My NHS Experience

Background

I’m 67 years old and thought I was reasonably healthy. However, in the second week of October this year, I suddenly became ill. I’d felt fine all summer and though I had what I thought was a minor hernia which needed dealing with, I was enjoying retired life. That week, I woke one night in great pain. My hernia looked like it had massively expanded, was painful and I had excruciating groin pain. Those who have been hit in the nether regions by a cricket ball will know exactly how I felt. This account of my NHS experience from GP to A&E to in-patient is objective and explodes a few myths frequently made up without compunction by the right-wing tabloid press.

Of course, in an organisation the size of the NHS, there will always be a few people who have had a poor experience. Based on what I encountered, these will be very few and far between.

I have separated my GP and hospital experiences. The two could not have been more different.

Part 1 - The GP experience

I want to include this because as the PM has said, one’s contact with a GP is almost always the first experience of the NHS we have for a new event. Now of course people’s own impressions of their GP practice will vary hugely but my encounter with mine has been simply appalling. This is an outline of events; 1 Oct I go for a blood test as ordered to by practice by text. On 9 Oct I wake in agonising pain. In morning I submit an “eConsult”, an explanation of my symptoms sent via the net. On 10 Oct a practice receptionist rings to offer me an appointment at the end of Oct - more than three weeks away. I explained the pain I was in. That’s all we can do was the reply.

You see, my practice has automated almost everything using eConsults and text messages but what I have found is that this has virtually eliminated the option of talking to a GP and is essentially a box ticking exercise. An eConsult counts as a GP consultation but it is clear from my case that some are never actually read by a GP. Texts demanding blood tests, blood Pressure readings etc are sent to me and acted on but then I hear nothing in response. I doubt that blood test results are read by a GP; in my case, my blood test results would have shown a number of red flags and my GP should have contacted me immediately. As it is, I heard nothing from him. To talk to a GP or get a face to face appointment means a wait of 3-4 weeks. What this practice is ignoring/suppressing is that most often, a patient only needs to see or talk to their GP when they actually fall ill but this rather important factor is disregarded. Of course this means a practice need employ fewer people be they GPs, Nurses or Pharmacists.

Why should a GP practice that was previously known for its personal and friendly touch and its good care change so radically for the worse? Well I believe for two reasons. First, there is the payment model. GPs are paid by patient volume - the more patients they have registered, the more money they can rake in. Yes, other factors are also considered but the number of registered patients is the main driver of a practice’s income. Our GP/Patient ratio must be ridiculously small. Second, my GP practice has recently, along with four others in the area, ‘incorporated’ under one financial umbrella; it is patently clear that the prime motive for this is a) monopoly and b) money. It most certainly not the care of patients.

Even after being discharged from hospital and receiving the detailed letter of my treatment going forward, new prescription details etc, I heard nothing from my GP. I had to call the practice and they refused to let me talk to a doctor or even to their pharmacist about my changed medication. I received a cursory text an hour after my call saying they had carried out the repeat prescription changes demanded by the hospital but this text left me with more questions. I haven’t even bothered to call them back, it’s simply too exhausting. I am thinking about making an appointment with my MP to discuss the way this GP practice operates and its effect on me.

Marks out of 10? Zero.

Part 2 - A&E

My symptoms had not improved after 3 days. Family were away so on 12 Oct, I called my sister and she took me to A&E arriving at 7.30am. I was seen within the hour, examined, had the cannula inserted and was wheeled to a treatment room for further examination, scans and blood tests. The first thing these tests showed was a dangerously low level of potassium and the appropriate drip was set up along with morphine. The A&E nurses were highly professional, unfailingly cheerful and kind. I was examined again by another doctor who asked further questions about lifestyle and my symptoms’ timeline. She was also very professional and entirely non-judgemental. At around midday, I was admitted to the surgical preparation ward. Like many I’d heard the scare stories and lies printed by the right-wing tabloids about A&E patients being left in corridors having to wait hours (see myths below). Well that may happen on Friday or Saturday nights when alcohol fuelled fights break out and idiots fill up A&E but I cannot criticise my A&E experience in any way, it was as good as I could ever imagined.

Part 3 - InPatient

I was wheeled up to the surgical preparation ward (SPW) where I was seen straightway by a consultant from the general surgical team. After further examination, more blood tests were ordered and more pain relief administered. The consultant explained that he needed to do further tests before deciding whether the problem needed a surgical or medical solution. Two excellent nurses introduced themselves and explained that I had to have an NQ tube inserted so my stomach was fully emptied and its contents could be examined. An NQ tube insertion is very unpleasant procedure (which empties the stomach) but the nurses explained what the whole process entailed and how I would feel and it happened exactly as they described. It took 24 hours before my oesophagus and nose got used to this foreign object but it had to be done, first in case surgery was the preferred solution and second to see if I had any stomach bleeds. It was in for two days.

After two days and further examinations by consultants from the Haematology team, the Hepatology team and the surgical team, the NQ tube was removed and I was sent for an endoscopy. This revealed/confirmed no gastric bleeds. Later that day I had a further examination by the consultant from the hepatology team who explained four things; 1) that the hernia was not impacting my bowel, 2) my stomach was ok and 3) I had liver disease and a large clot in the hepatic portal vein which was contributing to increased blood pressure and 4) my liver was still working. These four facts meant that surgery to deal with my hernia was not an option, at least for a while and I needed to be treated medically.

Now though I’ve always enjoyed alcohol and I knew I drank far more than was recommended by the medical profession, particularly since retirement some 12 yeas previously but I’d never considered myself to be an alcoholic. I didn’t drink to such a level that I couldn’t walk or speak coherently, I just loved wine. However it was clear. As far as the medics were concerned, I was an alcoholic purely in terms of the amount consumed and that drinking had to stop. I should add that all this information was delivered to me factually and again in an entirely non-judgemental way. Incidentally the Hepatology consultant said that alcohol related liver disease had more than doubled since COVID.

I stayed in hospital for a further two days and my medication, already changed, was changed further by the consultants. The most important was a blood thinning drug taken via self administered belly injections 3 times a day that would hopefully break down the clot.

The care I received as an inpatient was absolutely first class. The consultants communicated really effectively so I didn’t have to repeat much about my symptoms and story. The nursing teams run by the ward sister were without exception cheerful, efficient despite having to deal with someone who was occasionally grumpy mainly due to pain and they carried out the doctors’ instructions to the letter. I cannot rate them more highly.

Part 4 - Discharge and Plan

I was discharged after four nights. The plan was continued medication as newly prescribed and further examination and treatment by the Hepatology team as an outpatient. I was wheeled down to the discharge lounge where I waited for the medication. Two hours later I was home.

Part 5 - Myths

Myth 1. You get left in a corridor for hours in A&E. This is simply untrue. If after examination by an A&E doctor you need further examinations, tests or treatments, you are taken to a treatment room where this is administered. If it is decided that you must be admitted, you wait for a bed to become available (I had to wait for about 90 minutes). However if after examination by an A&E doctor you do not need immediate treatment but do need to be admitted, you may wait in a bed in a corridor. I saw about a dozen or so such people while in A&E.

Myth 2. The NHS starves you and the food you get is inedible anyway. This is another total fabrication. Outside of surgical ops, The NHS wants you to eat properly even though being unwell, you don’t have much appetite. Logistically feeding five or six hundred people three times a day is not an easy task but the food is good and tastes nice enough. There is a daily menu from which you can choose. It includes vegetarian and vegan choices. Breakfast of tea/coffee, cereal and toast with honey, jam or marmalade is followed by a 3 course lunch and a 3 course dinner. Two courses was enough for me. Tea was available anytime. If you want some gourmet cuisine, book yourself into a fucking grand a night private hospital which will almost certainly use the same NHS consultants and facilities to treat you anyway.

Myth 3. All the doctors and nurses are ‘forrin’ and you can’t understand them. 1) Bollocks. Not that it matters a jot because every single member of staff was British but probably half the consultants I saw were white and about 30% of the nursing staff. 2) If you don’t hear something said to you clearly, ask politely for it to be repeated. 3) Fuck off you racist git.

Myth 4. They can’t get rid of you fast enough. More utter balls. No-one is discharged until it is safe for them to go home. The only criteria considered is the patient’s care and condition.

Myth 5. It was so much better when we had sisters and matrons running things. We still do. Ward sisters (sometimes called ward managers) are responsible for all the nursing teams on their ward and there are matrons (not sure what they’re called now) responsible for groups of wards. If you expect your hospital stay to be akin to a Carry-on film, you’re just delusional.

In summary, I cannot rate my whole hospital experience more positively. It’s a shame I can’t say the same bout my GP practice. Finally, if you’re 50 or over, get yourself an annual MOT health check and be totally honest about exercise, drinking and smoking. I wish I had got such regular checks.

Part 6 - Post Discharge and My GP Practice.

I was discharged with a new prescription for various drugs, the most important of which was a blood thinning and blood clot breakdown drug called Dalteparin. It is self administered via subcutaneous injection and would hopefully breakdown the clot in my Hepatic Portal vein. Until this was treated successfully, an operation to deal with the hernia could not take place.

The prescriptions I was issued on my inpatient discharge summary stated that the Dalteparin was to be re-issued by my GP. Now we come to the fun part. My GP practice texted me saying they cannot issue a prescription for Dalteparin. I called them. I read my prescription discharge notes to them. They simply said they cannot do what the Hospital is telling them to do and that I should contact the hospital about it. Now a decent GP surgery would have said something along the lines of “we’re having trouble with this one, we’ll call the hospital and get back to to as soon as we can” but oh no, this was left entirely up to me, recently discharged and still feeling very fragile.

Well after about a dozen calls over a week, I finally got through to the right team and I’m waiting to hear back from them. Every doctor and consultant I spoke with expressed amazement that my GP Practice would not re-prescribe the drug. This had never been encountered before and several suggested privately and without prompting that my GP Practice sounded at best incompetent and uncaring. I could not disagree.

So BIG tip: before you ae discharged with prescribed drugs, ensure you have the name of each doctor who prescribed them and the team for which they work. If your GP practice is anything like mine, you’ll need this information.

More soon …