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Redesigning health care

Editor—The BMJ seems to have become an organ of government spin. There is little evidence to justify giving space to Smith's editorial on redesigning health care.1 The editorial starts by drawing an analogy with “just in time” manufacturing methods. The closest general practice would come to this is by having open access to investigations and ready access to early outpatient appointments. I am sure that hospital colleagues would love to be in a position to offer this. There is no evidence I am aware of suggesting that delays in primary care are an appreciable factor in treatment time when patients are referred to secondary services. 
 
Smith points out that in the United States “some practices” taking part in the “idealised design” project increased the proportion of their diabetic patients who had their glycated haemoglobin measured from 47% to 80%. It is laughable to suggest that we need to redesign general practice on such evidence. In my practice, which I am sure is not exceptional, 75% of diabetic patients have had glycated haemoglobin checked in the past year. As the initial figure from the United States was only 47%, the redesign suggested should be to base the system in the United States on general practice in the United Kingdom. 
 
There is no over-riding case for speeding up appointments in general practice. The American experience of waiting times for general practice appointments may not be readily transferable to the United Kingdom. Seven English practices doesn't seem a firm foundation to justify redesigning appointments. Prebooked appointments can be more convenient for many patients and do not just represent a backlog of work. The suggestion of Mark Murray from the American project—that we should match capacity to demand and try to do more in each consultation1—was probably closer to the reason why any system would cope with more work. 
 
Other measures to reduce visits to general practitioners included using the telephone. This is probably not a new idea to many general practitioners in the United Kingdom: many are likely to be doing this already. The availability of appointments on the day is not likely to reduce overall demand on general practitioners: in my practice patients have not turned up for appointments booked as urgent on the same day.