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

Jun 30, 2009
Theodore Dalrymple

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

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.

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