This isn't patient power: it's a government plot to cut GP budgets

Questionnaires sent to serial malcontents are not a good way to determine the effectiveness of a GP surgery

FIRST POSTED JUNE 30, 2009

In yet another governmental attempt to pretend that British public services are responsive to the opinions of the people they serve, GPs will have the incomes of their practices reduced if a sufficient number of patients answer a questionnaire, sent to them six months after their contact with the practice, unfavourably.

In a real market, of course, dissatisfied patients would simply up sticks and take their custom elsewhere, without filling in any forms at all. Except where there was no competition, a doctor who dissatisfied his patients would soon find himself without income and would, presumably, try a little harder.

But the NHS is predicated upon an absence of real or effective choice for the great majority of patients, on the grounds that the government knows and organises best.

Those who complain have little reason to and are often professional malcontents

In my little town, for example, all the GPs have been removed into one of those vast practices known in the trade as Darzi's khazis (after the junior health minister, Lord Darzi), so that if the income of the practice were reduced because of unfavourable replies by patients to the questionnaire the population of the whole town would suffer. For example, by forcing the redundancy of a nurse.

I have worked out that because of the number of doctors we have, it would take me roughly six months of concerted effort to see the same doctor twice: my choice in actual fact being to see whoever happens to be allocated me, or to see no doctor at all.

No filling in of forms, or reduction of the practice income, will change this fact: one that is as disconcerting to the patient as it is medically inefficient.

It is well known that people who answer questionnaires that are sent to them through the post are not necessarily representative of all the people to whom the questionnaires were sent.

According to reports, fewer than one per cent of such questionnaires were answered by the patients of some practices. Moreover, those who complain are sometimes (though not always, of course) a breed apart.

In my experience as a doctor, people who have every right to complain seldom do so, while those who do complain have often little or nothing to complain of, but are vexatious, in some cases being almost professional malcontents.

The questions that (for the moment) will particularly determine whether practices lose payment or not are whether patients feel they can get an appointment within 48 hours of wanting one, and whether they can book appointments ahead. These two things, while obviously desirable, might in some circumstances be incompatible.

Despite all medical advances, the day still has only 24 hours. Therefore too many patients booked ahead may mean less ability to see patients quickly, and too much time left available to see patients quickly means less ability to book patients ahead.

The scheme, then, has several possible purposes. The first is to give the government an excuse to cut costs. The second is to insinuate to the public that doctors are not working hard or well enough. The third is to give the government an excuse eventually to corporatise general practice: to hand over general practice to a few favoured companies or corporations.

The last thing the government is worried about is your health, let alone your comfort.

FIRST POSTED JUNE 30, 2009

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Excellent article, especially the last sentence. This government of course covered its own face in egg with the new GP contracts when John Reid was Health Secretary. They started paying GPs extra for things they were already doing. So it's no wonder that it's GPs who are on the receiving end of this bit of Nulab stupidity.

Posted by Sheona Hutcheson at 11:50am on July 1, 2009

Theodore, I think you have described a particular illness a mind set within the corridors of ineffectual power suffer from. If this illness can be clinically identified then I believe the suffering nation can justify sending men in white coats unto those corridors to remove the incumbents and place them verily into hospitals for the insane.

Posted by Ian Edwards at 5:44pm on July 1, 2009

An arrogant and facetious article with possibly a racist tint i.e. "Dharzi's Khazi's" (and No, I am not a member of the PC brigade"). When I have needed to see a doctor, nearly every time I have been able to see my own GP within an acceptable time-scale, so his comments do not reflect the reality of own personal experience. Furthermore, I have little time for people like Dalrymple who complain and criticise but offer no alternative solutions, unless he thinks trying to obtain patients views are unimportant. As far as M/s Hutcheson's comments are concerned, I wonder on what evidence does she base her view that "the last thing the government is worried about is your health, let alone your comfort." - here again my own experience of using the NHS is that whilst there is still room for improvement, the scope, speed and effectiveness of the care and treatment I have received has been excellent and the facilities and their range and accessibilty have much improved.

Posted by Sean Jennings at 10:16pm on July 1, 2009

Dear Mr Jennings: anyone who thinks the reference to Dharzi's Khazis has "possibly a racist tint" is indistinguishable from a member of the PC brigade (and no, I'm not Jeremy Clarkson).

Posted by Hammy Hamster at 4:44pm on July 2, 2009

Dear Hammy Hamster I presume you are unaware of the derivation of the term "khazi". or if you are, you are displaying a type of subconscious "racism" in which one sees no offence but nonetheless offence is given. In my own experience, whilst British born , my parents were Irish and because of this I was refered to as "Paddy" on sufficient occasions for it to become annoying, although mostly no offence was intended. In Mr. Dalrmple's case, offence was clearly intended. There is a difference between good manners and being PC.

Posted by Sean Jennings at 6:14pm on July 2, 2009

Generally, I find the NHS marvellous in every respect, but I did complain 3 years ago about the lack of drinking water in the waiting rooms (during a heatwave) and the state of the adjacent public toilets at Moorfeilds Eye Hospital. My complaint was answered promptly by the CEO and on my next visit, the toilets were superb and drinking water was generally avcailable. At the practice I attend, the doctor I consult with is pleasant, professional, and obviously regards me as an intelligent adult. The practice is clean and well kept, has excellent timekeeping and the staff are excellent - as a pensioner and diabetic, I tend to see the practice on a fairly regular basis and can only speak well of everyone who works there whatever their role. I recently had a cataract op at an NHS hospital and the whole experience, and the results, were first rate and would compare well with any medical facility in the world that has been within my experience. This government's mad idea of making online questionnaires available would almost certainly ensure that only people who are serial malcontents are have too much time on their hands would respond.

Posted by Colin Kendall at 11:56am on July 7, 2009