What are GPs actually doing right how?

[Darkchocolateandcoffee]

I've just been talking to my 84 yr old mum who can't get a GP appt for love nor money and is worried what she does next as she has a serious condition that she needs to talk to the doc about.

I love 100 miles away from her but I haven't been able to get a doc appointment for my children for months either.

One had such severe hayfever all through the summer and the only appt I could get was with my GP surgery's pharmacist over the phone, who sounded very unengaged and said the only remedies were OTC ones despite me saying we had tried all of them.

I eventually gave up and did a one-off private GP appt and got him prescription meds which worked straightaway. But I wasted weeks beforehand in which he was suffering trying to get the same thing via our usual GP.

Everyone I talk to says the same. The rest of the NHS seems to be firing on all cylinders.

What on EARTH are the GPs doing instead?

Bevan is reputed to have said, in order to entice greedy doctors to join the NHS,
‘I stuffed their mouths with gold’
That’s what many doctors seem to be expecting now before they will start seeing patients.,

I am able to do an e-consult and get a phone call or email back. If needed to be seen, we are.

Same here. And we’ve had a couple of video appointments. I found a lump and was still at the breast clinic within two weeks having had a phone call.

I do wonder about clinical advice for things that are a bit less usual though.

But you can book appointment slots online at my GP. You can see the available slots and choose one. It’s like any other online booking system.

'Well I'll certainly pass on your kind words to my staff who worked throughout the pandemic, putting their own lives and their families' lives on the line to continue seeing patients, even when the NHS hadn't bothered to provide us with PPE.'

🙄🎻

You mustn't take it so personally. We've had excellent care from our gp as have family and friends, however many haven't.

P.s I don't think anyone put 'their life on the line' working in a closed GP surgery last year with predominantly econsults and phone consultation.. Front line critical care staff yes.

My GP is brilliant. No issues at all. I call at 8am get an appointment for the day. I then get a call from the GP. Send any photos. If they feel they need to see me/my kids they ask us to come in. all worked perfectly

We have a friend who is the senior partner in a larger inner city GP practice with several health centres. He is heading towards retirement age and is absolutely exhausted. He told us recently that he just can't get young GPs to take on a full-time contract. They don't want to do it in the inner cities. He believes they are happier about working full-time somewhere with a less challenging patient list. In London they look for locum work for 2 or 3 days a week in an NHS practice and presumably do other easier work the rest of the week. That would explain a lot of the issues.

The government should be doing something to get more new graduates from medical degrees and foundation training onto GP training schemes and once qualified more of them choosing to work in the inner cities and other areas with difficult complex patients. Higher salaries for challenging areas, flexible working, generous maternity leave, jobshares, whatever it takes. Put in more high skilled nurses, midwives and other HCPs who aren't GPs to take on the things that don't need a medical degree.

@JaniieJones

It’s not like for like though. Take me. I have a connective tissue disorder, a bleeding disorder, a heart condition and a rare blood group. Dealing with me, even for routine surgery, is a pain as I will definitely bleed and there’s a decent chance something will go wrong. This means that private hospitals won’t touch me (believe me, I’ve tried…) but the NHS has no choice. Cases like me aren’t all that rare, so if several people like me are scheduled that slows consultants down massively. Does that make sense?

Well I'll certainly pass on your kind words to my staff who worked throughout the pandemic, putting their own lives and their families' lives on the line

What a joke. Are these the same GPs who locked their door at the first sign of danger, leaving elderly unwell people outside in the cold without so much as a seat whilst the reception staff sit about laughing and chatting all day.
Save your heroic tales. The GP used the 'covid excuse' to the extreme to have a work-shy period of rest.

@daisypond

But you can book appointment slots online at my GP. You can see the available slots and choose one. It’s like any other online booking system.

Sigh, it's not everywhere though. Think that's pretty clear by now. Just because your one has doesn't mean all of them do and thats the problem

Yesterday DH and I received texts from our GP to let us know we can now 'ring reception and book flu jab'. I'm going to call today, should be interesting - I wonder if their number will be permanently engaged?

HNRTT as don't have time but feel obliged to post some context while on a break. I'm now convinced there is an orchestrated campaign of disinformation though I don't doubt some patients are not receiving the service they want. The sad thing is that GPs are mostly fighting to keep a system that is against their interests. It's not just patients, I've had medics and nurses in acute ask if I enjoyed not working over the pandemic. I gave them more direct language than I'm using here, especially as all bar one of them had an easier ride in their specialisms than primary care over the pandemic.

I expect I'll get the same 'bully for you' or it's not like that everywhere' replies to posts that don't have the same contingency.

1. We've delivered c1900 'flu vaccs in the last fortnight by working 7 days a week despite delayed and short deliveries that needed rescheduling. While still offering the same number of appointments. We've never not offered F2F for a single day in 2020 or 2021. Many patients prefer remote consults. Sometimes F2F are required and I think our F2F have saved some lives over lockdown, one from a baby not seen by HVs but I'm not presuming all HVs have done nothing during lockdown from that one data point.

2. We're now doing home visits for housebound and care homes so they don't miss out on 'flu vaccs. We're doing their regular checks at the same time where we can.

3. We've also planning for COVID boosters when we receive them.

4. During 2021, we delivered the COVID programme through our PCN earlier than most until the government sabotaged it.

5. We're chasing up adequate letters and advice from acute so we can provide the 3rd primary dose safely to the patients who need it.

6. When people say all our GPs are PT, what do you think PT means? We have a GP who does the GP equivalent of half a week. How many non-medical work half a week PT and work over 60 hours a week? I have acquaintances who work in the City and work longer hours than me but every patient who wants to talk about how awful it is that we allow 'family-friendly' PT hours to our predominantly female GP and nursing employees think half a week would be c 20 hours. Out 60 hour PT weeks is more than they worked full time.

7. I see the call stats for my practice every day so know the waiting time for calls. I also listen in on the abusive calls from patients who haven;t had to wait. The abuse echoes that we receive F2F daily from people who don't have MH reasons behind it.

8. I see similar availability and not having to wait long on a call after the COVID message from the practices in me and my DC are patients.

9. We're looking if we can help as the next practice have decided to hand back their contract as they've had enough. I've seen practices close on retirement but have not seen the widespread handing back of contracts. If priimary care is such a cushy number with GPs sat at home, working PT and being paid a fortune, why aren't GPs fighting to take on contracts? Weve had partners return to salaried to reduce the burden. We've had GPs in early career leave medicine entirely - what does that tell you?

10. Too many of our partners, PNs and ANPs are looking at retirement, emigration and career change even though COVID has delayed things. We struggle to recruit.

Good luck.

@BoredZelda

How about all the elderly people for whom it’s not working? Who is speaking up for them?

How about all the disabled people who for years have been asking for things like phone appointments as it makes life much easier for them, who was speaking up for them before?

Are you seriously suggesting that because telephone appointments work for SOME people then everyone should be made to use them?

In any event, you’ve missed the mark because my 89 year old mum can’t even get a phone appointment at her surgery.

In my particular GP surgery :

• you have to wait on hold for up to 30 minutes before you can even speak to a receptionist

• when you finally get through, you will be offered a phone “triage” appointment in about 3 weeks’ time. F2F very rare.

• if you say it’s more urgent, your only option is to phone at 8am for one of the few same day appointment (also by phone). But a) 8am is school run/commute time so very difficult and b) even if you can call at 8am, and wait on hold for ages, by the time you finally get through they have all gone.

I believe phone triage appointments are sensible in principle. BUT to be genuine triage they have to be in the next day or two. Not in 2/3 weeks’ time. So many diagnoses are going to be missed or delayed this way.

• They have an online booking app, but only specific sorts of appointments (smear test for example) can be booked online. No idea why

I do not believe my particular GPs are run off their feet. I have been into the surgery a few times since they finally opened their doors in June, to pick up forms etc. Every time, there are maximum one or two people in the waiting room.

I know many of them work part time. In any other industry that had a sudden surge in demand, part time workers would be asked to work extra hours where possible. Has this happened? If not why not? Is it lack of funding, or fear that GPs would resign?

So as demand at out of hours/A&E has increased they have dropped their sessions as a GP and worked more hours in their other job, some because they feel that's where they are more needed and others because in reality it's a nicer job!

A relative is training to be a GP. They do locum shifts at A & E for the money. They have never said A & E is a nicer job - it's all for the money!

'What a joke. Are these the same GPs who locked their door at the first sign of danger, leaving elderly unwell people outside in the cold without so much as a seat whilst the reception staff sit about laughing and chatting all day.'

It's true some have taken the piss. I do feel sorry for the ones that have absolutely done their upmost to help their patients but sadly we hear many takes of receptionists barking at elderly people who are possibly hard of hearing and anxious.

If I were a practice manager when interviewing staff yes I'd ask how their IT skills are but more importantly I'd ask how their tolerance and patience are, how their people skills are.

I bloody love my GP’s and won’t hear a word against them. I’m sick of people whinging about them

That seems fair about your own GP, who's fortunately one of the many excellent ones, but I'm not sure it's any more helpful to treat them all as plaster saints than it would be to damn them all as workshy grifters

Shouldn't any profession accept shortcomings where they exist and be prepared to do something about it? Because failing in this is how we get the Shipmans - and before anyone claims "nobody knew", let's not forget a number were censured for not picking up glaring anomalies at the time

@RocksOnTheHill

Try the pharmacist. The GP couldn't see my child this morning but the pharmacist was really helpful.

There’s been a push for people to use pharmacists more for a long time now, since well before covid. They can be really helpful in some instances, often worth a try first for minor things.

@JaniieJones

'What a joke. Are these the same GPs who locked their door at the first sign of danger, leaving elderly unwell people outside in the cold without so much as a seat whilst the reception staff sit about laughing and chatting all day.'

It's true some have taken the piss. I do feel sorry for the ones that have absolutely done their upmost to help their patients but sadly we hear many takes of receptionists barking at elderly people who are possibly hard of hearing and anxious.

If I were a practice manager when interviewing staff yes I'd ask how their IT skills are but more importantly I'd ask how their tolerance and patience are, how their people skills are.

Couldn't agree more. Maintaining kindness should not have been the first thing to be sacrificed when fighting a virus.

@ilanois. How is it still the fault of government and politics when the government advice was changed months ago, indicating that all GP’s should now be offering face to face appointments ? And if it’s a policy problem why are some GP’s offering much better services than others ? There are some excellent GP’s out there and there are some who were substandard before Covid, and I think the pandemic has thrown the inadequate ones into sharp relief. I realise that there is a knock on effect from the pandemic, but I think something else is going on here too. I’ve never seen so many advertisements for what amount to privately paid GP services which can be booked online. There are even threads on MN and GN from people who have used them and found they could get an actual face to face appointment which was faster and more efficient that NHS services.

So much of our NHS is being directly and indirectly privatised and - sorry to sound like a conspiracy theorist - but I do wonder whether the pandemic has presented the perfect opportunity to sound out the British public to prepare us for the eventual effective ‘privatisation’ of GP services.

As for 'try the pharmacist..' that's all well and good for minor things but 9 times out of 10 they say you really need the GP because what I'd recommend is only available on prescription. A pharmacist shouldn't be held accountable for the failings of the GPs in this country, it's not their responsibility to provide health diagnoses,

My personal thoughts on this, I have social anxiety which means I absolutely hate using the phone, it takes me a long time to build up the courage to phone for an appointment in the first instance, so much in fact that I've only been to the GP twice in the last 5 years. There is no way I would be phoning for an appointment and then waiting for a gp to call me, my anxiety would be through the roof.

I also work 9-5 with a 30 min lunch break. I can not answer my phone at whatever time it is that the GP decides to phone me back.

The result of this is that I don't bother to get my health concerns sorted out.

They really shouldn't be automatically only using this telephone triage system for everyone.

Many people are just not bothering to try and get medical assistance and the ones who are still using it are those who would be using it previously for any minor cough, cold, ache or pain.

@minipie

In my particular GP surgery :

• you have to wait on hold for up to 30 minutes before you can even speak to a receptionist

• when you finally get through, you will be offered a phone “triage” appointment in about 3 weeks’ time. F2F very rare.

• if you say it’s more urgent, your only option is to phone at 8am for one of the few same day appointment (also by phone). But a) 8am is school run/commute time so very difficult and b) even if you can call at 8am, and wait on hold for ages, by the time you finally get through they have all gone.

I believe phone triage appointments are sensible in principle. BUT to be genuine triage they have to be in the next day or two. Not in 2/3 weeks’ time. So many diagnoses are going to be missed or delayed this way.

• They have an online booking app, but only specific sorts of appointments (smear test for example) can be booked online. No idea why

I do not believe my particular GPs are run off their feet. I have been into the surgery a few times since they finally opened their doors in June, to pick up forms etc. Every time, there are maximum one or two people in the waiting room.

I know many of them work part time. In any other industry that had a sudden surge in demand, part time workers would be asked to work extra hours where possible. Has this happened? If not why not? Is it lack of funding, or fear that GPs would resign?

If you cared about your patients you would look to make things easier like having a proper appointment app. I mean its ridiculous to cling on to old ways and processes that don't work.

And they wonder why people get pissed off.

Lets face it even jusg this thread alone the major complaint is being able to book an appointment of sitting waiting on hold...if that is the main complaint being feedback to them why wouldn't they just reduce that by sorting it out with an app.

Why is that so difficult to fix! It isn't in reality.

@POSITIVETHOUGHTSS Lots of people who aren’t gp’s are at work earlier than you. Lots of people go to work after being up all night with the baby. Lots of people (not doctors) deal with call outs all night and still go to work the next day and some people work weekends too. Many private sector workers would be happy with your workload.

My surgery are amazing. Last month had a phone call with same day face to face for a suspicious breast lump. Have phone appointments which then lead into f2f if needed. I do understand frustrations of not getting f2f on initial appointment but we really don't know how much pressure our GPs are under. I guess it also varies from surgery to surgery x

In the past when I've had a busy demanding job the last thing I could be arsed doing would be logging on to mn for a debate/argument

I have a busy, demanding job and 4 DC and I love a good argument/debate on MN. Clears the head