My GP has told me that 80% of their appointments don't need a GP appointment.

I think the one issue per consult leads to repeat visits and leads to some health issues needing more interventions further down the line. There is a lack of looking at a patient holistically.

Patients with more complex needs are increasing and there is a lack of looking at a patient holistically - this is further exacerbated in recent years as millions of people now have long covid, with more obviously falling into that bracket every covid wave. Some viruses make you more prone to other ones, as well as increasing likelihood of secondary infections that will need antibiotics. With things like whooping cough, meds should be given quickly, yet even if someone visited doctor, how likely is it that they would be tested?

If a choice is made as a society that presenteeism matters more than health and lower productivity, or that infection control even in places like GP surgeries and hospitals is too costly/inconvenient, or that there is a high threshold to access healthcare if it’s not an emergency, a high threshold to access treatment upon diagnosis, a reluctance to learn about (or in some cases even believe) complex conditions etc…we can’t also stamp our feet or act surprised when overall health of a population deteriorates.

Why not? I always saw the GP for my annual review until 6 or 7 years ago

I don't have toothache but I still go to the dentist every 6 months. I still go to have my eyes checked regularly.

What's so fucking special and precious about GPs that they can't stand seeing their own patients for a regular check up?

Literally the same thing happened to me, too. Two weeks in hospital, almost died, and still don't feel totally back to normal several years later! I hope your husband is doing okay now.

So why does it work for other aspects, such as opticians and dentists? People can make their own arrangements for such things and such places aren't inundated - they manage their new patients, either provide NHS services or not, or refer to specialists/other services as needed.

I think NHS dentists are inundated, but I always think that the system for eyes works pretty well and could be replicated.

I think pharmacists should be trusted to provide more medication over the counter. And for people to be trusted more as well. As an example why on earth does a woman over 60 need to see a GP for thrush? Do they really think that a woman who's suffered from recurrent thrush all her life (or has had a recent course of antibiotics) doesn't know what she needs? For goodness sake give her Canesten. If it doesn't work she'll be back. But it probably will work and she won't be.

So why does it work for other aspects, such as opticians and dentists? People can make their own arrangements for such things and such places aren't inundated - they manage their new patients, either provide NHS services or not, or refer to specialists/other services as needed.

My OH has been told by his oncologist that he needs physiotherapy for a prolonged leg pain. To get that, he has to go through his GP. Just why? Why can't he self refer direct to physiotherapy? Or why can't the oncology refer him directly. That's just one instance of a complete waste of a GP appointment. DH has literally dozens of other instances where one GP specialist/consultant has referred him back to the GP for onward referral to other NHS departments. It's all insane.

When my son had a severely infected toe nail, he was in and out of the GP's for several months before they finally referred him to child podiatry, who sorted him out within 3 weeks (toe nail removal) after several months of pain with the GP surgery farting around with creams and salt baths that did nothing and resulting infections. He then had an "open" file with child podiatry and they told us we could go back at any time in the future if he had any more problems with his feet, no need for GP referral. Why can't other departments do the same?

DH once used 4 different GP appointments over almost a year just to get a referral for a NHS hearing aid. At first appointment, the GP found an ear infection so that had to be cleared before a referral to audiology. A few weeks later, another appointment to check it was healed, which it was. Then told to wait a few months for an audiology appointment. After six months, he chased audiology to ask where he was in the queue and they said they had no record of the referral. So he phoned GP surgery who admitted they'd forgotten to send the referral but couldn't do it as he needed an ear inspection again as it was several months since the last one. Of course, the other ear had a minor infection, so antibiotics again, and finally another GP appointment a few weeks later, found to be clear, so the GP actually sent the referral and he was seen by audiology within a few weeks. Now, a few years later, he can go straight to audiology for reviews/new hearing aids every few years, no need for the GP to check ears are clear, at the inspection, if there's any wax, they just clear it there and then, if any infection, they issue antibiotics, but most times, they just do the inspection and hearing test. So no need for GP once you're in the system, but nonsensically, a need for GP inspection before you get referred. Make it make sense!

Health anxiety also needs treatment, a GP should be the one to assess need for that.

That's true.
It's a bit 50/50 as to which would work best.

Without GP's as gatekeepers there would be thousands of people who DON'T need to see consultants clogging the hospital waiting lists.

No but everyone I know who goes constantly has health anxiety or sees it as a ‘day out’.

I know a few people for whom their health has become their hobby, they go online and convince themselves they have ASD/ADHD/fibronyalgia/ME/CPTSD, and then sort of ‘live’ in their condition talking about it endlessly and joining support groups. When the diagnosis doesn’t happen they pursue another, or if it does, they pursue another anyway. It’s like they can’t cope if they don’t have a series of appointments to attend and somebody they feel is heavily invested in looking after them and exploring their mental state.

Exactly. I've often thought that the few occasions we've needed any kind of medical attention whilst on holiday abroad, their system of clinics etc has been far more useful/superior to the UK's outdated GP system. In literally every instance, we've been in and out of the clinic pretty quickly, had wounds dressed, blood tests, once an x-ray, and walked away with the prescribed drugs, all quickly and stress free, no referrals, no having to return the following week for something simple like a blood test, etc. We're really behind the curve in the UK with having GPs as gatekeepers, even more so now that most GP surgeries don't actually do much anymore, i.e. ours doesn't even do blood tests in house, don't do innoculations, don't do minor injuries, etc - they're basically just desk jockeys doing admin.

Econsult isnt a thing here. Id actually say telephone isn't a thing; to make an appointment you have to be at the surgery in person at 8.30. God knows how anyone who isnt mobile or has caring responsibilities or a job ever manages.

So true.

The last time I went to see the GP was a severe ear infection. I went through triage and it was decreed that I had to attend for a face to face for an ear examination. All good and sensible so far.

But, at the consultation, the GP couldn't find an otoscope. She checked all the drawers/cupboards in the consulting room, but nothing. Then she disappeared, presumably checking the other empty consulting rooms, and re-appeared maybe 20 minutes later proudly presenting it saying "finally found one". Then she started looking through the drawers and cupboards again, this time looking for a plastic hygiene cover for it, and then disappeared again for another 10-15 minutes, but came back crest fallen as she couldn't find one!

All she could do was suggest I phone for another appointment in a couple of days' time as she said she'd asked for some to be ordered which would take a couple of days.

Complete waste of half an hour of her and my time!

If they can't get such simple basics right, there's no hope for them.

My DH was diagnosed over the phone with gastritis by the GP. He ended up in hospital in a very serious condition with pneumonia, pleurisy and empyema. He needed i/v antibiotics and had a chest drain and narrowly avoided surgery for removal of infected material from the chest cavity around the lungs. He's been left with internal scar tissue that still causes pain and discomfort a year later. He should have been seen by the GP but they are still doing more phone appointments than face to face. I don't believe that 80% of appointments are unnecessary.

I suppose it depends on what defines need. I live in a country where a GP is a reassuring presence for minor ailments, if I had tonsillitis I would see an ENT etc which I can do in any polyclinic in most malls. I have looked at my last 3 GP visits, cuticle infection in finger got Flucloxacillin oral and Bactoban cream, referral and bloods for cosmetic surgery (not covered by insurance cost £50) and Sciatica, had MRI and painkillers, referred to neurologist for surgery opinion. None of those things would have happened in the UK. If I was dying, I wouldnt have to wait for a GP appointment and they wouldnt think it was their job anyway. I have lost a couple of family members to the GP issue, both from ovarian cancer, only diagnosed at stage 4 after literally years of begging to see a GP and the rare times they did, being fobbed off. I have a parent here with me at the moment who came because of a chronic UTI which the GP said you will have to live with. So no. I dont feel sorry for GPs and despise the whole dont bother the doctor brigade. In other countries you send your child to medical school if they aren't clever enough to be an engineer. You lot treat them like gods and they aren't even very good at what they do, on the occasions they do.

Totally agree. Time management and organisational skills are few and far between.

'Using minimum wage, non medically qualified staff as cheap triage is shitty employment practice and even worse patient service.'

Suggesting that those on minimum wage cannot be taught how to allocate appointments is just not true. It's a GP surgery not an a&e anyone presenting will have minor ailments and those with issues that need seeing that day can be seen that say. To have a GP answering calls and allocating patients is crazy. No wonder some say they're overworked.

Ours just use econsult. You submit one, someone <even those on 'minimum wage'> review it and the appropriate person gets back to you. Works fine.

Really? My family member, the A&E consultant with 30 years experience in the NHS at a busy city teaching hospital would disagree with you wholeheartedly.

Oh and I’d be fine moving to state backed insurance models as used by most of Europe. Not least because the sheer dysfunctionality in the structure and organisation of the modern NHS would be forced to be modernised and the concept of patient time having a value is much higher.

excellent idea. Other practises could note what works.

I think if a consultant decrees someone a time water, they probably are - no one is going to risk declaring someone that unless they are sure.

Just because you know a few bad examples, I highly doubt it outweighs the amount of drama llamas my BIL seems to see on a daily basis in A&E!

Honestly, it really is no wonder so many doctors are leaving given the scorn the face from the public…many of whole have nothing wrong with them. TBH we’d all be a lot better off if it was privatised - maybe people would stop wasting doctors time then!

Nail on the head!

It may save on drugs but what does it cost in terms of extra GP time and wasted patient time and of course pharmacist time to fulfil the prescription?

There is no such thing as a “one minute task” as anyone who has to bill by time and justify that time will tell you. Indeed I’m sure most doctors will tell you this from their private practices. One of the long term systemic problems in the NHS is excessive focus on Cost 1 within fiefdom 1 whilst ignoring Costs 2&3 in other fiefdoms. It almost never looks at or even cares about TCO as any business and most of the public sector has to do.

IBS is a diagnosis of exclusion, not of "fuck knows and I can't be arsed to look properly". Unless you are willing to let the NHS play fast and loose with your health, all unexplained symptoms of bowel cancer (change in bowel habit, abdominal pain, bleeding, etc) should be investigated, especially if there is a family history, and you are NOT too young. (I was barely 30 with no family history).

This! I was diagnosed with IBS for 20 years then eventually referred to a dietitian for something else and then diagnosed with adult onset CMPA. Giving up dairy completely meant my "IBS" went away.

After 5 years of no dairy and no bowel symptoms, I get new pain and rectal bleeding plus other symptoms such as weird skin bruising and poor wound healing, perhaps some kind of deficiency maybe? But also I have a family history of diverticulitis and bowel cancer....

So I go back to doc....... and they smile patronizingly and say well you have a diagnosis of IBS and it is just anxiety because you were abused as a child 🤬

Yes I have doctors and other HCPs in the family. Everyone of them has the tale of the broken toenail in A&E. The difference is they don’t generalise that to claim everyone is a time waster or a drama llama.

Your sneery comments about indigestion pain are particularly inappropriate since it can also be a symptom of heart problems. Upthread I posted about two cases I know myself of men with no previous history or alerts who died of “indigestion” which was actually angina.

Don’t blame patient for the dysfunctionality that is the modern NHS. Have a closer look at the piss poor communication between fiefdoms, to patients and the 18th century business practices and fix that. Don’t be surprised if the number of “time wasters” goes down dramatically as a result.

I think much of the NHS confuse being busy with working effectively.

And yet practices manage it just as mine does. They use GPs and occasionally the lead practice nurse for triage. The whole point is it saves them time, money and appointments and their patients get a better service and less wasted time as a result.

Patient time has a value too, although you wouldn’t believe it considering the dysfunctional structure and communication between providers/trusts etc.

If you were on triage eg one morning a fortnight that would be your appointment schedule for the morning planned in advance. The overall demand for appointments goes down. Using minimum wage, non medically qualified staff as cheap triage is shitty employment practice and even worse patient service.