Friday, 9 November 2007

Supermarket GP Surgeries - About Time!

It's not often that an idea strikes me as being really, really good and long overdue. But this report in the Sun is just such a rarity. It seems that "well established and trusted brands" like Tesco and Asda could soon be running GP surgeries, if a proposed pilot scheme goes ahead.

Well, why not? The current state of GP services is, frankly, bloody awful. They run a variety of chaotic appointment schemes that conspire to make it practically impossible to see your GP in any case; you either have to ring for an appointment at the crack of dawn and hope you're lucky enough to beat some other poor bugger to the last vacant slot (who wants to do THAT after being ill all night?), or book so far in advance that you will have either recovered or died before your GP gets to see you.

Of course, if you're feeling particularly optimistic (and, if you're trying to see a doctor, you probably aren't), you could always ask for a home visit. Trying to winkle a GP out of their surgery during business hours is like learning levitation - it's a nice idea, but it just won't fly. Trying it out of business hours is even worse; your call gets transferred to a centralised location where some snotty bint takes your details, asks what's wrong with you and promises that a doctor will call you back soon.

You might as well start writing your will in the interim, because it will be some time before a doctor calls to tell you why you don't need them, that they'll be delighted to tell you in person if you can crawl several miles to a health centre you've never heard of and can't find, and, if you feel any worse, don't hesitate to call an ambulance.

How, exactly, could the likes of Asda and Tesco run a service that could possibly be worse than this? There's at least a chance that, like their pharmacies, surgeries in supermarkets (if that's what the scheme entails) would be open all day until late, you'd know where to find them and you wouldn't have to make an extra trip to a late night supermarket to get your prescription made up.

Strangely, though, doctors don't think it's a good idea at all. Dr Robert Morley, of the British Medical Association, made some lame excuse about continuity of care for patients, before getting to the real nub of their concerns - some smaller practices could be forced out of business. He said: “Small GP surgeries are not going to be able to compete with the retail giants.”

Says it all, doesn't it? Concealed not very far beneath the apparent concern for patients (how many folks actually get to see the same GP more than once anyway?) is the far more pressing drive for self preservation. Actually, Dr Morley's comment is not entirely without merit - look what the rise of the supermarket did to previously thriving small corner shops. But, looked at the other way, do we miss them all that much?

Well, yes, actually, I do. A friendly small business is often far easier to deal with than a faceless giant, and they tend to go out of their way to help their customers. But, as the friendly - and now largely extinct - small shopkeeper found to their cost, those benefits don't compare well with the convenience and economy of the supermarket. They couldn't compete on the points that were most important to consumers, and so they failed.

And that is exactly what will happen to some, if not many, GP surgeries too. Yes, I know, GPs work long, hard hours and, for the most part, they do their best for their patients. Unfortunately, to some extent, they work very hard at the wrong things. It's a well-know saying that doctors make lousy patients, and it's true.

They also make absolutely clueless end-users of the health system. Even when they need medical attention themselves, they are never truly patients; they are simply consulting a colleague about something they can't, or shouldn't, deal with themselves. They are part of the system, and cannot see it from the outside any more than they can see the back of their own head.

As a result, while they may go to great lengths to deal well with their patients' medical problems, they do - and know - nothing about handling the whole "patient experience" thing. Sure, good medical care is important. But so is getting an appointment quickly, easily and with the minimum of aggravation. Sick people do not want to be put on hold, or told to press 1 for this, 2 for that etc. They want a nice, simple phone call, answered promptly, dealt with courteously. They do not want to wait two or more days for a doctor to get around to signing a damn repeat prescription.

In these and a thousand other ways, they want customer service. And, sadly, right now they don't get it. Of course, many doctors would claim that's none of their business; they earn their £100K+ per year for treating sickness, not pandering to patients' whims, customer service requires resources that they're not given, etc.

And they are wrong. Over 20 years ago I had a wonderful GP. He had his own practice, none of this partnership thing you see so much of these days, which he ran for years. Locally, he was famed for being almost unreasonably thorough in checking anything and everything, going far beyond the call of duty to ensure that as much as possible was done for his patients.

He held a surgery every morning (even some at the weekend), did his rounds every afternoon, never questioned whether a home visit was necessary - he assumed that if you called him, it was necessary - and held a second surgery in the evenings several times every week. His evening surgery did not run for a set period of time - it ran until he'd seen each and every patient, none of whom had to book in advance, and all of whom got as much attention as they needed.

And, if he was concerned about a particular patient, it was common for him to call on them on his way home after evening surgery. Many a worried relative has answered their door long after 10PM to find the good doctor "just passing", and his efforts were universally appreciated. His practice was enormous, yet it ran like clockwork long before any computers were used in surgeries. The administrative work was shared between his wife and a part-time secretary, both of whom did their level best to be helpful. Needless to say, long after he retired and passed his practice on to a partnership, this doctor is fondly remembered by an awful lot of people - unlike the partnership that succeeded him.

The big difference between this old-style doctor and his modern counterparts is attitude. Customer service was everything with him, although he probably didn't see it in such a colourful way; he just tried to do his best for everyone. Many modern doctors just don't seem to connect with the idea that they are public servants, paid for from the public purse. We, the patients, employ them, and it wouldn't be bad idea if some of the more out of touch members of the medical profession stopped looking down (even subconsciously) on patients as inferiors and started giving them the respect and service due from a servant to their masters.

For, if they do not, they are an endangered species. Big companies know a lot about customer service (even if they don't actually offer much!) and a lot more about market research and promotion. Sure, they may not know much about medical science, but specialist knowledge is just one more commodity, to be bought in as required. Before long, supermarkets' stock orders may include 10,000 loaves, 20,000 tins of cat food and 5 GPs.

When the likes of Tesco once discover that there's a huge market for GP surgeries that don't treat patients like cattle, they will have no difficulty in offering a service tailored to meet the demand, and, if they get it right, patients will vote with their feet. No wonder the BMA is worried about competition - they don't even know where to start!

Billy Seggars.

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