Most of us just want a GP appointment and a friendly smile at reception

http://www.theguardian.com/commentisfree/2014/nov/18/gp-appointment-cqc-watchdog-good-service

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It so happened that the release of the Care Quality Commission’s survey of GP surgeries came on a day when I had gone a couple of increasingly bad-tempered rounds with the practice where my husband is registered. So of course I rushed to look up its ranking on the CQC website.

After initial confusion as to exactly where the information was to be found, I took perverse pleasure in discovering that, while the practice’s overall score was a presentable five out of six, it had fallen down on two aspects. And one of them was the very point that had occasioned my strop: the difficulty of seeing the doctor you wanted, or even the one you saw last time.

For people like my husband, who has a long-term condition, continuity matters, but you have to make yourself pretty unpopular to come anywhere close to securing it. After some to-ing and fro-ing, the receptionist reluctantly agreed to send the doctor concerned an email asking about the possibility of fitting in an earlier meeting. We shall see.

For all the health secretary’s assurances of more joined-up care for the chronically ill and a right, within reason, to see the GP you are registered with, these remain, in my experience, two of the weakest points of the primary care system. The chasms – and shifting definitions – between healthcare (your GP) and social care (the local authority) are well known, but the aggravation associated with obtaining a routine doctor’s appointment crops up in practically any conversation about the NHS.

It was during the election campaign before last that Tony Blair was baffled by a questioner who complained she could not make a GP appointment more than 48 hours in advance because of government-set targets. It was clearly news to him that many GPs were essentially gaming the system by requiring patients to ring 48 hours ahead, neither more nor less, to fit in with their targets. Nine years on that 48-hour aspiration has made a reappearance – as one of Ed Miliband’s early manifesto promises.

There are so many mysteries about general practice. Why is it still so difficult to make an appointment? Why are so many GPs (and their receptionists) so computer-illiterate – you can bet most of them text and email in their private life – and why are so many reception staff so charmless? You approach with your best smile, vowing to be understanding and patient, only to be driven to instant distraction by the static queue, the gossiping behind the screen, the open talk of other people’s ailments (which could be yours), or the leisurely (and vain) search for a repeat prescription ordered well in advance.

There was a time, perhaps, when such amateurishness was endearing, but not when, for many people, a GP appointment has to be fitted around work and most private sector services – in terms of working hours, manners and technology – have been professionalised. GPs are well rewarded for their work; most practices – lest it be forgotten – are actually private partnerships. Yet at reception we patients are all too often patronised as petitioners disturbing their otherwise pleasant day.

On the one hand, then, it should be hats off to the CQC for tackling GP practices in England – many of which, I suspect, will not welcome such patient-focused scrutiny. Hats off, too, for identifying one of the failings of the practice I mentioned; at least some of its questions are producing the right answers.

Yet dangers lurk in this burgeoning survey culture too. The CQC rates GP practices on 36 separate criteria. So many categories makes for an over-complicated picture. And although the risk factors are singled out clearly, the tables themselves are pretty opaque – except presumably to the cognoscenti.

Nor should bureaucratic ingenuity ever be underestimated. As the Mid Staffs and other scandals demonstrated so tragically, there is much in healthcare, but not just in healthcare, that is hard to quantify. Specific targets, especially when linked to financial or reputational rewards, may exert a seriously distorting effect.

Earlier this week, Her Majesty’s Inspectorate of Constabulary confirmed the disgraceful extent to which the police in England and Wales have been able to manipulate their record keeping in line with targets. No wonder there is widespread public scepticism of performance ratings. It will surely not be long before GPs, too, figure out a way to maximise their scores, as measured by the CQC, while minimising the inconvenience to themselves.

Any genuine improvement in the service, of course, would be welcome. A smile at reception, or at least promptly updated records, would be a thoroughly cost-effective start. And if the CQC assessments manage to weed out substandard surgeries, that would almost justify the exercise by itself.

The pursuit of ratings for its own sake, however, should be dismissed as the wild goose chase it is. For those in rural or less well-provided areas, the need for proximity leaves little room for choice, while consistency, competence and an approachable chair-side manner would probably be enough to satisfy most of us. It is regrettable that it has taken an elaborate survey from the health watchdog to tell GPs what they should long ago have worked out for themselves.