The changes have been driven by changes in society & the insatiable drive to reduce costs.
Consequently the patient who finds on Sunday morning that their child is unwell must decide whether this is an emergency situation or an urgent one & must direct their request for assistance accordingly. As with many things in medicine there are huge geographical differences in quality and quantity of care provided. As ever, the main issues are resources (or lack of them) resulting in demand exceeding supply.
This latest survey shows significant & deep routed issues with patient satisfaction indicating a service exhibiting significant flaws in its manner of delivery. These issues are widespread & deep rooted & demand urgent consideration but in light of the governments drive to reduce NHS cost by £20bn (between 2011 & 2015) that does not appear an object likely to be achieved anytime soon!
Some years ago the government set up NHS direct – great idea – or is it? Do you know anyone who has a good word to say about it ? Isn’t that the first place to focus the so called “efficiency drives”? If you need to see a Dr , don’t you need to see a Dr not speak to an individual who appears clinically distant and whose responses are initiated by a computer?
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