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?

@Darkchocolateandcoffee excellent. It's unfortunate it's you who has to build the relationship but I do think it's worth a try. I think some older people have actually lost confidence in their abilities to push for what they want. Hopefully you can do this for them and the. Leave them to it. That had certainly happened to my previously pushy parents!
Good luck.

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’ve seen this used several times as a measure of how busy GPs are and it’s utter nonsense. Just because there’s no one in the waiting room doesn’t mean the GP’s are sitting about doing nothing. Covid is still with us and our own surgery is typical of many who don’t encourage the use of the waiting room for anything other than the absolute minimum of people - mainly those with mobility problems. It doesn’t mean they’re not busy.

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

You don't need to be a conspiracy theorist for that - you just need to observe, read widely and note what's already happened with things like dentistry, optician services, chiropody, etc, etc.

Does anyone seriously believe that the money to be made from privatising the NHS wouldn't be a temptation to our more venal leaders?

It seems very patchy but some GP's havent particularly shone with glory over the pandemic.

They are now asking for more money again.....

Practice can't be busy, there's only a few people in the waiting room.

Every consulting room might be busy and we try and reduce crowding in waiting rooms to reduce exposure to COVID for what's likely to be a more vulnerable population than average during what looks like a still high background infection rate.

I went to my dentist and they managed appointments to have only two people waiting with others in cars or waiting outside. I hadn't realised they were lazy, CF, I just presumed they were operating in line with sensible infection control guidance.

Whatever the problem is the consequences wrt the lack of ability to get health care are seriously frightening.

Ok, fair enough about the waiting room not indicating how busy they are. Perhaps they are all on back to back phone appointments.

It does indicate how few f2f appointments are happening though. With a surgery this size you would expect 10 people in the waiting room even if everyone has only arrived just in time for their appointment. Or several people hanging about outside if those numbers are not allowed.

GPs are mostly private except for a few run by acute trusts or Virgin Health Care and similar. I think it's the wholesale corporatisation to larger entities that is in play. Large enough entities to make political donations and have politicians as NEDs. Perhaps look at the large UK and offshore corporate health firms making donations to parties and Ministers now. For all of those who think it will improve things, I expect the performance of larger entities and corporates now is much better than the average for small practices (it could have changed but it absolutely wasn't the last time I looked though to be fair, they have taken on some 'failing' practices so improvements might be harder)? In wonder if the majority of your remote consults will be offshore in the future. I suppose PPs will say that will be fine if they can at least get one. We can be sure this will be a 'levelling up' of performance in line with other government initiatives.

@Rosscameasdoody spot in. We try and stagger times, easier for the half hour checks and reviews and such like.

Unless the patient has mobility issues or is elderly and vulnerable in the rain or cold then we don't want people waiting indoors in groups to be exposed to infection. We still have some patients who have not left their house except to come to us sine the outbreak started. Not everyone has forgotten about the infection and returned to norma but that is a different thread.

We have also continued house visits for the housebound which involved lots of sweltering in PPE in the Summer or freezing in the snow last Winter will getting changed on drives or in car parks so some of the vulnerable don't come into surgery at all.

It does indicate how few f2f appointments are happening though. With a surgery this size you would expect 10 people in the waiting room even if everyone has only just arrived in time for their appointment.

But it doesn’t !! Covid is still with us and if ours is anything to go by, surgeries are responding to this by adhering to appointment times, asking patients not to turn up early, and only using the waiting rooms if there’s no other option. Patients are not left hanging about unattended, so an empty waiting room isn’t indicative of anything. At all.

@JaniieJones

'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.

Tell that to the 20-odd GPs who have died, as well as the primary care staff. There have been more GP deaths than all other specialities put together - link to deaths up to Sept 2020 - there have been more since.

GPs are frontline staff. We have seen far more patients face to face than any other speciality with the possible exception of A&E (I am also an A&E doctor - as individual doctors, we don't usually see as many patients in a day as a GP, but we are exposed to more because they are all the dept at the same time).

In March 2020, no one had a clue how infectious or dangerous Covid was. My staff - not just the GPs -everyone, came to work and carried on seeing patients, not knowing whether they would lose their lives as a result. They went home at night, knowing they could be taking infection home to their families, but they put patients first. We never stopped seeing people face to face, even when we thought that many of us might die as a result. That was fucking brave and anyone who tries to minimise it is an utter twunt.

And by the way - our dentist’s waiting room is empty too, and by their very nature all dentist appointments are ‘face to face’. Like I said, indicative of nothing.

@FindingMeno

Whatever the problem is the consequences wrt the lack of ability to get health care are seriously frightening.

Absolutely right. This is what we should be worried about. It really frightens me.

Instead of demanding more doctors and a 21st century healthcare system, the public fall again and again for the cynical distraction of blaming GPs/hospital managers for the fact that their systems can't cope with a huge surge in demand after a decade of under-investment.

The public and the NHS should be on the same side. The only people who benefit from setting the public against GPs are the government. It lets them off the hook every time.

@DamnUserName21 Indeed. Perhaps it would be more surprising if the media put the responsibility where it belonged.

Research showed primary care was the most trusted/least untrusted part of the NHS so GPs were given a slightly enlarged gatekeeper role through CCGs in part to break or at least increase distrust in that part of the system. Who says government can't think long-term? Well, perhaps all the business owners being told this week at the party conference just to pay more and train up their workforce when that won't solve immediate staffing crises. Presumably this post-hoc justification for screwing up the economy without thinking things through would arguably ideally have been communicated with resources and incentives three to five years ago?

Both full time GPS at my practice are excellent. What isn’t excellent is the new, on the day only appointments system that doesn’t have any queuing option. Booking opens at 8am and then from 8.05 nobody answers the phone. They’ve disabled the on line booking system and there is no other way to make an appointment. I tried for over a week to get through and just gave up.

On the few occasions you can get through there’s the confidentiality issue. I don’t want to discuss my menopausal symptoms in front of other people thanks but you don’t get offered a call time so you can’t plan anything that day.

I don’t understand why more medication isn’t available over the counter in the UK either. Madness to need a GP appointment for the decent hay fever meds I need every year.

I find it much easier to get an appointment now with a gp than before the pandemic

Had a few house visits for aged parent and I’ve had some telephone and some face to face

Called mine after much nagging from family Monday morning this week. Had face to face at 11.30 that morning, back in for bloods at 1pm same day. He called hospital with ultrasound request and I was seen yesterday. Surgery rang me this morning with next appointment details for early next week.

Really impressed, tbh. Guess it depends on area/individual surgery and perhaps history/condition of patient?

@MissLucyEyelesbarrow spot on. No PPE here then comedy stickered expiry dated PPE then rationed and we never stopped seeing patients F2F where appropriate. We still have a couple of HCPs with long COVID. We had one colleague who lived in a caravan on a drive and one who moved out entirely because they couldn't live with the guilt of passing infection on to vulnerable family members. Lots of tears from colleagues worried at the time about family and work responsibilities. I would say people forget quickly but many don't even take the trouble to understand in the first place,. Fortunately, the Daily Mail will agree with them.

confidentiality issue. I don’t want to discuss my menopausal symptoms in front of other people thanks

That’s not a confidentiality issue but a problem with discussing the issue with the receptionist

The receptionist is also bound by GDPR and is asked to ask you the reason you’re calling

They are doing exactly the same as the last ten years only much busier. (Home visits, face to face consultations,phone consultations, referrals, paperwork, 100s of prescriptions a day plus many other things)

My doctors and all the other staff are at breaking point.

@CurlyhairedAssassin

I know of parents whose children are in year 13 and applying to Uni. They’re actively discouraging them from applying for medicine because of how stressful it has become working in the NHS. If this attitude becomes the norm then things are only going to become much worse in terms of GP shortages and a self-fulfilling prophecy.

Someone further up mentioned that other countries must have over anxious parents who take their child to the GP for just a cold. I’m not sure they do to the extent that goes on here. I recently had to take my son to A and E for an actual medical emergency late at night. The waiting room was full. It seemed to be a mixed bag, some of whom looked like they needed checking out, others who were eg walking round perfectly fine on a foot that had a tiny dressing on the heel - THAT’S the sort of thing that people need to stop bothering A and E for and instead wait till the next day and take them to a walk in centre or speak to a pharmacist (who in my experience are actually really helpful). Plus you see it all the time on the ambulance programmes on TV; people phoning an ambulance when they could simply have got a taxi there instead, saving themselves time and the NHS a grand, not to mention putting someone else in a genuine emergency at risk of not being reached quick enough by ambulance crews cos they re held up having to act as a taxi driver. It makes me fume. What’s needed is more education - more TV shows and campaigns on what each aspect of healthcare costs the NHS, example scenarios of what a patient’s options are when they’re looking for treatment. Unnecessary visitors to A and E advised by the triage nurse that they should go somewhere more appropriate next morning.

Problem is that will never happen just in case of the tiny risk that someone is sent away and then deteriorates. So they treat everyone’s the same and they join the huge queue to be seen by a doctor. I’ve seen it with my dad too. He’s in his late 80s, I’ve been in A and E with him all night and having to hold him upright in his chair as he blacks out from severe gallstone pain. All the while watching in amazement as groups of people treating it like a dramatic family or friends night out come in in a pack, one with a tiny cut on their head forehead where they fell over after the pub or got in a fight. I mean, for God’s sake. It’s disgusting. It’s like some people love the attention and drama, and so many just have no resilience at all. Sometimes I’m ashamed to be from this country, our healthcare system gets abused so much. We’re full of snowflakes, and the genuine people in need of care are too polite to push for themselves, and just soldier on.

I agree with much of this. I'd like to see hospitals enforcing a policy of not allowing large family groups to attend with a patient. I assumed Covid would have put paid to a lot of that, actually.

Better mental health care in the community would be a big help. From what I've seen on the various ambulance programmes, some people desperately need help and support and in the absence of any other way to get it they dial 999.

Also, further back, more support for families would prevent some of those mental health issues arising in the first place.

Pigs will fly before our current government invests money in the latter two areas, though.

@RuthW

They are doing exactly the same as the last ten years only much busier. (Home visits, face to face consultations,phone consultations, referrals, paperwork, 100s of prescriptions a day plus many other things)

My doctors and all the other staff are at breaking point.

Our GP doesn't do home visits at all unless you're seriously disabled. They haven't done for years so no change there. Face to face appointments are like rocking horse shit. Couldn't even get one for my 85yo mum when she was acting confused recently.

Ante natal care has been sparse and sporadic, no post natal check up at all. Health visitor did an over the phone checkup with newborn. How the hell can that be right?

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.

GP’s ARE frontline staff, and there HAVE been deaths among GP’s, both before the full implications of Covid were known, and after. There is a perceived complete shut down of GP ftf services during the pandemic, which is just not true. The pandemic isn’t something we were prepared for and GP’s, like everyone else, did the best they could in a scenario which initially, was changing from day to day. They adapted their services to protect themselves and their patients. They still are - Covid is still with us and I don’t think it’s realistic to expect GP’s to just throw open their doors with abandon. Government advice is currently that GP’s should start offering ftf appointments again and as far as my own surgery is concerned, that’s happening and I have to say that throughout the pandemic I had several ftf appointments as they were deemed necessary. Sure, there are bound to be some practices who aren’t up to standard, but in part, I think these are the ones who had shortcomings before Covid and these are now being thrown into sharp relief. I think it’s disingenuous to say the least, to suggest that GP’s closed their doors to protect themselves - hindsight is 20-20.

My gp has been amazing, you email in the morning and they ring about an hour later. Usually they'll prescribe over the phone which works for me but they also still do face to face if needed but they do have to ring you first. I've been seen face to face very quick when needed.