One appointment, one issue

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.

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'.

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)

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.

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!

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.

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.

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.

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.

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

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.

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!

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.

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.

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.

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 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.