Chickenpox - a study of frontline care in action

The NHS relies on patients being able to self-diagnose. If every patient went to their GP, or a walk in centre or A+E with a sniffle (and some do), the service would be swamped. So, the NHS expects individuals to be able to decide when they are ill enough to need a professional opinion.

My eldest son has chickenpox. Chickenpox is the last remaining widespread childhood disease. In the USA and other countries, a vaccination is offered, but the NHS does not offer it as it's largely harmless and short lived. Some parents, in an effort to expose their child to the disease young, hold chickenpox parties to spread infection. Varicella infection is dangerous in non-immune pregnant women as unborn babies can die from it, so I think a chickenpox party is a bit daft. However, most children will have it before they leave primary school.
Parents expect it, they recognise it and they treat it largely without professional help.

So, I phoned my doctor's surgery to ask them to record it on his notes. After all, doctors aren't psychic. The receptionist was astonished that I'd done this and told me only a doctor could record a diagnosis. So, I sighed a deep and heavy sigh, pointed out that I didn't want to infect her waiting room or waste an appointment, and my son isn't particularly unwell, just incredibly spotty and grumpy. Eventually, she agreed to put it on his notes.
Then I wandered up to my local chemist. There is a service called Pharmacy First that allows your chemist to diagnose and prescribe medications for children in the chemist. It's only really for over-the-counter medications, so parents can have them for free without using a GP appointment. They prescribe for conjunctivitis, hayfever and mild analgesia. I asked for piriton, if it was available, after asking for calamine. I didn't take my son with me, because he's INCREDIBLY spotty and likely INCREDIBLY contagious. After some argument about whether or not chickenpox is contagious after the spots come out (they said no, I said yes), they ummed and ahhed over whether to give me the medication without seeing the child. Eventually they agreed to - I use the chemist on a very regular basis, for all kinds of minor illness, so they're well acquainted with me and my kids.
But what else would I want free piriton for? I could buy it easily. I'm not going to sell it on the black market, or use it to drug my poor defenceless children. Their argument was that they had to be sure, and it wasn't a 'remote' service.

And you know, I understand that. It seems that the more the NHS tries to give patients additional autonomy, the more bureaucracy needs to be fulfilled, the more patients are put off. Why bother going through rigmarole and form filling at your pharmacy when you can go direct to your GP? I have eight years experience in general practice, as a receptionist, administrator and nursing assistant, I'm pretty confident I know how the system works and how to diagnose chickenpox, and everything I've done this morning has been aimed at saving GP time. My motives for doing so have been scrutinised. Is it that impossible to imagine a patient might genuinely want to avoid wasting resources? Is it impossible for a person to diagnose the most easily recognised rash without formal medical training?

The NHS relies on self-care and self-diagnosis. However, there seems to be another force at work trying to keep diagnostics firmly in the hands of professionals. Front line care is flooded by people who are anxious about minor symptoms, who need reassurance and OTC medication. The NHS needs to give people confidence in their autonomy.