Last week I had a letter from the surgery. At first I thought it might be for another check-up but it turned out to be something quite different which I had forgotten all about:
Dear Mr Gland (it began) You very kindly agreed to be a member of our patient participation group and we are planning to hold the inaugural meeting next Tuesday at 8 p.m. here in the Old Surgery. The agenda will be to elect a chairman, to discuss the recent Patient Satisfaction Survey and to make recommendations. We do hope you will be able to come to what should be a very interesting and productive meeting.
Yours sincerely, Elena Browning, practice manager.
PS I shall be acting as ex officio secretary of the new group.
So, yesterday evening as soon as we had finished supper and loaded the dishwasher I put on my good suit and took the car down to the surgery. It seemed strange to be going there so late in the day, long after the doctors had finished. I wondered whether any of them would be present at the meeting. There were lights inside the building when I arrived but the door was locked so I rang the bell. To my surprise, it was opened by Harry Pocket, our ex-neighbour with whom I had last crossed swords while we were waiting for our appointments.
‘Well, if it isn't Norman Gland!’ he beamed when he saw me. ‘I might have known you'd be up for this Patients' Group carry on. Come in, take the weight off your metatarsals and meet the rest of the Mafia’. So he ushered me in to the waiting room (trying to take control already, I noticed) where a little group of patients were assembled. There was a middle-aged woman I recognised as May Teddington who was a teacher until she retired, and a youngish man with glasses and a smart leather jacket. I wondered where I had seen him before; could he have been on television? Finally, there was a young girl with too many earrings who didn't look more than 18, no doubt representing Youth.
Elena the manager was also there handing round cups of tea and biscuits. She said she would help us to elect a chairperson and take the minutes but take no part in our deliberations except to give general guidance. First of all we should introduce ourselves. So we did. The leather jacket man said his name was Bob Gatsby and he was a media person who worked in print and television. He was very smooth and confident, no doubt from being on television and mixing in that sort of world. The young girl is called Tammy Jones and she has a ‘partner’ and two young children. Then we turned to the election of the Chairperson. May Teddington, to my surprise said she thought I would make a good chair, as I was mature and calm and had managerial experience. I have totally revised my opinion of this excellent woman. So she nominated me and as no one else saw fit to challenge me I was elected unanimously! Naturally I was pleased, although I wondered if Harry Pocket was just waiting for a chance to be disruptive.
Anyway I accepted their congratulations and turned to the agenda. Was everyone familiar, I asked, with the recent survey? Yes they were and everyone had taken part. A few months ago they were giving out these survey forms for people to fill in before and after seeing a doctor or nurse. I am fairly sure that the Department of Health made them do it or they wouldn't have bothered. The survey was a bit like the forms you find in hotel bedrooms, saying we are always eager to improve our service to you. It asked questions about how easy it was to make an appointment, could you see the doctor of your choice, were the receptionists helpful, was the waiting room comfortable and so on. Then it became quite detailed about your experience of the consultation: did the doctor listen? Did you have enough time? Were you satisfied with the outcome? Then there was space for free comments. Bob Gatsby said that the results had been professionally analysed and summarised. He would pass copies round from which we could see that while the Practice had many good points it also had some serious weaknesses. I shot a quick glance at Elena, but she looked quite unperturbed as she tapped away on her laptop computer. Bob told us that we patients on the whole were satisfied that, by and large, the doctors knew what they were doing. They listened to us for a few minutes (all the time they were allowed) and on the whole made the right diagnosis, although there were a few horror stories, but obviously we couldn't expect them never to make a mistake. There was a widespread feeling that some medicines were very hard to obtain, particularly sleepers, antibiotics, the more effective painkillers, and things to rub on aching joints. This was almost certainly due to downward pressure on costs by Government and any deficit would be deducted from the doctors' profits so they were very nervous about prescribing anything expensive.
Appointments could be made if you could get through on the phone but this wasn't always possible and it was better to turn up and be an emergency. The waiting room chairs were worn out and it was drab and depressing. I asked everybody if they would like to make recommendations based on the survey findings that we could pass on to the practice. Harry Pocket said the waiting room was a disgrace in his opinion. Had we seen the Customers Lounge at the POSH Private Hospital? That was more the style we needed here, he said: decent bit of carpet, nice comfy armchairs, tea and coffee available, all the newspapers and some up-to-date magazines. ‘How about Stud and Loaded, eh Norman? Suit you sir?’ Then he gave me a dig in the ribs and laughed his throaty chuckle. Disgusting man, he is.
Young Tammy said it sounded ever so nice but could the practice afford such luxury? ‘Course they can,’ said Harry, ‘GPs are coining it these days, have you seen the salaries they get? And they work shorter hours. Isn't that right, Mrs Browning?’ Elena looked up from her laptop and gave him a smile but offered no comment. She is very diplomatic.
‘And another thing,’ continued Tammy (who I noticed had a ring in her nose as well as her lower lip) ‘we should have a telly for the kids to watch while we're waiting and waiting; they get so restless, know what I mean?’ Mrs Teddington wondered if some books and games of an educational nature might be a good idea too; Although Tammy said yeah, yeah, educational, is good, I thought her expression lacked enthusiasm … Then Bob Gatsby said what he wanted in the 21st century was to be able to see any doctor he liked, when he liked and where he liked. He was glad to see that Gordon Brown, after a lot of dithering, was now putting pressure on practices to extend their hours. Personally, he was in favour of surgeries being open 24/7, and if the Old Surgery wasn't up for it they would lose out to competition from more efficient organisations like ‘Patients First’ the swanky new set-up in the High Street.
I felt bound to point out that Patients First were notorious for their lack of continuity of care with doctors appearing and disappearing every few months. ‘I do so agree with our chair,’ affirmed Mrs Teddington warmly. ‘We older patients want to be able to go on seeing the same doctors we have known and trusted for many years.’
I allowed the vigorous discussion to go on for a little longer before calling the meeting to order. ‘It is time,’ I said, ‘for us to organise our thoughts and summarise our conclusions. I suggest that we write our recommendations on the flip chart and then reduce them to a manageable form that we can present to the practice for their consideration.
So we did. And the flip chart was soon covered with Bob Gatsby's bold red writing. It read:
More appointments! More phones! Open from 7 a.m. to 10 p.m. 6 days a week and Sunday mornings. More antibiotics! More hospital appointments!
Waiting room to have new carpet and arm chairs. TV, video games, selection of daily newspapers and magazines to suit all tastes. Doctors to smile more!
Elena promised to take our reform programme (as Bob called it) back to the doctors and put it on the agenda for their next meetings. She had her doubts, she said, about how some of our recommendations would go down but she thought the discussion had been wide-ranging and thoughtful. Everyone congratulated me on my chairship. I felt really pleased with myself and, for a several hours remained free of symptoms of any kind.
Acknowledgments
We are grateful to John Salinsky for these extracts from Norman Gland's diary.
- © British Journal of General Practice, 2008.
