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To think this letter from gp was really rude?

(134 Posts)
ariane5 Sun 10-Mar-13 09:09:57

Dd2 has a lot of health conditions and is frequently very unwell.

Last sat (2nd) she was terribly poorly and our gps were shut so we took her to the ooh walk in and she was prescribed antibiotics.

On monday she was worse and woke up at 3am in the morning extremely ill and with high blood ketones (she is diabetic) so dh took her to a+e, she was let out the following morning.

Yesterday I received a letter from our gp and the more I read it the ruder it sounds.

"I noticed you took dd2 to a walk in centre on monday. I am concerned and disturbed by this. We have her records here and can provide better continuing care. I am worried as to why you felt it necessary to take her immediately to a walk in centre"

"Please make time to explain this to us, make an appointment or telephone as this issue needs to be discussed"

For a start dd2 went to a+e not walk in early tues morn-surely if information has got through to gp then it would have stated the time date and reason?

I don't understand why they had to write a letter like that, would have been much easier to phone me and clear it up.
It has made me really annoyed.I feel like phoning tomorrow and telling them to check their facts before writing a letter of that tone.


SirBoobAlot Sun 10-Mar-13 10:57:43

I'd be complaining. Even if it's a standard letter (maybe more so!) it's patronizing as hell, and almost reads like a jealous sulking boyfriend; "But WE provide the best care! Don't go anywhere else! <foot stamp>".

gallifrey Sun 10-Mar-13 10:58:02

My friend is a doctors receptionist and apparently the surgery get charged about £250 every time someone goes to A&E.

That's why if you need an emergency appt just say you are going to A&E and they will fir you in straight away!

mowbraygirl Sun 10-Mar-13 11:01:32

My SIL's docotor is in our local clinic plastered around the walls are notices from the doctor saying do not attend A & E unless urgent as it costs her practice £52 for every visit SIL says it is also on repeat prescription forms.

A friend of mine tried to get the doctor to visit her very sick father but she wouldn't so the receiptionist told her and said to bring him to the surgery which was impossible. His condition deteriorated in t he night so they had to call an ambulance and unfortunately he passed away not long after he got to the hospital.

Two days later had a call from the doctor herself as to why they called an ambulance and not waited till the morning to ring the surgery and bring him in after all it cost her £52 she was told they had tried to get her to visit etc. and she wouldn't and it didn't matter now as he had passed away she muttered something and then put the phone down.

We have a notice at our surg ery that recommends that you try our local Poly clinic for minor things if the surgery is closed as Poly clinic is open 8.00am to 8.00 pm every day and saves clogging up A & E.

BoffinMum Sun 10-Mar-13 11:05:33

I would make a formal complaint to the practice manager about the tone of the letter, quite apart from any healthcare issues, and then move practices immediately. They sound disorganised with poor communication.

RedToothBrush Sun 10-Mar-13 11:08:15

Guilting patients into not seeking care is appalling.

It will have the biggest impact on considerate regular patients who follow the system correctly in the first place; usually the elderly and most vulnerable who NEED to see a doctor.

The people who don't care, won't be affected and will still just go to A&E; they are the people who won't be regularly going to the doctor and seeing the posters or repeat prescription forms.

Don't these people have brain cells about the effect this will have?

BoffinMum Sun 10-Mar-13 11:09:58

I do think if this means surgeries will start opening on Saturday mornings again, and maybe reintroducing home visits in a few more circumstances (shivering bf mothers with newborns and mastitis, for example) this might be a helpful consequence.

ImagineJL Sun 10-Mar-13 11:12:17

Boffin that's exactly what I was about to say.

It's money I'm afraid, and not our choice at all (I'm a GP).

I agree that the wording of that letter was inappropriate and somewhat confrontational, and that should certainly be raised as an issue for them to address.

But the fact is we are very strictly rationed now. We are limited in how many people we can refer to outpatients, and how many people we can admit to hospital, and what drugs we can prescribe, because we are given a tiny budget and everything we do is scrutinised.

If too many of our patients go to A&E (which is HUGELY expensive) we get into trouble, and could potentially be closed down if we were overspent in other areas too.

So many surgeries have taken to contacting patients who have attended A&E, to discuss it with them. This is partly to ensure they know when the surgery is open, when it is appropriate to use A&E etc, but mainly (in my experience) to be "seen" to be addressing the cost issue of A&E attendance. So when the CCG bosses ask us what we're doing to reduce costs, we can say "well we write to everyone now", and that might get us a reprieve from their onslaught.

I know ranting about GPs is a popular hobby on MN, but please be aware that we have practically no autonomy these days. Virtually everything we do is dictated by government and their desire to slash our budget to almost nothing.

And to the person who wondered if we had nothing better to do - the answer is yes, we do, and I long for the days when I didn't have to work 12 hours a day and count every single penny, and refuse to refer people to hospital because we can't afford it, and run around asking people why they do what they do in the hope that we can save a few pennies.

ImagineJL Sun 10-Mar-13 11:17:05

Boffin I was referring to your original post, about GPs being charged.

ThreadPirateFanjoBeard Sun 10-Mar-13 11:20:27

Apalling all round. Lots of patients won't seek help, because they will be frightened of being ' told off' by their drs. Some are probably the same people who will be losing DLA and other support. Meanwhile all the bigwigs swan off to their (private) drs whenever they need to. This country is turning into a 2-tier society. We'll have the workhouse back before we know it angry

RedToothBrush Sun 10-Mar-13 11:20:53

So you think that rude letters like this are acceptable or appropriate? Because its appeasing the CCG bosses?

Its inexcusable no matter what the financial position of the this, to write letters to regular 'customers' who have a proven and valid medical condition that the GP is fully aware of. People like the OP are the ones who are most familiar with the system and least likely to abuse it for that reason.

Common sense comes free and GP are supposed to be some of the most intelligent individuals in our society.

They need to have the balls and confidence in their decisions to stand up to CCG bosses; not be bullied by them.

Frankly thats what I'm paying my GP to do.

IShallWearMidnight Sun 10-Mar-13 11:30:41

so how does it work then, if you go to A&E for something which is obviously an A&E issue, they patch you up, send you home and tell you if it gets worse to come straight back? Does the GP get charged for the second visit?

ponyandpotatopie Sun 10-Mar-13 11:36:02

ImagineJL - are GPs charged for referring children to a pediatrician or CAMHS also?

RedToothBrush Sun 10-Mar-13 11:39:05

The best way GPs have to make money, is to not refer anyone for anything unless they feel it is life threatening or might wreck their targets.


Thumbwitch Sun 10-Mar-13 11:39:08

I rather love Hecate's and Grovel's reply - but would also ask exactly what the GP would have been able to do about your DD's ketones etc.? Do they have the facilities to manage that situation? Somewhat unlikely, I would have thought.

So then - would they have had to send you to hospital anyway? And how much would that have cost them?

Interesting situation they're setting themselves up with.

ImagineJL Sun 10-Mar-13 11:44:30

RedTooth - I agree that the wording needs to be carefully thought out, and a phone call could be more appropriate. Although actually people generally find phone calls more intrusive, and anxiety provoking if they're out and come home to see the GP number on caller display. And "standing up" to bosses is not an option. A CCG consists of a large group of practices in an area, who purchase secondary care as a group. If an individual GP surgery is costing the group too much, the group will chuck them out. And an individual GP practice can't buy services as the funding is only for CCGs. So the bottom line is that, as a GP, if you don't play the game you are essentially shutting down your surgery. It's beyond crap. Thank the government. They don't mention this in the party political broadcasts do they.

IShallWear - yes, the GP gets charged every time you attend, regardless of whether you were told to attend or chose to attend.

The hospitals (who are also desperate for money) operate a sneaky system of double charging to try and get some money. Basically if a GP speaks to a hospital doctor and arranges for a patient to be admitted, the GP is charged. If the hospital doctor chooses to process that admission via A&E (ie assess the patient in an A&E room) then the GP is also charged for an A&E attendance. So two charges for the GP. And no amount of ranting and raving and begging and explaining to hospital bosses can change this.

This is the NHS now. Blame the politicians, not the doctors. We're just pawns in their money saving game.

qazxc Sun 10-Mar-13 11:46:18

I'd be writing what HecateWhoopass did. And following up by ringing and asking repeatedly for the home addresses and phone numbers and or assurances that they will remain open 24/7 for your DD, until you get an apology.

ImagineJL Sun 10-Mar-13 11:48:54

Pony all referrals are charged, although I think some psychiatric services have a different budget so it works differently. I know I can refer as many people as I like to adult psychiatry! CAMHS are tricky as they are hugely over-subscribed and are incredibly strict about who they will and won't see.

ImagineJL Sun 10-Mar-13 11:50:32

Please please don't waste your time and energy complaining to your GPs about this. If you feel strongly enough to complain, take it to your MP, especially if he/she is a Tory. GPs have no power.

RedToothBrush Sun 10-Mar-13 11:50:37

And "standing up" to bosses is not an option. A CCG consists of a large group of practices in an area, who purchase secondary care as a group. If an individual GP surgery is costing the group too much, the group will chuck them out.

Disagree completely.
Standing up to bosses is possible.
What are the bosses going to do if everyone in the group does the same thing? Chuck them all out?

You only allow the system to work if you comply with it. If the system is so broken that all GPs feel the same, they have power to rebel against it.

ImagineJL Sun 10-Mar-13 11:58:15

Red it's just not possible. In order to get an entire CCG of GPs to rebel you would need a strong, motivated, powerful leader, with plenty of time on their hands to coordinate such a rebellion. And you would need the GPs to have confidence that they weren't going to be doing themselves out of a job. No-one has the time to take on such a battle, as we're all too busy actually doing the job. Sure we have a committee who haggle and negotiate, but a full scale rebellion is just out of our reach. For a start, who would see the patients while we were rebelling? And ultimately, no one individual practice is prepared to risk the livelihood of their staff and the care of their patients, by just doing what they want and seeing what happens. Rebellions are time consuming and risky, and we can't afford to leave 2000 patients per GP without a doctor to see.

krasnayaploshad Sun 10-Mar-13 12:11:37

OP, you could try this:

Dear GP,
I do apologise for making you concerned & disturbed about my DD's recent treatment. To avoid this in future, I recommend that you provide a 24 / 7 service so that next time my DD has a medical emergency at 3am, I can visit you instead of the a+e.
I am worried as to why you felt it necessary to write to me immediately with your ridiculous complaint.
Please make time to explain this to me, make an appointment or telephone as this issue needs to be discussed.

Yours Sincerely,


Oh & yes, YANBU

RedToothBrush Sun 10-Mar-13 12:18:41

Bullshit Imagine. Just bullshit.

Leaving 2000 patients without a GP just isn't going to happen.

You just don't want to try and its all about making excusing about why you can't. If there is a will there is always a way.

ImagineJL Sun 10-Mar-13 12:21:52

Krasnayaploshhad have you read any of my posts?

You see RedTooth - this is the kid of support we have from the public, so how do you think they'd feel if their GP surgeries were closed down because we were trying to make a point? No-one wants to hear the truth or our point of view, they just want to be able to see their doctor and not be drawn into financial issues.

ImagineJL Sun 10-Mar-13 12:27:15

Red you have no idea. We are drowning in work,no-one has time to take this on. This Isn't a Hollywood movie, it's real life. We have lives, families, school runs, shopping, housework. I work non stop from the moment I arrive at work until the moment I leave 12 hours later. I have no breaks. Much as I loathe the government and these sanctions, I have no capacity to taken them on.

BalloonSlayer Sun 10-Mar-13 12:34:09

It its very rude of the GP in any circumstances but it does seem like they have been given information that has become muddled.

You took DD to the OOH on Saturday
You took DD to A&E at 3am Tuesday
DD was discharged during what would have been surgery hours on Tuesday.

The three events seem to have got somehow conflated, and the GP seems to have been given information that you took her to OOH during surgery hours on Monday.

The GP's letter - rude though it is - is reacting to the information the GP has been given.

I think you need to make sure you don't reply to the GP assuming that the GP is complaining about DD going to A&E at 3am, because it is clear that the GP is not saying that.

I think you need to politely tell GP in a letter that their information was totally wrong. Acknowledge that it is probably the hospital's fault that the GP received incorrect information, but nevertheless it is the GP's responsibility to check that their information is correct before they start sending out letters such as the one you have received.

And THEN give both barrels about the threatening, patronising, insulting tone of the letter . . . complain about being criticised for taking your DD to the OOH on Monday when you had to take her to A&E because the Doctors were closed at 3am.

I think you should add that you expect an apology, and suggest - as others have recommended - that the GP follows their own advice to you and phones or makes an appointment to explain themselves.

And mention that you will complain to the practice manger etc etc.

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