Speed. Efficiency. Immediacy.
If you were to think of three words to describe how the NHS operates, sadly you would be unlikely to come up with these. Although the NHS can sometimes defy our expectations, the organisation’s size and complexity seem inversely proportional to the speed and efficiency with which it delivers its service. At a hospital level, there are often long delays for individual patients – to be seen on the ward or in clinic, to receive medication, or to be discharged. Similarly, in primary care, patients can wait a long time to receive appointments and to have results communicated back to them. These delays lead to frustration (for both patients and healthcare professionals) and at worst, can result in a breakdown of trust in the NHS and the people delivering care.
As an FY1 doctor (first year working after graduating from medical school), I have rotated through three posts of 4 months each – two based in the hospital, and one based in the community (Integrated Paediatrics, working for Connecting Care for Children – CC4C). I have seen first-hand the distress that a long wait for any aspect of care can cause to a patient and their family. Since moving onto Integrated Paediatrics, I have also noted the differences between primary care (in general practice) and secondary and tertiary care (in hospitals).
During this 4-month post I have been working on a project around Type 1 diabetes – how communication and links between primary and secondary care influence diagnosis and management of this condition in children. It has made me realise that although there are often long waits in secondary care, primary care shoulders most of the delay in patients accessing progress in their care. For example, getting blood test results in hospital may take only a few hours. In primary care, it can take a few days.
Patients and their families often experience frustration when there is a long wait between being referred by their GP for a specialist opinion, and being seen in hospital. For some services this wait can be many months, during which time families can feel helpless and ignored, just waiting for the next step.
It has been great to see how CC4C is trying to change this model with GP Hubs. These are joint clinics with GPs and hospital paediatricians reviewing children together. They happen monthly at GP practices, meaning a much shorter wait for a specialist opinion, convenience for families who no longer need to travel long distances to the hospital and an increase in efficiency in GP/specialist communication – there is no need for a delay as a letter is dictated, typed out and sent by a secretary – the GP knows exactly what went on in the consultation as it is recorded on their own computer system. Having attended three Hubs myself I have personally seen the benefits and the appreciation that families have for this service. For example, I saw an infant who had presented to one of the hubs to have a potential foot deformity examined. Her mother expressed surprise and relief that this was one of the actual hospital paediatricians that she was seeing, and there was no requirement for her to come to an appointment at St Mary’s, which is quite a distance from her home. (Her relief doubled when she was told that the ‘foot deformity’ was entirely positional, and would very likely resolve when the child started walking!)
Although there are still many improvements to be made in increasing the speed and efficiency of the NHS, it has been deeply encouraging at an early stage in my career to see that positive change can be made by thinking outside the box and improving communication, ultimately for the benefit of healthcare professionals, who gain satisfaction from fewer restrictions on doing their job well, and for patients and their families, who receive better care.