I haven’t been registered with an NHS doctor since my teenage years, over 35 years ago. Although I’m thankful that I’ve never had any “serious” illness or other condition requiring medical intervention, the downside is that I’ve never had any real reason to re-register as I’ve moved from place to place during my life.
Now and again, the thought crosses my mind that I really should register, and the recent heavy snowfall here in London (and consequently slippery pavements) has brought that thought back to the front of my mind.
In Monday’s Guardian newspaper, the London Ambulance Service was reported as saying that it received 2,200 requests for help before noon today [2 February 2009] – about 50% more than usual, while the BBC News website carried the following quotes:
Dr Charles Gutteridge, medical director of the Barts and The London NHS Trust, said: “We’ve seen a dramatic increase in people with simple strains and minor fractures of the ankle, elbow, forearm and shoulder.”
“The ones we have seen slipped while walking to work.”
Chief Operating Officer, Rob Ashford, said: “Yesterday we had a steady stream of people who had slipped and hurt themselves.”
“In some cases it was as simple as an elderly person going out to retrieve their morning milk and slipping.”
And I have to say that I’ve been wondering what I would do if I should fall and hurt myself on my walk to or from the Tube station. It’s only about a mile or so, but in the suburban area where I live, the local authority hasn’t carried out any gritting or other clearance, leaving the footpaths in quite a treacherous condition.
All of this may seem like much ado about nothing, but my perspective on it is definitely shaped by personal experience as much as by my being a transsexual woman in her 50s…
A couple of years ago, before leaving for my GRS in Thailand, it occurred to me that it might not be a bad idea to register with a local GP in case I should suffer any post-surgery complications on my return.
(Although, given the denial of access to meds and surgery of Debbie Davies by her local Primary Care Trust (PCT), how successful any request for post-operative care would have been remains a moot point)
A couple of weeks before I left for Bangkok, I attempted to register with the practice nearest to my home; it’s literally at the end of the road and can be only a few minutes’ walk. I think it was one of the most unpleasant encounters with a healthcare worker that I’ve ever had. From my personal journal:
Monday 03 September 2007:
In which Helen tries – and fails – to register with her local NHS doctor
Having left work early to avoid the chaos of this evening’s Tube strike, I thought I’d put the enforced free time to good use, and register as a patient at my local GP’s surgery. Spot the mistake…
First, the receptionist told me that my passport and driving licence were unacceptable as proof of identification. Funny that, because the bank had accepted them only a couple of hours before, when I went in to arrange the wire transfer of the balance of my surgery fee… Okay, no problem, a quick walk back to the flat, pick up my Council Tax notification letter, electricity bill, phone bill and water bill. Back to the doctor’s surgery where the receptionist also asks for my passport – apparently it’s also required but isn’t enough on its own. Is she making this up as she goes along? She photocopies the passport and the Council Tax form (but not the utility bills she’d requested) – “for our records”.
Then she gives me two forms to fill in: a little purple thing – a GMS1, apparently. Like this one (PDF) – even though I’d already produced my medical card (a real antique: the date of issue is given as 4 January 1973). And I was required to complete their own in-house patient questionnaire, too. So I sit quietly and fill them in like a good girl. Hand them back to the receptionist.
“You haven’t put the name of your last doctor”, she says.
“Because I don’t remember. I haven’t seen a doctor since I was in school. That would be 35 years ago.”
“Well, what was his address? We can track him down from that.”
“Hicksville, North Wales.”
“I have no idea. It was 35 years ago. I was 16.”
“Hmm. And where did you live before you moved to London? And when did you move to London?”
Thinks: Wh-a-a-a-t? “Stringtown. And five years ago.”
The receptionist writes down these two vital pieces of information on the forms and turns to her computer. Clickety-clickety.
“The nurse can see you on Friday morning.”
“I’m sorry but I have to work. I was hoping I could do this while I was off work because of the Tube strike – it finishes on Thursday night so I’ll have to go back to work on Friday. I’m not ill. I don’t need to see a nurse. I don’t need to see any medical people. I just wanted to register as a patient. That was all I wanted to do. I just thought I should.” (Helen shrugs, suddenly and unexpectedly close to tears)
“Hmm. The nurse could see you next week.”
“I told you: I have to work. Look you’ve read my form, you know I’m gender dysphoric. I go for surgery in two weeks. I. Just. Wanted. To. Register.”
The receptionist is looking at me blankly. I realise I’m wasting my time.
“Look. I tell you what: why don’t we just forget it, eh?”
And I picked up the stupid forms, and I left. Came home in tears.
So that’s that: How to register with a GP. Or not.
In fact, it’s not how the registration process should work, at least by my reading of that last link (How to register with a GP), which states only that:
To register with a GP, you can visit your local GP surgery and request to register with them. They may ask you for your medical card details.
So where did all the other bureaucratic procedures and requirements come from? Some weeks later, at my first post-op appointment with the gender doc, I asked about the process of registering with a GP, and related the tale of my failed attempt. The doc was sympathetic and agreed that it really shouldn’t have been as complicated and stressful as that. Which is all well and good but even now I’m still not registered with a GP.
As I mentioned at the start of this piece, I’ve been concerned (again) about not being registered in case I should require the same sort of basic medical care as the 2,200 other Londoners did on Monday.
But there’s a twist: there are two specific issues I’d like to settle, both are related to my being transsexual, and an NHS GP could quite feasibly help with both.
First is the question of the prescription of my estrogen patches. As things stand, I’m able to obtain them through the gender doc when I go for my regular appointments. Until now, these have been every six months. After my next one, in March, they will reduce to one annual appointment. The point is not so much to do with access to a doctor for my checkup and blood tests, it’s more to do with being able to obtain my patches on the NHS. At the moment, being a single adult in full-time employment, I would pay top dollar for any NHS medical treatment (it was a factor in my choosing to transition privately) – but should I become unemployed for whatever reason, then at least I wouldn’t have to find the approximately £300 that I’ll now need to budget for annually (appointment (say £100), blood tests (say £70) and 12 packs of Estradot (say £120)).
There’s also the question of whether a regular GP would actually know what to look for in the results of my blood tests and at our annual consultation…
The second issue I have is one which is unquestionably related to my transitioning: vocal surgery. Although I had a year of speech therapy (£80 a session), finding a voice that enables me to ‘pass’ less unsuccessfully has always been beyond me. Blame half a century of testosterone damage for that. It has reached the point where my speech therapist has said that a small procedure known as Crycothyroid Approximation would probably be the best outcome to my difficulty in finding and maintaining a suitable vocal pitch. A referral from an NHS GP would mean this could be carried out at minimal expense to me; whereas if I went privately, it would cost in the region of £3000. It’s something that I would dearly love to have done; my voice is a constant source of distress to me, particularly on the phone. But £3k is way out of my range right now, and with no referral, then it has to remain on my wish list, even though I have written confirmation from my speech therapist that it would be of benefit to me, no question.
So there’s quite a lot hanging on my being able to find a trans-friendly GP in the London area – or perhaps I should say a trans-friendly GP’s receptionist? – and as time passes, I become more aware that I really need to get this sorted out sooner rather than later.
But it’s easier just to let things slide – keep my head in the sand and my fingers crossed that I stay in reasonably good health – than to have to undergo another humiliating and stressful encounter with a receptionist who plainly saw her role in healthcare to be that of a gatekeeper, not a facilitator. That kind of treatment I consider to be more damaging to my sense of well-being than being able to access the actual health services appropriate for a transsexual woman.