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Wednesday, July 7, 1999 Published at 15:36 GMT 16:36 UK


Waiting list policy under fire

The BMA disagrees with ministers over waiting list policy

The government's focus on the number of people on waiting lists has twisted clinical priorities and led to increased suffering for patients, doctors have said.

Doctors at the British Medical Association's Annual Representative Meeting in Belfast said on Wednesday that instead they should concentrate on how long people had to wait for treatment.

They also criticised the rapid introduction of walk-in clinics and an NHS phoneline before the schemes had been fully evaluated.

The initiatives could result in inconsistent patient care, they said.

Dr David Shubaker led the attack on the government's waiting list policy, saying it forced up the length of time people had to wait for treatment.

"Due to unacceptable waiting times, patients suffering from cataracts and glaucoma are going blind," he said.

Inappropriate obsessions

[ image: Mr James Johnson:
Mr James Johnson: "The govermet has inappropriate obsessions"
Mr James Johnson, a consultant surgeon and a member of the BMA Council, said the government had a "completely inappropriate obsession" with numbers on waiting lists.

"If you see 10 patients in your outpatients clinic on Monday and operate on them on Friday, on Wednesday you have a waiting list of 10.

"Next year, if you see 20 patients on Monday and operate on them on Friday, on the Wednesday your waiting list has doubled.

"Numbers are a sign of productivity," he said.

He said Labour's election pledge to reduce the number of people waiting for treatment by 100,000 was "totally inappropriate" and only kept alive by spin doctors at the Prime Minister's office.

Dr Hamish Meldrum, of the BMA's Scottish GPs committee, led an assault on the government's latest plan to improve patient access, NHS Direct.

NHS Direct is a phoneline allowing 24-hour access to nurse operators who can advise on whether or not a patient needs to see a doctor.

But many GPs fear that without proper evaluation the system could prove to be unworkable.

They say it could cut out the GP's role as a gatekeeper of the NHS.

Dr Meldrum said there was not enough evidence to show that it would work, yet the government was planning to introduce it across the UK as soon as possible.

"Even the National Institute of Clinical Excellence would find it difficult to recommend it on the available evidence," he said.

He said it would "ratchet up consumer demand" rather than responding to genuine patient need, and no demand existed for it at the moment.

"NHS Direct is just another Number 10 solution spun in search of a problem," he said.

Pandora's Box

Laurence Buckman, a GP in North London, said: "While some patients will get advised on how to use the NHS better, we will watch those who want swamp those who need.

"Once Pandora's box is opened we will witness an explosion of patient demand. NHS Direct will teach them a new habit - instant gratification."

And another of GP's fears - that walk-in GP clinics will destroy the relationship between doctor and patient - was tackled by the BMA's consultants leader.

Dr Peter Hawker, chairman of the association's consultants committee, said: "This government seems hell bent on making all the same mistakes as the last one."

He said walk-in clinics would mean that a patient could end up seeing a different doctor every time they had a problem, and this would lead to poor continuity of care.

This would make it hard to determine which doctors were responsible for which treatments.

"Who's going to be responsible when the cock-up occurs, and the patient actually dies?"

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