The role of the GP puzzles and sometimes angers foreigners, since in our system it is impossible to reach specialists except through the GP. 'Something is wrong with my heart. Why can't I go to the heart specialist immediately?' they demand. The reason is simple: the GP is there to ask questions and decide what is wrong, to give us simple basic advice and if necessary to prescribe medicine, and if necessary to send us to a specialist. Most adults know very well that with many illnesses people simply get better - eventually. If you catch a cold you will feel ill for three or four days and then you will feel better. Pain-killers can take away some of the unpleasant symptoms, but they cannot hurry up the process. The same is true of flu, sore throats and many other conditions. So the GP does not encourage his patients to go to specialists unless it is necessary, and thus the specialist doctors have more time to spend on seriously ill patients.
Let us suppose that I have some worrying chronic pain in my left leg. I first visit my GP. Since it is a non-urgent matter I will phone and make an appointment for the following day or the day after that. At the appointment, the GP examines me, and advises me. I may get a prescription for medicine and be told to go home and rest. The pain in the leg is muscle strain and will get better, he assures me. But - especially if the pain has existed for some time - the GP may arrange for me to see a specialist at the Outpatients Department of the hospital, first arranging for me to have an X-ray. The specialist will then decide whether I need hospital treatment. (If that means that I stay overnight or remain for several days, I become an Inpatient, occupying a hospital bed.) I will have some choice of hospital where the treatment will take place. After hospital treatment such as an operation or a course of complicated drugs, I might be offered a range of services: a nurse at the doctor's practice who treats wounds, infections and simple nursing problems; community nurses, physiotherapy and other outpatient clinics. All these services, from the first appointment with my GP to the last visit to physiotherapy are free.
Now suppose that my daughter, aged seven, wakes up with a fever and headache. Small children often 'get temperatures' (i.e. have a high temperature, a fever) but it seems to me that the headache is strange and that I do not remember seeing this symptom in my child. I am worried and phone the GP who is likely to ask me to bring the child to the 'out-of hours' emergency GP service that my GP supports. We may be given reassurance and advice. The emergency doctor may ask me to drive her to hospital, or, if necessary, summon the ambulance to take her to hospital. There she will be given whatever treatment is necessary, and, if she is a child, a parent can always be with her.
Home visits used to be common; now that more people have cars and also have access to other kinds of information, such as that given by the NHS on their website, GPs still make home visits but sometimes advise people by telephone. The NHS also has a helpline phone for anyone who is worried about an illness and cannot easily reach a doctor. Once again the idea is for trained nurses to provide patients with information, reassurance and advice. Sometimes, of course, the person seeking help is advised to come to the emergency part of the hospital immediately, but usually detailed and careful questioning and advice can calm worried callers. Despite all these new services, most GPs still make occasional home visits, sometimes on a very regular basis when the patient is disabled. In my experience, most doctors are helpful and conscientious; one part of being conscientious is to tell a patient that he or she will get better without any medical intervention. 'Go to bed, drink fluids, keep warm, sleep and wait to get better.' We would prefer a magical cure, but instead we follow the good advice our doctors give us (and our grandmothers used to give us).
One consequence of this approach to health is that in Britain children rarely go to hospital, and if they do so, they do not spend days in hospital for no particular reason. Adults, too, do not spend time in hospital beds unless necessary. And this policy is not unpopular. Most people do not wish to go to hospital unless they are seriously ill; they would prefer to rest at home.
Women have their babies either in specialist maternity hospitals or in the maternity wards of general hospitals (with fathers normally in attendance). Sixty years ago, a perfectly healthy mother with a perfectly healthy baby would expect to spend ten days in hospital after the birth, often without much chance of seeing her husband. Forty years ago there was a strong movement to encourage fathers to attend the births of their children; at about the same time doctors become convinced that the sooner a mother was up and about after the birth, the healthier she would be in the long run. So mothers are now sent home from hospital one or two days, after the birth, or even a few hours if there are no problems. All the lessons of how to look after a baby take place in special classes before the birth or at home when midwives make daily visits for a week or so. When I first visited Russia, your maternity services were like ours sixty years ago; now they are closer to common practice in Britain and other western countries.
Dying patients are sometimes cared for in hospitals, sometimes at home, sometimes in special hospices which provide inpatient beds and a home visiting service (though there are too few of these and they only receive part of their funding from the National Health Service; for the rest of the fee, patients or their relatives or a charity pays). Most people would prefer to die in their own homes, and government policy is directed towards providing enough home nurses and support for this to happen whenever possible.
How good are our hospitals? They should all be very efficient, although the inevitable answer is 'mixed'. However, in recent years much government effort has been put into making sure that the less good hospitals are improved both in buildings and numbers of staff, and that waiting times for operations are significantly shortened. In fact, during the first decade of the twenty-first century, the money spent on the Health Service nearly doubled. In future years the NHS will receive less money, but much of the improved infrastructure and many more trained doctors and nurses are already within the system.
One policy of the government is to give patients more information and more choice when they have to face going in to hospital. Very recently the Minister for Health has launched a new information website which will enable patients to compare practical non-health issues (such as whether there is adequate car parking for visitors to patients) and provide facts about such matters as mortality rates, hospital infection rates (when patients actually catch diseases in hospital), cleanliness, patients' evaluations of the helpfulness of staff, and - significantly - whether patients felt that they were involved in decisions about their care.
Choice and involvement are always tricky matters. If something horrible seems to be happening inside me, I wanted clever professional people to do their best to cure me. How do I know what is the best treatment? I have no idea so I have to trust them! But very often there are choices to be made about when and whether to have an operation: in such cases patients need as much easy-to-understand information as possible. Very often they turn to the Internet searching for websites that deal with their problem, so the NHS has set up its own website for them. Doctors also need to say, 'I will do my best, but I cannot predict the outcome' - if that is the true situation. While there are some people who would prefer to know nothing about their illness, who would rather wake up and discover that their leg has been amputated than discuss it first, most people want to know what there is to know. Even when things go wrong, there is plenty of evidence that patients (or their relatives if they have died) prefer a simple honest apology and explanation to months of argument, obfuscation and suing.