Saul Miller is a GP in Wooler, Northumberland.
I can see what has happened.
Marj and I have known each other for years. I appreciate this is unusual given national policy promoting episodic care as it does. She has sometimes had to submit requests many times, she tells me, and says she calls it the Larkins Lotto.
‘Doc Larkins,’ she’ll say, ‘my granddaughter is an angel, because I can’t fathom the technology at all. So she tries and tries —’ she breaks off with a cheeky laugh, ‘lies and lies I mean! Until the system offers an appointment with you.’
And I, of course, always reassure her that when I see it is her who has another appointment with me, that I completely ignore the system recommendations about what the problem is and what I ought to do about it. I spare her quite how awkward and difficult this is to achieve given that it is important not to reveal to the system that she has lied since this will have negative consequences for her registration status — there is a special practice 40 miles away for patients like that. I spare her this because I have become fond of her. Albeit in a strictly professional way.
“… ask and most GPs will say it [the system] actively seeks to prevent patients developing a relationship with a particular GP.”
Admittedly, she is by no means the only patient to game the system in this way. But she is by far the most persistent. Or rather, her long-suffering granddaughter is. Most patients find it too taxing in the end to keep submitting bogus medical problems in the hope that one of them will lead to an appointment not only with a GP but actually a particular GP.
The system administrators obviously deny this, but ask and most GPs will say it actively seeks to prevent patients developing a relationship with a particular GP. We think this is because of the research showing that the only way to get them to accede to the dogma that one GP is interchangeable with any other, is if they have no relationship. This in turn helps ensure we are all in thrall to the system. Why else keep allocating us clinics in random different sites? Logistics, administrators say, merely logistics.
But the truth is, we have no choice. If the system decides not to allocate me any patient appointments, I have no other means of obtaining work.
I actually remember how it used to be. My training practice was an old-fashioned one with partners who had been there years and patients who were well known to them. They were a bit of a mixed bunch in terms of their enthusiasm for artificial intelligence when national policy first moved to promote an American product as safe for healthcare professionals to use. Some pronounced it the thin end of the wedge, others liked how it offered shortcuts on some things like writing reports. Even those who held suspicions, however, never foresaw that it would facilitate the ending of the partnership model itself. My trainer did grumble on occasion that she felt like she was serving the computer system more than it was serving her, but I am sure she would be turning in her grave if she knew the system would become this powerful.
Probably even the government back then had no idea of the degree to which it was ceding sovereignty either — the entire NHS dataset in the control of a single American company. Reassurances about confidentiality are still issued but everybody knows the adverts they see are not solely because of self-disclosure about their health on social media sites.
Anyway, I know what has happened with Marj. The system has learnt not to allocate her to me no matter how many times she tries.
I feel sad and wonder if her granddaughter is still lying in vain.
Featured photo by dylan nolte on Unsplash.
