The quick medical ‘MOT’ – and why patients are getting left behind in 21st century Wales

By Roy Noble CBE, Bevan Commissioner 

Those of us of a certain age might remember the medical ‘MOT’ – which, in today’s NHS, seems like something from a parallel universe in a different time. I’m not suggesting we bring it back, but it does evoke memories of a closer patient-doctor relationship that I think we’re missing in today’s digitally-driven era. 

When I was growing up, our large village in the Amman Valley had three doctors – a husband-and-wife team and an Irishman who could only be described as ‘six cylinder’, such were his many qualities. This Irishman, no matter your ailment, had a rapid three-point plan if he hadn’t seen you for some time; he would simply say: “Stick out your tongue, turn over your hands and let me see your eyes.” This quick MOT was carried out in an era of twice-daily, packed surgeries, house calls and night visits. He knew his flock well – to the point where, if the Monday morning regulars who attended just to get a ‘doctor’s paper’ for a week off didn’t show, he thought they must be really ill. 

Now the village has no GP and the morning ritual has entirely changed. The 8am phone call sees patients in a showdown for the golden ticket: admission to the doctor’s surgery. If one is fortunate enough to get an appointment, the next hurdle to actually seeing a doctor is the receptionist’s questionnaire, where your responses could see you downgraded to a phone call from the GP.  

In my role as a Bevan Commissioner, I am privileged to represent patients and the public, and at times this means listening to complaints. These include concerns about the effectiveness of phone calls, a viewpoint with which I have some sympathy, given the ‘optics’ of going to the surgery only to be greeted by an almost empty waiting room. GPs are undoubtedly working harder than ever, yet, for the patient, the sense of disconnect is only exacerbated by such scenes. So, does this template need reviewing, or are results being achieved – albeit without an avid audience? 

I must point out that my own surgery is excellent and I hear of other surgeries and medical centres which merit very real acclaim. In many communities the patient-doctor relationship remains personal and warm – yet we have all heard anecdotes about a breakdown in good practice. The development of larger surgeries with more staff has possibly distanced this relationship further, as has the closure of some local surgeries in favour of larger, centralised health centres, where you are less likely to see the same GP each time you attend.  

A friend of mine had an appointment with the GP about one ailment and, in passing, he mentioned that three weeks previously he’d had a blood test at the surgery. Were the results back yet? On checking his laptop, the doctor replied that they were indeed – but that my friend would need to make another appointment to discuss them due to the surgery’s ‘one ailment or query per visit’ policy. There is no doubt that the Bevan Commission’s Silly Rules National Report, written in partnership with patient body Llais, is needed as a practical call-to-action to take away such barriers and place the patient at the centre of their own health and care. Instead, my friend felt like an inconvenience to the service that should have had at its heart what was best for him. 

Since the days of my Irish doctor’s MOTs, life has changed in many ways, and not just in the medical world. Think of all the times you have phoned a company or organisation, be it in the care sector, finance, transport, retail or your local council, only to be greeted by a recorded voice offering you a series of options, several times over. Religious venues are closing and between six and eight pubs are being lost every week in England and Wales (although, in 2026 to date, this trend is starting to reverse in Wales). After listening to concerns from patients and relatives about access to services, I have often considered whether holding a surgery once or twice each week, especially a rural area, would be a boon. After all, banks now do it in hubs – why not health services? 

Of course, today there is an app for your every need and technology can help to make healthcare easier, safer and more efficient. Yet digital services remain out of reach for many, and I venture to suggest that there is a disenfranchised tribe out there; people who do not use laptops or smartphones. Dare I suggest that, in view of the rate of Post Office closures – again, particularly in rural areas – providing pharmacy facilities at these sites could be a step forward? 

Going back to those early-morning scrambles for a GP appointment we must mention A&E departments. Today these are visited by parents carrying small children who are clearly very ill; without access to a GP, they may feel they have no other place to venture to or call and are desperate. In the days of the medical MOT, there was another alternative to A&E – the doctor who worked nights and, where necessary, was followed by treatment nurses. These angels came when they were needed and their efforts were a truly uplifting experience. 

Today, countless healthcare professionals are working relentlessly, in challenging circumstances and without adequate resources, to give the best possible care to patients. But I would argue that it is time to put the patient experience back at the centre of everything we do, instead of trying to make patients fit around the service.