Complaints about primary care services increased by 4.5% last yearBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3839 (Published 07 September 2018) Cite this as: BMJ 2018;362:k3839
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It is concerning to note that complaints in primary care have gone up by nearly 5% . Primary care is increasingly facing the workforce crunch, with dwindling number of GPs and wider primary care staff. With CCGs trying to balance their books, there is more pressure not to refer or admit patients at a time when more care is being transferred into the community. Local initiatives to cut down on prescribing over the counter medications, etc, add to an increasingly unsettled relationship with our patients.
Financial constraints have never been so apparent within the four walls of the consultation room. Then of course, central pressures such as the promise of access to your GP almost seven days a week add to the unrealistic expectations. All these factors appear to be resulting in a toxic mix, exacerbating discontent with front-line primary care. The vast majority of practices are working extremely hard to do their best and must be proud of their hard work but the leaders and the powers must take note of the changing dynamics and an urgent need to properly resource general practice.
Competing interests: No competing interests
My complaint is about the proliferation of guidelines and straitjackets about a) prescribing and b) limitation of out of hours nursing services. In the NHS.
Cast your memories back fifty years ago.
There was the BNF (the British National Formulary). You prescribed what was listed.
Rarely, you prescribed a drug not listed in the BNF.
The REGIONAL MEDICAL OFFICER (general practice) would drop in to the “offending” general practice, by appointment. If he was satisfied, it was the end of the matter. If he was not, a gentle slap on the wrist.
The BMJ used to publish a series” Was it a drug?”
IF the GP prescribed a medicine to be administered by a nurse - eg by injection, or by cutaneous application or an enema, the local medical officer of health was duty bound to make a district nurse available. No ifs. No buts.
And there were plenty of local, really local, ”casualty departments” in the local hospitals. You never turned the patient away. No lengthy waits unless there had been an accident.
Look at the present state of affairs.
There is NICE. It deliberates. Finally it gives judgement on drugs. But that is not the end of the process.
The GP may prescribe, BUT ONLY IF THE LOCAL CLINICAL COMMISSIONING GROUP APPROVES.
The GROUP is composed of GPs and other “stake-holders” . If these ladies and gentlemen were to go back to their “shops” and work there, we the patients would be better served.
Now the GP may prescribe a steroid ointment to be applied twice a day. If it has to be applied on areas you, the patient, cannot reach, and you have nobody to apply it for you, then on Sundays you have no nurse to do it for you. There are no formal arrangements with the minor ailments clinic open on Sundays to do this little job. “Unlikely that you will be turned away”.
Out of hours tooth-ache? You may have to travel fifteen, twenty miles. The local centres of population take turns, hosting the tooth troubled patients.
Did you say the complaints have risen only by 4%?
Not surprising. One clinical commissioning group took two months and twenty days to reply. And the reply was waffle.
You think we should complain to the Parliamentary Select Committee? The Committee does not deal with individual complaints.
Any serious ssuggestions will be gratefully received.
Competing interests: I am an NHS patient who has worked in more decent times. When doctors were doctors, nurses were nurses, the pharmacists were pharmacists. When there was not a plethora of useless committees.