No wonder you can't get a GP appointment

[Intherightplace]

Currently all first GP appointments at our surgery are telephone. Which is OK for most things, even good, more efficient for both GP and patient. However, for some things a telephone appointment is never going to be any use. For example, if I'd been able to explain to "someone" that I needed an appointment for a dodgy looking mole, surely they could have seen that a face to face appointment was necessary?

Anyway, I waited 3 weeks for my telephone appointment. GP said she couldn't do anything by phone and she'd need to see me (like it was my fault, I hadn't seen her!). So that's one completely wasted appointment.

10 days later I had the f2f appointment. Buzzed the door, not allowed in before they've checked you out. Receptionist said she'd tell doctor I was there. 10 mins later the doctor herself came to collect me from the door. Now this is a large medical practice, it's a fairly long walk, involving 2 flights of stairs and she was wearing heels she could barely walk in

I was with her literally seconds before she said she'd refer to a dermatologist. So, at least 20 mins of her time, for a few seconds with the GP to do something she probably could have done at the telephone appointment, if that was going to be the level of the examination.

Either way, she could have dealt with other patients in that time. Why on earth are the admin staff still working at home? There are usually loads behind the large reception desk, but only the one answering the buzzer currently.

And why not just refer the first time and save everyone so much wasted time?

@Intherightplace

Because it makes no sense getting a GP to do a blood test at £70 an hour when you can get a HCA to do it for £9 an hour

But it wouldn't be any addition time for the GP, you've already got your 10min (or whatever) slot and it would take moments, as opposed to a whole appointment with the HCP and the associated admin of making the appointment.

Its not really true that it would take 'just moments' though. GP appointments are already just five or ten minutes. This includes getting the patient into the chair, history taking, examination then a treatment plan. You can't just squeeze a blood test into that- it's not just a case of taking the blood- there's the form filling that goes with it. It would be more inefficient to have GPs doing it. People are already complaining there's not enough GP appointments- having other people do things like take blood frees up GP time.

I’ve found the system ok for repeat prescriptions, although I have two different meds - one I can request via the app and the other I need to email reception for. But when I had an msk issue, or rather when it initially started as I’m still suffering I did find it a bit half arsed. Quickly got a GP telephone appointment and was referred for physio triage quite quickly. Given exercises and told to do them for six weeks. Within a fortnight I was really struggling so requested another (telephone) appointment which wasn’t quite as quick, then referred to the msk at the hospital. Again this took weeks to come through and by then I was unable to dress/undress myself. Had I been seen initially I think they’d have been able to see what the problem actually was. I’ve now ended up in a worse position than I was six months ago.

@Buildingthefuture

Exactly this! WHY are we all having to go through the rigmarole of phonecalls first? They just make it SO difficult! DP has a hernia (as identified last year in a scan carried out privately and in his notes) Hernia is now bothering him so he called the surgery to ask for a referral back to the surgeon who did the scan, as advised to do by the surgeon if hernia became an issue. Dr refused (after we waited 2 weeks for a response!) and said he needed phone consultation first, which can't be for 3 weeks?? We complained and low and behold, referral written

It's crazy, isn't it, that serious flare-ups of known, existing conditions can't be quickly re-referred to the consultant's clinic? I was only just out of time for a self-referral as well.

But no, I had to undergo a time-wasting, pointless, clinically inept f2f in the lair of the Quatermass Experiment before that 'ping' could be 'pinged'.

This is why people end up at A&E.

I had similar during second lockdown. They got me to email a photo of it in and forwarded it to dermatology dept at local hospital. They emailed me back next day to say “nothing to worry about”.

They should offer the possibility of sending a photo in for something like that.
I'm in another country and apart from during the first lockdown the GPs and dentists have all been operating as normal. We also have a slightly different system here in that you wouldn't go to your GP for a skin problem but would make an appointment directly with a dermatologist (working from their own practice as opposed to a hospital). They would then decide whether they could treat the condition themselves or refer to the hospital.

@emmathedilemma

This sounds just like my practice! Getting in is even harder than getting an appointment (and I never thought I'd say that!!). They've got an intercom on the door but there's 2 practices share the building so depending on which one answers they don't have your name on the list, then they go to check but never come back, the sound quality on the intercom is awful (i've no idea how anyone hard of hearing copes), and last time I went there was 5 people shouting their personal details down it for half the village to hear!! By the time they let me in and i got to the waiting room I was late for my appointment and the GP was waiting at the door for me. There's some things which work great over the phone but having to wait for a phone appointment then wait for a f2f appointment is just a waste of times. Repeat prescriptions, changing tablets etc I'm great with discussing over the phone but skin conditions probably need a f2f appointment as the first contact.

Yes to f2f for skin problems - my dd was wrongly diagnosed twice before I kicked up a stink and she was seen f2f. So two telephone appointments with a nurse practitioner and Dr, £50 spent (they refused to prescribe the medication they claimed she needed so had to buy over the counter and it was more than I could afford) and weeks of suffering on her part and she still wasn't treated correctly until she was seen by a Dr.

Enough really is enough. I am considered CV and am cautious but this is getting ridiculous now.

M surgery is a nightmare at the moment. I found a lump under my armpit so called 8am, got through after around 30 mins to be told I would get a call back within 24 hours. They called back at 1pm and agreed I needed to be seen in person so appointment at 4pm.

Lump was suspicious so was told I would get ultrasound urgently - finally got appointment in 4 weeks on a Saturday.

Called go surgery on Tuesday as advised they would have result. Receptionist told me doctor hasn't looked at result call back Friday. Called back Friday and was told no doctors there all day as all off sick or on leave!

Finally got a text to say they had tried to call (which they had not) and they were referring to breast clinic, great! Now waiting for that appointment

@mibbelucieachwell

Even before covid I've often thought that some processes seem inefficient. Eg blood tests ordered by the GP. Why don't gps just do the blood tests there and then instead of requiring the patient to have to bother the receptionist to make another appointment with a nurse who has to come out of her room to find you in the waiting area and walk you back to her room. GP could do it in seconds.

This is such a good point and if it was implemented would save so much time. Is it a case of some doctors think this is a nurses job?

Had a similar situation, GP asked for a pic to be sent. On receipt made derm ref. Easy peasy.

You are 100% right, OP. It's beyond ridiculous that GPs are being allowed to carry on in this manner while everyone else in a critical role has been forced to carry on as usual.

My mum is currently in hospital with what I think will be dx as sepsis eventually..

On Monday I filled out an e consult form as the surgery insist everyone do now (you can no longer make appointments at the surgery itself and getting through by phine is impossible).

She was phoned back that afternoon and dx over the phone with a uti. (How you can dip urine over the phone and correctly dx a UTI is beyond me but there you go..)

By midnight that night she was more ill than I've ever seen her (even more than when she had a heart attack) she couldn't walk, pain all over, vomiting, low 02 sats...

This is a 75 year old with a complex medical history and multiple issues including a bladder prolapse and was STILL not seen f2f.

She is now on IV antibiotics, IV fluids, IV pain relief and Supplemental oxygen.

She is having x rays and scans done.

If I'd not gone to check on her that night I'm not sure she would still be here.

My last GP appt : went online at 8 am and made a same day telephone appt with GP for that afternoon - he actually phoned me in the am as he knows I was working at home and he had a cancellation- uploaded a picture of my rash via a secure text and he prescribed a cream that I collected from the pharmacy that day . Efficient and he even had time to ask after DS - a long time patient of his.
They are plagued - like the rest of us with staff isolating but still give a great service .

I’ve had phone appointments for skin type stuff three times. I sent photos, they prescribed. It was no problem.

The business with the GP having to come to the door is absolutely ridiculous. Query it with the practice manager? It must be a total pain for the GPs and they'd probably appreciate some support.

This is such a good point and if it was implemented would save so much time. Is it a case of some doctors think this is a nurses job?

It's because they're convinced their time is so valuable it makes no sense for them to be doing menial tasks but when the patient is already in front of them, of course it would be more efficient. They could still have someone cheaper doing the paperwork.

I had to go in recently to get a growth on my birthmark checked out.

Got a face to face appointment 4 days after calling the receptionist. Seen, asked to send in a photo so they could show dermatology. Did that, they called back and they couldn't find my photo, went back in the next day for another ftf. Referred to dermatology and currently waiting an urgent procedure to remove it. Despite the lost photo it was well managed. Very long wait for urgent removal though.

However my daughter was offered a phone appointment to discuss the fact that she was having stomach aches often- two weeks to get the appointment, then they decide they need to examine her. We are looking at over 4 weeks for her to be seen. I thought it was obvious they would need to physically examine her as soon as I called! The first phone appointment was a waste of an appointment.

...and don't get me started on over the phone physio ffs

I’ve had a mixed experience with my doctors, starting with one of my 3 day migraines. Don’t respond to anything, not sleeping at all and vomiting constantly. In the “old days” doctor would come out, give me injection to get me to sleep. Not in covid though - it’s too dangerous apparently for the doctor to come to my door with me masked up and no f2f appts. At this point I had already seen my dentist! Told to go to A&E where I spent a night in hospital.
OTOH had a leg abscess and saw (eventually) f2f doctor and two nurse appointments all much quicker than normal.
I had to return a paper prescription given to me unsigned - the receptionist couldn’t get it signed that day as only 1 out of 7 doctors were in! And if I listen one more time to the telephone message “we’re not through the crisis yet” I’ll scream!!
Going into my doctors is, I imagine, akin to entering a nuclear bunker - black/yellow tape up all over and barriers everywhere.

...and don't get me started on over the phone physio ffs

DD has had weekly video physio sessions for the past 18 months. Way more convenient for us all.

How can the physio assess my back condition without seeing me?

They aren't omnipresent!

They are planning to keep things similar to this for a long time and hospitals are also planning to do as many appointments over the phone too

@Reasonistreason

I’ve had a mixed experience with my doctors, starting with one of my 3 day migraines. Don’t respond to anything, not sleeping at all and vomiting constantly. In the “old days” doctor would come out, give me injection to get me to sleep. Not in covid though - it’s too dangerous apparently for the doctor to come to my door with me masked up and no f2f appts. At this point I had already seen my dentist! Told to go to A&E where I spent a night in hospital. OTOH had a leg abscess and saw (eventually) f2f doctor and two nurse appointments all much quicker than normal. I had to return a paper prescription given to me unsigned - the receptionist couldn’t get it signed that day as only 1 out of 7 doctors were in! And if I listen one more time to the telephone message “we’re not through the crisis yet” I’ll scream!! Going into my doctors is, I imagine, akin to entering a nuclear bunker - black/yellow tape up all over and barriers everywhere.

It's ridiculous. Most if not all hcps are double jabbed - as are most of their adult patients - and they wear full ppe. Primary care has not covered itself in glory imo.

This is such a good point and if it was implemented would save so much time. Is it a case of some doctors think this is a nurses job?

As a nurse once said to me, who do you want taking your blood, someone who does it every day, hundreds of times a week, or someone who does it twice a month? I’d never want a GP to take my blood.

After a nightmare getting to see a Gp for a condition my child has, as the nurse triage said it didn’t warrant a f2f appointment or a Gp phonecall, the Gp referrered to a consultant. Problem is there are no appointments available, so we are not even in the queue for an appointment it seems and will need re-recording. Sigh. Condition still there and who knows what damage may be being caused.

@AzureTwist

After a nightmare getting to see a Gp for a condition my child has, as the nurse triage said it didn’t warrant a f2f appointment or a Gp phonecall, the Gp referrered to a consultant. Problem is there are no appointments available, so we are not even in the queue for an appointment it seems and will need re-recording. Sigh. Condition still there and who knows what damage may be being caused.

Scary, isn't it? Only 20 excess deaths in my whole county since covid began yet the number of people who will die from undx or late dx cancer, mh issues, who will suffer because all unelected Surgery has been cancelled is rising every day. But I agree that the GP provision as we knew it is gone forever. The partners at our surgery only do 1 day a week now.