 photo: vicki couchman |
It's true, says one of the UK's top HIV doctors. The clinics can't cope. Mike Youle outlines the problem - and suggests a few solutions
In last month's Positive Nation two of your columnists drew my attention. The first was Sam Cotton, who noted his difficulty in making an appointment for his HIV doctor. "How about seven weeks on Thursday?" was the reply.
Sam correctly pointed out that loads of people are testing positive and very few are dying, so there's no longer a turnover of patients. Those of us who work in the clinics know this only too well.
For instance, at my clinic in north London's Royal Free Hospital we have noted, over the last year, a 25 per cent increase in outpatient attendances. That's an increase from 8,000 to 10,000 in the patients visiting us with no increase in infrastructure - such as doctors, nurses, pharmacists, or receptionists.
Since the devolvement of funding to Primary Care Trusts, fighting for funds has been a major problem for hospitals. The Commissioners feel other areas of health should receive funding over HIV. Rationing is back on the agenda. Two hospitals, one in east London and one in the north of England, have both been told they cannot prescribe HIV therapy to any new patients.
While we have not yet had to restrict funding for therapy, there has been no additional funding to help support the provision of health care. At a recent meeting of the North Central London HIV Sector Group it was made clear that there will be no new infrastructure support for staff or clinical facilities for the next financial year. This means clinic workers will be under increasing pressure to ration time spent with patients. This clearly impacts on the likelihood of therapy being effective.
Two pages later, Allan Morris noted that he was unable to get treatment for his facial lesions outside normal working hours. He says: "So, are my health and my unwillingness to walk around with a disfigured face contingent upon the working hours of doctors and nurses? I don't think they should be."
I agree entirely. My normal working day starts at 7.30 a.m. or 8.00 a.m. at the latest and on two days a week, I run clinics until 6.30 p.m. However, I would say that I receive no payment for doing these out of hours clinics. A number of my colleagues, especially those with families - or social lives - do not feel that it is in their interests to extend their working days over and above the 50 or 60 hours that doctors normally work, especially as On-Call commitments also have to be figured into this equation.
Several clinics do run late and early clinics. But it is usually, once again, the infrastructure support from the NHS which is not available to fund the working time for receptionists, pharmacists and nurses, let alone doctors. I would suggest that Allan and Sam both contact their local PCTs to discuss these issues, as well as the Chief Executives of the hospitals they attended.
Allan also asks: "Why not email access? I would love the opportunity to email details of my medical problem to someone who could very easily give me an answer within 24 hours".
I have been running an email service for my patients for the last two years, and have been trying to formalise this through a project at the Royal Free Hospital. Once again, there have been infrastructure problems - lack of computers and lack of staff to deal with the increased workload. So the email service I currently run is a double edged sword. I am very willing to provide information to patients but where are the limits? At present I receive approximately 250 - 300 emails a day and have to find the time to deal with those. A rising number of these are from patients, and inevitably take an increasing proportion of my time.
In conclusion, I would say that the major problems raised by both columnists are related not to the willingness of the staff within the NHS to work hard, or to provide a good service, but the lack of commitment by the managerial and commissioning side of the NHS to provide an ever-improving service, especially in the face of a rising number of patients and falling mortality. The service is already at bursting point. It is likely to burst soon.
