Should GPs be nationalised?

[windingroad]

This is slightly apropos of nothing, but what are everyone's thoughts about folding GPs into the NHS (ie. properly, this time)?

The current situation doesn't seem sustainable to me for a modern universal healthcare system, because it's such a patchwork throughout the country with very little consistency. Websites are different (and often appallingly designed), appointment procedures are different, waiting times are different, quality of service is different, and so on. Surely it would make so much sense to manage them all directly, along with the efficiencies inherent in that, so that the experience is more or less consistent no matter where you live?

My personal experience of NHS hospitals has been excellent (other than waiting times) but primary care can be very hit or miss.

 

[Bletchleyite]

Interesting you post this, as most people don't know, in this talk of NHS privatisation, that the parts of it they use most - GPs and dentists - were never nationalised.

Yes, I think it would in most cases make more sense to have salaried GPs working in publically-owned health centres/"megapractices" than the old style "cottage" surgery. Include a pharmacy operated by salaried pharmacists, too - it's silly that you often have to go to one then the other rather than both together!

 

[windingroad]

Yes, I think it would in most cases make more sense to have salaried GPs working in publically-owned health centres/"megapractices" than the old style "cottage" surgery. Include a pharmacy operated by salaried pharmacists, too - it's silly that you often have to go to one then the other rather than both together!

Absolutely. You then have (sort of) one place, under one roof, you go to for all your primary care health needs. There is a huge amount of duplication right now that really needn't exist, and lots of practices that really feel very dated in terms of the way they work.

It's maddening really because there's absolutely no reason why we can't have a modern, well designed, and well managed health service that looks after you well from beginning to end. It just requires a bit of bravery and a bit of vision to make it happen. Usually, I must admit, my solution to a lot of things is "give it more money", but I'm coming round to the view that the NHS will basically swallow up whatever you give it, no matter how much. So it needs modernisation.

 

[Bletchleyite]

FWIW, while it's obviously privately run as they all are, my practice is a very large one more like a health centre as I'd propose, and overall it seems to me to offer reasonable service. It's not just about flexibility of the service offering (which could be better) but because e.g. if you've got 8-10 GPs working in a practice, each will have their own specialisms and in a sensible world certain things can be directed to each one. For instance I know one of them is an ultramarathon runner, so is the best bet to see for any sports injuries because he "gets it" and doesn't just come up with the standard "well stop doing that, sit in a chair and get fat, then". Larger practices can also add other services like physio and minor surgery closer to home, and why not have a dentist in the same building?

 

[DelayRepay]

I think that a single NHS GP service could bring real benefits. As well as the things @Bletchleyite mentioned, there could be much more flexibility for patients.

If it's more convenient, you could see a GP near your workplace, or in another part of the country if you're working away. And if your own surgery can't offer an appointment at a convenient time, you could try others in the area.

I accept that for some conditions it's beneficial to see the same GP every time, but for a lot of minor ailments it doesn't matter if they're your 'usual' GP.

I'd also outsource handling of telephone calls to 111. They should be able to book appointments to try to avoid the situation where 30 people are ringing the surgery at the same time, while the receptionist is in the loo!

 

[Bletchleyite]

I'd also outsource handling of telephone calls to 111. They should be able to book appointments to try to avoid the situation where 30 people are ringing the surgery at the same time, while the receptionist is in the loo!

What I would like to see is a more triage-based system with multiple entry points. 111 could certainly form part of that for those who would prefer to "log a case" by telephone, but online could also be an option. Personally I would prefer to "log a case" online because I could spend some time ensuring I described the issue well - that could in some cases result in a prescription without the need to see anyone in person, thus saving appointments. I find trying to remember all aspects of the issue while sitting in front of the doctor stressful.

It'd also better deal with stuff that's a bit "blurred" between what sort of care is needed, e.g. tooth abscesses are not always painful (I have had a "silent abscess" more than once, including a "very large" (said the surgeon who took it out) jawbone abscess - all I had was general infection symptoms - they only cause pain when they press on things) so someone could be redirected to dental care instead of a GP. And if it's obvious what specialist is needed*, why see a GP at all? Just refer direct from 111. And if it sounds like it needs A&E, again, refer straight there.

OK, my career is IT service management - but the same principles can be applied very well to any "stuff that's broken and needs fixing", including people. You can also do powerful root cause analysis with the data to proactively find conditions and treat them, e.g. has someone who keeps going to A&E with broken bones got a serious calcium deficiency - are they a victim of domestic abuse - or are they just a mountain biker ( )?

* I've certainly gone to a GP before, basically going in and saying "I'm pretty sure I've got X because I've got symptoms Z, can you refer me to specialist Y" and walked out 30 seconds later with a referral as requested. That was an utter waste of an appointment.

 

[Yew]

Usually, I must admit, my solution to a lot of things is "give it more money", but I'm coming round to the view that the NHS will basically swallow up whatever you give it, no matter how much. So it needs modernisation.

I think that with spending, we need to make sure there is time and money ringfenced for infrastructure improvements that are going to help the organisation work more effectively in the (still near-ish) longer run; as opposed ot jsut firefighting. You don't get lean and efficient if you don't have time to improve.


Unfortunately, X new hopsitals, makes a much better political soundbite

== Doublepost prevention - post automatically merged: 18 Jun 2022 ==

I accept that for some conditions it's beneficial to see the same GP every time, but for a lot of minor ailments it doesn't matter if they're your 'usual' GP.

I feel that for longer term conditions, that'd happen naturally; even in a system where you could go to any GP.

I can go to any Tescos, but I generally stick to the one near home or near work.

 

[HullRailMan]

Some GP surgeries are state run; there are number in my local area that are owned and operated by a local NHS Trust. However they are still run on a commercial basis, like all GPs, just with an NHS owner.

As has been said, money isn’t the key to greater success here, but efficiency is. The wide variety of IT systems in operation across different NHS service providers is mind blowing, as is the total lack of system integration and information sharing. Fixing that though would be one heck of a task!

 

[Bayum]

I think that a single NHS GP service could bring real benefits. As well as the things @Bletchleyite mentioned, there could be much more flexibility for patients.

If it's more convenient, you could see a GP near your workplace, or in another part of the country if you're working away. And if your own surgery can't offer an appointment at a convenient time, you could try others in the area.

I accept that for some conditions it's beneficial to see the same GP every time, but for a lot of minor ailments it doesn't matter if they're your 'usual' GP.

I'd also outsource handling of telephone calls to 111. They should be able to book appointments to try to avoid the situation where 30 people are ringing the surgery at the same time, while the receptionist is in the loo!

Difficult for those with chronic issues or potentially mental health issues where the particular GP they have seen for those issues has a deeper knowledge than the test because of that 1;1 time thiugh

 

[DelayRepay]

Difficult for those with chronic issues or potentially mental health issues where the particular GP they have seen for those issues has a deeper knowledge than the test because of that 1;1 time thiugh

That is true. On the other hand, if I need to see a GP because I've got, say, an ear infection, why do I need to wait for an appointment at my local village surgery, when there might be an earlier and more convenient appointment at the city centre GP near my work?

For some people and conditions, it will be better to see the same GP. For other people/conditions, it won't matter. There needs to be more flexibility, both for the benefit of patients and to maximise the use of resources in an efficient way.

Also, even in the current set up, whilst I go to the same surgery, I dont see the same GP. I see whoever they book the appointment with. Since I moved here I've been to the GP three times. Each time I saw a different doctor.

 

[tomuk]

The wide variety of IT systems in operation across different NHS service providers is mind blowing, as is the total lack of system integration and information sharing. Fixing that though would be one heck of a task!

Parts of it were tried before and it was a complete disaster a central patient record system.

Abandoned NHS IT system has cost £10bn so far

Bill for abortive plan, described as 'the biggest IT failure ever seen', was originally estimated to be £6.4bn

www.theguardian.com

== Doublepost prevention - post automatically merged: 19 Jun 2022 ==

This is slightly apropos of nothing, but what are everyone's thoughts about folding GPs into the NHS (ie. properly, this time)?

The current situation doesn't seem sustainable to me for a modern universal healthcare system, because it's such a patchwork throughout the country with very little consistency. Websites are different (and often appallingly designed), appointment procedures are different, waiting times are different, quality of service is different, and so on. Surely it would make so much sense to manage them all directly, along with the efficiencies inherent in that, so that the experience is more or less consistent no matter where you live?

Just re-write the service contracts properly with a proper specification and adequate monitoring. I remember watching a health select committee enquiry into GP access. The civil servant appearing in front of the committee was proudly explaining a new initiative where the GPs were being paid extra for extended hours in the evenings and weekends etc. It then became clear from the questioning that the Dept for Health didn't know what the existing opening hours of GP surgeries were, didn't know what extra hours the GPs in the initiative were providing. There was evidence GPs were beinbg paid extra for service they were already providing and in some cases they were closing during the week so they could open in the evening\weekend to take the extra money.

My personal experience of NHS hospitals has been excellent (other than waiting times) but primary care can be very hit or miss.

You've been lucky then there a lots of rubbish Hospitals around.

Coeliac patient died after being fed Weetabix in hospital, inquiry hears

Hazel Pearson’s condition not signposted by her bed as coroner deems Wrexham Maelor’s plan of response ‘amateurish’

www.theguardian.com

Shrewsbury hospital bed death of ex-police officer ‘avoidable’, inquest rules

Max Dingle, 83, died after his head became trapped between the rails and mattress of his hospital bed

www.theguardian.com

 

[DynamicSpirit]

This is slightly apropos of nothing, but what are everyone's thoughts about folding GPs into the NHS (ie. properly, this time)?

The current situation doesn't seem sustainable to me for a modern universal healthcare system, because it's such a patchwork throughout the country with very little consistency. Websites are different (and often appallingly designed), appointment procedures are different, waiting times are different, quality of service is different, and so on.

What makes you think that - for example - a website designed centrally by the Government - would not be just as badly designed? Or that a centrally designed UK-wide (or England-wide) appointment system wouldn't turn out to be worse than many people currently experience? Or that waiting times wouldn't become worse?

 

[windingroad]

If it's more convenient, you could see a GP near your workplace, or in another part of the country if you're working away. And if your own surgery can't offer an appointment at a convenient time, you could try others in the area.

Absolutely. No need to register with a practice; your details are held centrally and (ideally) could be easily updated through online self-service. I think it would also help to (slightly) reduce A&E admissions from people who need medical attention but aren't in their usual area.

Abandoned NHS IT system has cost £10bn so far

Bill for abortive plan, described as 'the biggest IT failure ever seen', was originally estimated to be £6.4bn

www.theguardian.com

== Doublepost prevention - post automatically merged: 19 Jun 2022 ==

An absolutely obscene amount of money and I cannot fathom how any IT system, in any universe, and no matter how complicated, could possibly cost that much. I understand it's a difficult problem to solve, but I worked in an organisation which developed highly, highly complex front-end and back-end systems and these were completed in a fraction of the time and at a tiny, tiny fraction of the cost. And they were extremely well designed and suffered no collapse. So I simply don't get it.

What makes you think that - for example - a website designed centrally by the Government - would not be just as badly designed? Or that a centrally designed UK-wide (or England-wide) appointment system wouldn't turn out to be worse than many people currently experience? Or that waiting times wouldn't become worse?

Strangely enough website design is something the government does very well thanks to a very talented civil service team. Gov.uk is simple, accessible, and well designed (as is the NHS website, which uses the same design system). It's so well regarded that several international governments now use it as a base for their own websites. So with the right leaders and the right team, government can absolutely produce world class stuff.

Your point about things getting worse is absolutely possible, as it is when companies take over (just look at the recent reports about the GP chain). Any change, in any sector, just has to be managed properly.

 

[DelayRepay]

What makes you think that - for example - a website designed centrally by the Government - would not be just as badly designed? Or that a centrally designed UK-wide (or England-wide) appointment system wouldn't turn out to be worse than many people currently experience? Or that waiting times wouldn't become worse?

That is a risk, and any change would need to be carefully managed. But the system is already broken.

The government do some things well - the whole Covid vaccine booking system worked quite well for example. I appreciate they do other things very badly. But ultimately an online appointment booking system isn't difficult and that's basically what we're talking about.

 

[BananaRepublic]

Rather than trying to tinker with the system by creating an even larger monolithic structure, why not focus on the primary cause of shortfalls in GP provision; not enough supply to meet the demand.
We need more GP’s, not less, which is the likely outcome of taking all GP practices into NHS ownership and management.
You’d be taking away one of the most significant incentives to become a GP rather than a hospital doctor.

The wide discrepancies in the level and quality of GP provision, is an issue than needs to be addressed, but putting it all under NHS management will not resolve that situation. As already pointed out, there’s a wide discrepancy in the level of NHS hospital provision, across the land.

As for centralised, super-sized surgeries.
In my mother’s town, in the NW of England, all 6 practices in the town were merged into a brand new GP centre about 10 years ago.
They still exist as separate practices, but are in the same multi-storey building.
Each surgery leads off a central atrium on the 2nd floor.
There are between 5 and 7 GP’s in each practice, plus nurses.
Clinics and physio are manned by nurses and health specialists are on the 1st floor.
There’s a Lloyds pharmacy on the ground floor.
The building is lovely and the ambiance is very positive.
However, the whole project has been a big disaster for a lot of people, particularly many of the elderly (who make up the largest proportion of appointments) and the poorest who live on the most deprived council estates on the edge of town.
The major failure is in accessibility and for many, the cost of getting into the centre of town, to visit the surgery.
Many of the bus routes don’t pass close by and the bus station is up a steep hill and nearly quarter of a mile away.
For many of the elderly, sometimes on a tight pension, that means having to book taxi’s both ways, or rely on a relative to be available to take them.
Be careful what you wish for.

 

[DynamicSpirit]

An absolutely obscene amount of money and I cannot fathom how any IT system, in any universe, and no matter how complicated, could possibly cost that much. I understand it's a difficult problem to solve, but I worked in an organisation which developed highly, highly complex front-end and back-end systems and these were completed in a fraction of the time and at a tiny, tiny fraction of the cost. And they were extremely well designed and suffered no collapse. So I simply don't get it.

I totally agree (and with reference to the Scotland thread, another one for the record ). To waste that amount of money on a failed IT system, the surely has to be an extraordinary level of management incompetence somewhere. If the figures in that article are correct, then allowing for inflation, that will be well over half the actual final cost of building the Elizabeth Line - and more than 1/10 of the likely cost of building HS2 - all lost by the Government on software!

But the irony in the context of this thread is that this is an example of a centrally designed national system going spectacularly wrong - so it looks to me like direct counter-example to the idea that having some centrally organised bureaucracy would be better than the current decentralised GP system.

Strangely enough website design is something the government does very well thanks to a very talented civil service team. Gov.uk is simple, accessible, and well designed (as is the NHS website, which uses the same design system). It's so well regarded that several international governments now use it as a base for their own websites. So with the right leaders and the right team, government can absolutely produce world class stuff.

Really? Out of interest what's the basis for that statement that the Government does website design very well? I'm not aware of any systematic research, but my own anecdotal experience is that those Government websites that I use regularly (which for me is mainly HMRC, Companies House, ONS, NHS to find health info, and parliament.uk) seems to be that it is invariably unnecessarily hard to navigate the sites and find (or submit) the information I need. The visual design in terms of things like high-contrast text, and no unnecessary clutter on pages is good, but the navigation/functionality seems appallingly bad.

 

[Yew]

What makes you think that - for example - a website designed centrally by the Government - would not be just as badly designed? Or that a centrally designed UK-wide (or England-wide) appointment system wouldn't turn out to be worse than many people currently experience? Or that waiting times wouldn't become worse?

The government can afford to pay a team of people who know what they're doing to design a proper website and system, and to engage in extensive UX testing. And modern software project management methods are much more resilient to the typical over-detailed specifications that often come from the Govt and Civil Service.

 

[skyhigh]

What I would like to see is a more triage-based system with multiple entry points. 111 could certainly form part of that for those who would prefer to "log a case" by telephone, but online could also be an option. Personally I would prefer to "log a case" online because I could spend some time ensuring I described the issue well - that could in some cases result in a prescription without the need to see anyone in person, thus saving appointments. I find trying to remember all aspects of the issue while sitting in front of the doctor stressful.

Thankfully my current GP is very good at this. There is an online process where you describe your symptoms, it asks relevant questions and you can add any additional information that you deem pertinent. A GP or nurse will then review the information along with your medical record (generally over the course of the next working day) and either call you or send an email with next steps - if they need you to book an in-person/phone appointment, if they want to issue a prescription or they think you need a referral or whatever. If they want to book an appointment, they will do it there and then when they phone you, no need for you to call them and try to get an appointment with someone appropriate. It's a really good system.

 

[Killingworth]

The GP organisational model is an amazing patchwork that has evolved since the NHS was launched. At that time the system was left much as it was as too difficult to 'nationalse' without driving GPs away. Ever since there have been attempts to improve it and they've worked better in some places than others due to the complex nature of British society. Unfortunately each change seems to end up effectively driving more doctors away. Currently early retirement and going part-time is making the workoad ever harder for those who remain and discouraging new entrants.

The big danger is that any changes will create as many problems as they solve. Nationwide changes may help in big city urban areas but be unhelpful in more remote rural areas like in Northumberland or Devon where internet access and public transport are very different.

Having just received an NHS leaflet with 3 pages of A4 in about 20 languages I can't help wondering how the NHS is doing as well as it is. The complexity of modern medicine is totally different from where we were in 1948.

 

[Bletchleyite]

The government can afford to pay a team of people who know what they're doing to design a proper website and system, and to engage in extensive UX testing. And modern software project management methods are much more resilient to the typical over-detailed specifications that often come from the Govt and Civil Service.

Some aspects of gov.uk are good and some are bad. For instance, the "one question at a time" thing prevents one pulling up a form, leaving it on screen and going to prepare all the necessary things to answer all the questions. In some ways it could do with a "lead me through simply" and "I can cope with a form" option.

 

[Yew]

Some aspects of gov.uk are good and some are bad. For instance, the "one question at a time" thing prevents one pulling up a form, leaving it on screen and going to prepare all the necessary things to answer all the questions. In some ways it could do with a "lead me through simply" and "I can cope with a form" option.

Send them a feature request, having an option for an "all in one" and a "stepper" type form wouldn't be particularly hard to implement, and I think they have a team of Devs working on it.

 

[High Dyke]

My local surgery also has a small pharmacy in its building. That can be useful, to a point. I'm not one that tends to need to visit the doctors that often, however, I've just had me bus licence medical. On the back of that the GP, getting his his £100 payment, suggested that I hadn't had a health check lately. Two weeks later I visit the practice nurse, to basically answer the same questions again, though this visit also included an ECG recording (never needed to have one before), and a blood test. In both visits I got the "your blood pressure's a bit high" advice, but aside from putting me on the waiting list for a 7-day (at home) monitor, no further treatment / action was suggested.

If I need to book an appointment, they insist I use the Ask My GP facility, but it only operates during surgery hours. I can phone for an appointment, but only in a morning to see if there's any availability later that day or the following day - if not I am supposed to ring each morning. Not much use if you're unable to ring at that time of day! Unless it's changed, I don't meet the criteria for moving to a different surgery in town. Source: https://www.nhs.uk/nhs-services/gps/how-to-register-with-a-gp-surgery/

Changing GP surgeries
You can change your GP surgery if you need to.

This might be because:

• you have moved
• you have had problems with your current practice
• you were removed from the patient list

You should tell the GP surgery if you change address or move out of the area.

As I get older I may need to use the services of the GP more, currently I don't even know who my actual GP is - that shows how rare I need to visit.

Someone mentioned about the lack of co-ordination. I had this during the COVID inoculations. The surgery text/phoned me to arrange an appointment. The NHS also sent me a letter inviting me to arrange the appointments. I duly sorted all the required visits. Ironically, I was sat waiting, after having the 3rd jab, when the surgery phoned proclaiming "I must book my booster jab." The caller was taken aback when I advised that i was currently sat at the appointed centre having had said jab. Seemingly the two computer systems don't correlate to one another.

 

[Phil56]

Seeing the same GP for continuity of care has disappeared in lots of surgeries, as has being able to see a "specialist" GP.

I've never spoken to the "named GP" on my record - not even sure they exist in real life. I've had diabetes for 20 years and never seen our practice "diabetic" specialist GP - I've tried (and tried), but he never has any appointments available. I think in the past 20 years, I've seen the same GP about twice - it's always a matter of just having to see whoever is available - that's fine for urgent things, but it's the same for ongoing/chronic issues too. The website (a poor one) has a list of about 10 "partners" who seem to stay the same year by year with only the occasional change, but they're nigh on impossible to see. Most appointments I've had have been with locums.

Such a contrast from my previous practice in the 80s and 90s where they had 3 GP partners who actually saw patients - there was only a locum on Saturday mornings or to cover GP holidays - and it was usually the same locum - a retired GP who used to be a partner at that practice! Continuity was very good indeed - I didn't have any particular one of the 3, but I saw all 3 and all 3 "knew" me to some extent, so we didn't have to go through the same "twenty questions" at every consultations, as they may not have known my situation in great detail, but they knew enough not to waste time asking routine questions every time.

 

[Snow1964]

The big problem is the GP system has got too general (and yes I know the g is for general)

As examples
1) Any regular medication has to go through your GP, even if been no changes
2) Many specialists (even private) need a referral via a GP even if it is blatantly obvious that that a GP isn’t a specialist in the area
3) Routine screening isn’t centralised, it would be better if everyone had a blood test every 5 years at a district hospital, rather than involving GPs in routine scheduling

Need to free up GPs to deal with ill patients rather than having to fight system to get initial appointment. The NHS is very good at mending people, but works the same way as South Wales Health Unions did in 1930s (on which NHS system is based). There was no diagnostics then and it still acts that way. Wait until a patient is ill, fight your way to see GP, then patch up someone.

No attempt to use modern diagnostics to early spot potential problems or vulnerabilities. The NHS is all based on waiting until a patient has often gone beyond the easy to fix stage, when they eventually feel it is bad enough, and only then doing something.

The GP system in current form is not designed for modern world where the GP spends big chunk of time referring or repeating medication, rather than dealing with those newly ill, or where follow ups would be better dealt with by same person.

 

[DynamicSpirit]

Send them a feature request, having an option for an "all in one" and a "stepper" type form wouldn't be particularly hard to implement, and I think they have a team of Devs working on it.

Pretty much every year, after filling in my tax return, I respond to the online request for feedback. In my feedback, I point out the stupidity of having some fields that require you to type in '0' if the answer is zero, while other identical-looking fields require being left blank and will reject an answer of '0'. Or the frustration of there being - as far as I can tell - nowhere on the site that answers the simple question 'Based on the figures I've submitted, how much tax do I owe?' - which is surely the first question that comes to the mind of almost everyone who has just completed their self-assessment return. Or the way that, if you want to check what you've filled in, you can't jump to any part of the form - you have to jump to the start of that section and navigate through every page in that section to get to the page you want to check. Yet nothing ever seems to change on the site

(Before I'm accused of straying too far from the thread title: The point is not the details of HMRC's web pages, but that central-Government-designed websites are not necessarily well designed, nor do they seem responsive to suggestions for improvements).

 

[Bletchleyite]

1) Any regular medication has to go through your GP, even if been no changes

Yep, as someone who now has a few repeats, this. If you need the medication for life, just set the system up to issue it for life. By all means query the database of prescriptions and invite people in for a review if a new better medication is available, but if it's just "you'll need this pill until you die" there's no point wasting appointments to review it.

 

[windingroad]

Pretty much every year, after filling in my tax return, I respond to the online request for feedback. In my feedback, I point out the stupidity of having some fields that require you to type in '0' if the answer is zero, while other identical-looking fields require being left blank and will reject an answer of '0'. Or the frustration of there being - as far as I can tell - nowhere on the site that answers the simple question 'Based on the figures I've submitted, how much tax do I owe?' - which is surely the first question that comes to the mind of almost everyone who has just completed their self-assessment return. Or the way that, if you want to check what you've filled in, you can't jump to any part of the form - you have to jump to the start of that section and navigate through every page in that section to get to the page you want to check. Yet nothing ever seems to change on the site

To be fair to them, any front-end development team receives hundreds (maybe thousands) of feature requests a year from a vast array of stakeholders (users/colleagues/regulators/organisations) and have to be absolutely ruthless about what they allocate time for.

I used to work for a very well known technology company and the development team were painfully aware of all the various quality of life improvements they could implement, and indeed wanted to implement them, but every single thing you decide to work on means something else that has to be put on the backburner. So ultimately unless something is a showstopper, the highest impact changes will take priority. The issue you highlight is an inconvenience but doesn't substantially affect the efficacy of the form, so it'll be fairly low down the list of priorities.

 

[Yew]

I used to work for a very well known technology company and the development team were painfully aware of all the various quality of life improvements they could implement, and indeed wanted to implement them, but every single thing you decide to work on means something else that has to be put on the backburner. So ultimately unless something is a showstopper, the highest impact changes will take priority. The issue you highlight is an inconvenience but doesn't substantially affect the efficacy of the form, so it'll be fairly low down the list of priorities.

In this case, I feel Don Norman screaming at the inconsistent behaviour!

 

[windingroad]

Really? Out of interest what's the basis for that statement that the Government does website design very well? I'm not aware of any systematic research, but my own anecdotal experience is that those Government websites that I use regularly (which for me is mainly HMRC, Companies House, ONS, NHS to find health info, and parliament.uk) seems to be that it is invariably unnecessarily hard to navigate the sites and find (or submit) the information I need. The visual design in terms of things like high-contrast text, and no unnecessary clutter on pages is good, but the navigation/functionality seems appallingly bad.

Really! I'm not being ideological here: it's genuinely extremely well regarded among professionals and often used in case studies. It's so well regarded that quite a few governments use it as a basis for their own, like Canada and Australia. It's one of the things we do that is legitimately world class and seen as such. Similarly, the NHS website has a superb reputation abroad and is used by lots of medical professionals as a source of reliable advice and information for patients.

I'd recommend giving this post a quick read as it really highlights the scale of what Gov.uk has achieved. Bringing thousands of discordant websites under one consistently designed, accessible roof is a huge feat of engineering and design, and has also saved a lot of money. A lot of very smart and talented people work on it and honestly I think we're very, very lucky when you compare it to most countries around the world. We can do pretty much anything easily online which is much rarer than you'd think.

It can certainly be improved, but the important thing is that we now have a solid foundation to work on. That didn't exist before as every single service and department did their own thing independently.

In this case, I feel Don Norman screaming at the inconsistent behaviour!

Don't get me wrong, I agree it should be fixed! I just don't think minor issues like this should detract from the massive achievement that Gov.uk is as a whole.