It's all our fault, apparently

All day long I've been listening to pundit after pundit wheeling out the received wisdom that the crisis in Accident and Emergency is down, in large part, to the GP's contract of 2004, which allowed GPs to hand over responsibility for out-of-hours work to the (mainly private) OOH companies. It is said that the ending of evening and weekend surgeries has placed intolerable demands on A and E departments. Well here's the news: it's crap.

Sure, GPs said goodbye to Saturday morning "emergency" surgeries in 2004, and I can't say I grieve their parting. But evening surgeries? I've been a GP since 1979, and neither I, not any other GP I know has ever conducted an evening surgery (though my afternoon surgeries often extended in to the evening as far as  8 pm.) I've also done quite a bit of work for the OOH services, and they are in general hard working and efficient concerns who do what it says on the label: supplying GP-type services in the evenings and weekends.

So what's really going on? The fact is, demand is increasing in all areas of the NHS, as great wells of unmet need gradually begin to be addressed. Then there's the burgeoning immigrant population, many of whom generate enormous demand on our services because they often have poor health when they arrive; plus the fact that some cultures demand to see a doctor straight away for whatever ailment they happen to be labouring with at the time (I'm thinking here particularly of immigrants from central Asia, though I would be lying if I said they had a monopoly on excessively high demand). Then there's the persistent view of a huge number of patients, whatever their ethnic background, that if the GPs are closed, well, you go to A and E, right? Wrong. A number of studies have confirmed that many of the people sitting in A and E departments, whingeing on about how long they are having to wait shouldn't be there in the first place. Accident and Emergency. Think what those words mean. Yet any day of the week you'll find people waiting to be seen for their sore throat or bad back which they've had for days. These people need educating, pronto, by doing a quick screening and simply turning away those who are using the service inappropriately. Before they slope off you could tell them:
"This unit is called 'Accident and Emergency'. Your problem is neither an accident nor an emergency. The right place for you is just over there, marked 'Out of Hours GP Clinic.'"

In my local hospital the OOH centre lies directly adjacent to A and E, so it's hardly a great stretch for them to wander next door where they can be seen in a more appropriate setting. That alone would ease the pressure enormously. Not that GPs are completely without blame. A lot of them restrict their surgeries artificially to no more than 15 patients in a session, regardless of how many people have asked to be seen, and some even have the highly aggressive warning pinned to their notice boards saying
"ONE PROBLEM PER CONSULTATION ONLY"
which is ridiculous and unfair, especially to the elderly and disabled, who often suffer from multiple health problems and may find it extremely difficult to get to the surgery at all.
The changes brought about in 2004 were meant to bring doctors in Britain into line with custom and practice in the rest of Europe, and is no bad thing. As long as they do their work properly during the day, that is.