Why are GP surgery’s still locked down?

[Itwasoverwhen]

I work in an acute hospital which is fully open (in and out patient). A&E is open. Minor injuries is open. Urgent treatment centre is open.

Tried to get a very rare GP appointment only to be told they are doing face to face, I need to wait for the next block of telephone appointments to be released on Monday (for the following week) and then ring and try to get one of them. They’ve suspended the online appointment booking facility and you have to sit in a queue on the phone hoping you get a phone appointment for the NEXT week?!

Are they ever just going to open up again?

@FrancesFlute @LadyWithLapdog

How does your hubby ensure his quality of work is up to par if he is working such long shifts? Surely there would be more risk for human error working those times. I can't see what's wrong with asking them to temporarily work weekends or have shifts so they cover the weekends. Instead of jamming everyone into 5 days and then the cycle begins every Monday of trying to get an appointment.

Remember they brought doctors out of retirement to deal with covid becos it threatened the economy now it's starting to move again, there needs to be a similar initiative to get the back log reduced.

@Itwasoverwhen

It’s fucking barmy. Don’t tell me GPs aren’t locked down when the place is like Fort Knox guarded by a receptionist wearing more PPE than the doctors in the hospital wear. Temp check, new mask, hand sanitizer just to stand at the door whilst they fling a prescription at you.

Same at my surgery I half wondered do GP’s know something we don’t and are refusing to work as before ? Plus my gp is suddenly retiring after telling us 2 years ago he would be at the surgery at least another 10 years now he can’t wait to go and it does all feel very odd

[quote Rubyrecka]**@FrancesFlute* @LadyWithLapdog*

How does your hubby ensure his quality of work is up to par if he is working such long shifts? Surely there would be more risk for human error working those times. I can't see what's wrong with asking them to temporarily work weekends or have shifts so they cover the weekends. Instead of jamming everyone into 5 days and then the cycle begins every Monday of trying to get an appointment.

Remember they brought doctors out of retirement to deal with covid becos it threatened the economy now it's starting to move again, there needs to be a similar initiative to get the back log reduced. [/quote]
Honestly, I have no idea how he does but that is part of the issue. Noone would choose that working day. He'd love to finish at 6.30pm and be home for 7.

I can tell you why it varies

GPs are independent contractors
Each surgery is it's own small business which is contracted by the NHS
The main incentive for them to behave a certain way is that they won't get paid if they don't eg there are vaccination targets and smear test targets to meet
There is also regulation by CQC to maintain basic standards
If your standards are woeful you could get your contract cancelled but that would rarely happen
Other than that it is entirely up to each surgery how they choose to run their appt system etc
Some were already using more telephone appts pre pandemic but for those who weren't it's a huge shift to change their traditional ways of working. Some will have managed it better than others
GP partners are Drs with very little business training. The practice manager is the business person. Many of them would not have much of the systems expertise that posters often expect on here. It's quite a big call to expect someone to be excellent at diagnosis and treatment of all kinds of illness and simultaneously a great business manager who knows how to manage change and provide a great customer experience
If a practice fails or just no-one wants to work in a certain area sometimes the health board will run it directly which is usually even worse so probably making everything centralised isn't the answer either.
I suspect that if the government wants to see more uniform standards in primary care then they need to a) incentivise what they want to see in the contract eg penalties for not meeting wait time targets and b) provide more business support to spread good practice
Remember that there can be good reasons for variation too. It's unlikely that a Gp practice in Central London and one in Rural Lincs should be run in the same way. Sometimes local variation is good and meets local need.

I was just going to fill in the online form for my DD. She has eczema which has flared and what we usually do is not working so she needs a review but not particularly urgent and maybe they can advise from a photo.
I figured I'll fill in the form today whilst I am not working and she's off school then the Dr can see it when they get back to work but you are only allowed to fill it in within working hours which does seem particularly unhelpful
I suppose they don't want to deal with a backlog on Tues am perhaps?
Things like that are not helpful, are frustrating and do make me sigh but they aren't the end of the world and it does not particularly cause me to think the Gp is incompetent.
Maybe they'll have a feedback form somewhere that I can fill in

@CovoidOfAllHumanity thank you, hope that is helpful for others. I do think that managing appointments and systems is not something a doctor is there for, but wonder how such admin systems could be improved. I expect the reputation of GP receptionists and the behaviour of many when ill (out of frustration probably) does not make the job of GP practice manager a very enticing one.

My only issue is that the telephone ring back times tend to be vague which can be difficult as I work Monday to Thursday talking to people via phone most of the day.

However I've been called in for a face to face appointment which was offered the same day, have had follow up hospital treatment which was swiftly arranged and also several blood tests, one at a different surgery in the evening. Straight in and out and no waiting. My medication has been sent to pharmacy with no issues and letters have arrived via text and email.

I think they're doing a good job and an ongoing hybrid model will probably cut out a good few time-wasting appointments.

Ours is a nightmare - handy notice on the website that they're upgrading their phone system which may take several months (!) to complete, alternative number appears to go to a poor receptionist with a mobile trying to single-handedly deal with the calls that 3 of them would usually be taking! DH had to go and pick up a blood test form the other month, they thrust it out of a window at him.

It's difficult because many of these systems issues require a good non clinical manager to sort out and yet the NHS is routinely lambasted for spending too much on management. In fact I suspect they don't spend enough or get good enough people.

I am not sure why they can't give a proper time slot for a tel appt but maybe there is a good reason? In secondary care tel appts are booked just the same as F2F ones and usually run to time a lot better.
I wonder if it's because they are triaging the most urgent stuff rather than just proceeding through all the calls in order of them coming in?

If the admin staff are not supposed to triage (and most people think they should absolutely not) then I guess there is a risk that the most super urgent thing gets left until 6pm unless a dr looks at the call requests and puts them in clinical order hence the receptionist doesn't know the order and can't give you a time.

@CovoidOfAllHumanity
Each practice does it differently so it varies. Until recently we have to do total triage (directed by NHS England) but how each practice is individual.
Currently we have a list where all the telephone call requests and e-consults go. Two doctors and 1 nurse then go through this list sorting it- they will call anyone that needs a call on the day or see patients that need to be seen that day so they can’t give a time for those appointments. They also do sick notes etc. Anything that doesn’t need to dealt with that day they will be book into a slot for a call/f2f as appropriate. These appointments will be 48hours, 72 hours, 1 week or 2 week and are given a more precise time slot. It needs the clinicians (doctors or nurses) to review and triage hence why when initially submitted a time slot isn’t given.

In secondary care the appointments are booked days/weeks or even months in advance as by their nature their amenable to that- very few OP appointments in secondary care are booked at less than 48 hours notice unless for a cancellation or under the 2 week wait rule for cancer.

I’ve probably not explained it very well but you can’t really compare the appointments in secondary care OP to GPs as their nature is very different.

@Sillyduckseverywhere arrange an appointment with your GP, they can send a text link so that you can reply with a photo of your skin condition. Your GP can use these images, with history taking, to diagnose & treat your condition, & to refer to a dermatologist if required. @Itwasoverwhen GP practices did not close & have continued to provide their services. Telephone consultation is a well established & safe consultation system & is here to stay, the appropriate use of PPE by all health care staff is to be applauded. Many practices are currently overwhelmed, hence why e-consults in some areas have have been turned off.

What's total triage?

I was actually agreeing that primary and secondary care can't be compared and I think I had close to the right idea if I've understood you that it's not 'first come first served' but ordered by urgency by clinicians on the day

I think this needs to explaining better to people as they clearly don't understand why they can't just book a convenient slot. For non urgent stuff you would think they should be able to but for urgent same day then it seems reasonable you would make yourself available if you are that sick to need to be seen same day.

In the old days I think the calling at 8am was only if you wanted an emergency appt that day and that you were asked to wait until later to call for a non urgent appt. that seems sensible rather than having everything in one pot. You could even have an urgent and a non urgent number if resources allow. I think it's the not being able to book a slot for routine stuff that people struggle to understand.
I like to think people would understand that if you want a same day very urgent appt you may not be able to choose the timing.

Ours is like Fort knox. The only level of need you could have to get a face to face appointment would be the same level that they would tell you to go to A and E. There's a huge backlash in the town about it and I suspect this will lead into some serious incident investigations because the behaviour of the surgery has been horrific in some well known local area cases.

My dsis lives one side of a town and to be fair her surgery has been absolutely brilliant.

4 miles away my dp surgery collected a catalogue of errors , all around refusing my DF a face to face appt which directly led to a misdiagnosis which then led to DP being hospitalised. (Including a receptionist that was beyond disgusting to my DF). We actually don't believe in complaining as we are very aware , having spent some formative years in the states (although all British born and mainly resident) of how lucky we are to have state healthcare.

However the consultant that saw my DF in hospital felt differently and raised an incident over how he had been treated.

Look we all know its absolutely a postcode exercise. Some surgeries will be brilliant and some will be awful. However you'll have to forgive my irritation with wailing and weeping that GP's surgeries and receptionists are so hard done by and they couldn't possibly be at fault (as you often see on MN ) when I sat on the phone to my sobbing DM because the chance of losing DF was very high (a long history of medical implications affected by the screw up).

It was directly connected to not being seen face to face and a receptionist spending time telling DF that she was so hard done by than listening to him when he explained his issue.

my GP surgery is only doing triage for scarce appointments by telephoning - granted online requests for repeat prescriptions is available.
I have ongoing heart problems and still waiting on an endoscapy
I cannot do an e-consult (and I suspect this applies to many 'older' people) have ongoing problems and cannot get through to try and obtain a face to face appointment. With age-related health problems there is no point in going to A and E.

All I really want is an MOT and health check (this was usually done by a practice nurse on a 12 month basis.) This for me and many others like me could pick up small problems before they become big ones requiring more NHS resources.
Don't tell me I am the only patient ( for which the GP is collecting money from the government for non-existant service) who is finding the 'new way of working' untenable - anyone with mental health issues, the very old, the forgotten transient population are also left out .

It seems about the only patients who are being looked after are - maternity, child healthcare, and of course the well-heeled who can pay for a GP
rant over

I think it's quite insulting to come on repeatedly on these threads to dismiss people's actual experiences with their GP and say it's just not true. There might be some that are doing as they should but there seem to be an alarming amount of GP surgeries who are still locked down and people are allowed to be frustrated with that. Not be told they're full of shit hmm

I agree with this completely. I realise that services are varying wildly throughout the country, and am very glad for those who are both supplying these services admirably and receiving them satisfactorily.

My own surgery sends out a very clear message that people are not welcome to come in. They take ages to answer the phones and ask you to do everything by email (which is, I'm sure, far from helpful for a lot of elderly patients) - but then they don't reply to your emails. We have to email in our repeat prescriptions and they supposedly send it straight to the pharmacy, but when you turn up at the pharmacy, more often than not, they haven't received anything, or there are random items missing, with no explanation why. Amazon are able to send me (and 100,000 other customers that day) the exact books/DVDs/whatever that I've ordered, but my local GP/prescriber seems unable to carefully read a request list of items that are essential to my health and wellbeing - items that I need every month or so and have done for years.

I would change surgery, but I hear that all of our local ones are pretty much the same.

I'm all for change, when it makes things better, easier, more convenient, more efficient etc.; but this is not what seems to be happening, as far as I've witnessed it. Whether it's the intention or not, I get the very clear impression that patients are an annoyance to be batted away like flies, if they aren't 'properly' deterred in the first place, rather than the whole reason for and purpose of the service in the first place.

My surgery has been great but at work I’m seeing a lot of people who haven’t been able to (or felt able to) access their gp and are really quite unwell as a result.

@CovoidOfAllHumanity Yes- I just wanted to explain to others why you can’t compare as often we get told that if secondary care can stick to the time, why can’t GPs

Sorry I should of explained what total triage is. It was mandated by nhs England- GPs were forced to use it- not by choice. And only in the last few weeks has it started to change. In fact NHS England are pretty much flip flopping on the whole issue. One day telling us it must continue and the next (after backlash from GPs and the public), changed it. Total triage means that when a patient contacts the surgery they provide some information for the reason for contact so that the clinician can then arrange a suitable appointment based on the information given.

Under the previous system patients would, in theory, call to book an appointment either on the day or routine if they felt it was routine issue. I say in theory as the reality was even pre pandemic it was difficult to get an appointment with a GP. And that is down to under funding and lack of staff. Now with increase demand it is even harder so we are needing to prioritise the most sick so routine stuff is being pushed back. So yes sometimes things are getting worse before they are seen but if I only have one appointment to see two people I have to prioritise, which means they lump over the knee pain will win. It isn’t ideal- I wish I could see both but there simply aren’t enough of us.

In reality a hybrid system is what a lot of GP practices would like. There are benefits to more online/ telephone appointments, particularly with the workload at the moment but it does have its down sides for patients and for GPs. Personally I prefer f2f work but I know some of my work will permanently move to telephone/ online.

I fully understand people’s frustration about not being able to see a GPs. And I’m not saying that it is right people are struggling. But it is disingenuous to say that we aren’t working- of course there will be a few bad practices but most of us are working longer and harder than ever. The blame is being laid at our feet for things that aren’t in our control- 1. Less GPs overall 2. Increase in demand 3. Inadequately funded and 4.a mandate from NHS England for the system we have.

@BuggerBognor So what is your solution? Enforce full time working on them? As you will probably end up with even less full time equivalent GPs as a result. Lots of people to train to be GPs as historically it has been the more family friendly speciality and is more amenable to part time working. Generally 2 part time GPs are often working more hours and are more productive than 1 full time equivalent. If you take away my option to work part time I would be leaving medicine altogether because I can’t increase my hours due to my caring responsibilities for my child.

Are your outpatient departments actually fully open?

Last week DS's had 5 appointments between them. 2 different trusts. Only two appointment were F2F, two were virtual and one via phone.

I find it a nuisance that you have to call and request a call back. You have to call at 8.30am which is the time I start work and normally the call back is during the morning - I can't answer as I work in education so no phone access. I think the idea of not having people just making apps when not necessary, so using phone consultations or online etc is great, but giving patients flexibility over when they can call etc would be useful. It's fine if I'm off sick, but a couple of times I've needed help over something that has warranted a day off and I've just had to manage without.

The first stage at our GP surgery is now always a telephone appointment but following that it's generally possible to get a face to face appointment if needed. I think they're doing their best under current social distancing advice.

In some respects I find the telephone calls work better and are just as thorough. We had a call about DS on Saturday afternoon and it went on for nearly 30 minutes so if apologies if you were late having a call after us. Just got to book him in for blood tests now.