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?

@Midwife1997 care navigators perform a particular role. It’s not a new name for receptionists

www.hee.nhs.uk/our-work/care-navigation

@Whenigrowupiwanttobea

This is why the ED'S and Ambulance Trusts are so stretched! People are attending ED because the GP's aren't seeing them. People are calling 111 for advice and an Ambulance is sent because the algorithm says so! Ambulance crews being requested by GP's to go and take a look on their behalf as they aren't doing f2f!!! The system is collapsing!

It's probably time to dismantle the GP system. It's an outdated relic.

There was a time when the GP really was at the heart of healthcare, i.e. they'd attend accidents, deliver babies, perform operations, even have "cottage hospitals" or a ward attached to the surgery.

Over the past few decades, their role has changed out of all recognition to being basically a admin/desk job, where their main role is a gate-keeper/navigator.

I think we need to adopt the "clinic" approach seen in some European countries and even cruise ships, etc., where the medical staff actually do things, i.e. treat wounds, x-rays, etc., and the doctors do "hands on" treatment, with referrals/transfers to specialists if they can't do it within the clinic/surgery.

Well, DH had a hernia last year, he saw a GP via video call pretty fast, who then called him in to examine the lump, and referred him for surgery, which he had within two months. That was late last year - we were pretty impressed. I've seen the GP twice on video calls, once for me and once for DS, and I think that option was always available for the phone consults I've had too, if necessary. I also had to ring my GP about pelvic pain recently, and after talking to me, she decided she wanted to have a look at my cervix as well as the referral for a scan, so we did that.

Not wanting to gloat, but different health centres seem to have different ways of doing things.

I agree people do attend when they don't need to. I was a GPs receptionist and the worst offenders were the elderly and SAHMs. I feel for the elderly but it's not a good use of the Drs time.

But I agree that some Drs have been awful during the pandemic. Secondary care are really unhappy at how many people present at A&E because they can't get seen by their Gp. I would fine GO practices if their patients turn up at A&E as a result of not being able to be treated.

I also think that primary care should be dismantled - it isn't fit for purpose and we should look to some of the European systems as they seem to work much better.

However you can't have a sensible discussion on this board (or anywhere really) about the NHS as it's seen a being a sacred cow. Plus posters state as fact that the Govt is trying to privatise it - several people on this thread have trotted that out with no thought process behind it. NHS is massively inefficient as anyone who works in in is fully aware of.

Hi Lapsidasicle - I didn't know there was extra training involved for Care Navigators. Our longstanding Receptionist who let me into the surgery the other day had the title 'Care Navigator' on her name badge

Midwife

@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?

And the GP surgeries are bloody loving this I can tell you. Keep the riffraff out and do it all by phone. And I don't know about your surgery but with my telephone appointment last week they wouldn't even give me a time, had to wait all day worrying I'd miss the call. I think this will be how surgeries operate from now on as it's all convenient to them.

I'm exasperated at our new online GP triage and booking system. I started with a UTI Friday night, have a penicillin allergy so can't get antibiotics at the pharmacy, but started on OTC cystitis stuff rather than bother OOH. Thought I would book online and hopefully get phone appt Monday am, drop in with urine sample and pick up a script on my way out, head straight to Boots to get started on tx straight away. This was what happened the last time I had a UTI, in December.

They switch the GP booking system off out of hours, I can see why, but it's not great if you just need to get in some kind of holding pattern for a non-urgent appointment. Got in touch Monday morning, all appointments gone. Got a call back Monday afternoon, prescription organised, no sample required, all scripts now sent direct to chemist.

Tuesday: hobbled to chemist in firey agony, no prescription.
Wednesday: phoned chemist, no answer. At work all day, couldn't get to chemist anyway, no point in chasing the surgery.
Thursday: prescription finally at chemist. Hopefully the UTI hasn't taken too much of a hold and will respond, watch this space.
It's certainly not a more efficient service for patients.

My GP surgery is fantastic. Phone appointments, email consults and when I went to collect my prescription today, there were three people on the waiting room waiting for appointments including a mum and baby.
Full reception team in. All GPs contactable.

Has anyone seen the Health and Care Bill that was going through Parliament? In it private companies will be able to sit on decision making boards for NHS funding. It is the way the Conservatives plan to allow privatisation of the NHS. How do you think the current situation helps them achieve that goal?

Underfunding and a criminal neglect of future planning will open the door to many people being persuaded to ‘let the private companies do better’. This is not by chance. It’s by design.

@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.

The nurse at your practice does blood tests? This sounds a whole lot better than having to book them at a totally different place and wait for weeks.

The biggest barrier for me accessing healthcare is GP receptionists! Always has been, even pre-Covid. Puts me off seeking help.

My dad is 71 and has Parkinsons and cancer. He's also had 2 dvts and cellulitis in the past. My mum rang the GP practise as his leg had swollen up and was very red and painful, which said someone would ring him back at some point that day. So they went to a and e. Dr diagnosed cellulitis and was disgusted that the GP hadn't seen him as an emergency.

I don’t understand how trains, planes, dentists, schools, shops, offices etc are all open to the general public, yet doctors are not.

receptionists believing they're qualified to advise on complex health conditions and refusing access to medical staff

That's been the case for decades. The receptionist at my old GP was an old school 'mate' who had always been a total durbrain. Didnt really want her deciding on whether I got to see a doctor or not. I changed practice.

@MzHz

I genuinely don’t understand why every surgery seems to think they have to reinvent the wheel!

Surely there is some kind of association or group that identifies best practice in terms of organisation of a good surgery so that they can implement policies and systems that are more universally understood and successful.

This really isn’t rocket science I don’t understand why gp surgeries have to make things so hard for themselves and for patients

This is the problem with general practice being run as small, private businesses. No standardisation of care. It isn't fit for purpose and the whole system needs overhauling. I say this as a practice nurse who loves my job, but the whole system is so unequal and inefficient.

We recently went to face to face for (some) obvious cases, after over a year of all appointments being telephone first. So reception could book patients for a F2F if it was obviously needed. Just been told that's been scrapped and we're back to telephone triage again. It just means we have even fewer appointments available, as we have to save slots for the GPs to bring people in as most of them bring in around 10-15% of their list each session.

@PolkadotClouds

But for all the problems, and poor management, the NHS is the envy of many other nations, and rightly so.

This, I'm afraid, is a myth. Most comparable developed countries have far superior healthcare with far superior patient outcomes, much faster and better quality treatment, etc. I don't know anybody in the 9 different countries that I have family living in who "envies the NHS". 😂 In fact, many people who live in the UK fly home to their own countries whenever they need a doctor or dentist, which speaks volumes.

Last time I took DS for a haircut, the barber was telling me how we was leaving in a few days to take his toddler back to Turkey to see a Dr because they'd had such poor care here. Flying the whole family abroad during a pandemic, to access better health care... I was quite shocked it had come to that.

@FinallyHere

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.

Absolutely. A huge problem with this is that our retainer and locum GPs are often contracted to see say 12 patients per session. That's it. No, room to add extras or get them to pop in when a nurse realises the patient they are seeing needs antibiotics/GP input. Or they are there until a set time and then have to leave at the end of the session. The partners we had were always staying hours over their session times to see extra urgent cases or follow up patients from a few days ago that they were worried about. Their biggest gripe with the newer, salaried GPs is that it just isn't the culture any more. They do their sessions and they go home. Many because they are parents and have to leave to collect their children etc, which is why they have chosen those hours/contracts. Which is great for them and their work life balance, but it doesn't fit with how general practice has always worked. The older partners find it frustrating and say it will be the death of general practice, which it will.

Many practices can't find partners and are being taken over and run by organisations that run many practices.

Re: the talk on here about privatisation... you do know that GP practices have always been private sector. They are owned and run by the Partner GPs, this has been the case since the inception of the NHS. GPs did not want to be overtaken by the state, so lobbied to stay as private businesses.

There are some huge chain practices. Also digital based GP practices eg. Babylon health. There’s never been anything stopping these companies setting up as practices so it is misleading to say that privatisation is happening by the back door in primary practice. It’s always been private sector.

Sorry Primary Care... ie GP practices

As a student nurse circa 1979 it was easy to see then how privatisation by stealth was going to happen. Boris levelling up agenda smacks more of contracts for donors/ mates. Simìlarly that with the NHS .. Create enough fear and chaos = ripe for greedy bastard vultures!

Mine is awful! They don’t operate the e-consult system, so the only way to access appointments is through the 8am scrum. That includes non emergency appointments such as medication reviews (which I’d be absolutely happy with a phone appointment for). They also don’t operate a call queue, so your only option is to call - engaged - hang up - redial - often upwards of 100 times. Then you get through, all appointments are gone, try again tomorrow.
I think at the bare minimum e-consult should be available at all practices. The NHS should be offering the same level of service to all primary care patients.

At mine you get to send pictures in. Someone I know was referred a dermatologist for the same reason same day just by sending a picture in

Why can’t a GP do a blood test?
We do, for emergencies.

We get 10 minutes to:

• review previous notes, letters, blood tests
• get the patient into the room
• take a history, physical examination, observations
• if prescribing, review every medication you are on and allergies to ensure safe to prescribe and determine any monitoring that may be required
• Request any blood tests, scans, write referral letters
• Document the consultation so that it is on your medical record

Honestly, how long do you think that takes? I’ll give you a hint, it’s already well over 10 minutes for each patient before you add in blood taking.
I’d be happy to take blood, would you be happy to wait days-weeks longer for a GP apt (cumulative effect of taking bloods from every patient who requires them).

@ColdTattyWaitingForSummer econsult (or an equivalent solution) should be offered by all GP practices now. It’s written in the GP contract that patients should be able to access GP services digitally. NHSE specifies that access should be multi channel. But a lot of practices - including my own - are not offering yet or turning the system off after hours to stem the flow. It won’t be long before they’re forced to offer digital access.

The challenges for primary Care are many and you need to have sympathy for GPs. It’s not in common for GPs to see around a third of appts used by people with non clinical issues. That’s why lots of funding is being pumped into social prescribing - it’s quite new along with care navigation. That should help ease the pressure.

Other issues including growing obesity rates, ageing population (I bet all the people saying their GP is amazing live in an area with a younger population who are much cheaper to care for), retiring GPs who are not replaced by FTE GPs - younger GPs often want to work PT for work life balance and don’t want to be partners.

Health prevention/ self care/ digital services for people who can use them, thus releasing f2f care for those in actual need are the answers.

The government is about to launch a big programme to pay people incentives to eat healthy and exercise. It’s this sort of radical thinking along with lots of new initiatives (eg Healthier you diabetes prevention programme) that will make a big difference.

It’s just going to take a while for patients to see the benefits.

@ColdTattyWaitingForSummer

Mine is awful! They don’t operate the e-consult system, so the only way to access appointments is through the 8am scrum. That includes non emergency appointments such as medication reviews (which I’d be absolutely happy with a phone appointment for). They also don’t operate a call queue, so your only option is to call - engaged - hang up - redial - often upwards of 100 times. Then you get through, all appointments are gone, try again tomorrow. I think at the bare minimum e-consult should be available at all practices. The NHS should be offering the same level of service to all primary care patients.

I agree. Recently my DH took my 4 year old who has confirmed asthma to out of hours via NHS24 because for 2 days we could not obtain a GP phone consult & then when we finally did they refused to see him only administer antibiotics which we did not think he needed.

Out of hours GP @ 10pm said he just needed an additional inhaler & not to take ABs. That worked perfectly so clearly a face to face app't was more effective.

I love phone appt's when appropriate but at my surgery it's ridiculous.