Abstract
Dr Bulger’s letter 1 in your March issue is disappointing. We agree that it is an important challenge for the National Health Service to maintain patient satisfaction while general practitioners increasingly work part time. But his analysis that general practice may now be ‘past its sell by date’ is flawed. It is likely that a substantial group of general practitioners wish to be salaried, as many already are. Dr Bulger describes the problem as being general practitioners losing their commitment to their patients and practices but then proposes a system completely removing any commitment.
Placing all general practitioners into hospitals is illogical, as currently 60% of people are within ‘pram pushing’ distance from a general practice. In many cities, there is only one hospital which is inevitably less accessible, especially to the underprivileged.
Polyclinics were used in Eastern Europe for decades, were universally unpopular with patients and with doctors and were abolished after the fall of the USSR Soviet Union in most of those countries as soon as they gained their independence.
Most bureaucracies do not allow significant client/patient choice. While patient choice between general practitioners is not as free as is desirable, it is much easier for patients than trying to change doctors in hospitals. Patients in general practices with personal lists had significantly higher satisfaction rates. 2
Patient satisfaction with the average consultation in Accident and Emergency departments, which do not seek to build relationships with patients, is much lower than in the average consultation in general practices. 3 Finally, he is wrong in writing that ‘patients seem to want to go to hospital anyway’ and he would be wise to talk patient groups about this. The facts are against him: about 25 million patients per year go to Accident and Emergency departments (including some referred by General Practitioners), whereas 340 million go annually to general practices.