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?

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

I know any private system is slated on MN, where the NHS is “wonderful” but where I live there are 3 or 4 private radiology groups. This means that GPs and private specialists can get urgent outpatient imaging within reasonable time frames (days) with same day reporting. The “best” locally has the complicated paediatric reporting by one of the same paed radiologists who also works for the local children’s hospital. Hospitals can also access outpatient radiology images.

Most of them will bulk bill do there’s no additional cost to the patient.

Yes, there’s also a long wait for hospital imaging but it does reduce some of the strain on hospital services

[quote bubblepond]@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.[/quote]
And it costs a fortune to run vaccination campaigns - we bring dozens of staff in on their days off, paying overtime, hire marquees, buy eye-waveringly expensive vaccine fridges - and the vaccines themselves (other than the Covid ones, we have pay for the vaccines). I don't think most posters on here have a clue how expensive it is to run a GP surgery.

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

If the pharmacist was able to help you why do you think you needed to see a GP? A GP shouldn’t be the first port of call for absolutely everything. Pharmacists are great and should be used a lot more when appropriate so do.

So your expertise on GP finance is based on occasional conversations with GPs? OK.

No, it is based on years of speaking to GP representative bodies, specifically in relation to financial settlements. Just as my post said.

Why are you attempting to present that as ‘occasional conversations with GPs’? It couldn’t be that you are trying to belittle the opposition, could it? No, surely not.

The narrative that practices are choosing not to recruit so that they can increase profits does not stack up. Practices are folding because they cannot recruit.

Actually I spoke specifically about practice support staff. Why aren’t practices better organised? Why are old people forced into a ridiculous game of fastest finger first? Why have some practices switched off e booking? Answer: because you won’t pay for the best managers and you won’t pay for modern applications, which as a PP points out, even small gyms can manage.

GPs are handing back their contracts, often at a huge financial cost (because of early redemption charges on mortgages) that they bear personally

Handing back your contract is your choice. You are a business owner. If your business redeems a mortgage early then yes, there will be charges. You have the rewards of owning a business with few risks, because everyone wants what you are selling: healthcare. Now you want to be indemnified against all risk, too?

As an expert on economics, perhaps you can explain why it's so hard to recruit to a job that's apparently so over-paid and piss-easy

There you go again, being aggressive. You stand a better chance of being taken seriously if you can argue sensibly. I did not say that I was an expert on economics. I said that I had worked in senior NHS finance and spoke to GP representative groups for years. Nor did I say that a GP’s job was “piss easy”.

If you want to know why it’s hard to recruit, maybe all the complaining by current GPs, including you, is putting them off?

And the government bots get busy in the NHS again. Yes we know you want to privatise it. It's becoming boring.

@Iamthewombat

So your expertise on GP finance is based on occasional conversations with GPs? OK.

No, it is based on years of speaking to GP representative bodies, specifically in relation to financial settlements. Just as my post said.

Why are you attempting to present that as ‘occasional conversations with GPs’? It couldn’t be that you are trying to belittle the opposition, could it? No, surely not.

The narrative that practices are choosing not to recruit so that they can increase profits does not stack up. Practices are folding because they cannot recruit.

Actually I spoke specifically about practice support staff. Why aren’t practices better organised? Why are old people forced into a ridiculous game of fastest finger first? Why have some practices switched off e booking? Answer: because you won’t pay for the best managers and you won’t pay for modern applications, which as a PP points out, even small gyms can manage.

GPs are handing back their contracts, often at a huge financial cost (because of early redemption charges on mortgages) that they bear personally

Handing back your contract is your choice. You are a business owner. If your business redeems a mortgage early then yes, there will be charges. You have the rewards of owning a business with few risks, because everyone wants what you are selling: healthcare. Now you want to be indemnified against all risk, too?

As an expert on economics, perhaps you can explain why it's so hard to recruit to a job that's apparently so over-paid and piss-easy

There you go again, being aggressive. You stand a better chance of being taken seriously if you can argue sensibly. I did not say that I was an expert on economics. I said that I had worked in senior NHS finance and spoke to GP representative groups for years. Nor did I say that a GP’s job was “piss easy”.

If you want to know why it’s hard to recruit, maybe all the complaining by current GPs, including you, is putting them off?

Not knowing the backstory, I'll resist the urge to address some of your other points. But on the "applications" issue your comments strike me as coming from someone who knows nothing about GP IT procurement and more broadly practice management. GP practices do not fully control their IT.

For some years GP applications have been procured at a locality level (be that PCT previously, CCG, and more recently PCN or ICS) and not individual practice decisions. It would be very unusual, for example, the practice manager to decide which e-consult system was selected in their own practice and that's why most/all practices in one area will be on the same system. Apart from anything else dozens of different systems would make IT support from CSU much harder, affect interoperability and group working and generally result in a very messy solution.

Furthermore, GPs cannot simply pick up off the shelf solutions - there are now only 2 major GP IT systems in England (EMIS/SystmOne) and any peripheral software needs to communicate this via API - most standard solutions do not.

Finally, any applications selected should be on the NHS Digital Framework as it has to have been tested to meet IG requirements (UK data centers etc.).

I'm not sure what your background is but you should probably stay in your lane - comments like the above are probably making the other GPs think WTF is this person on about?

And on the recruitment issue do you honestly think that the newer doctors coming through (who are much savvier than my generation) are put off just by older GPs explaining what an average day looks like? LOL. They see how hard we are working, they see that the service is/was running only on goodwill, they experience GP early on (it's common for FY1/FY2 to include a GP rotation component) and they see the abuse in the press / media and from the general public. There's nothing a demoralising as working your arse off over and above what you're meant to be doing and then being told you're useless. Us telling it how it is is only a small part of the picture.

I need a referral making to a different NHS trust (following a hospital consultation) I rang and asked the surgery to make it, no I had to either ring back first thing the next day or do an e-consult. Just making more work for everyone.

@Tinpotspectator

And the government bots get busy in the NHS again. Yes we know you want to privatise it. It's becoming boring.

Oh yes it must be bots and not people dealing with a worsening condition that are not able to be seen.

Mine have been fantastic and continue to be so. Fill out an e consult and get called back within 24 hours, if it's urgent I can get the duty doctor to call me within hours. I've been seen in person same day on a number of occasions, even being told to turn up and wait and she'd see me between appointments as she had none left but didn't want to leave me unseen. Booked in for next day bloods when they wanted them done. Pretty much unfettered access to advice re medication when trying to get dose of new drugs settled, follow up calls etc.

I'm seeing several others on social media complaining about the same practice that they can't see anyone in person, and I can only assume that the GPs are able to treat them successfully over the phone and they're unhappy they haven't been 'seen', because I can't imagine I'm getting special treatment and anyone with a clinical need is clearly being seen too 🤷

I'm sure there are some gp practices that find this harder if they have staffing issues/too many patients which is obviously an issue but I seriously doubt any are sat with the doors shut drinking tea all day!

They're working unsustainably hard, just in some places there's not enough of them!

They are running on empty. Target your frustration on those who are behind the chaos, those in government who underfund the services and lie, and those who value lower taxation and massive profits at the cost of the vast majority of the population.

There are so many nice comments on here from people getting a good service. When I read the GP bashing threads (started weekly) I think where are the others, the 10% of the population which gets consultations every week? Surely they’re not the same 10% every week.

What I am finding is that GP practices are working more creatively and perhaps for the first time ever. They appear in my area at least to be triaging appointment requests and then referring accordingly so that anyone who doesn't need to see a GP can be seen by another member of the primary care team.

My son for example is autistic and is having a lot of MH issues at the moment. I rang for a GP appointment which was given for three weeks ahead.

Now my son is not suicidal so I knew we could wait . I also knew I was going to ask the GP for referral to a MH worker.

Then the appointment came and instead of a GP phoning it was a MH worker. They'd taken the issues on board and referred him directly to the MH team who phoned him(and me).

The worker was great, really listened to DS and also adjusted his medication, all without having to take up the valuable time of the GP.

The same is true of my dad who has dementia, a case worker visited and did a complete assessment of his needs . She reviewed all his medication and liaised with the GP and the foot clinic. GP phoned later that day with a prescription for antibiotics which was sent straight over to the nearby pharmacy. The foot clinic phoned and arranged a home visit. All without my parents having to leave the house. Fabulous service.

The numbers of GPs has fallen but in our area their time is being used better by using this triage system

I think GPs are over used. A lot of things can be handled by a pharmacist. If people did that more, then GP appointments could be used for more serious issues.

As an example, a colleague this week had a GP appointment for a cold. She expected antibiotics.

I'm not sure what your background is but you should probably stay in your lane - comments like the above are probably making the other GPs think WTF is this person on about?

(From another furious GP).

I told you what my background was: NHS senior finance. Including dealing direct with GP representative bodies.

You’re not going to win support on here from people frustrated by the inability to book any kind of appointment if you constantly complain that nobody can possibly understand the reasons unless they themselves are a GP.

No, we must not question or criticise, ever. We must ‘stay in our lanes’. Even if we have had direct experience of GPs negotiation strategies in the past. Anyone who challenges your defences, some of which are genuine and some of which are frankly rather self-serving, is a ‘government bot’.

Its really simple. People keep voting for the Tories who have ensured our health service is chronically underfunded and resourced. There are simply too few GPs. Other European countries have far more GPs per head of population

@Iamthewombat

I'm not sure what your background is but you should probably stay in your lane - comments like the above are probably making the other GPs think WTF is this person on about?

(From another furious GP).

I told you what my background was: NHS senior finance. Including dealing direct with GP representative bodies.

You’re not going to win support on here from people frustrated by the inability to book any kind of appointment if you constantly complain that nobody can possibly understand the reasons unless they themselves are a GP.

No, we must not question or criticise, ever. We must ‘stay in our lanes’. Even if we have had direct experience of GPs negotiation strategies in the past. Anyone who challenges your defences, some of which are genuine and some of which are frankly rather self-serving, is a ‘government bot’.

Furious? Lol.

I'm not furious, I calmly pointed out in a moderately detailed manner why your comments expose your lack of knowledge in the area in which you're commenting. If your background is in NHS Senior Finance that explains why you don't know anything about GP IT. That makes sense to those of us that do.

"Staying in your lane" was a suggestion that you should comment about things that you actually know about. But there's good news for you: you don't have to follow that suggestion. Carry on posting about GP practice management - if anything it will make us laugh! And we need that right now!

I repeat: you will not win support by attempting to close down anyone who questions or criticises you by cherry picking things to ridicule, getting angry or claiming that nobody can possibly understand what it is like to be a GP unless they themselves are a GP.

How about you answer some of the questions that have been repeatedly asked on this thread? Why are old people with health needs having to call GP practices at 8 am, waiting on hold for up to an hour, before being cut off or told that they can’t have any kind of appointment, face to face or telephone, bad luck, try again tomorrow? How is that acceptable? That’s entirely due to poor practice admin. Explain that.

Why have some practices switched off e booking?

A PP reports that one of her GPS is touting for private work, during NHS time, with appointments miraculously becoming available. I believe her. Why is that acceptable?

Why are some practices using inadequate call centres to answer calls from patients? Why not pay for more people to answer calls?

Why was a GP upthread complaining that she couldn’t see as many patients because she was dealing with absence and locums? Why not pay for proper practice management to do admin?

@anniegun

Its really simple. People keep voting for the Tories who have ensured our health service is chronically underfunded and resourced. There are simply too few GPs. Other European countries have far more GPs per head of population

Yep! I always feel as well it's people who are tories and reading the daily mail etc who are the ones complaining about lack of provision.

When I see these threads I often wonder have you actually had load of bad experiences getting a gp appointment or did you have one or two and also read the daily mail?

I've actually had really good care from my GP during the pandemic and I got surgery a few weeks ago after a nearly 3 year wait. The staff were excellent as was my care. So I feel despite chronic under funding the NHS is actually doing OK in some areas mainly because of the staff's dedication.

@Iamthewombat

I repeat: you will not win support by attempting to close down anyone who questions or criticises you by cherry picking things to ridicule, getting angry or claiming that nobody can possibly understand what it is like to be a GP unless they themselves are a GP.

How about you answer some of the questions that have been repeatedly asked on this thread? Why are old people with health needs having to call GP practices at 8 am, waiting on hold for up to an hour, before being cut off or told that they can’t have any kind of appointment, face to face or telephone, bad luck, try again tomorrow? How is that acceptable? That’s entirely due to poor practice admin. Explain that.

Why have some practices switched off e booking?

A PP reports that one of her GPS is touting for private work, during NHS time, with appointments miraculously becoming available. I believe her. Why is that acceptable?

Why are some practices using inadequate call centres to answer calls from patients? Why not pay for more people to answer calls?

Why was a GP upthread complaining that she couldn’t see as many patients because she was dealing with absence and locums? Why not pay for proper practice management to do admin?

Firstly, I'm not trying to "win support", I'm not quitesure what you think this is. All I did was calmly and reasonably politely pointed out that you had posted something that was simply untrue, and explained why.

I'm sorry if you felt ridiculed but that's sometimes what happens when you post bold but incorrect statements about something and are then corrected by someone who knows more than you in that field.

I wouldn't boldly comment about NHS Senior Finance because that's not my area. I know that I'd look like an idiot. And if someone did coming along that knew about this, I would stop digging a hole.

In terms of the other issues, I'll circle back in a second.

Finally, can you stop implying that I'm somehow angry / furious? This is gaslighting and re-reading the posts your posts come across as much angrier than mine (perhaps because you feel ridiculed as you yourself imply). Again, sorry about that.

I became both menopausal and I'll over the last 6 months as well as ha e another injury.
Just one of those things, nothing for years and everything at once.
I have joined the doctors and got an advanced ed practitioner nurse phone appointment who asked me to come in an hour later. I got diagnosed and was given a prescription.
I e has a couple of phone appointments which were very useful and I also got slkwd in for blood tests.
Personally I'm finding the
phone calls helpful. I dont have to leave the house, they phone up when they say they will and if there's concerns they will ask you to come into the surgery.

I don't think any of the GPs on here are trying to 'win support'. Their posts read as trying their best to explain what is going on because it is complicated and sure as hell not as the Daily Mail make out. MN is a forum of intelligent and thoughtful people who can understand that it is not a case of 'lazy GPs'.

Firstly, I'm not trying to "win support", I'm not quitesure what you think this is. All I did was calmly and reasonably politely pointed out that you had posted something that was simply untrue, and explained why.

I'm sorry if you felt ridiculed but that's sometimes what happens when you post bold but incorrect statements about something and are then corrected by someone who knows more than you in that field.

I wouldn't boldly comment about NHS Senior Finance because that's not my area. I know that I'd look like an idiot. And if someone did coming along that knew about this, I would stop digging a hole.

What you are doing, of course, is trying to avoid the real question - which is the OP asking why the service being offered at the moment is so poor - by seizing on an opportunity to say “you know nothing, you’re ignorant, you’re an idiot, you’re making all of us GPs laugh”.

What I asked, amongst other things, was, why couldn’t GP practices use apps to modernise bookings when small gyms manage it?

The answer, it appears, is “because the PCTs do all the procurement locally and they won’t let us”.

(Who usually chairs PCTs and which group has significant influence over them? Oh yes, GPs. Let’s not mention that, eh?)

But don’t let that stop you from claiming that because I don’t know all the nuances of your particular practice and PCT’s IT systems, I therefore know nothing and should step away, because I’m providing amusement for you and the other GPs.

It’s the oldest trick in the book: try to shut down your opponent with ridicule or the ‘you don’t know anything so shut up’ defence. It doesn’t do you much credit, I’m afraid, and demonstrates that you have reasons for trying to close the argument down. Thanks for your concern, but I don’t feel ridiculed because I can see straight through your attempts to dissemble.

This isn’t a debate about your specific IT systems. It’s about why it’s impossible for many people, including some vulnerable people, to get an appointment of any kind and why those people are forced into a ridiculous and fruitless game of fastest finger first each morning, simply to chess the healthcare they need.

I look forward to hearing what you are doing about that.

@StewardsEnquiry

I don't think any of the GPs on here are trying to 'win support'. Their posts read as trying their best to explain what is going on because it is complicated and sure as hell not as the Daily Mail make out. MN is a forum of intelligent and thoughtful people who can understand that it is not a case of 'lazy GPs'.

Says the GP. The thread is full of posts from GPs telling us how hard their lives are and why it’s the government’s fault. Or, on occasion, the patients’ fault.

What’s the relevance of the Daily Mail? Which posters questioning the level of service from GPs have referenced the Daily Mail or have otherwise indicated that they have read, or are influenced by the Daily Mail’s stories? Or is it that you would like to suggest that anyone disagreeing with you must be a Daily Mail reader?

The questions have been answered repeatedly: not enough doctors, underfunding, unprecedented demand.

@Iamthewombat

I repeat: you will not win support by attempting to close down anyone who questions or criticises you by cherry picking things to ridicule, getting angry or claiming that nobody can possibly understand what it is like to be a GP unless they themselves are a GP.

How about you answer some of the questions that have been repeatedly asked on this thread? Why are old people with health needs having to call GP practices at 8 am, waiting on hold for up to an hour, before being cut off or told that they can’t have any kind of appointment, face to face or telephone, bad luck, try again tomorrow? How is that acceptable? That’s entirely due to poor practice admin. Explain that.

Why have some practices switched off e booking?

A PP reports that one of her GPS is touting for private work, during NHS time, with appointments miraculously becoming available. I believe her. Why is that acceptable?

Why are some practices using inadequate call centres to answer calls from patients? Why not pay for more people to answer calls?

Why was a GP upthread complaining that she couldn’t see as many patients because she was dealing with absence and locums? Why not pay for proper practice management to do admin?

So I'll caveat my answers here with a couple of points:

I appear to be coming to an existing sub-thread mid-way and haven't full RTT
I practice (NHS) in a well funded, "leafy" area where we score highly on all GP metrics and where we are well staffed
We have an excellent practice manager who earns £50k for a standard working week - pro rata this is close to many GP partners who earn closer to £100k but probably work twice the hours at higher intensity and higher personal risk
This answer is off the cuff and not normally as considered as I would like

1. Why are old people with health needs having to call GP practices at 8 am

Well there are a limited number of appointments - lets say 100 to make it easy. And 200 people are calling for those. So 100 will be happy, 100 will miss out.

This will include old people with minor problems, old people with major problems, babies with minor problems, babies with major problems and everything in between. You don't know why people are calling and to find out why everyone was calling and decide would itself take the whole day.

What is the most equitable way of deciding who gets an appointment? Should older people have enhanced access? Is an older person with chronic plantar fasciitis to have priority over a 6 week baby with bronchiolitis? How would you prioritise access for old people? Slots that only older people could book? - We discussed this last week (actually talked about a dedicated line). The thing is you need capacity to do this. And it's potentially discriminatory. And what happens when the "younger person" slots are filled? Can you take one of the older people slots if they're not filled? If so, whats' the point? So actually everyone fighting for slots at 8am, whilst being unsatisfactory, is actually relatively equitable. Out of your list of over 10,000 there are only 5 or 6 that can't use a phone.

It's actually much more equitable than having everything online as many older folk (certainly over 80) cannot access this. Like many / most problems this is due to capacity. Not enough GPs (and a reducing number) and a sharp increase in healthcare wants (and needs to a lesser extent). The NHS doesn't ration on cost, so rationing of healthcare when Demand>> Supply will always take place somewhere.

2. waiting on hold for up to an hour, before being cut off or told that they can’t have any kind of appointment, face to face or telephone, bad luck, try again tomorrow

Well our phone system doesn't know when we run out of appointments - lots of reasons for this. There are many types of appointment - we can be out of doctor appointments but be ok for nurse appointments and we don't always know who's calling for what. Our phone IVR menu offers various options but patients are I'm afraid not very good at always knowing what they need (that's fine, that's what receptionists are for). But even when we do run out of (eg) GP appointments there are often stills things that we can do. Suspected Simple UTI? Well reception will probably knock on my door for that and I can normally sort that within a couple of minutes. Crushing chest pain or sudden facial droop/weakness (yes, we get calls about this) - redirected to 999.

Again, this is a function of Demand (D) >> Supply (S). But once we're truly out of appointments, well what do you do? Take out tomorrow's slots? OK. Then what do you do tomorrow? And the next day. Again, D >> S and there's a physical limit to what a small number of individuals can safely deal with on a particular day. At some point you have to start saying we're full and reset / start again. It's not "entirely" due to poor practice admin.

3. Why have some practices switched off e booking?

Don't know why any particular practice does this. We switched this off briefly as people were trying to book telephone appoints and then come down F2F during lockdown. It's back on now. I suspect that this is still a problem for some practices. Equally booking up everything in advance leaves you less on the day - do you want us full of routines or full of urgent stuff in the day. The appointments are limited whichever way you fill them. Some practices might (legitimately) have decided that they would rather deal with urgent / acute issues compared to the chronic back pain / annual cholesterol checks / admin type stuff that many of these slots are used for. And if you're really worried about the really elderly with complex issues (over 80s) in general our appointment metrics show that these slots are used by younger people who are more tech savvy (confirmed by audit).

3. A PP reports that one of her GPS is touting for private work, during NHS time

This isn't acceptable, I've never come across this in my entire career and I know dozens of private GPs and hundreds of NHS ones. My practice practice specifically asks and excludes patients that are on my NHS list even though (technically) I could see them.

4. Why are some practices using inadequate call centres to answer calls from patients? Why not pay for more people to answer calls?

Well the amount of calls that you successfully answer kind of depends on how many appointments you have. There is no system that cope with hundreds of people phoning at the same time, but it links back to the appointment issue above. Sure, we could double the call handlers and we'd reach "full" in half the time. Seems an expensive way of not achieving very much.

5. Why was a GP upthread complaining that she couldn’t see as many patients because she was dealing with absence and locums? Why not pay for proper practice management to do admin?

I don't know about that particular practice. Our PM deals with this kind of thing fine, but as a Partner (aka business owner) I always want to have oversight of what is happening . And if the PM is about the spend the practice's (and therefore indirectly MY) money - a locum can be £800+ per day I'd probably want to know about it.

I hope that helps - as I say these are "stream of consciousness" answers but I don't have the time (today) to provide more detail. Hopefully an insight though.

The bottom line is: virtually everything stems from Demand >> Supply, not enough GPs and increase in healthcare needs from the population.