THERE is no surer way of getting a conversation flowing with UK residents than by bringing up that thorniest of British issues: booking a GP appointment.

"Postcode lottery" has become one of these phrases overused to the point of losing its impact, but one of the issues that is undoubtedly a case of postcode lottery is how one accesses one's GP.

It is rare to come across them because they are so unusual a species but you do occasionally meet a person who is – and good luck to them – able to pick up the phone, book a doctor's appointment and go and see their doctor.

Must be magical. Much more common is anecdote after anecdote about impossible booking regimes, impenetrable phone systems and appointments, when you can get one, at inconvenient times.

GP provision is barely out of the headlines at the moment, with the most recent major story being the lines from last week's first in-person conference of GPs since the pandemic.

"We risk sleepwalking into the death of general practice," Dr Andrew Buist, chair of BMA's Scottish GP Committee (SGPC).

Much is blamed on the pandemic and the pandemic has certainly given renewed vigour to discussions about the future of the NHS but the truth is that methods of accessing GP services have been ineffective and unsuitable for an extremely long time.

The BMA committee is calling for a national conversation around what patients want from a GP service and that conversation is achingly overdue with it a scandal that it's seeing the service taken to breaking point to prompt an appetite for change.

We really romanticise the NHS and we know we're lucky to have the system. In discussing the future of the NHS there is always a tension between the sense of gratitude and the need to be able to speak freely about what doesn't work.

It's this conflict, I'd wager, that leads to the deployment of the Very British Problems sense of humour. There are standing truism-based jokes about GP surgeries: the doctors' handwriting is illegible and the receptionists are ferocious.

These are vaguely amusing tropes. It's also a truism that accessing appointments is an Olympic-style hurdle. This isn't funny; it's stressful, upsetting and time wasting at best and exacerbates patients' physical and mental health problems at worst.

And yet it's sort of a national joke. We just seem to accept that seeing your GP is tricky business and instead of demanding change, chalk it up to silly national foible. Quirky, almost.

A friend's GP practice, for a time, switched the phones off at 11am. You could ring from 8.30am til 11am but once all the appointments were allocated that was that. No one would pick up. You could leave a voicemail to ask for a repeat prescription but for anything else it was a case of trying again the next day.

A few months ago I got through to my GP reception on the 103rd try on day four of phoning and I really, really wish I was exaggerating that for effect. I saw a former colleague tweet recently that she'd had to call more than 100 times before getting through to hers and plenty of people in the replies had the same experience.

Anyone I mentioned these bonkers numbers to laughed in response, a sort of what-are-we-like, depressingly amused response.

At my own GP practice the set up is that you phone in the morning to ask for an appointment and are told a doctor will call you back between 2pm and 6pm. If you miss each other, tough luck. You have to phone back the next day and go through the rigmarole again.

This, and similar set ups at other practices, aren't designed with the patient in mind but, unavoidably, with the ease of allocation of resource in mind. Basically, the GPs are doing the best with what they have but it creates a clunky service that's only manageable for people who don't work.

If you are a working adult then it's hellish trying to see a doctor. Now, in the days of working from home, it's very slightly easier. Previously, it would be a case of taking the morning off work to try to access an appointment with no guarantee of actually getting one.

Making yourself available for four hours to be glued to a phone is impossible for anyone without a desk bound job, an office with private space and a sympathetic boss.

It's ineffective for patients but the vast numbers of doctors leaving general practice speaks to the fact they're also overwhelmed and struggling. Reception staff report being abused and intimidated by frustrated patients.

We know there aren't enough GPs, retention of current GPs is a problem, the system doesn't have enough money.

In having a public conversation about the future of general practice we have to be very careful to distinguish between the system and the people in it. Criticising the system is not criticising the GPs working in it.

Ultimately, it should be the most straightforward thing in the world to call a surgery and speak to a doctor. It's not, and it's past time that this was meaningfully discussed but we must stop viewing a chronically failing system as a bit of a joke and take very seriously the issue of what must now be done to fix it.

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