One appointment, one issue

I think when you mix money for as an incentive for reaching a target on prescribing, you are in danger of compromising how you practice medicine.
I think that is the problem.

i think we’re actually mainly agreeing on the prescription thing. So yes dispensing practices that meet pre-defined clinical standards get rewarded - so for example prescribing generic rather than branded drugs, or prescribing statins for patients who meet certain criteria. Why is that an issue? These measures save the NHS money and should provide better health outcomes.

I did not say they did. They do get money via the NHS if they meet certain targets. Dispensing practices can earn extra money for doing so. Some get incentivised payments for issuing certain types of drugs.
To suggest they do not get money via prescriptions would be incorrect. The problem is they are businesses.

Therr are certainly isssues with GPs but it’s not true that they make money every time they write a prescription. And although they are businesses, they are not like private healthcare in that they are not making a profit on each consultation. Their income is based on other factors such as the size of their list and certain performance targets.

It's why complex conditions like MS are so under-diagnosed. The symptoms are multiple, and very far-ranging. A GP has to add up lots of different presentations, usually over a long period of time.

I actually think that AI could be used to review a patient's full history and prompt a GP ask specific questions or flag conditions they should be ruling out. It could never replace a qualified person examining a patient, and I wouldn't like to see AI making diagnosis and prescribing (not yet, anyway), but I would provide the GP with a back-up check to allow them to work more efficiently and wholistically.

Yup, stiff neck is classic. You may find you need to change your pillow or sleeping position. Body pillows are great for side sleepers and if you get sore hips, and you can get orthopaedic pillows specifically for sore neck. Some take a bit of adjustment to get used to, so do a bit of research, don't get the really expensive ones! I can recommend a chiropractic adjustment if you can afford it.

The RSI was miserable, I'm so grateful to the GP for spotting it was made worse by the peri. When I thought about it I remembered that carpel tunnel syndrome is common in pregnancy, and my RSI was terrible when I was expecting, but never gets mentioned with meno!

I can understand your frustration. Symptoms don’t always fit neatly into separate boxes, and sometimes the wider picture is what helps a clinician understand what’s going on. I appreciate appointments are limited, but patients should still feel listened to and have a chance to explain how their symptoms might be connected.

Thanks so much! I definitely get a stiff neck from sleep fairly often and have various minor allergies eg dust ... I am a state in the morning. Luckily don't suffer from RSI - that sounds horrendous

Sure! Fluctuating oestrogen causes systematic low-grade inflamation throughout the body. So you might notice a constant stuffy nose, stiff joints, and flare-ups of pre-exsisting autoimmune conditions. Inflammation is also what causes the brain fog. Pregnancy can cause these symptoms too, but with perimeno it tends to be more severe.

The inflammation made my RSI so bad it was constantly burning from my wrist to my elbow, i couldn't even pick up a jar of coffee. I've also started getting stiff ankles and achilles in the morning. Inreased HRT has calmed the RSI, but it took months before i could use that arm properly again. Frozen shoulder is also a common complaint in perimenopausal women.

Look up Hormonal Rhinitis. You can get a nasal spray with a mild steriod in the pharmacy. Once you've delt with the inflammation, regular use of saline spray helps to keep the skin high up in the nose clean and less irritated.

Sorry to go off on a tangent but could you tell me about the stuffy nose and peri?

Since it started being autumnal outside I'm frequently sniffly and snotty.

That good old adage of ‘the thing you suddenly say ‘oh by the way I also …’’ about being the thing that will get the gp thinking is so true.

Monkeymama … I am always really happy to look at a list and go through and say what may be related .. but then I need to make a plan to deal with what’s important and ,maybe related , and what isn’t.
Its not fair on me , or other people waiting, if there is a list unrelated things and I am not doing a good job of if I try to deal with all of them.
I am a good GP.. I work hard, I really have genuine care and regard for my patients. I don’t usually have tea break and this week I missed my lunch break to help someone who needed me and was in crisis.

The thing is though if everyone did this every appointment would overrun. I bet you’re the type to sit and complain about appointments being delayed!

My thought is that she will be qualified as an Advanced Practitioner. That is to say that, yes, she initially trained as a paramedic and then will have had to complete a further 3 years' training (similar to GP training) in order to be able carry out her role effectively. She will then need to debrief at the end of each day with a GP.

This is what it used to be like.

I realised after my last appointment that the person I saw must have been more interested in checking boxes.
I went in with my one thing but they were more interested in asking unrelated questions which once upon a time my family doctor would have known the answers to because he was on top of not just my care but my family's care.

I've also learnt not to say anything unless you want to see it written in your notes. I was paddling hard, trying to build some sort of connection with the practitioner that I saw and there was one of my throw away comments written down when I checked my notes (other important stuff was not recorded).

In addition, if anxiety is a resolvable symptom of the thing you suspect is wrong with you, try to mention any other symptom but that one or you risk being ever more labelled with anxiety and any future physical symptoms put down to it (diagnostic over shadowing)

I had a recent experience of the same and ended up paying for private blood tests.

Then I was gaslighted that 'we wouldn't have said that, let me check who your last appointment was with......oh it was me....I wouldn't have turned you down for blood tests'.

Unfortunately, I don’t believe that this statement is correct. It is very convenient to think the one single change would revolutionise the primary care model to such an extend that the current profound mismatch of resource vs demand would suddenly be resolved. It’s a nice fantasy, but it’s exactly that- fantasy.

The truth is the problems are complex, wide-ranging and not solely rooted in primary care/GP failings. You would need to simultaneously fix problems in: GP and practice nurse recruitment and retention; the significant issues with primary care/community clinical support, such as district nursing, community pharmacy, rehab (OT/physio); community/cottage hospitals; and the availability of home care, including rapid response services. That’s before we even touch on the problems within secondary care and how they impact on primary care services (and yes, problems within primary care also impact on secondary care too).

It is simply untrue that the demand is driven solely by the 10 minute appointment system. I am sure longer appointments, allowing for a more holistic view would have an impact both on appointment demand and improving patient care and the patient experience- particularly for those with complex and/or chronic illness. But it would not, on its own, reduce demand sufficiently for it to offset the reduced number of appointments available without increasing waiting times. It’s something which has actually been looked, the conclusion from modelling would suggest your assumptions about the impact are not borne out. It would require a substantial increase in clinical staffing and, in some cases, expansion in physical resources such as larger surgeries to accommodate this. It’s not that it cannot be done, but it has to be financed and the clinical staff available.

I am not defending the current system it as the ideal. It isn’t. If you were designing a modern, effective healthcare system, the current system (both in primary and secondary care) is absolutely not what you would produce.

The demand exists because of the 10 minute appointments - if the same system continues, the same problem will continue. Obviously, changing things would be difficult and require a big initial push, but the fact is that most people don't want to keep going back to the doctor over and over - they want their issues dealt with and once that's done, the demand will go down.

Ridiculous. I have chronic complex issues and only see one gp as he knows and understands and remembers which is very efficient.However you have to book ahead. If something urgent comes up you get a gp in training, which can be ok , but they seem to follow a script. I have no objection to a nurse giving me antibiotics and have seen a pharmacist for a med review. I would only let an actual doctor diagnose me. I dread my lovely gp retiring as I know many don’t have this luxury.

In an ideal world, I would agree that longer appointments would be a good idea. However, the current mismatch between demand and resource is such that it would simply create a new set of problems, because if a GP had 30 minute or 45 minute appointments- or however long is decided upon- they will inevitably be able to see fewer patients in a day.

So even if it did result in fewer repeat consultations (which I agree it probably would), that reduction would need to be very substantial to prevent the almost inevitable consequence of longer GP appointments leading to even longer wait time to see a GP (which would be viewed as unacceptable). I have grave doubts that the reduction in repeat appointments would equate to the number if appointments lost due to lengthening appointment times.

I don’t disagree with the principle, the practicality under the current resourcing model seems likely to cause other issues. the resource- financial and staffing- is highly unlikely to change in the near future.

I have found taking my own notes (that I am happy to hand over) saves them time and they are more open to discussing the crossover due to having some of the ‘legwork’ in front of them.
I understand not all GP’s view this as helpful but mine finds it particularly useful and my appointments are much more efficient.
Hope you get sorted soon OP

I’m ever so grateful for private medical care, it’s a necessity now it seems. Went to the Gp the other day and I think I spoke about 7 different issues, went away with a few referrals too. It’s an absolute joke, 1 appointment per issue

When you try to book a double appointment you get the Spanish Inquisition anyway, why do you need it whats the symptoms, who has told you to book a double appointment, questions questions questions

One appointment one issue is the reason that early diagnosis and treatment of cancers is so bad in the UK. My DH had a cluster of symptoms and I was reasonably sure that they were indicative of something serious. When we saw the GP she was only interested in the main one - shoulder pain, dismissed the rest and said they weren’t connected so he would have to make another appointment. She diagnosed him with a trapped nerve in his shoulder - he’d been suffering with worsening pain over a period of about five months and had seen the same GP at the practice throughout this time - fobbed off with painkillers and anti inflammatories.

This time she reluctantly referred him for physio. He never got there - before they could make him an appointment he fell and broke his femur. Apparently this is the strongest bone in the body and the ease with which he broke it prompted a full investigation when he got to hospital. He had lung cancer which had spread to his bones and the shoulder pain was apparently a common symptom when paired with the other symptoms which we tried to report and which the GP dismissed - I believe in favour of the easiest diagnosis to get us out of the surgery.

He never recovered - they couldn’t even treat the cancer because while in hospital he developed pneumonia secondary to it and had to be placed on a ventilator. He died a week later. They may not have been able to change the progression of the disease but at least we would have known about it earlier and would have had the opportunity to say our proper goodbyes. Instead of which I watched him slip away in front of me, unable to communicate. I will never trust another GP as long as I live.

Ive seen the dr 3 times in 3 weeks because i can only talk about 1 thing at a time. I even said surely a 3rd app is a waste of your time too and she said yes but im running way behind (and it was only 9.15am) and so you need to come back. What's worse is i wss being referred to the hospital for a skin issue and I wanted to talk about another skin issue, so they could very well be related. I also have a chronic condition and my body react different, so really, I do need to talk about "unrelated" issues because they need to know the whole picture to diagnose properly.