As I write, the light fading at the end of an autumn day in the northern city that is now my home, I can look out from my first-floor window at tall redbrick tenements, squat terraced houses and the conical slate roof of a modern GP surgery.
In fact, now the lamps are lit, I can watch a GP at work. A dark-haired man in a cream-coloured jacket, he seems, like me, to spend a lot of time at the computer. Through a judicious seating arrangement his patients are concealed from my view. So too is his face, for he sits with his back to the uncurtained window.
Perhaps one day my neighbour and I will get to know one another a little better. But as to whether we will ever meet in a professional capacity, I'm not yet sure. For I have a confession to make. It is now a year since I moved here and I have yet to register with a local GP.
But how to choose a GP? Everyone says it is the most important relationship a citizen has with the NHS, yet how am I, still a relative newcomer in town, to know whether cream-jacket is any good?
I start with a Google search, producing a helpful article by one Peter Lavelle, promisingly entitled 'How to choose a GP'. He concludes:
You probably have a good doctor if he or she:
is generous with time. A typical consultation should be 10-20 minutes;
is a good listener. Good communication skills can be at least as important as how well a GP has been trained to diagnose and treat illness;
doesn't over-prescribe - a good GP won't fob you off with a handful of prescriptions;
doesn't just ask questions, but also does a physical examination;
asks about other conditions or problems you may be having, besides the problem that you attended for.
Sounds great, but how to find out whether any local doctor shapes up? With competition from the pharmacy chains and supermarkets apparently imminent, practices will surely be oiling their marketing machinery to attract my custom.
Four separate lines of enquiry leave me no clearer. The guys down the pub suggest a GP practice a mile away is the best, but their criteria seem less than scientific and frankly some of them do not look like an advertisement for preventive medicine. An old friend suggests asking a mature, independent pharmacist for a recommendation: sound advice no doubt, but I do not know any local pharmacists either. Another friend tells me cream-jacket's practice just refused her an appointment for three days later with an offhand 'we can't release appointments that far in advance: come back tomorrow after 12pm'. Sounds like the initial rigidity of the target culture is alive and well in this part of Yorkshire and practice receptionists have not changed much either.
My fourth source, the local primary care trust website, does not help much either. There is factual information about each practice, but little to distinguish them. The opening hours appear identical: strictly 8.30am-6pm, Monday to Friday. Most boast disabled car parking, probably meaning the other spaces are reserved for staff. 'All patients will be registered with the practice and not with an individual doctor': looks as though I am expected to choose a building, not a person. A link to a practice's own website identifies who provides 'the out-of-hours service' and considerately offers the phone number: but it is a PCT I happen to know disappeared in last year's reorganisation.
Impressions of the style and values of these organisations begin to emerge, but I am still no wiser about which doctor - sorry, practice - is generous with time during consultations, is good at listening and so on. Never mind who is competent enough to catch in time that potential killer disease we all quietly fear when we turn up with a persistent croak or an unexplained ache.
It does not feel like empowered choice. Indeed, the wording of the PCT web page for each practice - 'provided you are residing within our practice area and we are accepting new patients, you will be asked to complete a registration form' - hints that any choosing will be done by them, thank you.
Perhaps it will be different when commerce takes over. Round here it is more likely to be Lidl and Netto than Tesco and Boots, although the PCT, notorious for financial problems, would probably prefer Costcutter. Something about the name. But they all understand the value of extended hours and decent access for attracting custom. There are no catchment areas or registration rituals. You can choose a checkout person with the shortest queue or the most cheerful look.
And then comes the insidious thought: why bother searching for a GP? The city already has a no-doubt excellent nurse-led walk-in centre open until 8pm seven days a week. Besides, junior health minister Lord Darzi's interim review promises 150 GP-led walk-in centres 'in easily accessible locations'. And cream-jacket's practice would probably see me if I described myself as a temporary resident, as in a way I am. We all are.
There is always accident and emergency if desperate. Continuity of care? At a pinch I could make an appointment with the London GP who still has my registration.
According to a recent Home Office report, migrants entering the UK often use the NHS more or less this way. Shunning the process of registering with a GP, with all the suspicion that form-filling arouses, they seek direct access as and when it is needed. As a recent (internal) migrant myself, I am beginning to wonder: so what is the problem?
Let me throw the question open. How should someone moving to a different place go about choosing a GP? And, more challengingly, why should they bother now that direct access services are so good? Answers to: noelplumridge@aol.com and I'll publish a selection next month.
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