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Criticizing the NHS - Can students do this productively?

Written by jacob matthews · Friday 17th May 2013

In this month’s SBMJ (May 2013) a GP called Dr Michael Ingram has written a very good article highlighting some of the problems with the modern NHS’s administrative systems, especially relating to the huge amount of GP time wasted on following up after administrative errors and failings. I personally think that it is important for people working within the NHS to write articles like this because without them then many of us would be unaware of these problems or would feel less confident in voicing our own similar thoughts.

The NHS is a fantastic idea and does provide an excellent service compared to many other health care systems around the world, but there is always room for improvement – especially on the administrative side!
The issues raised by Dr Ingram were:

  1. Histology specimens being analysed but reports not being sent to the GP on time or with the correct information.

  2. Histology reports not being discussed with patient’s directly when they try and contact the hospital to find out the results and instead being referred to their GP, who experiences the problem stated above.

  3. GP’s are being left to deal with patient’s problems that have nothing to do with the GP and their job and have everything to do with an inefficient NHS bureaucracy. These problems and complaints often taking up to a third of a GP’s working day and thereby reducing the time they can spend actually treating patients.

  4. Having to arrange new outpatient appointments for patients when their appointment letters went missing or when appointments were never made etc.

  5. Even getting outpatient appointments in the first place and how these are often delayed well after the recommended 6 week wait.

  6. Patients who attend outpatient appointments often have to consult their GP to get a prescription that the hospital consultant has recommended, so that the GP bares the cost and not the hospital.

My only issue with this article is that Dr Ingram highlights a number of problems with the NHS systems but then does not offer a single solution/idea on how these systems could be improved.

When medical students are taught to write articles for publication it is drummed into us that we should always finish the discussion section with a conclusion and recommendations for further work/ implications for practice. I was just thinking that if doctors, medical students, nurses and NHS staff want to complain about the NHS’s failings then at least suggest some ways of improving these problems at the same time. This then turns what is essentially a complaint/rant into helpful, potentially productive criticism.

If you (the staff) have noticed that these problems exist then you have also probably given some thought to why the problem exists, so why not just say/write how you think the issue could be resolved? If your grievances and solutions are documented and available then someone in the NHS administration might take your idea up and actually put it into practice, potentially reducing the problem (a disgustingly idealist thought I know).

A number of times I have been told during medical school lectures and at key note speeches at conferences that medical students are a valuable resource to the NHS administration because we visit different hospitals, we wander around the whole hospital, we get exposed to the good and bad practice and we do not have any particular loyalty to any one department and can therefore objective observations. So, I was thinking it might be interesting to ask as many medical students as possible for their thoughts on how to improve the systems within the NHS. So I implore any of you reading this blog: write your own blog about short comings that you have noticed, make a recommendation for how to improve it and then maybe leave a link in the comments below this blog.

If we start taking more of an interest in the NHS around us and start documenting where improvements could be made then maybe we could together work to create a more efficient and effective NHS.

So I briefly just sat down and had a think earlier today about a few potential solutions for the problems highlighted in Dr Ingram’s article.

  1. A community pathology team that handles all of the GP’s pathology specimens and referrals.

  2. A “patient pathway co-ordinator” could be employed as additional administrative staff by GP surgeries to chase up all of the appointments and missing information that is currently using up a lot of the GP’s time and thereby freeing them to see more patients. I am sure this role is already carried out by admin staff in GP practices but perhaps in an ad hoc way, rather than that being their entire job.

  3. Do the majority of GP practices get access to the hospitals computer systems? Surely, if GPs had access to the hospital systems this would mean a greater efficiency for booking outpatient appointments and for allowing GPs to follow up test results etc.

  4. In the few outpatient departments I have come across outpatient appointments are often made by the administration team and then sent by letter to the patients, with the patient not being given a choice of when is good for them. Would it not be more efficient for the administrative staff to send the patients a number of appointment options for the patient to select one appropriate for them?

  5. Eliyahu M. Goldratt was a business consultant who revolutionized manufacturing efficiency a few years ago. He wrote a number of books on his theories that are very interesting and easy to read because he tries to explain most of his points using a narrative – “The Goal” and “Critical Chain” being just tow. His business theories focussed on finding the bottle neck in an industrial process, because if that is the rate limiting step in the manufacturing process then it is the most essential part for improving efficiency of the whole process. Currently, most GPs refer patients to outpatient appointments at hospitals and this can often take weeks or months. The outpatient appointments are a bottle neck in the process of getting patients the care they require. Therefore, focussing attention on how outpatient appointments are co-ordinated and run would improve the efficiency in the “patient pathway” as a whole.
    a. Run more outpatient clinics.
    b. Pay consultants overtime to do more clinics, potentially in the evenings or at weekends. While a lot may not want to do this, a few may volunteer and help to reduce the back log on the waiting lists.
    c. Have more patients seen by nurse specialists so that more time is freed up for the consultants to see the more urgent or serious patients.
    d. An obvious, yet expensive solution, hire more consultants to help with the ever increasing workload.
    e. Change the outpatient system so that it becomes more of an assembly line system with one doctor and a team of nurses handling the “new patient” appointments and another team handling the “old patient” follow up appointments rather than having them all mixed together at the same time.

I am sure that there are many criticisms of the points I have written above and I would be interested to hear them. I would also love to hear any other solutions for the problems mentioned above.

Final thought for today … Why shouldn’t medical students make criticisms of inefficiencies and point them out to the relevant administrator?

If anyone else is interested in how the NHS as a whole is run then there is a new organisation called the Faculty of Medical Leadership and Management that is keen to recruit interested student members (www.fmlm.ac.uk).

Responses

jacob matthews
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Junior Doctor (FY1) - Birmingham
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Posted over 6 years ago
Also sorry to spam, this only occurred to me this morning. I suggested a number of system changes above, which Dr Williams correctly said would be unlikely to ever happen because of the cost of implementation. However, I was wondering how people work
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Dr Damian Williams
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General Practitioner - Hall Green Health
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Posted over 6 years ago
Please call me Damian - I am nothing special just because I'm further on in the process than you! The idea of 'spend to save' is a very important one and one that is embraced by the NHS although you have to work hard to show that your spending will pro
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jacob matthews
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Junior Doctor (FY1) - Birmingham
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Posted over 6 years ago
Dear Louise, Many thanks for your feedback, I am really glad you found it interesting. 1) To answer your first point I must first make explicitly clear that I am currently an “armchair reformer” – the worst kind of back seat driver. I have only l
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Dr Damian Williams
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General Practitioner - Hall Green Health
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Posted over 6 years ago
Thank you Jake and Louise. I would start by saying that I think people should point out problems and inefficiencies in the NHS but in a constructive way. Students are in a unique position because they move around and they haven't been worn down by NHS
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Louise Roper
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Posted over 6 years ago
Dear Jake, Thanks for your blog, I enjoyed reading it. I'm glad to see that you posted some suggestions for improvement, I agree that if we are going to highlight these inefficiencies it is also right to offer some comment on how they might be rect
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jacob matthews
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Junior Doctor (FY1) - Birmingham
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Posted over 6 years ago
Many thanks for your comment Dr Williams, I look forward to reading more of your blogs and I greatly appreciate the time you have taken to inform me of the 2 systems you described. Let’s hopes they are used more universally soon. Would you mind if I
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jacob matthews
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Junior Doctor (FY1) - Birmingham
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Posted over 6 years ago
Thanks for your reply Damian. I can fully appreciate your argument now, I hand't really considered the cost of increased wages over time. It would seem that since the NHS is going to try and cut £20 billion, there isn't going to be much room for new sta
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