Reform Scotland

A customer focus can end our doctor’s postcode lottery

This article by Alison Payne appeared in the Scotsman

‘Postcode Lottery’ is a phrase often used in the media referring to different levels of service people receive from the public sector depending on where they live. Sometimes such a phrase is unfairly used – for example local authorities in Scotland adopt different policies that can lead to different levels of service.

Crucially, however, on these occasions the public has the choice of voting out politicians and electing ones that offer different policies if they are not happy with the service they receive. As long as the public has some sort of choice, whether being able to change provider or vote for different politicians, there is no ‘lottery’.

In contrast, however, Reform Scotland believes our latest report, “Patients First: Improving Access to GP Practices”, demonstrates there is a genuine postcode lottery in Scotland when it comes to accessing GP services.

Depending on where you live, the way you can access GP services can be quite different. For example whether the practice is open in the evening or at weekends, whether the practice allows you to book appointments or order repeat prescriptions online, or indeed whether the practice even has a website.

And crucially, this system is a lottery because patients have very little choice over the GP practice with which they can register.

Reform Scotland carried out research looking at the way people could access GP practices in an urban and rural area – Edinburgh Community Healthcare Partnership and NHS Borders – which highlighted a wide variation in the way GP practices worked.

First, we looked to see whether GP practices had a website, something that is so basic in this day and age it’s almost taken for granted. We soon discovered while some GP practices had fully functioning websites that allowed you to order repeat prescriptions online and some even enabling patients to book appointments online, a fair minority did not have a website at all.

Of those that did have websites, we compared their procedures to see whether they offered open surgeries, whether there was an explanation of what you should do if you needed to see a GP on the same day, whether the practice offered extended hours and whether there was the ability to order repeat prescriptions online.

We would stress that this research simply looked at the operating practices and accessibility of GP practices. Reform Scotland is not suggesting that there is any correlation between whether a GP practice offers these services and the quality of care provided.

From this work we found:

In Edinburgh Community Healthcare Partnership

* 79 per cent of GP practices had a working website

* Of those with a website, 47 per cent offered some level of extended hours

* Of those with a website, 81 per cent offered online/email repeat prescriptions

* Of those with a website, 15 per cent ran open surgeries with 71 per cent suggesting you tell the receptionist your case is urgent if you want to be seen the same day.

In NHS Borders

* All 26 GP practices had a website (mostly a page on NHS Borders website)

* 23 per cent of practices stated they offered extended hours

* 12 per cent of practices offered online/email repeat prescriptions

* 15 per cent offered open surgeries with 58 per cent suggesting you tell the receptionist your case is urgent if you want to be seen the same day.

Reform Scotland believes that it is simply unacceptable that there is such a wide variation in the way people can access GP services, whilst there is little or no choice over where they can register.

Diversity is a good thing, and something which there needs to be more of in all public services. However, for diversity to help raise standards across the board, people have to be able to choose between providers, in this case GP practices. As a result, our report sets out a number of policy recommendations that we believe will extend choice to patients over the GP practice with which they can register.

Firstly, we believe that GP practice catchment areas should be enlarged. Expanding the catchment area would put no extra pressure on GP practices as they would still be able to close their lists to new patients if they reached capacity. The only difference would be that the area from which they could accept patients would be larger.

In practice, many people would still prefer to join the practice closest to them. Nevertheless, by enabling patients to move and go elsewhere if they are unhappy with the way they access services where they are there will be greater pressure on all GP practices to improve.

Secondly, we think new GP practices should be allowed to open up. Choice is currently limited for patients due to the number of GP practices serving their area or if practices have closed lists and do not have the capability to take on new patients. If NHS boards allowed new GP practices to open up alongside existing practices, this would give patients far greater choice. This competition, in turn, should also improve access and operating practices across the board.

Thirdly, we believe the ban on private companies opening up GP practices should be scrapped. It is often forgotten that GPs are usually private sector contractors to the NHS and the current situation where some private enterprises can run GP practices while others can’t is illogical. There should be a more consistent approach, either you believe that private companies should not be providing GP care, in which case all GPs should become salaried GPs and be employed by the NHS, or you believe that the private sector can provide GP care. Trying to ban certain types of private sector providers, but allowing others based on their perceived motivation is inconsistent and illogical.

Finally, during the completion of this report Reform Scotland was frequently frustrated by the lack of information easily available to the public regarding GP services. Whilst we appreciate that some individual health boards provide more online information than others, it is disappointing that there is such a gap in the quantity and quality of the information provided by NHS Choices in England compared to NHS 24 in Scotland regarding local GP practices.

We believe NHS 24 should certainly aspire to provide as good a range of information about local services, if not better, than is available in England.

No service is perfect, but it is very telling that the top five negatively-rated issues in the Scottish government’s GP survey were all to do with how patients accessed services. Reform Scotland believes the recommendations we have set out in this report are a step in the right direction and would help improve that experience for patients