- Smart Healthcare, Wednesday 4 November 2009 09.00 GMT
Recently, I chronicled the problems of two friends of mine, Tom and Charles, with NHS systems. Now Bill*, another mate of mine, is in deep trouble. (If anybody is of a squeamish disposition, look away now.)
About three months ago, he had a prostate crisis. His GP relieved it with a catheter and then booked an appointment with a consultant urologist. This was supposed to happen in four to five weeks, and finally happened in nine, because of scheduling problems.
This delay shocked me. Surely, if somebody in their late 70s has prostate trouble, you suspect you-know-what and jump all the queues. When, finally, he got round to seeing the consultant, he agreed, obviously, that he needed an operation, which happened in another three weeks.
The tests done after the operation have found malignancy (surprise, surprise), and he has just had a series of scans to see whether the cancer has spread. At last, a sense of urgency has crept in, but I get angry about the nine weeks he has lost because of hospital bureaucracy. Hospital systems may be in place, but are not working in a timely fashion. And Bill does not live in the sticks, but in a university city.
Bill is one of those chaps who has always steered well clear of doctors. He has never gone in for periodic health checks or any that nonsense. In his ignorance, he had always believed the mantra that the NHS is the best health service in the world, but until now, he has never had to test it.
His view, after four months of medical and emotional trauma, has changed: he is impressed by the doctors, but already finds the NHS systems are rubbish. He has also realised that the administrators and many hospital staff operate for their own convenience, not the wellbeing of the patients.
I find this a tad harsh, but it seems, from my experience, a useful hypothesis to base a strategy of self preservation within the NHS. Absolute trust is no good. Bill may be shaping up to be a doughty Patient from Hell.
He is a quick learner, and has twigged that his chances of survival depend on effective coordination and communication. So he has asked his GP to mastermind of, and be the information hub for, all his treatments in hospital or wherever. Unlike my usual hospital 'Fastrack', his hospital does not copy all consultant-to-GP letters to the patient, and so Bill has less access to what is going on than I have. And therefore less personal control of his own treatment. So, the GP must fill the gap.
His GP told him that nobody has asked him to do that before. This amazes me. I had always thought that that was what GPs were for. Indeed, it was this function – not just prescribing pills – that justifies their large salaries. My own GP makes sure that I am treated by the best surgeons around, in the hospital departments most likely to sort my various ailments. But I am not sure whether he would want to be the guy who is calling and coordinating all the shots, and telling hospital consultants to take a jump.
This is what Bill is asking for, and rightly so. The GP is the person where all the care pathways meet. So I was delighted by the positive response by Roz Foad of the BCS to my tentative suggestion last month that the GP, not the Spine, should be the custodian of the electronic care record. If the GP holds the record, then he rules the clinical world. And Bill may survive.
*Not his real name
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