A good news story about the NHS
Let me give you a good news story about the NHS, and then ponder a question that it raises.
We had been away for a few days (on which more later) and by the end of the break it was clear that one of the party had a chest infection that, whatever you think of the overuse of antibiotics, was going to need them. But we were back home on Friday too late to get to a GP.
So following the instructions on our GP’s website, we called NHS111 on Saturday morning, got a call back in about 5 minutes from a doctor at the urgent care, out-of-hours service and were given an appointment for 8.30 am (about an hour away). We turned up at the Chesterton Medical Centre about a mile and a half away to find a doctor and a nurse practitioner at work, and just 2 people in the queue in front of us. We were seen at 9.00. (No complaints on the slight delay; the lady in front of us looked quite a lot iller.) By 9.15 we were on our way to the chemist – only about 2 hours since we had first rung up. By this time there were 3 others waiting at the Centre.
Ah, you might say, but that’s leafy Cambridge, not the front line. Of course, you are not in crisis, like the rest of us. But NO. As I have often said before, Cambridge is not half as leafy as some sections of the press like to make out. And just a couple of miles away from Chesterton Medical Centre, Addenbrookes’ A and E has been one of the emergency departments with most, and widely reported, difficulties (on the October statistics Cambridge University Hospital Trust was discharging just over 75% of A and E patients within 4 hours, a long way short of its targets). It is possible that, while we were waiting at Chesterton on Saturday morning, Addenbrookes A and E was a haven of peace and speedy turnaround, but I very much doubt it.
So why aren’t people turning up, like us, at the GP’s out of hours service? Well maybe they are and we were just very lucky. But I think there is more to it than that. Part of it may have something to do with the initial encounter with NHS111, which was the only slightly suboptimal element of the whole excellent process. Your call is first answered by someone without apparently very much professional medical training, going through what seems to be a check –list of questions, some of which are designed to get you to call 999 if its looking really bad. (“Are you confused?” Don’t say, “Yes, I am very confused about your questions/the end of the Roman empire/or whatever”, as I guess you will find yourself either cut off or being told to ring 999). That bit of the encounter feels like something of a game of chance, in which you are trying to make clear that you are too ill to be told to take a paracetemol and plenty of fluid, but not ill enough for sirens to be blazing – in a way that fits with whatever instructions they have on their screen. It’s not till you actually get to the doctor, that things seem much more personal.
But more to the point, I think, is the NHS111 website and the confusing terminology used on it. As the husband pointed out, if you went to the website on Saturday morning and looked for a medical “walk-in centre” in your area, you were likely to be told (as we were) that none were open, except the local major accident department. If we had taken what the site APPEARED to be saying, we might well have fetched up at Addenbrookes. In fact, as no doubt the site said somewhere, but not obviously, we were not really looking for a ‘walk-in centre”. We wanted GP out-of-hours emergency care. The Chesterton Medical Centre that we visited was NOT “walk-in”; you had to ring up and make an appointment But unless you know the terminology, you are going to be misled.
So maybe all these instructions not to go to A and E unless it is absolutely essential, should be rather clearer and more welcoming. I am sure that the NHS admin will say that they have been as clear as they possibly could be. And, strictly speaking, they have been. But it’s all about how NHS111 can “direct you to the best medical care for you”… which seems a bit vague, and a bit crowded out by other bits of info, like sign language, when to call an ambulance etc. And my own experience says that when you are in a hurry and not very well and anxious about getting treatment pretty soon, you can easily misread and be easily misled.
The basic point is that most of us don’t need emergency care very often for most of our lives. When we do, we want to think someone will be there to make us better. And we are not at our best when it comes to taking things in! Maybe something more like “If you want to see a doctor now, this is what to do…”