The practice continued to evolve. One ongoing problem was providing enough appointments.
I read the results of a survey in Which magazine that claimed patients fell into two categories: those who wanted to book appointments in advance (for example those with long term conditions) and those who wanted to be seen quickly (for example those with severe chest infections). We therefore ran the normal ‘book in advance’ surgeries but additionally ran an ‘old fashioned sit-and-wait’ morning surgery between 9am and 10am … so anyone who turned up before 10 was guaranteed to be seen. Sometimes there were just half a dozen patients … but very occasionally 30 or so would turn up. It tended to be self limiting in that people who arrived at times when there was ‘standing room only’ and whose need was not very urgent would often opt to come back at another time.
This change coincided with the growing importance of the nurses in the practice. They were the first port of call for the ‘unbooked’ surgeries – with me hovering in the background trying to look important. They all had a sound clinical background and their years of experience meant they had ‘clinical antennae’. In other words, they could spot the patients who were running into trouble a mile off – so they worked safely within their (continually expanding) comfort zone. How different from the ‘physician associates’ who, after a brief training period, were thrown in at the deep end with predictable consequences in the early days. Needless to say they will improve with time … but our nurses hit the ground running.
It could be very hard work but the benefit for the practice was that nobody could claim: “I couldn’t be seen for 3 weeks” because they could have been seen that morning … or the morning before. It also gave the staff a chance to have a peep at those in the waiting room – and give priority to anyone who clearly needed to be dealt with ASAP. (Sometime stoic patients who were having heart attacks would turn up and patiently wait their turn – although that was pretty rare). Old fashioned GPs (like me) still cling on to the belief that you miss a lot when you don’t clap eyes on a patient.
We also tried to make the surgery more ‘user friendly’ in other ways. For example, there was a call for a minor injuries unit (which didn’t materialise) … so, to save people having to go to A&E (which involved a long journey, long waits and a substantial 3-figure bill for the NHS) we found we could deal with minor-ish problems (such as ‘cuts and bruises, sprains and strains’) quickly and easily … and cheaply.
Morale was good and there was a congenial atmosphere at the practice.
In 1997 Tony Blair won a landslide victory and there were the usual juddering gear changes within the NHS. By and large we felt that, as far as the health service was concerned, Labour’s theme tune summed up the situation – “Things can only get better.” Accordingly I set up an organisation to follow in the footsteps of ‘Medac’ (a patient-led body which brought pressure for improvements here). The new one was called ‘Healthcare 2000 which aimed to tap into any new initiatives so that SWF would benefit. Whilst we were cautiously optimistic, at the opening meeting we sang an old Noel Coward song (“There are bad times just around the corner, There are dark clouds hurtling through the sky“) to prove that we had a grip on reality.
Little did we suspect quite how apt that would prove to be! The untried/untested plan was to set up lots of small organisations (PCTs) to deal with the NHS minutiae … which was all very well but, as Nigel Hawkes pointed out in the Times: “There simply weren’t enough high-calibre people to fill these jobs. Many who were appointed were over-promoted, earning fancier salaries than they could ever have dreamt of. They all became lottery winners, with index-linked pensions to match.”
He went on to say: “All this could have been predicted. But, like so many NHS projects launched from the back of an envelope, the great PCT bonanza went ahead. There is no National Institute for Health and Clinical Excellence to apply the same rigour to management decisions as it does to drugs or new treatments. Evidence-based decision-making doesn’t apply.” His key message was: “If Oscars were awarded for the casual waste of public money, the Department of Health would never be short of nominations.”
Our low-calibre person was ‘Hopeless Harrison’. Private Eye’s ‘M.D.’ summed him up as follows: “The Chief Executive of Maldon and South Chelmsford PCT is Mike Harrison, who held a similar position at Southend Community Care Services Trust until consultants passed a vote of no confidence in him in 1998, alleging that he “colluded with South Essex Health Authority to destroy patient services.” Harrison vigorously denied this but eventually resigned after an independent review of his management techniques.”
Despite an unpromising start to the new era, Healthcare 2000 took root and organised regular meetings which attracted fairly large and diverse audiences. One of the stars in the early days was the late great Joe Dorado a resident who had considerable management experience and, unlike so many of that ilk, had deep affection and respect for the NHS. He’d had experience of Harrison in Southend and I think it would be fair to say that he concurred with the description in Private Eye. He was not afraid to approach the NHS decision-makers (most of whom worked hard to give the impression they had no knowledge of nor interest in SWF). Here’s one example together with the response it triggered. One recurring suggestion was that we should have better local diagnostic facilities – so the residents of SWF get the same standard of care as their pets. For good measure, I’ve added some ‘random documents’ to give anyone who is interested in this sort of thing an idea of what we got up to.
With the support we received we pressed ahead, obtaining patient feedback, coming up with ideas, grabbing opportunities as they occurred and pointing out the problems caused by decisions made without consultation.
Dr John Cormack