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.