Primary Care

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Primary Care - How it Works

Local health services (how they are organised)

Every area has a health authority that is responsible for local health services. The health authority can help you find a general practitioner (GP). It guarantees patients certain rights and deals with complaints. It also produces free leaflets and other materials on patients' rights and responsibilities. These may be available in tape form, in Braille and in various languages. Phone or write for information to your local health authority (listed in the telephone book, normally under the name of the town or borough), or look for leaflets in GPs' surgeries, pharmacies, libraries and other public places.

Primary health care (what it means)

Primary health care is the name given to all the services you go to first when you have a health problem. GPs (general practitioners or family doctors), practice nurses, community nurses, health visitors, pharmacists, opticians and dentists are all primary care workers. Secondary care describes any service which primary care staff can refer you to, such as hospitals and specialists. In the future, primary care workers will play an even more important role within a primary care-led national health service. Knowing how the family doctor and pharmacy services work can help you make good use of the health service.

The primary health care team (how it works)

GPs work as part of a team, called the primary health care team. This team includes nurses, health visitors, receptionists and other administrative staff, most of whom are based at the doctors' surgery. All these health care staff are trained professional people who can help you in different ways. Most GPs' practices offer health promotion clinics (for example on diet, smoking, diabetes or heart disease), vaccination and immunisation for children, cervical smear tests and family planning services. Most also provide maternity services. Check the practice leaflet at your local surgery or ask about the services offered. Ask for advice about who would be the best person to help you - it may not always be the GP.

AS A PATIENT YOU CAN:

	Get free information about registering with a GP in your area: All GP practices produce a leaflet about their services. To register with a GP, just go to the surgery of your choice and ask to register. If possible, take your medical card with you. (If you have lost it, contact your local health authority for a new one.) You may choose whether you prefer a man or a woman as your GP. Lists of GPs are available from your local health authority, in public libraries, citizens advice bureaux or community health councils (listed in the telephone directory).
	Receive certain services, treatment, referrals to other services, and redress if things go wrong: You are entitled to receive health care on the basis of clinical need. The Patient's Charter lists these legal rights, as well as others such as the right to be offered a health check when registering with a GP. Health authorities also produce local charters on standards of service, and many practices issue their own charters, which give details of what their patients are entitled to and what they can expect. Most health services are free at the point of delivery. However, there are charges for things like prescriptions unless you fall into certain categories (for example, there is no charge if you are receiving financial benefits, if you are over the age of 60, if you are under the age of 16 or if you are under the age of 19 and in full-time education). Ask your health authority, community health council, doctor's surgery or pharmacy about the Patient's Charter or for leaflets explaining it.
	See any of the GPs in the practice where you are registered as a patient: You can choose whom you want to see, but it's a good idea to stick to one GP and build up a relationship with him or her. To make sure you get a consultation as soon as possible, check whether your practice has an appointments system or whether you can just turn up and wait during open surgery.
	See a GP if you're staying somewhere temporarily: You can register with a GP as a temporary patient if you're staying somewhere for up to three months. If you stay for longer than three months, the GP may take you as a permanent patient.
	Consult your GP on the telephone without going to the surgery: Many people are not aware that GPs can give advice over the telephone. Most practices encourage this as it can save both your time and the doctor's. Don't be put off if you have to leave a message - simply ask your GP to phone you back.
	Be treated for your health problem in the way you and your GP agree is best for you: This may mean a prescription for medicine or, occasionally, referral to another service. But sometimes advice or reassurance is the best treatment. Don't be afraid to discuss with your GP what you expect or prefer. Your doctor's advice is obviously very important, but you are the person who decides what is best for you. Bear in mind that there may be several different ways of treating a condition. You always a have a choice.
	See copies of your medical records: Ask at your GP's surgery if you want to see your medical records. There are certain limits and requirements for getting these and you may be charged a fee for a copy.
	Expect your medical records to be treated confidentially: If you have any worries about confidentiality then ask your GP or receptionist. You must say if you don't want something written in your records. GPs and their staff take confidentiality extremely seriously.
	Ask for a second opinion from another doctor: Not all doctors agree on the best course of treatment. If you would like a second opinion from another doctor, discuss it with your GP. However, you are not automatically entitled to a second opinion.
	Decline to have a medical student present during your consultation: Some GP practices are training practices where medical students or doctors gain further experience with patients. If you are asked if a medical student or doctor can observe your consultation, remember that there is no pressure on you to agree if you don't want to. Just tell your GP you prefer the student or doctor not to be present.
	Decline to take part in research: Research helps improve health care in the long run. However, you are under no obligation to take part in any research if you prefer not to.
	Change to another GP if you are not happy with your current one: It's simple to do - just go to the new GP of your choice and ask to be registered. If possible, take your medical card with you. Your local health authority will transfer your medical records to your new GP, and can help if you have any difficulty arranging a new GP. You don't have to give a reason, but it would be helpful to tell the GP you are leaving. Do make sure you really want to change; you may be able to sort the problem out with your current GP by talking things through.
	Expect not to be removed from a GP's list without good reason: Removal happens rarely and usually only for abusive or violent behaviour towards the GPs or their staff. Patients shouldn't be taken off the list because their treatment is expensive. GPs don't have to say why patients have been removed, but it would be helpful if the patients were given a reason. Ask about your practice's policy on removing patients.

What can you do to help yourself and the primary care team?

	Understand that your GP is not the only person who can provide health care. Practice nurses, district nurses or health visitors have all received training and one of these may be the best person to see in some situations. Find out from your GP practice what everyone in the team has to offer.
	Appreciate that your GP and the team work hard in stressful situations - try to be tolerant of delays and occasional problems. Surgeries do their best to run to time but delays are sometimes unavoidable as some patients need more time than others. The average GP sees about 150 patients each week and emergencies can arise at any time.
	Be a considerate patient. Get to appointments on time, and try to let the surgery know if you can't make an appointment. Ask for a home visit only if it's really needed. Read the practice leaflet at your GPs surgery to see what the systems are and how to use them.
	Keep a copy of your medical history and treatment. This can give you more control over your health care. It can also be a useful reminder of medicines you are taking or of when to make an appointment for a test or a review of your medication.
	Learn more about your own health and how to take care of it. Most people act as their own 'doctor' all the time. By knowing more about everyday ailments and how to treat them, you can save yourself time and worry and help your family to stay healthy as well. You can also ask a pharmacist or chemist for advice. Ask your local health authority, your GP practice or pharmacist for a booklet on dealing with minor ailments.
	Take the initiative. More and more practices have an organised group of patients who support the surgery and other patients. These 'patient participation groups' or 'friends of the surgery' can help the practice decide what services to provide, make suggestions for improvements and give practical help to other patients. Information on how to start a patient group is available from the National Association for Patient Participation. (See right for the address.)

Sorting out problems and making complaints

Patients have the right to complain if they feel that the treatment they receive from their GP is not satisfactory. Any problems should first be brought up with your GP or the practice manager. If this doesn't lead to a satisfactory outcome, each local health authority has procedures for dealing with complaints. These should be made in writing within six months of having the treatment.

Ask the health authority or your GP's surgery what to do if you have a complaint. Your local community health council (an independent health services 'watchdog') can also advise you.