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?

Our GP is locked down like fort knox. The receptionist is wearing more PPE than I wear on an ICU.
My poor neighbour in her 70's struggled to get an appointment . She had been diagnosed over the phone as probable chest infection. It hadnt cleared after she finished her antibiotics , but she was struggling to get an appointment to get checked.
You have to phone at 8:30 for the days phone appointments, but it was constantly engaged and then they had all gone by the time she got through and had to start the whole rigmarole the next day. She couldn't do it via the web as she didn't have a smart phone or internet access. So she put it off because she didnt like to be a bother
Lovely lady. she died last week of undiagnosed non hodgkins lymphoma because by the time she was taken to hospital extremely poorly it was too late.

Ours is doing telephone still but they ring back normal within the hour.
I rang for ds Friday. She rang back about 40 min after. Then said she wanted to see him and for me to pick any time I wanted. So I did for 30 min after that.

@BuggerBognor Very few GPs I know do private work and I know many given I’m training to be one. Know far more secondary care doctors doing private work.
And it is very short sighted to put aside work life balance. Burnout is a massive problem and you would be kicking the can down the line. I’m part time as I can’t work full time due to looking after my son- it isn’t about work life balance it is practicalities. It wasn’t a given for me as I’m in training. I had to apply to the deanery and justify my reasons. Yes part time isn’t a given in many professions but stopping part time work for GPs isn’t solving anything. Just going to make shortages worse.
As to automation you are being frankly ridiculous there.

It is near impossible to phone our surgery, they never answer the phone. Routine telephone consultations and blood tests are three weeks ahead. The receptionists give out test results and medical information, completely inaccurately in my case.It takes a full week to get a repeat prescription.
All our GPs work part time so can’t be burnt out.

I don’t understand how you plan to automate it any further than what happens now? Which is why I said that is ridiculous. Automation implies a robot responding to queries or a fixed protocol. You still need the healthcare professional to actually review the clinical information. 111 operators are reading from a script, sending you on to another service be it an on call GP, minor injuries, a and e, pharmacy etc. so I really don’t understand what you mean by automation.

With regards to part time GPs- as I said 2 GPs working part time are more efficient than one. According one survey 1 in 10 part time GPs work the equivalent of full time hours in other roles. You seem to be arguing for forcing all GPs to work full time which will mean many of us will leave. There is a recruitment crisis in primary care and forcing full time work on people won’t help that. That will be more training money wasted if we leave because we can’t work part time.

I’ve shed out a fortune in my uni fees, course fees and my exam fees. I sped money on my continual professional development. Yes it costs the government to train me but I’m contributing hugely to that- not only through tax but through my own expenditure. Much the same as your husband may have done for his training depending on when he trained.

You said yourself had to change jobs to work part time and took a pay cut. If part time isn’t an option then equivalent of doing that for me is not being a doctor altogether, which is again a waste of money spent on my training.

Trust me- many GPs would like to find a solution for the problem but it isn’t a quick and easy fix. It isn’t a cheap one either but the continual posting of GPs are lazy, hiding away etc isn’t helping and is pointing the finger at the wrong person. The current system isn’t working, it is shit for patients and shit for GPs. People need to look to the government on that one.

If you are inclined take a look at this, www.bmj.com/content/367/bmj.l6813

All our GPs work part time so can’t be burnt out.

How do you know what they are doing?
When you say part-time, what do you mean?
Do you mean they are only available to see patients part-time, that they are part-time GPs but also teaching or covering a hospice or acute hospital emergency department? Do you mean they work thirteen or fourteen hour days over four days - so have a day off each week?

You can’t get into my surgery without an appointment - this means that phone lines are now even more busy, a pre queue to get into the main queue and average waiting time 45 mins if you’re lucky.

If you manage to get through all of that abs are lucky enough to get an appointment, your assessed by a GP and then told to come down to be seen face to face if deemed necessary. So basically one person can use up 2 appointments..

Ours is locked still. Prescriptions thrown out of a side window; phone call appointments only and if you don't get through at 8.30am you've got no chance of one.

DD ended up in A & E on thursday - she's had months of heavy bleeding with her periods, and passed out at work. They called an ambulance, and she was given a scan/blood tests and saw a gynae - Dr all within 5 hours. She's seriously anaemic, and has been advised to have her implant removed and replaced with a Mirena. She came home with a massive cocktail of medication.

She should never have had to go in there, she was horribly embarrassed and it wasn't appropriate as it was neither an accident nor an emergency. But she's been trying since November to book a GP appointment.

Mine have finally taken off the “as I’m sure you are aware, there is a global pandemic…” message at the start of every call, before launching into their own message before you could even press 1 for the receptionist or 2 for the prescription line.

To be fair they’ve been awful for a long time even pre-pandemic.

I really need to change GP actually, I called for my prescription the other day on my tea break and was seventh in the queue, called again at lunch and was 19th in the queue and it was the only day I could call. Absolute nightmare! Had to get my husband to phone in between his work calls.

I wish we had an online system or easier way of ordering repeat prescriptions.

I do appreciate that, like schools, some gp practices has done well but others really have not. Our go practice has been operating a combination of online and telephone triage. DH completed the online form and heard nothing for a couple of weeks. At that time it was almost impossible to get through by phone. When his condition worsened he ended yo going to a&e and was very seriously unwell. Thankfully, after a couple of days he was stabilised and able to return home. More recently, DC had a strongly adverse reaction to their first covid vaccination. Tried calling gp - only to get an automated reply stating no appointments, call back tomorrow. Same message next day. Ended up calling 111 and being sent urgently to a&e. Was in hospital for over a week, a further three weeks off work and still not entirely back to normal. When you are able to get through to book a telephone appointment, as others have said, you are expected to be available whenever the doctor calls. This is not always possible - not everybody works in a job where it is possible to drop everything to take a call and not every condition requires taking time off work.

Mine is only doing telephone appointments, and when you ring up you have to listen to a full two minutes of covid/vaccine guff before you’re even put in the call queue.

I feel like screaming “I don’t give a fuck about covid!!” every single time.

A few weeks back I waited a week for my telephone appointment, the Dr rang me three times in the space of a minute which I missed because I was on the loo, then he put me down as a no-show and took me off the appointment list, and I had to re-book and wait another week.

The issue that I have is the time that it can take. I could telephone for an appointment tomorrow, not receive a telephone appointment for a week or so later and then have to see the GP which could be another 2 week wait. This is not an efficient system, I have witnessed a large number of patients end up in A&E because this system takes too long.

The majority of practices I have come across do have online prescription requests exactly as you describe. The practice where I am a patient I can do it online through the nhs app, through the system 1 app (the programme they use for patient care) and through the e consult system. The surgery where I currently work you can email your request, put in a paper request, through the nhs app or through e consult. With regards to being able to only have 1 month at a time that is down clinical commissioning group which have directed it that way- it isn’t a choice the practice has made but what they have been told to do.

I don’t think you can compare the precedent in your field of work with medicine for minimum payback of service- you are talking of firms which are private businesses in the case of law firms whereas junior doctors are providing patient care for the NHS. Also with law you don’t have to have a firm sponsor you, it is expensive but you can self fund. All speciality training is run by the NHS, you can’t self fund it. I have worked 4 years full time for the NHS before becoming part time once I had my son. Would this apply to all doctors or only GPs?

I think part of the problem is the perception. I work 3 days a week- that is 33 hours in theory but I end up doing my admin in the evening once I get home so in reality is more. Lots of GPs work full time hours but compressed, so 4 days a week not 5. This plays into the perception that they are part time, but they are not. Yes some GPs have other streams of income but the vast majority don’t.

Does your husband do any private work? Are all his outpatient appointments back to face to face? The oncologists at my hospital are hardly seeing anyone face to face. I also know quite a few oncologists who work part time, same for surgeons etc but they don’t get the same stick GPs get.

Each GP practice is different and I don’t doubt there are some awful practices out there but as I said up thread, it is very demoralising to be tarred with the same brush.

Sorry posted too early.

.. as I said up thread, it is very demoralising to be tarred with the same brush, when lots of the problems are beyond our control or as individual GPs we cannot fix.

It’s quite demoralising to be constantly doubted. If we are going to solve these problems we need to acknowledge the individual experience first . It is very unhelpful to constantly deny and obfuscate peoples genuine experiences.

It really must be based on area. My GP has been fabulous, smear done no problem, repeat meds and reviews no problem, DD4 got seen within an hour of calling with a water infection. I had a dodgy mole, it took 10 days from when I called GP to removal in hospital (plastic surgeons removed as was on my face).

I can't say a bad word about them really. I went for my COVID jab at the GP surgery on Saturday and it was like a military operation. Brilliant.

My current GP has always been a bit rubbish. I used to live in a neighbouring city and could always get an appointment. Since moving to this smaller town I have seen a real decline in my ability to see a GP.

Since Covid it has been like Fort Knox trying to get into my GP. Yes, I can complete the online form and have either a call back or, as they decided this week, send me a prescription straight to the chemist without any discussion.

I truly think some surgeries are coping better with Covid (and seeing patients in general) and my current GP surgery just isn’t up to the job.

It seems that oncology services, just like GP services at the moment are variable.
I’m glad you husband is advocating for his patients, just like I try to advocate for mine, sending referrals to specialists who are closed to referrals. I’ve said numerous times on this thread that GP services are variable, that I don’t doubt that there are awful practices out there but there are many of us trying to do the best for our patients. I feel for any patient that has had an awful experience with any part of the NHS at any point in time not just recently. I’ve seen it in every area I’ve worked in since qualifying- good and bad practice.
As I said I do 3 days a week, as I’m training I have educational time in that as well but in my clinical time I am seeing f2f, calling patients and responding to econsults. My practice responds to any econsult or telephone within 24 hours either with an appointment within an appropriate time frame or a call/f2f on the day. The majority patients at my practice seem happy with our system. However there are practices that aren’t working well and I’m sorry that people are experiencing that.
I don’t know if you feel that I personally am part of the problem as I am one of these part time GPs (albeit a trainee) but I cannot increase my hours for multiple complex reasons. The choice is for me 3 days a week or not at all- and at present I’m sure the NHS would prefer me part time rather than not at all.

BuggerBognor- I reckon the average person in the street doesn't understand '12 sessions' I suspect they would think 'well he's got a day off then. Lazy part timer should be using that to see NHS patients. And that Saturday as well'

As far as most people are concerned if he works 4 days for the NHS that's 'part time'. Not to mention if he uses some of that time for SPAs (he'll have at the very least 2) ie admin, management if he's CD, plus teaching, service development. They may very well decide that any time not actually spent seeing patients doesn't count as work if this thread is anything to go on.

Or is that only GPs who are held to that standard and must not appear to be having any days off even if their clinical working days are 12 hours long? Even if they are teaching, managing etc on other days?

Many 'part time' GPs are probably not really part time at all if we take the standard that 1 session= 4 hours and full time is 10 sessions including at least 2 non clinical as standard in most hospital Drs job plans.

If they do do Botox 1 day a week then that's really very much the same as many surgeons do. A day a week private practice is very standard.

I'm a hospital Dr and I don't do any private work. The NHS very much gets its money's worth from me but still I find this idea of blaming 'part time GPs' for all the woes of general practice bizarre.

If they all went full time tomorrow then perhaps the backlog would be cleared more quickly but the wage bill would go up and I assume the government doesn't actually want to pay for that. If they did then they could do it right now like they did with the waiting list initiative a few years ago. Pay overtime for people to work additional hours to get waits down.