After 20 years of building therapeutic relationships between doctors and patients, patients present to the surgery when they need to and the doctors time is spent productively. This is rational, needs based care. It takes a long time to build up relationships with patients, to give them the confidence to manage problems themselves and to work out the best way to use the expertise of the general practice team. This works better with continuity of care, which we are continually trying to improve, but in an urban practice like ours where there is a 30% per year list turnover it is a never-ending task.
A walk-in centre opens up next door, and forced to see 40 patients a day, they try whatever they can to get patients through the door. They are incentivised to see patients as often as possible, rather than help them manage problems themselves. This is the effect of perverse incentives and is typical of market driven healthcare.
Before long patients are popping in to the walk-in centre for second opinions from nurses with a fraction of the experience of the patient’s own GP, with itchy toes, furry tongues, odd smells, and a sore throat that started on the way to work. In short, anything. All that matters for the walk in centre is that the patients, now rebranded as consumers, come in through the door.