Back in November I spoke to my GP over the phone. I felt that this was quite a civilised way of dealing with a medical matter as it didn’t entail sitting for ages in a crowded waiting room absorbing other people’s germs. I like my GP: he wears trainers and his parting comment to me at the end of our phone call was ‘May the force be with you’. He said some more sobering things about the fact that however good I am at taking tablets and getting my eyes and feet checked out regularly, diabetes is insidiously attacking my internal organs and the only surefire way of minimising the risk is to lose a shedload of weight. Yes. And if it were that easy there would be no obese people.
Before his rather cool exit line, my GP asked me to make an appointment to see him in January. I put that to the back of my mind throughout the rest of November, over Christmas, then idly starting to think about it in January. I went online and had a look at the new appointment booking service at the health centre. Four times I went online and had a look. It appeared very efficient but there was no sign of my GP on the list of available appointments. In fact, when I looked on Thursday there were no appointments at all. Very reluctantly I phoned the surgery from work. I explained to the receptionist that I wanted to make a routine appointment to see my GP in January but that there were never any appointments for him online.
She agreed with me.
“You’ll have to come down to the surgery at 0830 tomorrow.”
“I can’t. I work full-time.”
“Well you’ll have to phone then. After 0830.”
“I can’t. I’m at work at 0830 and we aren’t supposed to make personal calls – I could get into trouble for talking to you now.”
‘You’ll have to go online then. After 0830.”
“Is that when you put the list of appointments up?”
I gave the receptionist my details and after some tutting and sighs she came back with:
“Doctor said to make an appointment for the end of January February. That’s what your notes say.”
“Fine. Even better really. So can I make an appointment for February then?”
“I’m sorry – could you explain why I can’t make an appointment?”
“We don’t book that far ahead.”
“Not even for a routine review?”
“You make those with the nurse and you can’t make that appointment till the end of January.”
“But my GP said to make the appointment with him.”
“So you say. Did he give you a slip to confirm that?”
“No. It was a telephone appointment.”
“If Doctor wants you to book a specific appointment with him he will give you a slip and you take it immediately to reception and make an appointment.”
“I ddn’t get a slip.”
“Doctor obviously didn’t think it was that important then.”
“It was a telephone appointment. he couldn’t give me a slip.”
“You’ll have to book an appointment online, by phone or in person the same as everyone else.”
I’m beginning to feel more than a little cross now but I’m at work in an office with several other people who don’t deserve to hear me lose my temper with this upholder of petty bureaucracy.
“Can I speak to the practice manager please? I feel that your appointment system discriminates against people who work full-time and I’d like to make a complaint.”
“Everyone else likes the system. We have lots of people who work at the surgery. No one else is complaining.”
“Nevertheless, I’d like to speak to the practice manager please?”
“You can’t. She’s off sick. You can speak to the deputy practice manager.”
“She’s in a meeting. I’ll put you through to someone else.”
Sending up a silent prayer that the someone else is more flexible than the receptionist, I am put on hold and forced to listen to a series of clicks and whirrs that are still better than the overloud muzak that you usually get on hold.
“Hello. my colleague tells me that you are expecting a priority appointment and you’re complaining because we can’t let you have one.”
My hackles rise.
“I’m afraid your colleague is incorrect …”
“..I don’t think so. She was very clear. I’ve looked at what Doctor has recorded on the system and this is just a routine appointment. You’ll have to use the system the same as everyone else.”
“This may be a routine appointment but the doctor asked me to make it with him for January ..”
“…end of January February.”
“I’m not privy to what my doctor has recorded on my notes. He said January to me, that’s what I put in my new diary to remind myself to call. I don’t expect priority treatment I’m just trying to explain why, as a person who starts work at 0830 and works full-time, I can’t use your booking system. I phoned asking for advice on how to book an appointment.”
“The instructions are on the website and in the practice handbook available at reception.”
“Who am I speaking to please?”
“My name is S and I am one of the other receptionists. I can answer your questions perfectly well. If this is a routine appointment you should be making the appointment with the nurse anyway.”
“My doctor told me to book it with him. Doesn’t it say that in my notes?”
“Possibly. I don’t see why though. he should have given you a slip.”
“It was a telephone conversation. Unless you’ve started using carrier pigeons he wouldn’t be able to give me a slip. A slip wouldn’t be any use in this case because accordingly to your colleague I would have to take it immediately to reception, but back in November you wouldn’t be making any appointments for January anyway.”
“Quite. I think it would be best if I put my complaint on paper because you aren’t really helping me and I feel that your system is discriminatory.”
“Everyone else likes it. You don’t have to write your complaint down. I can deal with that.””
“No thanks. I’ll write to the practice manager, if I put it in writing you can’t ignore it and I can guarantee accuracy..”
“We wouldn’t ignore it anyway. I can speak to doctor and see if he wants to make you an appointment?”
At last a glimmer of hope in a morass of red tape.
“Yes please. I’ll be in meetings for most of today but you can always leave me a message.”
I give her my telephone number and end the conversation with a splitting headache and a brooding hatred for receptionists.
Much later in the afternoon S calls back
“I’ve spoken to Doctor. he says this isn’t a priority appointment so you shouldn’t expect special treatment.”
“I didn’t say that it was a priority appointment and I’ve never asked for special treatment.”
“He says that if you have an acute medical problem you should access the system the same way as anyone else but this is just a routine diabetic appointment. In fact he said you should make the appointment with the nurse.”
The woman’s voice is thick with glee at the fact that she has defeated me and protected Doctor against another demanding patient.
“That’s fine with me – I’m quite happy to see the nurse – it was his idea for me to come back and see him.”
“So you say. Shall I make you a diabetic appointment with the nurse?”
“A diabetes appointment – appointments can’t get diabetes.”
“There’s no call for you to go correcting my grammar thank you.”
“I thought you couldn’t make appointments that far ahead?”
“When do you need the appointment for?”
“I believe you said end of January February?”
“We don’t make appointments that far ahead. Not even for the nurse.”
“I’ll leave it then.”
The National Standard Framework for Diabetes is a DoH document that provides guidelines for good practice. Section 3 is all about Empowering People with Diabetes. It waxes lyrical about the importance of health professionals working closely with people with diabetes (not diabetics!) in order to help them take responsibility for their condition.
Addendum: In the supplementary information of the NSF Diabetes section on the DoH website there are some very interesting statistics on non-compliance and people with diabetes. Non-compliance covers not taking your medication as directed by your health professional – AND not turning up for routine appointments and tests – hmmmmmm – earlier on in this section they also state that :
‘The attitudes, skills and knowledge of health professionals, including their communication skills, also influence the behaviour of individuals and their ability to self-care.’
The rational behind Section 3 is:
‘Users of the NHS should have choice, voice and control over what happens to them at each step of their care. Empowering people with long-term conditions in their relationship with health and other professionals enables them to assert control over their lives, build confidence and be active partners in their care.‘
I get the distinct feeling that the NSF Diabetes is not a document that has ever been briefed out in my surgery.
Rant over 🙂