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Abstract

First, the main reason given to justify its blanket introduction is that ‘surveys show’ that patients want rapid access. We all know that we want isn’t necessarily good for us, but before I am accused of paternalism (heaven forbid that doctors should know best how to run their practices), ask yourself this: in how many of these surveys were patients asked whether, in return for rapid access for any problem, however trivial, they were prepared to pay the prices of (a) lack of choice of doctor, (b) being triaged away from the doctor, (c) telephone advice as a substitute for a face-to-face consultation and (d) lack of follow-up care and continuity? Practices and their patients are discovering that these are the consequences of prioritising rapid access, as complaints about lack of appointments are replaced by complaints about lack of choice and continuity. There is no such thing as a free lunch. The change of focus from long-term therapeutic relationships (whose benefits are intangible and difficult to measure) to short-term interventions may have unforeseen consequences for the future health of our patients, and for our own levels of job satisfaction (and thus recruitment and retention). Only time will tell.