We celebrated getting the go ahead to restart the practice as a NHS surgery with our amazing band of volunteers – but this was just the first step.
The PCT was still stealthily putting every available obstacle in our way. I mentioned that in order to make it crystal clear that a large number of patients wanted to join the surgery I had to get them to complete the type of form everyone has to fill in to join a NHS surgery anywhere in England. We were then told that they’d have to fill these in all over again as, at the time they originally filled them in, there wasn’t an NHS practice to which they could apply (as we hadn’t yet been given the go-ahead). This was clearly a case of ignoring ‘patient choice’ and was done with the intention of creating ‘natural wastage’ … in other words, hoping that patients would get fed up with jumping through all the bureaucratic hoops and would stay registered at the PCT run practice (to which they had been moved without being given any say in the matter).
Fortunately the great majority of the patients came back and dutifully filled in another form. These were then taken back to the NHS registration dept by a very ‘leaky’ van. We jokingly assumed that the driver left all the doors and windows open because, by the time the van arrived, there were seemingly far less forms in the vehicle. Sometimes patients had to fill in two or three forms before they were officially registered at Greenwood Surgery. I had a strange conversation with the guy who ran the registration department. He seemed to be sympathetic to our cause. He had spotted a family who had the same surname as his – and he mentioned that the registration forms for just two of the family members had reached him. By an unfortunate coincidence, one member of this family was working at the surgery – so we knew all the forms had arrived and been sent off in the leaky van at the same time.
All this took its toll on me – as the ‘before’ and ‘after’ pictures (which were somewhat ‘doctored’ by my son, Ben) demonstrate.
The biggest problem we had was working without records. The PCT had taken a day to transfer the computerised records from Greenwood Surgery to the Portakabins. It took them a year to return them in anything approaching their entirety. As for the ‘paper’ records … they came back VERY slowly … and in dribs and drabs. We had to store them in cardboard boxes as I had foolishly let Harrison take the ‘tailor made’ records cabinets when he gave me his word that he would return them. Needless to say, he reneged on this agreement.
As I’ve mentioned before, the lack of records put patients at high risk. One example – a patient came in suffering from pain resulting from inflammation. His normal pain-killers “didn’t touch the sides.” I asked him if he’d had anti-inflammatory medication (NSAIDs) before. He said he’d taken one of these … Voltarol. I asked him if he’d tolerated it well.
He said he had. I specifically asked him if he’d ever had a gastric bleed. He said he hadn’t. I gave him a prescription plus the usual advice e.g.: take after meals, report back if any side effects – etc. Sometime later his Lloyd George envelope (containing paper records) arrived at the practice and across the front was a bold marker-pen warning: “NO NSAIDS – GASTRIC BLEED”. He’d forgotten to mention this … which might sound strange but, when you’re sitting in a GP’s consultation room having questions fired at you, it can be hard to remember details of your past medical history … so much so that I sometimes take a crib-sheet with me when I visit my GP! Luckily this patient didn’t have another gastric bleed (an event which can be catastrophic).
The PCT must have known that this was an extremely dangerous situation – but patient safety and wellbeing was very low on its list of priorities in circumstances such as this …. ‘all is fair in love and war’ seemed to be the motto, not that there was much love lost. We assumed that it was hoped that depriving us of the medical records would make it likely that we’d make an enormous cock-up … one that resulted in a tragedy. News of this would spread rapidly on the SWF grapevine and patients would steer clear of the practice. Given the gross underfunding, it wouldn’t take much to put us out of business altogether – despite the collection box which helped pay for the basics.
Later on the PCT instigated a celebration of ‘quality’ in general practice and invited all the GP surgeries on its patch to send in posters. We sent in one celebrating the fact that we hadn’t accidentally bumped any patients off whilst we were working without adequate medical records. Needless to say this wasn’t put on display with all the others.
Dr John Cormack