Thursday, February 21, 2008

NHS saga

At 11pm on Tuesday evening I went to take my pill and realised it was the last in the packet. Unconcerned I went to get a new packet from the first-aid box and discovered that somehow I had managed to forget to get some more. Cue mild panic that I had 24 hours to procure some more. A relatively easy task one might think; I live in London, how hard can it be.

Pills do not qualify as an emergency so I couldn't call my doctor at 9am and make a same-day appointment. I am prepared for that though and for the past 2 years have instead made an appointment with the family planning clinic nearest my work. If they don't have any appointments left for the same day there is usually a clinic one can turn up to and wait. Not ideal but acceptable if one plans ahead and doesn't need same day treatment. I.e. Becomes an issue if you have an 'emergency' and need emergency contraception. I called as soon as I got to work and finally reached a recorded message indicating that they were closed until 12pm. At 12pm I started calling, going round and round their system until it finally kicked me out and then wouldn't let me back in, stating "this line is busy" ad infinitum. At 1.45pm I finally managed to speak to someone. They had no appointments (for that day or the next). Clinic times had also changed. They now closed at 3.30pm. Definitely not ideal. I couldn't leave work at 3pm at no notice. "What do you suggest I do" I enquired, "I really need to see someone today". "Call X in X" she replied and hung up. Called X at X clinic. Yes, they did have a clinic until 6.30pm every day. "Excellent", I said, "so as long as I get there before 6.30, I can see someone?". "No" came the answer " if you're not here before 5.30pm at the latest, we will have filled our quota and you won't be able to be seen". At least that one was open - I tried 3 others to be told the earliest I could be seen was next Tuesday.

Boss allowed me to leave at 5pm so I raced to get there before their seemingly random deadline, running down the road looking at a map hastily printed from google. I made it at 5.32pm only to hear the administrator attempting to turn away the girl at the desk in front of me. I explained the whole saga, the other girl explained hers. Administrator claimed that "on health and safety grounds we can only allow a certain number of people on the list" and "don't you know it's the end of the financial year". We negotiated for a while; in the end I found out that the whole of the area had been on a training course all morning and that all family planning clinics were closed that morning in the borough. Eventually she consented to letting us both wait and if the doctor (the only one on duty) had finished the list before the end of the clinic, she would see us. The administrator herself explained that she should have left 15 minutes earlier and left the clinic, handing me a printed piece of paper stating clinic hours - 5pm to 6.30pm. Presumably she was simply following instructions:she then said she was locking the doors on her way out so that no-one else could get in. And with that, she left. Nothing I could do but sit and wait and sit and hope. With growing frustration I watched the doctor accompany each patient back out into the reception area and place their notes in a basket and collect the next set of notes - a three or four minute time delay accompanying each patient. To the doctor's credit she did see me, eventually, at 6.40pm. She was so rushed she barely listened to any of the questions she fired off in rapid succession. 3 minutes later I had my pills and was back in reception, mission accomplished, finally.

In this specific instance it was in many ways my own fault for my mistake in not realising I needed to get more pills ahead of time, but it raised significant issues in my mind. The majority of the administrators I spoke to were more concerned with quotas, targets and so on than helping patients. No-one volunteered more information until I asked for it. The doctor seemed to be wasting time between each patient by having to collect and return each set of notes herself. There surely must be a more effective system. All of the clinics I spoke to seemed surprised I couldn't attend daytime clinics. I work 9.30 until whenever every day of the week. Thankfully my boss is fairly understanding about personal issues and generally lets me leave on time if I really need to and there is nothing of vital importance happening. The majority of days I wouldn't be able to leave on time as a matter of course. This is unfair on those who are attempting to be responsible by having a job and using effective contraception. If I had needed the morning after pill, such reduced options would mean I would in all probability have been forced to purchase it at a chemist for £25 when I should be able and am entitled to get it free. I could envisage a situation where someone with more dubious morals who found it hard to schedule an appointment for contraception would be tempted to leave it to chance, taking the morning after pill (if they could get it) or even simply arranging an abortion (which seems even easier to get than simply trying to arrange contraception in the first place). Surely we do not want our system to punish those trying to be responsible and to put quotas and targets ahead of patient care and safety? I am pleased people are being sent on training courses, but surely staggering them is a more viable option than crippling the system by closing everything on the same day. Until there is improvement in basic services, I cannot see confidence in the NHS improving.


Hannah said...

If you had called NHS direct they would have been able to direct you to somewhere that could have seen you that day.

Next time though, if you're central-ish, you could try the Margaret Pike centre? It's on Charlotte St, near Goodge St tube. They are brilliant there, so helpful and professional and kind. They're open from 9.15 until 6.30 ish most days and have clinics over North London as well. I can't recommend them highly enough, their website is and it's NHS so it's all free.

Rachel said...

Would you believe that the Margaret Pyke centre is the one to which I usually go and which couldn't help me.

I finally ended up going to one in Camden. I went on the NHS Direct website which is where I got the list of clinics to call. When I have rung NHS Direct in the past as it is a non-emergency they have not called back for about 4 hours and even then directed me to the website. Still, it would have been worth a try so thank you for your advice.

The Grocer said...

Most reasonable employers would allow time off albeit unpaid for a medical appointment. Most people can manage one night without sex, I know my wife can. There are alternatives forms of contraception available that dont cost £25 i.e. condoms.
If this whole blog is a wind up I bought it ok but it is funny.

Rachel said...

I think you missed my point.

(and, at no point did I say that contraception costs £25; in any event a condom is useless after the event. It is the morning after pill which costs £25. And if you miss a pill it isn't just 1 night you are inconvenienced but the 6 after that as well)

Tinsie said...

Oh wouldn't it be great to be a man and have no contraception worries other than having the occasional night without sex :-)

I feel for you, Rachel. I've been in a similar situation and it sucks. Plus it's all very well saying that reasonable employers will allow time off for medical appointments, but what about those who don't have office jobs they can nip out of whenever they like/need to?

The Grocer said...

Think of the career options that open up with a whole week without sex, you would almost be a nun.
Oh and I don't have an office job, I gave that up five years ago - Tinsie but I make the point again in the 21st century most employers whether in offices would & should give reasonable time off for medical appointments.

Rachel said...

with the 'goatee' and your attitude (to sex and other subjects)I rather pity your wife

lain said...

you tell him, Rach!