Comparative registration [S. Worthen

When I registered with a doctor in Canada, I was a student. I was allowed to use the university's health services. It was a large operation, five days a week with continuous hours, always someone available, drop-in appointments, and supplementary services all in one place. The day of my first appointment, they poked and prodded and took three vials of blood so that they could recreate my immunization records from it. (It hadn't occured to me to bring them with me to another country.) It was sloppily done - the bruise lasted for three weeks.

I finally got around to registering with a GP (aka General Practitioner aka a doctor) this week here in the UK. It was an unexpected challenge in some ways. The NHS website has a lookup for one's geographically closest GPs, but those which are closest are not necessarily the ones one is allowed to register with. In my case, it wasn't. The receptionist gave me a phone number to call (since there was no way to look it up on line). I called Find-a-doc with my telephone number and post code, and two hours later, they called me back with the list of three possible GPs I was allowed to use.

The next step is to call and see if the GP is taking on new patients. Luckily, I was okay on the first call with that one. The step after that is to come in to collect paperwork. Oh, and they're closed from 1 to 4 every day. And Thursday afternoons - when I made my first attempt to go collect the paperwork last week. After I collected paperwork, I had to go away and fill it out. Then I could go back again, with the paperwork, hand it over, and request a registration appointment. At this point, they highly recommended I go to a different branch of their practice since it was closest to me. So I went to the other practice, where the paperwork was already half-done, and made my appointment. After this, it was very friendly and helpful and didn't involved giving up three vials of my blood. In a heart-warming turn, the nurse even pronounced my name correctly!

Still, for all the lovely, friendly people, I'm not hugely impressed. It took me three trips to the GP just to get registered, four if you count going to two different branches while mid-paperworking (and not even counting my attempt on Thursday afternoon to pick up papers when it was closed). The practice is closed for three hours in the middle of the day. Drop-ins are non-existant. And being close - give or take practice areas - seems to be The Most Important Thing about registering with a GP here. The GP can even collect a rural allowance if they are more than 1 mile away from their patient.

Note: I have no idea how this experience compares to registering normally in Canada or in the US.

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When I registered for a GP they didn't bother asking my address before they booked my first appointment, asked for nothing but a filled in questionnaire and a small vial of pee, and then were open from 7.30 in the morning...

As with all things in our joyful NHS, it seems to be the luck of the drawer.

Oh, it may have been easy to register, but they were quite awful on the treatment front, and I haven't been back for 4 years.

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I have a theory that university health centres are rather more likely than the average practice to Have Their Act Together. They have to deal with hundreds of people registering and leaving all at once, every single year, so they pretty much have to handle it efficiently.

I don't remember having any particular problems with the NHS when I was registered at university. However, since moving to London, the service has been of somewhat variable quality. I don't really know whether to blame the bad bits on localised incompetence, the government, or just poor luck. I do suspect that the good doctors quickly end up too busy to take on any more patients, though.

I've had varying experiences in the US - the first physical can take upto three months to schedule, but usually as long as the doctor is taking new patients you can see them for illnesses immediately. And since I do research to determine if there are walk-in centers (not all offices have them), I've never had a problem getting to see _a_ doctor, even if mine is busy. Usually if you really need to see one, you get in the same day. Though with my latest doctor, it's better to call the day before. But which insurance I have and the flexibility to see the Doctor I want to see is really important to me. Had not so great dental insurance for a period and paid an extra $50 above the copay just to get the dentist I wanted. You have not known pain until you've had your teeth cleaned by an incompetent dentist. :) I always pay extra to get a flexible insurance plan. It's been worth it in terms of getting to see a Doctor recommended by friends and when dealing with the extras like physical therapy.

In my US (non-university) experience, to get an immediate appointment you have to be either (a) referred by another doctor, (b) already a patient of that doctor, or (c) incredibly lucky. It takes about 6 weeks to get your first appointment with a new doctor. They do their own inquiry and examination on you, and they ask you to have your prior doctors forward your records (including immunizations - no tests for that). There's a long wait, but little red tape.
This is without insurance, mind you; I imagine that presents some complications on which doctors you can choose, but haven't had to deal with that yet. I can update you if you want, as it comes up, which it should soon. :P

Anyway, once you're in with a GP here, you can see them at the drop of a hat, pretty much.

Well, I've had decent insurance in the US for the past few years. Initial appointments can take a good long time -- up to 2 months. But I've never had to wait for an emergency appointment. Because I have the PPO, I can see anybody I want. If the person is one in the insurance network, the visit's pretty much covered; if not, the insurance pays something like 80%. If I had an HMO, my monthly payments would be less, but I would be limited to the doctors in the network. Still, I've had that kind of insurance before, and have always had pretty decent care.

In Germany, we could go to any doctor, and generally the surgeries had drop ins and appointments. I don't rememeber ever having to wait very long.

From my UK experience registering when going to university - it wasn't a centralised university operation, but rather an ordinary GP's surgery in the city. It involved queueing a lot and having height and weight measurements, but nothing else - no samples of any sort. There isn't any kind of initial consultation; you see the doctor if you're ill, never if you're well.

And more generally in the UK on the NHS - unless a GP has appointments that moment, I don't believe you can ever just drop in except at designated walk in centres. From my experience of those, it means you have to wait for about three hours so that you can see a doctor who will misdiagnose you and disbelieve your telling him that you know what the condition is and you know what the treatment is because you've had it before. After all, you're not a doctor - why should you know anything about medicine?

It does seem to vary wildly; my home town GP's office is lovely, and the one Heidi's registered with here in Manchester is pretty good most of the time and quite happy to give you appointments. And drugs. On the other hand, I don't even know who I was registered with while I was at university, which is a shame since the fuckers lost my medical records, meaning I had to get a full set of jabs for the US further down the line.

I wouldn't go to a GP who was closed 3 hours in the afternoon, frankly. I know they work hard most of the time, but ever since the new GP's charter came into force it seems that taking such liberties is becoming more the norm than the exception, thanks to the amount they now get and the things they can opt out of.

I didn't have a huge choice on the three-hours-in-the-afternoon thing, alas. I was given a choice between three GPs I could register with. Two of them are branches of the same surgery and keep the same hours, i.e. closed for three hours in the afternoon. Both branches had multiple doctors and nurses on staff, however.

The third option only closed for an hour at lunch - but only had one doctor on staff. I figured it would be safer to go with a larger practice, to up the odds of sooner appointments.

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A lot of the barriers and inconveniences are a result of the target culture that obsesses the current government. This is why there there's seldom a drop-in service at GPs and why you often can't book an appointment more than 48 hours in advance (this latter is so that 'all patients get to see a doctor within 48 hours', which is the target that has been effectively gamed into non-existance by the GPs who are clearly a lot brighter than the civil servants or politicians who came up with the target).

Yes, this is the NHS, where politically motivated targets are more important than patients.

Registration in Canada is nowhere near such a complicated process, and our medical insurance doesn't impose any restrictions on whom you can and cannot see. The only restriction is created by a severe shortage of doctors, especially GP's. When my long-time GP retired recently, I had to consult a list of who was taking new patients, and here in Victoria that list was pretty small. I was lucky to get my first try, and was able to get in to see her within a few days. She is usually available for consults with about 2 or 3 days notice. If I wanted to change now, my choices would be severely limited, and doctors are getting picky about whom they take - some won't take smokers, for example, or seniors (or anyone BUT seniors).

On the other hand, to offset the shortage of personalized GPs, and the overcrowding in emergency wards, in urban areas there are a large number of walk-in clinics, where you can see a doctor without an appointment. I have two or maybe three within walking distance of my house, and several more a short drive or bus-ride away. I tend to use one of them for those times when you just have to see someone NOW (like an ear infection, for example).

Good luck going to the ER, though. The last time I went with my mum, even in what was a genuine emergency, we waited 6 hours before being seen by a doctor. For something that was not genuinely life-threatening (a broken bone, for example), the wait could be as much as 12 hours.

My current GP is a sole practice, but as well as appointments, he runs surgery sessions at least four mornings and evenings a week on a first-come, first served basis, so it's possible to get to him fairly promptly.

Unfortunately, I'm not very impressed with the standard of care he offers -- unless one is actually likely to expire in his office, it's struck me he's very much a 'take two Aspirin and call me in the morning' sort.

Since I'm moving home shortly, I'll probably want to find a new doctor, anyway. I shall try to remember to report my own experiences. :)

Please do let me know what happens! I'm curious now.

I used to use a GP at one of the Family Health clinics at St. Mike's. He was OK but the clinic admin was chaotic. The lemur saw a different doc there but she moved to Ottawa. We decided to change to the Albany clinic. The only difficulty was finding a doc who was taking new patients. The actual registration process took just a few minutes. I find I need about three weeks notice to get an appointment with my own doc but Albany has a walk in clinic seven days a week as well so emergencies are easily handled. They also have an on-site lab which is handy.

General practices vary hugely: at mine you can make appointments (but it may be some while before you can see doctor of preference), and there is also a 'ring up on the day and they will fit you in somewhere' facility. You can drop in but I assume that would mean waiting around until there was a free slot. However, there are also things where you can just see the practice nurse. I like it, but then I've had the same GP for, I recently realised, 30 years, almost!

(Also, practice I go to was at least once a flagship group practice: don't know how it scores under the more recent NHS meaningless targets regime.)

What the others said about how much practices vary. You're in London, where there is a serious shortage of GPs and practices; things are different and often better out here in the sticks.

This closing for a large chunk of the day and one afternoon a week seems to have come in insidiously over the last decade. Our health centre (about eight docs plus nurses etc) closes for an hour every lunchtime, plus Friday afternoons. I think the message is "If you're ill you shouldn't be at work anyway, so why should being closed at lunchtime be a problem? If you're not ill, why are you bothering us?" Stupid, because there are plenty of reasons you might need to consult a doctor without actually being at death's door.

I think the rationale is that the closures enable them to stay open later in the evenings and offer more out of working hours appointments. Ours now has a "traffic lights" system, with routine appointments being bookable up to six weeks ahead, but sometimes you may have to wait four weeks before there's a slot that suits you, semi-routine bookable three days in advance and urgent on the same day - they also offer a nurse appointment if it's not vital to see a real doctor, and telephone consultations if you need to check test results or check whether something is serious enough to warrant actually going in to see a doc.

The new GP Contract has led to a major decline in standards in my view, especially in terms of home visits and out-of-hours treatment. The reason proximity is an issue is that up to about a year ago you could actually expect to get a home visit, day or night, if the situation was serious enough to warrant it. Few of my US friends seem to have experienced that. Now they do their damndest to persuade you to go to an "out of hours centre", in our case at the local hospital, next to A&E (ER), where you wait a long, long time but do eventually get to see a Real Doctor. However, in the case of frail people or tiny children at least, you will get a domiciliary visit still, if you make it clear it's serious enough.

I think they are supposed to have an initial consultation to check records are accurate and give general health advice, but we've been registered with this Health Centre thirteen years now, so changes have passed me by. It's not as good as the HC in the Outer London suburb where we used to live, but I don't think it ever was - standards do vary a lot. Inner city provision, as I said, tends to be worst, because of scarcity.

I will say the NHS has always come through for me and mine in extremis, such as the time I sprained both ankles catastrophically while on holiday near Hadrian's Wall, or when my father collapsed from an aneurysm, also on holiday, near Cheltenham. I think we probably get value for what we pay for, but I wish we had less of a postcode lottery and more evenness of provision, especially in the less glamorous areas.

S. Worthen | Weblog

Comparative registration

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