Why does Downing Street want details of all your appointments with your doctor?

Despite hiccups, Downing Street is still keen to get its hands on details of when, how often, and why you visit your doctor. For what purpose?

caroline m.jpg
Caroline Molloy
21 July 2015

Flickr/Alex E. Proimos. Some rights reserved.

The government is trying to get its hands on the personal details of millions of patients’ GP appointments.

The government has written to the companies who provide IT for GPs to ask them to help it obtain the date, time and duration of each appointment for 18 million patients, including the “reason” for each appointment, and the gender, year of birth and most of the postcode for each patient. It wants the details for every appointment in the last two years, as well as all appointments going forward.

The request came in a letter from one of Cameron’s key officials, Tracey Grainger, Programme Director for Prime Minister’s Challenge Fund Digital Team, who claimed it was backed by “the most senior levels of government including ministers”.

The letter, which OurNHS has seen, insists on considerable haste, stating that "there is an urgent need within short delivery timescales" and that the extraction of the patient information “needs to be in place by September 2015”.

After a media backlash today, NHS England claimed it would not after all be trying to extract the information through the back-door, via software companies - but would now be expecting GPs to deliver it to government directly.

The move – the latest in a long list of ongoing attempts to wrest confidential patient data away from patients and their doctors  - has outraged privacy campaigners. Last year there was an outcry when it emerged that patients could potentially be ‘re-identified’ from the new NHS ‘care.data’ records system, and that insurance and pharmaceutical companies could get their hands on the data. More recently it emerged that patients requests to opt out of the system had been ignored in an attempt by NHS bosses to hunt out ‘costly’ patients.

But the prospect of Number 10 getting its hands on the reasons behind each individual doctor appointment takes concerns to a new level. Phil Booth of medConfidential said that NHS England’s claim that such information wasn’t “personal information” was “bizarre”. Booth added that in his view “the intentions of NHS England are clear - trample on every rule of confidentiality, and collect it all.”

But why is Number 10 so keen to collect this data, anyway?

The government says the move is designed to assess demand for a 7-day NHS, according to the report in the Daily Mail. 

But there’s something that doesn’t quite add up here.

Cameron and Hunt have spent months making a “24 hour, 7-day NHS” the central plank of their NHS policy. Yet they’ve only decided now to find out whether there’s actually any demand for it?

In fact, if the prime minister wants to assess whether there is demand for 7-day GP surgeries, he needs only to look at the evidence from the pilot schemes, many of which have already folded, at least on Sundays, citing lack of demand from patients, with some finding as few as one in 10 appointments were filled.

The lack of patient demand for weekend GP access is perhaps unsurprising, given that a high proportion of GP visits are by people who are retired, off work sick, or parents at home with small children – and the rest of us do have the right to time off work to see a GP, if we have a half-decent employer.

Rather than asking for details of every "patient encounter" in the last two years (most of which will tell Cameron nothing about the uptake of the more recent seven-day trials), it might be more useful for Cameron to listen to – and act on - the voices of GPs themselves. The Royal College of GPs is telling him loud and clear that there is a severe shortage of GPs to provide services Monday to Friday, let alone over the weekend - even as the government appears to be back-tracking on its pre-election promise of 5,000 more GPs.

A possible clue to the real agenda here is provided by a clearly rattled NHS England, who put out a statement saying that the aim had been misunderstood, and that the move was aimed to "help" GPs with “auditing their data so as to reduce their costs and workload”.

So how exactly is Number 10 going to help GPs reduce their workload, once it gets its hands on our data?

Will we have a team sitting in Downing Street in September deciding whether they approve of why we went to our GP, how many times we went - and if not, using this data to justify some policy wheeze they've got up their sleeves? 

We’ve already had Tories suggesting a ‘cap’ on the number of GP appointments people are allowed on the NHS each year, charges for patients who miss appointments, charges for patients who overeat, charges for any NHS services that could be redefined as 'social care', and more charges for NHS services in general.

We’ve also already had attempts to divert people with politically unpopular diseases like depression, alcoholism and obesity away from face to face contact with NHS medical professionals and towards less trained staff working for private ‘solutions’ providers. One region has even gone as far as trying to ban fat people and smokers from having any routine operations

Although so far Cameron has distanced himself from most of these efforts, his own Number 10 policy advisor, Nick Seddon, has also previously called for charges for GP visits.

It's also notable how many government-friendly media outlets and think tanks are now pushing the message that the NHS’s problems are primarily caused by our own irresponsibility. The mantra of the “undeserving” is in danger of drowning out the experts who point out that it’s a multitude of government-imposed problems causing the NHS’s real pain. That those supposedly ‘unnecessary’ visits to GPs aren’t unnecessary. And the most inconvenient truth of all, that if you introduce charges to put people off visiting the GP, you merely end up with sicker, more expensive to treat patients - as Germany found when it had to abandon its catastrophic GP charging experiment for this reason.

Of course it’s not just assessing - and then narrowing - access to expensive professionals by poor patients that might be of interest to the government and its friends.

Perhaps more immediately, postcode-level data could enable the segmentation of the well-off, worried well – those who might be willing to pay a separate fee (whether through insurance, co-payment, or subscription to a paid for, NHS-endorsed service) for the luxury of a weekend or online GP consultation. Especially when expectations are raised but then it turns out the cash-starved NHS can’t realistically offer a 24/7 non-emergency service, after all. 

And voila - a two-tier health service, and profit opportunities galore.


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