Listening to the podcast of AVfM radio this morning at the gym, I heard the voice of Peter, who I had met yesterday in London. He had relayed the story about his doctor’s rudeness, but I had not made the connection to a policy statement about appointment length until I heard him speak to the team on the radio.
Working in health myself, and having experienced the 5 minute appointment scam that makes up a lot of care in the UK, when I got home I immediately searched, using the kinds of words I knew would throw up any guidance on gender based appointment length in NHS settings. I didn’t find a gender based commentary, but there was a big cluster of news articles in 2010 on the drive in the NHS to save money by shortening GP appointments, so it would not surprise me if this is where it is coming from.
Those of you who don’t live in this country need a bit of an explanation of how the NHS works to help you get what is going on. General practitioners are the primary care physicians in the health service here. The vast majority of initial contact for health care is done via your GP. This is free at point of contact. However, GP surgeries are effectively private businesses, who contract to the local commissioning body (which is regionalised to within a local authority boundary e.g. London, Cambridgeshire, Peterborough) to deliver primary care services. As long as they meet their contract they get paid. And rather well, with the typical GP earning around £80 – £100 K and many of them working part time. This is their salary after paying for the expenses of running their business and the staffing, but before tax and pension contributions.
As you can imagine this set up makes for a lot of reasons to find as many ways of getting bums on seats as possible; as surgeries are also paid to achieve certain targets with key disease conditions on a capitation basis. One way this is done is to devolve care down to nurse practitioners (qualified nurses with specialist additional skills, often able to prescribe), practice nurses or health care assistants. Another way is to use telephone triaging. A third is having short appointments, where the doctor is almost writing the script for a medication before you open your mouth.
In fact, Peter mentions one important contract variation around appointments in his commentary – the appointment for pregnant women being 30 minutes. This is completely correct and is part of the contractual agreement for pregnancy services. The vast majority of GPs will not do this themselves, but will pay their local health trust to provide a community midwife to deliver this service, and it is quite common for the community trust to have a community midwife and a midwifery healthcare assistant delver these services in a central point in a town for several GP surgeries. The actual face to face time with the midwife may be reduced to 20 minutes, with the first 10 minutes care being the measurements taken by a relatively unskilled and low paid HCA.
So, how can we work out if there is a misandrous policy on appointments? I’ve contacted Peter and asked him if he could get more information from his GP surgery regarding this. If he gets lucky he might well be slipped a document which will blow this wide open…we are all trained up on our rights as whistle-blowers in the NHS as mandatory training, but I don’t think I would feel confident on a lowly paid admin job to whistle-blow on my employer who probably earns 6-8 time what I do.
There is however another way that might work. Our Freedom of Information (FOI) legislation might help us expose an example of institutional misandry. Under the FOI legislation the responsibility of public departments can be summarised as follows
- a general right of access to information held by [the public body] subject to certain conditions and exemptions
- a duty on us to inform any person who requests information whether we hold the information; and to communicate that information to the applicant unless one or more exemptions apply.
There is a list of exemptions available here for anyone interested in further reading here.
So, failing the option of getting the data via the surgery, then an FOI response would be revealing, regardless of what information comes back. The only problem here is who owns this possible policy – is it a Department of Health policy, or one which belongs to the local NHS trust. I think some digging might be needed.
A disclaimer here: many people reading this will think that this article gives a good set of reasons to avoid moving to a state run healthcare system. I still support accessible healthcare for all, but would prefer to have some elements of means testing within the system. People don’t value what is given to them free. Needless to say, my opinion is not popular either, but I would prefer to tell patients the cost of their failed attendance, so they truly understood the nature of the costs in the NHS.
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Dr. F (Ian Williams):
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Your proposition here, if I understand right, is that there exists a possible (probable!) sexism in waiting and consult times. It is tantalizing due to the fact that an FOI might just give us this bombshell information.
Aimee, I encourage you to pursue the FOI and you have my pledge to help advertize the results to the world at large if they show sexism. This would be an absolute bombshell if a gender bias were discovered…
Good luck
How would this be a bombshell? Business as usual, nothing to see here, move along citizen…
It would be a bombshell if official data confirmed it and it was taken up by the media. If you have official data showing this is business as usual then show it to me bro. Saying we all just know this in our own minds doesnt get us very far.
I’ve seen what can happen when good quality FOI material get released to the press for the first time. In fact I have applied for sensitive FOI material in the past and leaked it to the press and the results were impressive.
The sexism in our courts is literally tearing families apart, and even worse is encouraging more of the same. We have decades of case studies, we have hundreds of thousands of disenfranchised Dads, we have court documents going back decades… and how much outcry do we hear about it? Have you even heard a single person who isn’t an MRA or Father’s Rights group member complain about it? I sure haven’t. If they don’t care about this level of injustice and stupid… then why would they care about waiting times in a GP’s clinic?
I’m not saying don’t do it… I just don’t expect anyone to care. Like I said, business as usual.
When it comes to the family law things are difficult to shift, agreed. Its easier in the medical and health area – eg. recently increasing attention, funding, research and services for prostate cancer in the last few years. This thread is about health proper, not the family court.
Even in the family court I’ve seem countless people making a difference…. if you think the family court is bad now I can tell you its lightweight compared to the legislation feminists have attempted to pass into family law but failed to achieve- they failed to achieve it because a lot of men and women wrote submissions to parliamentary committees on same, submissions that cited a lot of cases, studies, data, stats, personal experiences, etc. These submissions made a difference – the Australian 2006 father freindly ammendments being an example of success, along with derailing the attempted watering down of those revisions by feminists in 2011. There is a lot more to do and it isn’t going to happen by moving along and ignoring it.
We’ve got a long way to go and it won’t happen without a effort to fight it. The slow progress is cold comfort to dads alienated from kids now and I sympathise with them… but hopefully our efforts can at least make a difference for dads of the future.
I have a role in my department ensuring we are compliant with the Equalities Act 2010. The act specifically names gender as a “protected characteristic”. To say men had less clinical need without some pretty compelling evidence (and I mean compeling to the level of “we can say without refute men have better health, lower suicide rates etc than women, so don’t need as much healthcare time)
Written policy would be directly in contravention of the Equalities Act. There is not yet much case-law on the Equalities Act, but its starting to get there, and this would be a serious breach if my understanding is correct.
Put it this way: our HR people have interpreted the Equalities Act to say we can’t give number or frequency of sick days in a reference for another job. This would be seen as potential discrimination on the grounds of (in many cases undiagnosed) disability.
It would be a bomb shell if there was a written policy document. If there was none, we are not at the end of the trail by any stretch. Electronic patient systems could give us how long patient appointments were actually booked for in individual GP practices. It might take some careful phrasing of the questions to get the FOI right.
Having responded to FOIs before, the question is critical. I might be asking for assistance from folk here to get the questions right.
One little thing you left out. the relevant info from the podcast.
He said that he can only get 5 mins max with a GP, but women get 15 and pregnant women get 30
It may be happening in a regional manner to have the male/female split in time of appointments. As a woman I usually get a 5 minute appointment, but I am in a different region of the country.
One of the reasons I want to know if this is regional or national, is it will influence how we present it to the media. If it is a national pattern, it needs to go in via the national press, if it is regional we are more likely to get interest at a local level first, and then it make national if it is picked up.
There is bias in the NHS. Let me give you some examples I know of.
Male friend (yes really a friend) suffering from depression after two family deaths, he’s coped with it for 6 months but now it’s too much. He’s gone to the doctor after telling several people he feels like killing himself, goes to the doctor and she basically tells him it’ll get better and everyone feels down after a bereavment. Kicks him out after maybe 10 minutes.
Female friend goes to doctor because she lost her job, it’s only been 3 weeks and she feels a little down, doctor prescribes SSRI’s and lets her talk for 20 minutes.
You might also want to look up discrimination in the benefits system. I would love to get some hard figures on it but I havea sneaking suspicion that men get turned down for certain benefits more often than women. I’m thinking disability and ESA.
I’ve got a similar situation with a close male friend getting a nasty lack of care after a suicide attempt…and I am sure it is a gender bias issue.
Problem is, individual cases make the headlines in the popular press, but if we want this to make a big ripple we need to see if there is a systemic bias, even at a local comissioning level. That would be picked up by more serious media outlets.
Also, if we do find regional differences, approaching the local MP with evidence would be a way of getting our message out there – it doesn’t even have to be framed as an MRA issue. We only need to mention our male suicide rate and ask how men are supposed to be identified as suffering from depression in 5 minute appointments.
Thanks Aimee, certainly if this is a practice policy it should be exposed ( I am assuming it’s not global NHS policy – that would be incomprehensible wouldn’t it? )
In Australia we have a compulsory system based on a medicare levy ( really a tax, but called a levy because a health care tax would be unconstitutional) About 70% of GP consultations in Australian are billed directly to medicare for the government prescribed “rebate” fee. This is referred to as “bulk billing”. GPs who exclusively “bulk bill” services, often practice the so called six minute medicine, will not deal with more than one issue at a consultation, make multiple follow up appointments and essentially do anything necessary to maximize throughput and income, their clientele value no payment at the point of service over quality of service. This system encourages over-servicing and inadequate servicing.
At the other end of the spectrum you have “privately billing GP’s” who see one patient on average each 15 minutes,( and will book long appointments when needed) the patient pays at the point of service and claims the “rebate” amount back from the government. This is how my practice operates, but we have the option to simply accept the rebate amount in cases of hardship. Successive governments have toyed with the idea of nationalizing our health system but have met resistance, their is an increasing push to a blended payments system, with some incentive payments to practices for targeted outcomes.
In the case you mention in Australia the patient would be more likely to get a good hearing and appropriate therapy via the second option not the first.
Nothing would surprise me with NHS policy after 6 years of being on the receiving end of having to interpret policy documents.
Nothing at all. If they told me that all hospital beds were going to be made 1 foot shorter to save money, I would barely blink.
I’m fortunate that my boss has a similarly warped sense of humor and we entertain each other by finding the worst examples of pen pushing madness.
Aimee, I do not think a private system will work in the UK. If you start privatising major parts of the NHS then you will quickly see all of it privatised, costs rise dramatically at the patient end and life expectancy go down as people put off appointments to save money. Conditions being diagnosed late because of this just end up costing more to treat.
What we need to introduce are fines for people who miss appointments. Also I’m for fining people who turn up at A&E more than twice due to alcohol intoxication.
Costs rise dramatically at the patient end but fall precipitously at the taxpayer end. The NHS in Great Britain will have to do be away with eventually. Tt’s a socialist program that is nearing the end of its inefficiency cycle, it’s getting more expensive at an ever faster rate while quality of service slowly but surely deteriorates. There will come a point eventually when it delivers such a low standard of service for such a calamitous cost that voters will finally be willing to do away it.
Check out the efficiency of a private system like the USA. You’ll find they spend almost 3 times as much per capita and have worse outcomes for most illnesses. So if you want to spend more for poorer healthcare that looks flashier then petition for a private system.
So no, the NHS despite the Daily Mail headlines is not that inefficient compared to private systems. And it’s also pretty wrong for people to go bankrupt in order to stay alive. Morally that’s just not defensible.
I see the only way of getting the NHS to continue to work (other than your excellent suggestions, which I would endorse), is to frontload to preventative services, so people can maintain their health…but this is not going to happen as the vast majority of preventative health is not sexy and doesn’t make the drug companies any money.
Fortunately, I am an incurable optimist and keep pushing the prevention agenda in my workplace to anyone who will listen. I wonder if this explains why most people run in the opposite direction when they see me coming
I hate to say it but I can’t blame the drug companies for not pushing the preventative approach. Preventing illness is something everyone can do and we’ve had tons of campaigns about it so there is no excuse to not know. Most people really don’t want to give up the bad foods and exercise on a regular basis.
Good on you for at least trying to push the preventative stuff and not giving up. I imagine it can get a little frustrating at times when you see so many people with completely preventable illnesses.
And hey, if they run when they see you coming at least they’re elevating their heart rate
Campaign work is a total waste of paper and pixels.
Good preventative work involves working in an intensive manner in family and community settings using individualised approaches broadly based on social marketing parameters.
It is about giving back ownership of the prioritisation of health agenda to populations. When I was working in diabetes prevention in a poor urban setting we asked what they wanted to learn. They wanted to know the signs and symptoms of different illegal drug use and how to access services…we got curious as to why, and one of our translators pointed out that loads of the children and grandchildren were drug users and this would help the community develop knowledge and skills within families to address the issues. We got very good feedback and a request for annual updates from this community – it is hard to measure the impact long term but there was some evidence of an increase in accessing addiction services in the next few years.
I completely understand where you are coming from, but when it comes to simple healthy choices I think people generally know what they should and should not be doing.
It’s just lazyness. People don’t want to exercise, they don’t want to give up a large pizza 3 times a week, they want what they think are easy solutions, 7 day diets and surgery.
I know I’m being a bit cynical here but it’s my experience while coaching people that this is the reality.
@ Chris,
For a long time I felt it was laziness, until I started doing a lot of research into the dertminants of behavior change.
I’m not anywhere near 100% successful, but I find that now I “get” this area a lot more, I am increasingly successful at finding the “key” for motivating “lazy” people. Often it is surprising…this afternoon I had a situation where patient was doing the “yep, I did this bad, this bad and ths bad”, I listened then said “OK, scale of 0-10, how compliant does this make you?”
She said “Three”, I said “Lets review the success you are having at an effort of 3, and talk about what is preventing you from being at a 5.”
We chatted about the success, and we bounced some ideas about why she was stuck at this level, and just as she was going out the door she suddenly went “Oh, I know the problem – this has happened. I’ve got a worry about [x issue]” I acknowledged the worry and said “What could you do to reduce the anxiety?” She said “Its about the writing it down isn’t it?” (A tool we had explored before). I said “Yep, same old” She said “Can I email you with my progress next week.” I agreed and she went out the door quite a lot happier.
She has done this cycle before, but the big difference, this was a 3 week lapse not a 3 month one. She is learning skills.
OT – We could do with some intellectual muscle on The Vancouver MRM Feminism Debate page on Facebook. They are many, we are few. Help appreciated.
http://www.facebook.com/events/282914461821497/
Thanks, everyone!
I checked it out, and I think my IQ just dropped a few points. “Intellectual” should have been the key word of your original request…
Well, Ontario sure as hell is discriminating against boys very openly.
http://www.health.gov.on.ca/en/ms/hpv/
Grade 8 females only are eligible for publicly funded vaccination.
The reasoning from another page on that site is:
“Q: Do boys get HPV too?
A: Yes, males can be infected with HPV, but they are not at risk of cervical cancer as they do not have a cervix. Males can also be carriers of other HPV types that may be transmitted to their partners during sexual activity. Without experiencing visible symptoms, they can pass the HPV virus unknowingly to their partner.
Answered by:
Dr. Vivien Brown – MDCM, CCFP, FCFP, NCMP”
It seems this “Doctor” is unaware that HPV in males can cause, oral cancer, anal cancer, penile cancer and genital warts.
http://www.bloomberg.com/news/2011-10-03/oral-sex-may-cause-virus-linked-throat-cancer-in-men-study.html
http://www.webmd.com/sexual-conditions/hpv-genital-warts/hpv-virus-men
Yes, the HPV campaign has been a matter of open discrimination the world over. I have a family member who is an oncologist who is challenging for the right to vaccinate boys.
Same here in Australia. Absolute garbage. My only option for the vaccine is to shell out around $700, yet if I were female I would have been able to get it for free. It’s just the usual – let’s look after women and girls, but we only care about men and boys if they can provide something which is useful to women and girls.
Raven, Where did you find that answer from Dr Vivien Brown ? I would like to persue that response from her further.
The health services of Ontario Canada does discriminate against boys in that the HPV vaccine is only publically funded for girls. This despite the fact that the National Canadian Committee on Vaccines now recommends the HPV vaccine for boys. I hope that a disgruntled parent will lodge a complaint with the Ontario Human Rights tribunal about this blatant unequal service since its own government now recommends this vaccine for both girls and boys.I cannot see how they could fail in this complaint since it is clear cut discrimination. The morbitiy for boys is just as poor as it is for girls since boys get warts. penile, anal and oral cancers as well.
To their credit the the Association of Medical Women of Canada recommended that their be equity in the disctribution of this vaccine in one line of a press release.
http://www.cbc.ca/news/canada/ottawa/story/2012/04/13/hpv-vaccine-boys.html
CBC news
The Ontario Ministry of Health has sex discrimination written right into their physician payment methods. Most Family Doctors are paid fee for service by the government. Male and female patient services are obviously paid the same fee. However there is also a patient rostering incentive. This means that for every patient rostered to the doctor , the doctor gets paid a monthly amount. This averages about between $1-$2 per month per patient. the value depends on the age AND SEX of the patient. In other words females are paid at a higher rate which therefore rewards a doctor more for having female patients. The governments rationale is that women make more doctors visits. This perverse reasoning perpetuates the the status quo, that men dont take care of their health and dont visit doctors, and now are further discouraged by doctors who are now discouraged from rostering men. A family physician with a larger mens practice will earns less per patient rostered than a physician with a largely female practice.
Our constitution guarantees equality , so WTF?
Yep, this is wrong thinking.
I will need to dig further but I seem to remember there is a single rebate for sexual health appointments regardless of gender in the NHS…a nurse colleague used to recode all her health promotion activities around testicular cancer under this code, as it gave her employers reason to accept her health promotion efforts (her brother had died of testicular cancer, she felt if she prevented one death through her work it was all good)