When I worked for our local council I had a lot of contact with NHS colleagues, many of whom referred to our main hospital in the North East of Scotland as ‘the factory.’
The reason was clear.
It’s big, with major investment in recent years going into a new children’s hospital on the site and, currently, new A&E facilities. It’s also partly replaced the traditional lower tier of local community hospitals that most rural areas once had.
As a patient it can seem impersonal – buildings of different ages linked by interminable corridors, at the right time of day what seem like crowds of staff, patients and visitors surging back and forth, navigation by coloured lines painted on floors or walls, a shopping parade at the main entrance, in places a shabby and unkempt look that at best leads you to hope the money’s going into improved medical practice, the proliferation of ‘information’ that on other occasions I’ve called the NHS’s ‘disease of poster-itis and advanced leaflet syndrome.’ And don’t mention the car parking.
The counter to this moan of course is the service it provides, and on three recent occasions – a diagnose of a neurological problem, the emergency admission of a family member with appendicitis, and an A&E visit of another family member with a broken wrist – I’ve had reason to be grateful for the service the hospital provides.
The use by NHS managers of the slightly disparaging term ‘factory’ went along with a drive to get minor surgery and diagnostic procedures devolved to more local facilities – the community hospitals that remained and GP surgeries, where necessary upgraded.
The irony of this otherwise worthwhile aim is that it has actually led at the lowest level to a concentration of facilities, the de-personalisation of services, and the creation of what you might call mini-factories.
The fate of my own local GP surgery, once known to all and sundry as ‘Dr X’s practice’ is a case in point, Dr X being a much-respected middle-aged woman known for both her sympathy and wisdom.
Her surgery and another over a mile away in the city have been combined in a new building into a much larger practice.
The practice doesn’t have its own web site and two of the four links about it on the NHS Grampian web site are broken. The other two take you to an outdated page about the construction of the building (two years ago) and a general page about ‘how to get involved’ in the NHS.
According to other web sites (Aberdeen City Council and Grampian CareData) either seven or eight GPs practice there. I thought I’d seen nine listed a while ago but I could be wrong. It is not clear who is in charge: my assumption is that all the medics are now NHS employees. There is a ‘practice manager’ who I would guess is an administrator and manages ancillary staff but certainly won’t be telling the doctors what to do.
This is how the average contact works.
- Phone the practice’s 0845 number
- Select option from list given by recorded voice
- Wait an indeterminate time while music plays
- Make request of person answering – for non-urgent appointments with both a GP and a nurse I have been offered dates a fortnight away, ‘nothing earlier is available although you could try phoning to see if there’s a cancellation.’ The standard appointment is seven minutes long but if you make a case for a specific purpose you may be offered a ’20 minute appointment’
- On arrival wait at reception area with c. 20 seats, listening perhaps to the local commercial radio station which no one has been asked if they want streamed into the building. If desperate browse the available leaflets (see ‘advanced leaflet syndrome’ above)
- If you’re lucky the GP/nurse will come to get you for your appointment, otherwise a voice on an intercom will direct you to the appropriate room
Now, I may be naïve about why this has to happen. And I’m not having a go at the people who work in this system or at the quality of medical care (eventually) available. But tell me, has the service got better and is this anything other than another factory?