One appointment, one issue

For me this was a benefit of not having face to face appointments in covid. Before then my doctors would discuss 2 symptoms and no more. If you were lucky you might get a double appointment so 4 symptoms. I had 20-25 which led to various outcomes depending on how you group them. Everything from a vitamin deficiency to cancer and AIDS.
Had a telephone appointment in covid times. Explained this to the dr. She sent me a link to upload a document too. I wrote it all down. Uploaded it. She called me back a couple of days later and arranged full bloods.

Of course even telephone appointments these days aren't that helpful.

It is harmful to patients and it is totally inefficient and wastes a shit-ton of money.

So many studies have shown that if you do the 10 minute one-issue model, people keep coming back over and over, progressively deteriorating between appointments, so that by the time all their issues are dealt with they are far more complex than they would have been if they had just been dealt with properly on day one. Every bit of evidence clearly demonstrates that the only way to save money and ensure people are kept healthy is to give them as much time as they need in an appointment, covering every possible issue. The 10 minute model is wasteful and inefficient and GPs hate it. I can't understand at all why they persist with something so stupid.

I agree totally. I have an appointment later this week due to suspected coeliacs disease. Typically my endometriosis is also now flaring up and I'm having lots of mid cycle bleeding. Getting a face to face ever about my endo is nigh on impossible and generally get fobbed off with a pharmacist call (who always sheepishly admits they don't know what to advise about endo and HRT).

I could try and shoe horn it into my appointment but I suspect they will use the endo as an excuse not to explore the coeliacs. Honestly it's so hard sometimes, I'm just trying to feel as well as I can function!!

I think the way your GP surgery is applying the policy is ridiculous. I think it's fair enough for GP surgeries to ask patients not to raise two or more unrelated issues at the same appointment (eg if you want a mole looked at and also want to discuss heavy periods you should make a double appointment/two separate appointments). But where conditions are related to each other, patients need to be able to discuss them all at the same appointment. If your symptoms don't improve very rapidly with whatever treatment the paramedic prescribed, I would go back and insist you need an appointment with a doctor. Be prepared to make a formal complaint if the practice tries to refuse.

It is bonkers. I have been a bit unlucky healthwise over the last few years and am under the care of: cardiology, rheumatology, neurology, gastroenterology, orthopaedics - all of the problems interact and influence the progress of others.

It fits comfortably with the surgery for one item to be addressed at a time, but it is clearly nonsense. and the knee jerk reaction of passing people on to lots of different specialities is needed on some occasions but causes fragmentation of care which is exactly what the GP is supposed to be managing. They are supposed to have an overview and cannot do that if they insist on only addressing one problem, especially as further appointments are so few and so far apart.

And on the subject of booking with a GP and then seeing someone who is not a doctor ...... words fail me.

I had a 111 callback from a "doctor" who turned out not to be. Half way through the conversation I clocked this as she was proposing to prescribe something that was incompatible with another of my meds - I asked her directly if she was a doctor.

Ten minutes. Seven if you are a regular and they consider you a bit batty and/or a pest.

It is not good enough. A bit longer and they might save themselves more appointments.

I do find they can be trying to see so many people in one day it cannot help them do their job properly.
Some surgeries intake is wide. Too wide. And too many work part time and not full time.
One of the issues is that they are businesses. And so want to make money by giving you tablets ( they get money from the NHS if the practice meets various tablet targets), but spend less on actual staff.

It has to change. There has to be a better model.

I read a paper on use of GPs a few years back.

Couple of thing stayed with me:

Lots of people don't want to "bother" their GP unless it feels very important, which is often when they have a number of different concerns built up.

People with embarrassing or mental health problems often will start talking about something else (eg backache) until they feel comfortable, then will bring up the real concern after that.

This one isn't relevant but stuck out - on average most GPs interrupted the patient before the end of their first sentence!

Obviously I don’t know who OP saw, but I’ve seen/spoken to a paramedic twice at our surgery.

The first time she examined me, did some basic obs, then went and got the GP who then repeated it all.
The second time she prescribed antibiotics for a UTI over the phone - I think some paramedics have additional training to allow prescribing for things like that but not more complex issues.

Don’t see a PA or paramedic see a GP

Are you sure you saw a paramedic and not a physician associate ?

Neither should be diagnosing you

Yes, if you need an interpreter.

Can you book a double appt?

I had an appointment where I complained about irregular periods. I also mentioned bloating and was told one complaint per appointment.

This was utter madness.
The two are connected and can be symptoms of the same condition.

I agree it’s dangerous.

Patients might not be best placed to connect symptoms either. You might find something that seems unrelated is actually really important, but as you can talk about it, and doctors generally don’t know the patients well enough to connect dots, it never gets discovered.

You're right OP, in your case the two issues are connected and it's relevant to ask about current medications and how they interact with the matter you are there for. You weren't bringing up a separate matter like an ear infection or a broken toe.

Edited to add: my gp was treating my peri and asked about other symptoms, i said constant stuffy nose and my RSI had got almost unbearable. He said both matters were hormone related and gave me an increased hrt script and some anti inflammatory nasal spray. Thing is it didn't cost him more than 2 minutes and meant i'm more productive at work, and i won't have to make further appointments down the line that will cause more backlog at the surgery.

It’s crazy and dangerous

It really is an issue - you can see why they brought it in as a principle, to stop people using their time with a GP to run through lists and lists of minor gripes.

But the body is holistic and medicine should be likewise. I often have this conversation with a friend of mine about how the lack of joined up thinking contributes to fractures within services - all of which are at overall detriment to the patient. We like to have this whinge as we both worked in the NHS for well over a decade each - doesn't stop staff being dedicated and professional, but there are some areas that just don't operate effectively for the patient.

I hope you get the care that you need and are feeling better very soon.