Getting in to see a family doctor in England had long been slow. Ailing people, The New Yorker later wrote, were often told they would have to wait weeks. Tony Blair’s government set out to fix that with money. As part of a new contract for general practice, it negotiated a national scheme to reward GP surgeries for offering patients an appointment within 48 hours.
By 2004 the targets were being met. Then, on April 28, 2005, in the middle of a general election campaign, Blair faced a studio audience on BBC Question Time.
A woman in the audience explained her problem. Her son’s doctor wanted to see him in a week. The surgery wouldn’t book it. “You can’t make the appointment in a week because you are only allowed to make it 48 hours beforehand,” she said. As The New Yorker later told it, if she wanted that appointment, she would have to call at 8 a.m. the day before and stay on hold.
“Is this news to you?” the presenter asked.
“That is news to me,” Blair replied.
The presenter turned to the audience and asked whether anyone else had had this experience. People started shouting. Blair called this interpretation of the targets “absurd” and promised to look into it. By the next morning’s reports, he said he had been “astonished.”
His health secretary, John Reid, said the vast majority of family doctors offered both urgent appointments within 48 hours and appointments booked in advance. In 1997, he pointed out, most people had complained that they couldn’t see a GP for a week or more. But, he said, “there are wrinkles to be sorted out.” Labour said a Department of Health survey found the problem in 2 percent of surgeries. The chairman of the British Medical Association’s GP committee called it a “rather crude target” and said it was affecting a significant number.
Reid’s proposed fix changed what was being paid for. Doctors who saw the highest percentage of patients on the day the patient chose would be the ones “rewarded.”
Later that year, the health minister Lord Warner moved to tighten checks. “There is absolutely no justification for this target being used as an excuse for an inflexible appointment system,” he said, as the British Journal of General Practice reported. The journal’s columnist was unimpressed: the government’s interference in appointment systems, he argued, had itself fostered the inflexibility.
In 2008, Parliament’s Public Accounts Committee looked back. Ninety percent of patients were now seen within the 48-hour target. “However,” the committee wrote, “this has also had a perverse effect for patients, as GPs reduced the amount of appointments that were available to be booked in advance.” The Department of Health had started tying some of GPs’ performance points to patients’ satisfaction with access.