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?

I'll be honest, when my medication review was done over the phone, it was so much better than the ballache of having to go to the surgery, sit in a boring, uncomfortable waiting room and wait goodness knows how long for a harassed gp, running late to go through the usual questions and then ask you to make another appointment for blood tests, if they were due.

@BuggerBognor
“I have the same issue with any doctor working PT while kvetching about shortages. It’s not confined to GP’s, it’s just that GP working patterns impact directly on patients and delay access to specialist care.”

I feel this is a totally unreasonable attitude. Funding, recruitment, resourcing, organisation cannot be blamed on individuals’ work patterns.
You are making it personal. It shouldn’t be.

Everyone thinks they know what the job of a GP or teacher entails and therefore relishes in bashing these professions. Regular as clockwork on MN. Train up, people. Join the ranks and save the system.

@bringmelaughter

This is depressing. It’s not ok for NHS staff to be totally not understanding of the pressures on other staff/clinicians.

NHSE have tasked GPS to remote triage with face to face reserved for those triaged in. They need to wear appropriate PPE and should and it’s a good thing that surgeries are providing this and making sure it’s worn.

GP surgeries are overwhelmed. Practices in England delivered around 784,000 more appointments in a 10-week period at the start of 2021 and over 5.5m more items of clinical admin work - such as referrals, prescriptions and messages to patients - compared with the same period last year. Not their fault that the system needs more investment.

I hope people are more understanding about the challenges and limitations in the area you work in.

Couldn't agree more. I heard someone ringing in to a radio station last week with the same tale, that hospitals are swamped as "lazy GPs" are not doing their part. I am not a GP but work in a surgery and our workload is still dramatically increased by many hospital departments still doing their clinics by phone and then sending on all the requests for tests, medication, etc to us. Primary care is picking all that up in addition to a generally increased workload, funny that is never factored in to these complaints by people claiming to work in hospitals As to the comments about PPE. All our staff, including reception, wear surgical masks with normal uniform and patient facing clinical staff wear scrubs and surgical masks. We had several "hot cases" of Covid last week, first time for months but part of the rising picture here, what part of that PPE would you like us to ditch and why?

@BuggerBognor

I’m simply being factual. GP’s working PT means less clinical time available for patients. It also makes it very difficult to train enough doctors, with the best resource planning in the world. There may be good reasons for so many GP’s working 2 days per week - including workload - but it’s also self-evidently a factor in the resourcing problem (and therefore the patient access problem). It’s not of course the only factor.

It could well be argued that DH’s 4/5 days a week are not “enough”, yes. But his private clinics are currently rammed with people trying to get past the huge NHS backlog and many of them either delayed seeing their GP or were not seen and referred appropriately when they did. Most of those will end up back on the NHS once they actually start their (often delayed) treatment. Again, it’s a fact that delayed referrals mean that treatment is less likely to succeed.

An alternative view might be that 12 sessions is actually more than the NHS considers “full time” but can be done (by DH at least) in 4/4.5 days a week. Doesn’t that suggest that even those doing the standard 10 sessions could work much more efficiently? (Usual caveats about different specialisms apply, of course).

Patients cannot and should not be required to suck up the pandemic-driven skeleton service indefinitely.

But this isn't factual. The NHS are paying for a certain amount of GP hours.Those hours are covered by some GPs who work full time and some who work part time.If all GPs worked full time you would have either a situation where the cost to the NHS was the same but hours were covered by less GPs working for longer ( ie all full time) or one where the cost to the NHS was greater because on average all GPs were now working longer hours. You can't move all GPs to full time work without paying a higher wages bill (even if they are all willing)

Government in recent years hadn't shown any enthusiasm for paying out more.

My GP surgery has been great. I have had 4 2 week wait appointments over the last year (🙄fun times,but ok thank goodness) the only one that didn't meet the 2w was the first,because the outpatient clinic was not seeing patients. Referral for 3 from a phone appt on the day I rang in,the last I saw the GP f2f,same day.Our surgery is easier to reach by phone than pre lockdown,and seems much more flexible with problem solving. The worst management was from the hospital clinic who pre Covid would have been one stop but instead involved phone call,scan,second scan,appt for impossible biopsy ,phone appt with consultant and finally f2f with consultant -at which point they decided all was well.At least going to the hospital got me out of the house,and they were lovely but it was organisationally lacking. We have been able to manage repeat prescriptions online for years, with the Rx going direct to your pharmacy if requested,I'm amazed there are surgeries still not doing this.
(I am very grateful for our GP and realise from MN how lucky we have been)

Every time I talk on the phone to the gp I keep getting told we need to see you. Oh great when? Erm we aren’t seeing patients at the moment.

Things get worse and I end up admitted and those referrals, tests and treatments are all sorted.

I’ve seen more dentists than gps in the past year.

Primary care isn’t monitoring patients locally as they should with various medications. No diabetic clinics. No asthma clinics. No smear.
Medications given without being able to check blood pressure etc.

I''m a practice nurse who has done hundreds of diabetic checks, asthma checks, smears etc all the way through this.
Blood pressures can be checked at home and are more accurate, although we are still doing them if patients insist.
Many primary care services are monitoring patients locally as they should. Coupled with extra requests for bloods etc from secondary care and sexual health services who are still refusing to see patients, in over ten years I have never been so busy.

And ageee, we are still seeing several 'hot Covid' patients every day. I don't think continuing to wear a plastic apron and paper mask is a big deal. Not all HCP are vaccinated.

The bit that stands our here for me is the blood pressure thing.
I don't have a machine, I can't afford a good one and have no idea of the accuracy required or how to read the results.
Why is this being pushed so much?
Pharmacies aren't doing it.
I attended a vaccination centre where the volunteers were getting on with it, but the blood pressure machine (that was there for public use) was taped off.
That is why people insist!

@BuggerBognor

“I’m simply being factual.”
No. You are being unreasonable and blaming systemic problems on individuals.
You could say that by harnessing the supply of part-timers, General Practice is getting something right.
People who say I’m simply being factual/stating a fact are often starting from a warped perspective. It reminds me of the colleague who constantly bitched about the fact that the two of us were on the same grade when she was so obviously superior.

I think a PP hit the nail on the head here in pointing out that Doctors are not business managers. Those who have coped better probably have at least on partner who is interested in the business of running the practice and a very good practice manager .

I used to act for a lot of GPs ( I am an accountant) so many of them have little or no idea about the nuts and bolts of running a business let alone disaster planing . This is not their fault , they have neither the time or the training , what does annoy me is when they skimp on buying in a good and experienced practice manager to take that load off them .

I''m a practice nurse who has done hundreds of diabetic checks, asthma checks, smears etc all the way through this.

Just out of interest, have those attending asthma checks had to wear masks? If so, I can imagine that would have caused those with the worst asthma to self-exclude from attending a check-up.

I'm not bashing any individual GP, but with some exceptions, the system as a whole is broken. It's been flapping around for some time, but (forgive my cynicism) it does seem like the NHS want to exploit Covid so as to make it even worse and much less helpful, convenient and efficient for patients.

I'm sure there is very much a place for telephone appointments, but they aren't a silver bullet for all.

It's ridiculous that the ability to get an appointment depends on your available time, working status, job flexibility etc. rather than the seriousness of your medical need.

It's also outrageous the number of people who are ending up in A&E, simply because they cannot get to see a GP. If we're going to run the NHS as a business (which those at the top have clearly indicated), it needs to have the efficiency and good management of a well-run business. Can you imagine Tesco being happy if customers were constantly tweeting their board members over thousands of mundane queries and issues, because the in-store customer service desks were closed or had permanent two-hour-long queues?

We patients are the entire purpose of the system - we aren't an irritating inconvenience to be tolerated and fobbed off where possible. I realise that some patients are unreasonably demanding or even abusive, and that we too need to play our part in making the system work; but knowing that we have GP facilities available should we need them should be a comfort to us, not a source of worry and fear in case we do.

A GP working PT or FT has bigger all to do with whether they are competent or not. You can’t force people to work more than they can simply because your DH runs himself ragged. Other people have other circumstances. Next you’ll say it’s the fault of women training for these roles. Bring back the mighty men.

You sound unreasonable as you are laying blame at the individuals who are part time rather than at the system that isn’t training enough doctors in the first place. Every rota I have ever worked, in every speciality, is understaffed. It isn’t a problem that is unique to GPs but you hear about it most as, like you have already said, GPs are the gatekeepers to the NHS. People are waiting over 6 months for routine outpatient referrals for a large number of specialities but you don’t hear the same suggested that they are all lazy if they want to work part time.

The reasons for these part time GPs varies but a large number are women, who are part time because they have families. Now childcare shouldn’t mainly fall on the mother but it often does. You said upthread that you changed your role and took a pay cut when you had your child/children. Your husband works full time, I can’t pass comment on how much your husband does at home or how much childcare he does but you are a family where one of you works part time, albeit not the one who works in medicine. Many women, myself included choose GP as speciality because of the flexibility it offers, the family friendly nature of it. This has been known for decades now, the system could have planned for this. As to saying the number of GPs who can be trained is limited- at the moment the programme is under subscribed. In training part time I’m not preventing someone from training and working full time as there isn’t loads of people wanting to take up the places in the first place. Making the speciality less family friendly by removing the part time option isn’t going to increase the number of GP hours, in fact, due to an exit of staff like me, will make it worse. Interesting many medical trainees who work part time, do so while children are small and then return full time at a later date.
Overall you are unreasonable to suggest that GPs can’t point out there isn’t enough of us, just because we work part time, many of us for very valid reasons. Supply is not scarce because so many GPs are part time all of a sudden, this has been decades in the making of underfunding and poor planning, not down to individuals.

To suggest that me working part time causes my patients to be unsafe and thus in way that I don’t care is frankly insulting. It is because I care both deeply for my patients and my family that I am part time, looking after my health so I can give my best to my patients. Just because I’m part time doesn’t mean I’m less dedicated. I stay way beyond my hours and work hard to advocate for my patients. However, I’m no good to anyone if I’m burnt out something I have previously been dangerously close to.

I think the issue of part-time GPs is a bit of a red herring. Pre-pandemic there was a generally accepted formula for working out the number of appointments a GP practice needed to make available, based on the practice list size.

BB You always Pop on these threads to have a pop at GPs. Always. On account of being married to a doctor. A bit tiresome.

A PT Dr who works 4 days a week for the NHS...

Mine is open, I've been going in for regular blood tests and also a couple of face to face appointments. So it must depend on location.

My mistake regarding you being part time.

My point is there isn’t limited training places for GPs available. The programme is undersubscribed. I’m going round is circles but the point being if you remove part time working you will have less GPs hours overall as many people will leave or won’t become them in the first place.

With regards to competency you imply it, say you’re not then go on to suggest it again. Continuity of care doesn’t mean seeing the same doctor/nurse every time, it can be helpful but not vital. The same occurs in secondary care. Some clinics will be with a consultant, your next one with a registrar. As an impatient your doctor can change on a daily basis on a ward in some places.

Tbh whatever I say you are going to turn it back to say GPs shouldn’t work part time as you’ve fixed your mind on that.

Discussion on You and Yours on it right now

(On annual leave this week not skiving off work)

The thing is, BuggerBognor, doctors are in short supply. They can pick and choose where and when they work and many choose a role that might allow some work life balance.

If you choose to remain a hospital doctor, then you don't get to pick the place you work and can be sent well away from your home area for eighteen months or two years to complete core training before specialising. That might mean weekend and night shifts and then you might have to move again to get a specialist training post. Meanwhile your partner can be sent to the opposite side of the region or even to a different region. Then you have to compete for the few training places that are available for specialist training. Not always an easy life.

If you choose the GP path you might get sent somewhere whilst in the foundation programme, but once you have started GP training you at least know you can start putting down roots and building a life as you will be in the same deanery for three years. Only the first eighteen months will need night shifts and weekends on a rota.

By the time you qualify, you might want to be thinking about marriage and families. A GP life might just about make that compatible - although pay is barely sufficient to cover housing and childcare in London or the south. Gone are the days when two GPs could comfortable afford a reasonable family home.

Most childcare providers don't offer fourteen hour days and that would not be terribly fair on a young child, would it? So many GPs take the part-time option and juggle that and other commitments. Others might be stepping down towards retirement and not wanting to do five fourteen hour days at sixty, feels quite reasonable.

If the public want greater access to GPs, they need to vote for a government that will fund more GP time and who encourage people into the profession by treating them reasonably. Otherwise increasing numbers of young GPs are going to seek employment elsewhere, on a higher salary, with a lower risk of being charged with manslaughter or losing their livlihoods and without the vitriol they get from more unpleasant patients.