Another day, another doctor-bashing headline - this time, it's: "Patients daren't complain about bad GPs - one of the great unspoken scandals of the NHS" . The report comes from the Patients Association, and offers the terrifying-sounding statistic that 4.4% of patients who complain are removed from their GP's list. Of course, that same statistic means that over 95% of patients who make a complaint have it dealt with to their satisfaction and continue to see the same GP afterwards.
Dr Clare Gerada, chairman of the Royal College of GPs and herself a practising GP in a challenging inner-city London practice, reminds us that the vast majority of patients are happy with the patient services they receive. I absolutely echo her view that: "GPs are working extremely hard to deliver the best care they can for their patients against a backdrop of NHS upheaval and increasingly limited resources." Major studies such as the annual Patient Experience Survey show that last year, 36% of patients rated their overall experience with their GP as good and 54% said it was excellent.
There are over a million consultations in primary care every day. GPs are doing more face-to-face consultations with patients every year, as we work with our patients on more and more preventive medicine measures to stop them getting disease, as well as treating the same patients when they get ill. In our practice, as in the vast majority of others, there is a comments/complaints box prominently placed on the reception desk, and all complaints are followed up promptly and in great detail.
None of the GPs I know would dream of removing a patient because they complained - but if a patient steadfastly refuses to see half the doctors in a practice, they can't be provided with high- quality continuous care because at some times of day there is one duty doctor and a practice cannot guarantee that another one will be available. No, that's not because the other GPs are out on the golf course - between surgeries we have endless dull-but-necessary meetings about how to make cuts without compromising quality of care for patients; meetings on reducing prescribing costs or referral rates without risking patient safety; meetings with other members of the community team on how to put all the steps in place to allow patients to die at home if they want to. Lunch breaks? Forget it.
Doctors are human - they work under enormous stress and while in an ideal world it shouldn't, that stress might sometimes show. Of course they shouldn't react to patient complaints by removing that patient (or even worse the whole family) from the list. But sometimes the doctor feels threatened, and too worried to keep the patient on their list because they might have to visit them at home. In some cases, the GP undoubtedly gets it wrong - but there are two sides to every story.
The Patients Association suggests that the threat of being de-registered deters patients from complaining about their GP - yet statistics from the General Medical Council (GMC) suggest otherwise. Complaints to the GMC about doctors have been rising steadily since 2007, yet there has been no corresponding increase in findings that doctors are providing substandard medical care.
We live in a consumer society, in which many of my colleagues talk about patients feeling they have rights but no responsibilities. A report last month shows that one in ten patients are not bothering to turn up to their outpatient appointments, costing the NHS millions of pounds a year. I have had a formal complaint because I suggested to a patient, who rang for a prescription for a few paracetamol that if he bought them from the supermarket they would cost him 16p, while to give him the same number of the same tablets on prescription would cost the NHS several pounds.
The report notes that one in five complaints about GPs to the Ombudsman is about 'inappropriate de-registration'. The Ombudsman confirms that they have found evidence of a 'zero tolerance' approach, but does point out that the majority of de-registrations are because the patient is aggressive or violent to General Practice staff.
Nobody complains when the London Underground advertises a Zero Tolerance approach to violence or aggressive behaviour towards their staff. Let's think again about the Ombudsman's comment - the majority of de-registrations are because the patient is aggressive or violent to General Practice staff. Yes, there are times when GPs need to work harder on communication - but when the statistics remind us that they live every day with the threat of violence from the people they're trying to look after, maybe we should look at the bigger picture.
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