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‘People tell me they pay their taxes and so can specify the treatment they want’

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As the government continues to push forward its patient choice agenda, Paul Cornforth asks if people are becoming too demanding of a limited health service and are treating it just like a supermarket

‘Are you being served?’ This famous line is from, and was also the title of, the classic 1970s queen of sitcoms, set in a busy department store.

And in the current patient-driven (or should that be customer-driven?) NHS, it is now a phrase that I find myself hearing more and more frequently.

It is certainly the case, especially in unscheduled care services such as
NHS walk-in centres, that patients see themselves as being customers who can demand the service they want as though they were queuing in their local Asda
or Sainsbury’s.

Recently, during a 12-hour shift, I dealt with seven patients who all felt they were entitled to be supplied or prescribed with antibiotics or given an X-ray based on the fact that they pay their taxes, and can therefore demand from the health service what they wish, rather than treatments being prescribed and investigations conducted on the grounds of clinical need.

The other thing that the patients keep telling us is that they feel they are waiting too long to be seen. During periods of peak activity, which in a walk-in service is almost impossible to predict, they believe I can make a loudspeaker announcement (like a checkout supervisor in a supermarket) calling all available clinical staff, and then open up more consulting rooms to deal with what they see as an unnecessary wait of between 45 minutes and an hour to be seen.

So what has led to this sudden increase in patient demand, and the expectation of receiving retail-like customer service based around their requirements?

The blame can largely be placed at the door of political spin and media perceptions of the patient-driven healthcare service. People believe the political propaganda and expect to be able to access the NHS 24 hours a day, based on their perception of need, and that because they pay their taxes they can have exactly what they demand when they demand it.

What is the answer to this increasing problem? Well, one solution would be
to reduce the choice that is available to people. What happened to the days when patients only attended A&E if it was a genuine accident or emergency, or saw their GP only when they could secure an appointment?

Patients are presenting with minor ailment problems at services such as walk-in centres on the day that their symptoms develop, expecting an exact diagnosis and treatment. They often present with symptoms of non-specific viral infections, are given self-care advice, and in some cases present again days later with more advanced symptoms, annoyed that they were denied antibiotics for their cough or sore throat.

With the range of choices that are available in current customer and demand-driven healthcare services, people are presenting with very early symptoms and
it is often impossible in this stage of an illness to make an exact diagnosis. When people were obliged to wait a few days before seeing their GP, those who had self-limiting conditions would often recover without intervention.

The NHS is not like a supermarket. We do not have a supply of clinicians and facilities that can be delivered at will, in order to meet the demand for a product or service.

Patients are patients, not customers, and need to remember that the health service is not a retail establishment that will respond to their every demand. They also need to remember that they receive a high standard of evidence-based care that is driven by clinical need. They are not given a treatment wish-list just because a small proportion of the taxes they pay provides some small part of NHS funding.

So what’s the way forward for the future? Patient-operated vending machines for antibiotics in the foyers of the local supermarket? Being able to attend an outpatient appointment at 10pm, or find a CT scanner located between the freezer
cabinets and the in-store bakery in Tesco? Well, when it happens, don’t be surprised – you heard it here first.

Paul Cornforth is consultant nurse, unscheduled care, Wandsworth Teaching
PCT, London

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