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?

@bunnybuggs if the government ever tried funding primary care on a payment per contact (and believe me it never would) it would NEVER be able to afford it. Primary care is the most spectacular bargain ever. £150 per year per patient? To deal with all the complex, chronic diseases? Some patients are seen ever single week. Multiple times. Home visits. Payment per contact? Yes please..... bring it on!!!

Ours have been fantastic. All over the phone, didn't need to see them face to face, and the service has been brilliant. I sent photos of a problem DD had with her skin and then had a phone call about best next steps. All sorted very quickly. I'm sorry to hear that others are having problems but let's not turn this into a GP bashing thread akin to what was dished out to teachers last year. Everyone is working round the clock and on their knees dealing with a pandemic.

@Musicaltheatremum.Thank you for your work

Apart from rate per patient, what else do GPs get money for? Do they still get extra money for every vax they put in an arm?

www.bmj.com/content/371/bmj.m4354

There are 6,000,000 GP practice appointments per week. That is 10% of the population per week. Who are consulted at a surgery by phone or face to face. Face to face are 60%. In addition there are letters, prescriptions, home visits, referrals and everything else. What % of the population does that make it who are dealt with day in, day out?

It’s so depressing
I had a phone appointment in august for an issue she couldn’t hear me on the phone so asked me to attend 1 1/2 hours later-
She did tests which I had the results for at the end of September
Prescribed meds etc and told me to call back of any probs. All good
Except I do have problems. The meds haven’t worked and I can’t get an appointment because they insist you ring at 8am for a phone call which could be anytime that day but I’m seeing my own patients until after lunch by which time they’re not seeing by one else that day - the advice is ‘try again tomorrow’
But I can’t I’m at work.!

So I’m stuck The advice from the pharmacy and the consultant is ‘see the gp’
Arrgh

I'm with you @Heatherjayne1972 There are some good US docs on YouTube.

Yes! Why is there no recognition from GP surgeries that not all their patients are elderly or retired or layabouts. The vast majority of people are extremely busy and running about like blue arsed flies between 8:00-9:00 - getting children up, feeding babies, doing the school run, getting ready for work, travelling to work. It impossible to get an appointment using this method at my surgery. And I mean impossible. I tried this morning, I was on hold for 42 minutes (stressful, while driving), finally got through and as I started to speak I had to flick the sound over from the car to the headphones and was immediately cut off before I could get a word out. I'm in my forties and can multitask, how do elderly, ill, disabled people manage? So I'm left with online bookings whcih are at least 3 weeks out.

When you finally get a phone appointment, you then get called randomly at some point 2/3 hours aside of your appointment time. Why do GPs thing they are the only people with busy, stressful jobs? It's so stressful trying to keep the phone free or yourself free to answer it for hours at a time. What do teachers, bus drivers etc do?

it really does come across as rude I'm afraid when they deign to call you and then get huffy if you're distracted, or need a minute to pull the car over, or wipe your arse or whatever you were doing!

@ARudeTerriblePerson

Apart from rate per patient, what else do GPs get money for? Do they still get extra money for every vax they put in an arm?

I understand from a practice nurse I know that yes, they do. Happy to be corrected if this is wrong

@ARudeTerriblePerson I'd need to check to be sure but in England I think there's additional funding for COVID vaccination and the annual 'flu program but most most of the regular vaccination programme, including kiddie imms, are required within the contract without additional payment. Travel vaccs are a little more complicated, some are private with the patient needs to pay with a few for public health reasons were free to the patient but there are some can different variations individual practices can agree.

@Sonex one of the problems is that relatively well patients are taking appts for relatively minor issues, so less tech savvy elderly cannot get through

Yes because they were told not to got to the doctors at all for almost 2 years and now the non urgent reasons are building up! Are GPs only for emergencies now? Where are you meant to go for HRT/depression/in grown toenail/strange rash/suspicious lump?

@PeasLily

It's the same in my area, you can't even speak to a GP on the phone, only the triage nurse. I don't know anyone in real life who has managed to speak to a doctor for months. I have been signed off work for several months and they still don't know what my ailment actually is - I just ring up every few weeks and tell the nurse another possible thing I've discovered from constant googling. She will then refer me for the test I've asked for (I've now had several, and been to nearly every hospital in the area), or she will prescribe me the meds I suggest. I know the GPs are there somewhere, as it's their signature on my sick notes, but I'm not sure what else they're doing. I do know that I could probably be one myself now as I've been pretty much left to research everything myself!

This made me laugh... particularly the last line.

Yes dear, you could be a GP with your few months of Google as opposed to four years of medical school, a year of pre- registration in hospitals, a further year of post registration in hospitals plus several years of going round the specialties. That's before a year in a practice as a GP trainee.

But yes...a few months of Google will suffice.

In short, it is not the case that there is additional payment for every vaccination and before someone implies it, certainly no desire to jab when not required. The COVID programme involved 7 day a week working for some staff for months. The last two weeks have involved long hours on top of the day job.

We delivered the COVID programme quickly as a PCN then withdrew when the government sabotaged it.

We've got third primary doses to delivery though comms with consultants have been poor. Then COVID boosters. Will need to look at the funding but am unsure any of the COVID boosters or third primary doses will carry funding that will be significantly more than the activity involved.

The NHS has had YEARS of underfunding, as a result we don't have as many GPs as we used to.

All out local surgeries are joing up in various medical groups so that they can cover the area better.

People are moaning like crazy....but they will all rush out and vote Tory come the next election. Then they will continue to whine as it continues to get worse.

Funny old world eh?

Christ I wouldn't be a GP for all the money in the world. Thankless bloody job judging by some of the comments here.

@NotPersephone

Are you allowed time off work or do the general public get to dictate what you do when you’re not at work?

In the private sector nobody who is unable to meet the demands of their job (by seeing adequate numbers of patients) is not permitted to go PT. There are literally no other jobs with equivalent pay, status and seniority to GP's where the right to work a couple of days a week is treated as a sacrosanct human right.

Obviously it's the government and not individual GP's who are primarily to blame for the current disaster unfolding in primary care, but I have (limited) sympathy for a system in which training 1000 GP's only leads to (say) 300 FTE's. It's inefficient and a waste of cash.

A) that doesn’t answer the question B) the demand for GPs and health services is never ending, they would literally never go home if they stayed to see every person who wanted an appointment. Because the demands and expectations of the community are rising all the time. C) you don’t seem to understand that health care is not the same as producing paper clips or whatever in the ‘private sector’ so you’re comparing apples and oranges, pointless and we learn nothing D) you seem to be quoting random figures which are made up and even then you’re not even attempting to consider the contributing factors.

@NotPersephone "part time" or "a couple of days a week" for a GP is realistically 3x10-12 hour days - almost full time.
Obviously if working less than full time they will get less than full time pay.
The vast majority of GPs do not work 5 days a week because that would simply be unsustainable. It's not a 9-5 job.

I'm in Shropshire and can't get a call back appointment nor a face to face appointment it's ridiculous

I’m a GP working in an incredibly deprived area.
Of 4000 patients, I estimate we are seeing the same 250 patients on rotation the majority of the time. Many are severely mentally ill awaiting mental health secondary care, many are financially destitute. Many are poorly educated and do not have the skills to ‘self help’ or cannot afford over the counter medications. Many are 2 years into a waiting list for a joint replacement op and need help managing their symptoms. Many are morbidly obese or heavy smokers or drinkers and are suffering the effects of their lifestyle choices.

Kid having issues with behaviour at school- teacher advises ‘see GP’. Social worker thinks Mrs Jones needs a bungalow and not a 6th floor flat - see GP for a housing letter. Employer wants an exemption letter so Mr Smith can be let off wearing steel toe caps - see GP.

Social care, secondary care, education, economy, primary care.. they’re all broken.

GPs are the filter and receive the consequences of all of the above issues. We just cannot cope anymore.

We are not the GPs of the 1970’s anymore where your doctor knew every patient and did house calls just to check on you. The model is completely different because of a massively increased population and massive change in society’s needs.

I come home after 12 hours and can barely speak I’m so emotionally drained. Not sure if I can carry on for much longer.

[quote Pokhora]A lot of them are either emigrating or retiring becuase they are fed up of the working conditions in the UK.
www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice[/quote]
Bollocks! at £100k p/a and £12 per jab dose you have to be kidding!!!

Gave up on our GP yrs ago - used to go to the Pharmacy in the first instance instead, even for my son - which was esp helpful when I had a uti and was given 3 days of antibiotics - instead of having to wait 10 days for a GP appt !!

The nurses are brilliant though I must say!

@VenusTiger individual GPs don't get the £12 per jab dose straight into their pockets. The money goes back into the practice, often to make up for the shortfall which comes from having such a small budget for unlimited consultations per patient per year.

Gastroenterology in my local hospital has just hit 63 weeks wait for an appointment. Other specialities not far off. What am I doing? Managing complex cases, in whom I have already tried everything I can to manage symptoms or investigate before referring, for who I have no way of moving things forward, whose symptoms and mental health is likely getting worse. Multiply this by every speciality and you will get a good idea of why we are swamped.

Gastro here is pretty good, but not-urgent neurology is now booking dates in 2023 (seriously) with no local GP access to CT Head or MRI Brain.

It's a massive issue, and I have no idea how the hospital will dig themselves out of this. Of course, these patients will sit in primary care in the interim.

@Offerdecisionneeded

I’ve received 2 job offers in the last few months from departments I have previously worked for to work in a specialist Dr role- 9-5, proper clinic apts. Seriously tempted by the offers, this is unsustainable.