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?

This thread just proves the point that different GP practices have evolved different types of services, with different levels of efficiency, and that some are good and some are shit.

Some GPs will make a referral directly from an e-consult with photos. A poster came on to say her husband is a HCP and that this can't happen. (But it obviously can and does.) Other posters wish it did happen when they have a serious flare-up of an existing severe condition, to save everyone's time and resources; but their GPs insist on hard-to-access f2f appointments first.

Many posters have great difficulty accessing appointments and contacting their health practice.

I think posters' experiences of telephone triage and telephone appointments are mixed. There is clearly some excellent practice, and some inadequate practice.

Some posters have noted that what started off well as a covid response in their practice was not maintained.

There are concerns that some GP partners are working very part-time, and that this is impacting services that used to work well.

There are concerns that primary care is shunting care of the more vulnerable off to secondary care and emergency departments.

Another factor impacting GPs surgeries and ways of working is the scarcity of GPs

There are insufficient doctors coming forward prepared to join as partners, rather than just working as locums. It's a reflection of the terms of business on which GPs are engaged.

@FinallyHere, is that why so many GP partners are working part-time now? Most at my GP surgery work only one half-day a week! Locums pick up the rest. Although I have to say I don't fully understand why.

I just know the system of investment and disbursement is broken.

I know a GP. He works part time and then picks up shifts on bank holidays (at least triple time) and other high paying days rather than doing a full week.

work only one half-day a week

@SpindleWhorl

Are they only working one day a week, or just available for patient surgeries one day a week? The difference between a GP partner and a locum is exactly all the other management activities required.

I know a good number of people, across a few different CCG who are GPs, some of whom have been awarded honours for their contribution to this work. Being a GP used to be compatible with raising a family. Now, any with childcare responsibilities have had to switch to locum work in order to contain their working hours.

Indeed, as PP have pointed out, the role of the partner GPs is not well rewarded for the required hours so it's really difficult to recruit 'partner' GPs, a vicious circle in which there are ever few partners to share the management load.

Our local surgery used to run with between 4-6 partner GP and one of two 'locums'. Over time, the locums would become partners and contribute to the management and direction of the practice.

Now, that management work which used to be shared out over 4-6 partner GPs is now carried by only one partner GP with most of the clinical work covered by locums who just do the hours assigned and have no other responsibilities.

Really not ideal.

I filled out an e-consult form and sent pics on Monday. Text at the end of the day to say a telephone appt has been arranged for Friday afternoon - no time given. I’m in work on Friday, and I work in a call centre on a secure floor (financial services) so no phones allowed. I called and asked whether they could make it after 3.30 when I finish but they said they can make a note but can’t guarantee it. The receptionist has then said that if I miss it I’ll have to fill out another form, for them to do the same thing all over again. Which is such a bloody waste of time, rather than just calling me after 3.30! I don’t get it. Fucking bullshit.

@spacefrog35

It took me 3 months to manage to book in for my smear test (every time I rang I was 20th in the queue so didn't bother waiting). Eventually, I got through, got my appointment booked (3 weeks away but still). 2 days later they cancelled. I now have to phone them back to rebook 🤦‍♂️.

Same. Received letter to book smear in may, called surgery, booked in for 6 weeks away, cancelled a day before and repeat. I've got my next appointment tomorrow and they haven't cancelled it yet 🤞

@PizzaPiePizzaPie

I know a GP. He works part time and then picks up shifts on bank holidays (at least triple time) and other high paying days rather than doing a full week.

That's become the norm except for partners. Most others are now part time, doing pretty low numbers of "regular hours" but cashing in on much higher locum/shift rates.

I think these threads show just how different the new systems are working across the country.
Some sound great; others are dire.

Triage and non face to face appointments sounds great but in reality it isn't working in lots of places.

Ours is dreadful. And no, I can't just move Gp surgery - it really doesn't work like that round here.

If you don't call at dead in 8:30am you struggle to get an appointment, even for a different day. All appointments now appear to be same day unless a GP makes it for you at the time if a first appointment.

All are telephone appointments initially. The telephone appointment can be at any time that day - no time slots given bar 9am to 6pm. You can try and request times or morning/afternoon but they won't agree to it. They call once and if you don't answer they do try again one more time - usually within about 10-15 minutes, then no more.

There is no proper app at present - can no longer book any appointments on it, can only use it for repeat prescriptions.

There is no way to send photographs or messages. All contact is via voice call only.

If you are deemed to need face to face it has to be same day, usually as soon as possible. They won't let you choose to come in later or next day.

Face to face: wait outside, then talk to admin via a glass window with small hole. Wait outside until doctor calls you. To be fair once with the nurse or doctor the face to face is as normal.

And our hospital system is even worse. Just trying to even speak to someone at rheumatology is a nightmare. Call a number, via the switchboard only, and leave a message. Message says they will call you within 72 hours (used to be 24) If you don't answer they don't call back, so you have to start the whole system again. In my last flare up I took me nearly 2 weeks just to speak to the department to try and get an appointment, despite being in a great deal of pain throughout. The appointment couldn't happen for another week either as they were in reduced staffing. Eventually the doctor at my GP took pity in me and prescribed liquid morphine via a telephone call - even he couldn't get through to the rheumatology department.

@Carriemac

It makes no sense for a GP to do the blood tests . They should have a drop in service with their HCAs and nurses doing them.

My past GP regularly did my blood test as part of my appointment. He claimed it would be much quicker than me trekking to the hospital or having to make a nurse appointment for it. My appointment still didn't run over - he was very quick and also very good at taking blood.

Current doctors (as now don't see just knee doctor but any available since they changed their systems) won't do it at all. So I have to make a separate nurse appointment.

Our surgery is open, you can just walk in although there is a notice asking people to go in only if they have an appointment, during the last year I’ve had several telephone appointments, been called within 24 hours of my econsult each time. All the reception staff are on the premises, phones answered quickly and pleasantly and queries dealt with efficiently. People are allowed carers or a support person with them too.
When I tested positive for covid I had a text the same day from my GP inviting me to contact them if I needed help followed by a phone call.

If my busy practice in Surrey can do this, why can’t all of them? Is it because it’s entirely staffed by female GPs apart from a male locum and sometimes a male trainee.

We don't have drop in sessions at our surgery.
There is one at the big hospital but the waiting times can be very long.

@FinallyHere, it was DP who got through to the receptionist and he was told that all the partners were only working a half-day a week.

(DSS needs to be seen. He has special needs and he'll only see a familiar face - and that's either his named GP or one of the long-standing partners. We built up these relationships painstakingly slowly.)

(It's not just that he'll refuse to engage with another GP - if he's forced to, he'll get violent and then try to crack his own head open, so we don't even go there.)

The swamping of the telephone lines from 8.30am every morning, and the lack of telephone appointments, isn't helping either.

It's a bit of a nightmare for families with vulnerable family members.

@Abraxan I think these threads show just how different the new systems are working across the country.
Some sound great; others are dire.

It's because of the fragmentation of the NHS into large numbers of different trusts, local commissioning groups, etc. It's caused massive variation in quality of service between areas, and even between hospitals/GP surgeries in the same area.

All part of the stupid political decision to create the "artificial market" for healthcare, whereby you have different trusts competing for the contracts to provide different services. The politicians and senior NHS management thought they could improve services by creating "competition", but it never works if the customer (i.e. patient) doesn't have choice. Free market only works when there is choice, and the artificial market didn't provide patient choice.

I have access to a private GP now; I needed urgent antibiotics for a skin problem.

Booked an appointment 11pm at night, got to chose my slot, picked 8:30am the next morning

Had a video call with GP and a prescription waiting for me at the local pharmacy by 9am.

I still need to get smears etc don't at my GP, I haven’t been able to get an appointment since December 2018 so...

@PTW1234, do you mind me asking how much that cost you?

We may need to do the same, and I'd like to be prepared. And did you find the private GP online easily?

I agree with BadBunny. The whole 'market' nonsense doesn't work with free healthcare, free state schools and public transport like trains. Ordinary people in the UK don't have the necessary personal infrastructure of relative wealth, generous in-work benefits packages and insurances, cheap travel, etc. What we've seen here isn't some golden age or a new dawn - it's been price hikes in transport, profiteering in academy chains, and stealth privatisation of the NHS.

@SpindleWhorl it a work based benefit, however l believe if you pay for private medical insurance a 24 hour go service will be included in the overall package these days

You do pay private prescription charges, especially if just using the GP service. Which depending on what you need will be more or less than the standard NHS charge

I had an operation though with full insurance and all medicines I was prescribed afterwards was covered by insurance

…bit off topic, but @PTW1234

If you’re concerned about delays re your smear test you can buy a home HPV check test. I used Check4Cancer, but there are other suppliers. (The NHS now endorses HPV screening.)

You take a sample and send it off to be checked for HPV. If all is normal you don’t need a smear test. If certain subtypes of HPV are found they’ll phone you to explain the results and give you a letter to take to your GP for onward referral.

It’s quick and easy, pain free, and is done in the privacy of your own home when convenient for you and results were back within the week!

The NHS is a disgrace.

The NHS is not a disgrace. It saved my daughter’s life when she was born prematurely. It has taken really good care of her and given her so many treatments and surgeries which have given her a quality of life she wouldn’t have had before the NHS and which bankrupts people in the US. It saved my husbands life when a CT scan for one thing picked up cancer in a totally unrelated area of his body and they operated to remove it within two weeks. They have done all his follow up scans even through the pandemic.

The NHS suffers because people use it for political purposes. How much money it gets is based on whatever political party wants to be seen to be doing. Root and branch changes are introduced to make the politicians seem to be proactive but these impact services and are rarely done in proper consultation. The lack of joined up thinking is by design and not by accident. The culture that has pervaded the NHS is top down and again is done for political gain.

But for all the problems, and poor management, the NHS is the envy of many other nations, and rightly so. The next time you need to call your GP, or go to A&E, or call an ambulance, be thankful your first thought isn’t “can I afford this”. When you pick up your prescription in England and it costs you a tenner for a drug, remember there are people in the US who are rationing their insulin because it costs over £1000 per month.

The NHS needs to improve, there are problems which have been exacerbated by the pandemic and health inequalities have become more visible. But to brand it as a disgrace is to seriously underestimates how fortunate we are to have it.

Sitting in that waiting room, it was also impossible not to realise that there were a lot of people who didn't need to see a GP -- who booked a regular slot for an ingrown toenail because they were lonely and wanted the company.

If you can tell by looking at a waiting room, who needs to see a GP or not, I suggest you offer yourself up to the NHS, that’s an impressive skill to have.

@BoredZelda The NHS is not a disgrace.

I'm glad that it worked out for you and yours.

Sadly, for lots of people, their experiences aren't as good nor successful.

Just look at all the failings/scandals, have you read the "Whistle in the wind" book by a respected consultant who was hounded out of the NHS for blowing the whistle on patients who came to harm at the hands of the NHS?

It's haphazard whether you get good treatment or bad. That's a travesty in itself. The very nature of a "National" system should be equality/fairness etc of treatment/outcomes, rather than the whim of the workers in your particular trust/surgery etc. We really shouldn't have to put up with a postcode lottery.

@BoredZelda

Sitting in that waiting room, it was also impossible not to realise that there were a lot of people who didn't need to see a GP -- who booked a regular slot for an ingrown toenail because they were lonely and wanted the company.

If you can tell by looking at a waiting room, who needs to see a GP or not, I suggest you offer yourself up to the NHS, that’s an impressive skill to have.

When you’re in regularly there with a sick child, sitting beside the same people cheerily discussing their minor ailments and how they thought they’d come in because it’s Wednesday and that nice Dr Patel is on and they didn’t see him for a bit, and would like to see what he made of their new funny toenail, then you really don’t need to be a diagnostician to grasp that lonely people are in for a bit of company. Which is entirely understandable, but unideal when you have a child with a medical need or are sitting beside someone in obvious pain.

I'm still waiting for a script to be sent to the pharmacy where I am on holiday.
And been over four hours in a 111 system and batted between local doctor this morning.
When I was sent somewhere by 111 they said on my arrival, they shouldn't have sent you here.

It's appalling and everywhere the phone lines are clogged up with extreme long and painful corona messages that are simply not relevant and take several minutes to get through.

The care I need could have been sorted within 5 mins instead I've been on phones in medical centers, pharmacy back to different medical center for six hours solid.

@PTW1234

I have access to a private GP now; I needed urgent antibiotics for a skin problem.

Booked an appointment 11pm at night, got to chose my slot, picked 8:30am the next morning

Had a video call with GP and a prescription waiting for me at the local pharmacy by 9am.

I still need to get smears etc don't at my GP, I haven’t been able to get an appointment since December 2018 so...

Don't give up trying. Smears save lives as I'm sure you know.