"Facts are stubborn things but statistics are pliable" Mark Twain
When a well-respected national daily newspaper headlines its front page with "Millions shut out of doctors' surgeries" you can either let your imagination run wild as you picture 40 million people snaking their way across Britain to a GP practice somewhere in Cumbria or you can try to find the facts behind the headlines, which, in this case, came from the annual NHS GP Patient Satisfaction survey.
The assertion made in the newspaper article was that 11% of patients claimed in the survey that they were unable to secure an appointment with their GP practice. But what did this actually mean? That they could not get an appointment convenient to themselves or that they could not be seen come what may? Well, here are the questions in the survey (amongst many, many others) relating to this point along with a breakdown from the summary of the report of the actual percentage of respondents who were 'shut out' of surgeries.
If you weren't able to get an appointment or the appointment you were offered wasn't convenient, why was that?
• There weren't any appointments for the day I wanted 5.5%
• There weren't any appointments for the time I wanted 1.9%
• I couldn't see my preferred GP 1.1%
• I couldn't book ahead at my GP surgery 1.4%
• Another reason 1.0%
This is quite a range of options relating to both time and person but a common thread, not unexpectedly, is one of convenience for the patient. So how did they overcome this? Well, the survey goes on immediately to deal with that question as well. Again I have put in the actual percentage of patient replies.
What did you do on that occasion?
• Went to the appointment I was offered 4.2%
• Got an appointment for a different day 2.4%
• Had a consultation over the phone 0.5%
• Went to A&E / a walk-in centre 0.9%
• Saw a pharmacist 0.3%
• Decided to contact my surgery another time 1.4%
• Didn't see or speak to anyone 1.2%
So hang on a minute, let's do the maths here. Are we saying that really only 2.4%, not a headline grabbing 11%, of people ended up not seeing or speaking to their GP/Practice Nurse but went somewhere else instead? That when they could not initially get what they wanted they circumvented the system? Could this not also be interpreted as a feature of a culture that has arguably become more selfish and demanding, a trait that we are trying to discourage in other areas of society? And, as always, are we not letting a minority drive the agenda for the survey also goes on to say, and I must admit this did surprise me from my own experience, that 'three quarters of patients (75%) say that their overall experience of making an appointment was good..... or very good'!
So how on earth are we supposed to interpret the data with its pitfalls of absolute versus relative numbers? Without a doubt the NHS Patient GP Survey is a highly useful tool but perhaps newspapers should run their articles by a statistician before publishing. Some hope! When have they ever let facts get in the away of a good headline? On the other hand GP professional bodies should also not be too quick in acceding to the charge made and turning the point to their advantage by shouting for more resources. In doing so they only fuel the prejudice that individual GP's want more money whereas in fact what we are asking for is more GPs.
Maybe instead we should just accept that no system is perfect and in one with nearly 400million documented contacts between human beings; that 10 million dysfunctional ones ain't that bad after all.