The End of the 8am Phone Call Roulette?

Replacing the broken phone system is overdue — but are GPs ready for the tidal wave of demand that could follow?

Wes Streeting has long said that it is ridiculous how in 2025, patients can not book GP appointments online in the same way that you can book a hairdresser appointment. Now some GPs already have such a system, but Streeting wants to roll it out across the whole country.

Imagine one morning, you wake up and have awful ear pain with an accompanying headache. You give it a couple days and now notice a bit of a swelling behind the ear. Instead of ringing your GP, you decide to try out this wonderful new online booking system that your local GP practice has implemented.

But unfortunately as this is a new system, the logistical safeguards are not put in place and you sit there with your acute mastoiditis for over 24 hours before it is noticed and triaged to hospital.

Streeting must know that such a system needs necessary safeguards to prevent urgent clinical requests being submitted online.

The BMA’s Ultimatum

The BMA has given ministers 48 hours to deliver the promised safeguards, warning that practices lack the staff and IT safeguards to screen a sudden surge of online requests and that patient safety could be harmed. GPs are rightly alarmed at the prospect of being forced to absorb an uncontrolled tidal wave of demand.

But is it ever this straight forward? There will be patients around the country who are put off from contacting their GP due to the difficulty of acquiring an appointment over the phone. Many presenting complaints are not even registered as patients don’t get through to their GP in time or simply give up waiting. How much preventable harm this leads to is impossible to calculate, but is certainly worth asking.

Some are pushing back at GP practices and the BMA for being obstructive and preventing a shift to the modern era in an attempt to maintain the status quo. There can be no doubt that the 8am telephone roulette scramble is heavily problematic for the GP practices with few staff, and therefore technology needs to be embraced.

Who Deals With The Requests?

If properly resourced and triaged, a single-portal approach could be a genuine accessibility win. But ‘properly’ matters here. The BMA and GPs are not arguing against digital access — they are arguing against a rollout that removes old barriers without replacing the clinical and administrative scaffolding which those barriers masked. Current online tools cannot reliably filter urgent from non-urgent presentations.

So how do we prevent these missed red flags? One option is for a trained professional to screen referrals. A 21st century solution could involve an algorithm picking up on red-flag phrases entered into free-text boxes.

We could also be dealing with a case of demand inflation here. Easier access can generate demand that wasn’t visible before. If you need to go through the 8am phone call roulette, followed by a cold car journey down to your GP practice, you may decide to sit on that new symptom of shivering you get at night in the middle of December after you refused to turn the heating on. But this new system removes all the hassle.

Autism Assessment: When Diagnosis Depends On Who You Ask

It is becoming more common to encounter patients with a diagnosis or presumed diagnosis of autism. How comfortable are you with its classifications and presentations? One in 36 American children now has autism, up from 1 in 150 twenty years ago. Is this because we are better at diagnosing, or is there another reason lurking in the background?

Some, like Canadian Autism specialist Dr. Laurent Mottron, argue that the rise out of keeping with reality; others, like Prof. Simon Baron-Cohen, believe rates now reflect reality. So basically, even the experts disagree.

Autism has no clinical signs or diagnostic tests; it is entirely diagnosed on a societal agreement of what normal behaviour looks like and self-reported experience. The DSM outlines two criteria: (1) difficulties with social communication/interaction, and (2) restricted or repetitive interests and patterns of behaviour with onset in the early developmental period (before the age of five).

The word ‘autism’ or ‘autistic’ is so overused, we forget how disabling it can be. At the severe end, children may be non-verbal; at the milder end, they may speak fluently yet struggle with conversation. These children may struggle with gestures, eye contact, and recognising others’ emotions.

Crucially, these difficulties appear not only in “challenging” settings like school but also at home. Repetitive behaviours take many forms such as a strong attachment to objects and unusually passionate interests that are highly specific (e.g. not just London bus routes, but specifically the 44 Victoria bus route). Self-stimulatory actions like rocking and bouncing are also common.

Autism assessments remain fraught with controversy and shortcomings. What counts as “impairment” is often left to the assessor’s judgment with a UCL study finding huge variation in diagnostic rates between assessment centres. Some centres diagnose autism in 85% of cases, whilst others did so in only 35%. This tells us that, however robust the definitions may be, they are being interpreted completely differently by practitioners.

When Should Doctors Get to Skip the Queue?

Is it ok to utilise your professional network to help yourself or your loved ones?

There’s a kind of privilege doctors carry that’s rarely spoken about. The type of privilege that stems from a contact list of doctors spanning several specialists.

Oncologist Dr. Ranjana Srivastava recalls the night her three-year-old son developed acute urinary retention. She watched on in panic as his abdomen swelled, before realising that there was only one place to turn. At her own hospital’s emergency department, a quick ultrasound scan confirmed the diagnosis.

Not long after, the Emergency Medicine (EM) consultant prioritised an in-and-out catheter and they were able to go home. The next morning, after her son became incontinent, her fear shifted to concerns about a spinal cord issue. A single phone call to her long-standing paediatrician friend, reassured her that the problem would settle.

For a worried parent or an anxious child to have immediate access to the advice of a specialist is to possess a unique privilege. For most of us, our careers leave us remarkably well connected.

It all begins at medical school, where we make friends that will go on to enter specialties of their own, and it’s continued throughout our training and various hospital rotations. More privileged still are those with doctors in the family. In moments of crisis, this web of medical relationships becomes a way of accessing advice, reassurance, and even expedited care.

Some Ethical Questions

Acting with neutrality is practically impossible when a loved one is sick. Many would consider it a duty as a parent, son, or daughter to put their loved one first. This type of social capital, where a doctor utilises the good fortune of their connections to access healthcare or valuable knowledge will be frowned upon in some corners of society.

Medicine is not the only profession whereupon we see the privileges that contacts and connections bring, but for most people medicine ‘feels’ different to a celebrity getting their child concert tickets by skipping the queue.

Mechanics fix each other’s cars; top CEOs of banks may access better interest rates; and lawyers use contacts to secure second opinions. Healthcare, however, seems to carry a different moral weight.

The crucial ethical hinge is harm. If accessing one’s medical network displaces another patient in need (e.g. if a scan or an admission is expedited at someone else’s expense) then the principle of justice is compromised.

But in many cases, as Dr Srivastava’s story shows, no harm is done. She notes how the EM consultant did not leave a patient in resus unattended, and the paediatrician did not abandon a patient halfway through clerking them. To her, they fulfilled their duties, then went beyond them to offer advice and reassurance.

Queue Jumping Unease

When doctors use connections, someone without such access can be left on the sidelines, and that person could arrive at some degree of harm. Knowledge, and having access to it readily, is perhaps the most important capital one can have.

But hang on, every day, thousands of patients “jump the queue” not through friendship but through money, choosing private medicine to bypass NHS delays. That practice is widely accepted, even institutionalised, with no public outcry. Why should the quiet privilege of professional networks provoke greater moral questioning than the significant privilege of wealth?

In the end, the quiet privileges of our professional connections are unlikely to ever disappear. Humans are not going to stop drawing on the relationships and resources available to them, especially when emotional ties are brought into play. All we can do is to ensure that when privileges are exercised, they do not compromise fairness or cause harm.

“Imagine the chaos if they ever decide to make IMT an MSRA speciality.”

“Every discipline has its all time great rivalries. We could be seeing another one unfold under our very eyes between the Hoka and On-Running crowds. They could even threaten the monopoly Sketchers holds over consultants.”

“An International-Graduate Medic asked me something at work today that left me slightly bemused. He asked me why Brits say sorry when someone else walks into us... Amongst all this recent talk about what ‘British Culture’ truly is, we have a candidate for the list here”

“CT Head ?Head remains the greatest thing I have ever read in my 4 years as a doctor”

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Some things to review when you’re off the ward…

In a recent Medics Money survey of over 6000 doctors, 81% of respondents reporting regularly put money aside from their pay cheque, but only 24% had an three-month emergency pot at hand ready. Find the full results to the survey here.

The On-Call team found the breakthrough in Huntington’s disease management last week pleasing to read. Director of UCL’s Huntington disease centre, Prof Sarah Tabrizi, led the trial where patients underwent a 12 to 20-hour surgical procedure to locally deliver medication to the brain. Results showed that the gene therapy slowed the progression of disease by 75% after 3 years of follow up. Read the full piece here.

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Financial Discipline In A Medics World

We are told that we need to be financially responsible: trim our outgoing, spend intentionally and invest for the future. On paper it sounds so simple and it’s incredibly easy for the money gurus to shout out these commands from their positions of financial security. But in practice, especially as a medic, the psychology of money and spending is anything but straightforward.

After a gruelling month of nights, weekends and on-calls, there are few feelings more rewarding than the payday notification on your bank app. It almost feels like a sense of justice, a deserved reward for the hours that drove you to the edge, and whilst you have absolutely earned your paycheque, that perfectly human mind set is also the gap where overspending slips in.

Reward bias is that desire for immediate pay-off after hard work. In fact, ask yourself this: Did you find yourself spending more during busier rotations, or less because you didn’t find the time to spend your money?

The issue is that consumer culture knows this vulnerability well. We are sold the idea that buying things will soothe our exhaustion and stress. Yet we all know the happiness this brings is momentary. If we had to recall the times where we truly felt distant from hospital woes and had a clear mind, we would think about moments such as a walk in the park with a loved one, or a meal at a friend’s table… all experiences that carry a much smaller price tag.