How does the patient get to the general practitioner's surgery?

W HEN I visited the Antipodes and Canada on a Nuffield Travelling Fellowship, I was soon aware of the fact that the vast majority of patients attending the doctors' surgeries came in a motor vehicle. All those who lived any distance away, and many who lived close to the surgery, came either in a private car or by taxi. Pram parks were considered unnecessary. Patients were firmly persuaded to attend the surgery, if at all possible, and in some cases there was the additional factor that cost of a taxi was less than the difference between the cost of a home visit and a surgery consultation. In this country much rethinking and reorganization is going on in general practice. General practitioners are coming together in groups in centralized premises, provided by the doctors themselves or by the local authorities, where they can have adequate ancillary help and the stimulus of contact with their colleagues. In the interest of efficiency and providing their patients with a better service, more and more patients are being persuaded to attend the surgery and some branch surgeries are being closed. The day when there was a doctor's surgery at every street corner is fast disappearing and rightly so. Although the number of cars in this country increases year by year, we have not yet reached the stage when there is one for every family. So how do the patients get to the surgery? Many will walk or use public transport, but how many, and is the pattern changing? Most general practitioners can give an impression, but it is only an impression. As a first step in obtaining factual information, which could indicate the present position and act as a base line for future enquiries, a pilot survey was undertaken. Method Six semi-rural practices completed a questionnaire of all patients attending for consultation during two consecutive weeks in February 1968. Semi-rural practices were selected because this was thought to give the best spread of distances travelled. All had appointment systems, five practised only from central surgeries and one had four sessions a week at branch surgeries. The returns were limited to patients who came for consultations, because this required the actual physical presence of the patient at the surgery. Other services (repeat prescriptions, making appointments, etc.) could be done by alternative means, e.g. telephone or post. The forms were divided into sessions-morning (before 1.0 p.m.), afternoon …