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?

Well let’s pick your Anorexia allegations. Cahms hasn’t broken down it’s under pressure.have an Anorexic daughter who has been hospitalised several times. The GP never does the obs it’s a nurse and it’s not 3 times a week. Medically compromised teens like my daughter are admitted to the local paed wards which are under huge pressure. Don’t think my dd has seen her GP once.

Getting doctors appointments for Calpol. You ring and if you need an appointment you get one. If you need Calpol it’s suggested and you then pick up a bottle of supermarket brand.

You don’t need a doctors not for absence. My daughter has been off for weeks and not been asked for a doctors note once……..

@Ashville5
First of all, they aren't my allegations as I said I reposted from another thread (I assume the person I quoted was a GP):
Second of all, that's your experience with your daughter. Other people will have different experiences but you are right---the nurses do most obs but the GP will see/chat with the patient and refer them first. That's not to say a GP won't see the same patient several times in a week if they feel that patient is at risk.
Thirdly, when people make appt they don't say it's for paracetamol when booking (the appt will be for something else) but will ask during that appt for paracetamol, Calpol or whatever.
Fourthly, you are also right-you don't need a sick note or letter for school but schools often demand them, especially for children who are off a lot, and so the GP will get asked by the parent for a letter.
HTH.

@DamnUserName21 really good post.
Add to the fact that a lot of hospital outpatients appointments were cancelled as doctors were pulled to general medicine/outside their specialties to stop people dying. So people usually dealt with in secondary care hospitals were lef to GPs and those patients got sicker whilst awaiting hospital appointments, through no fault of the Go or the hospital or anyone. The pandemic is shit and this is the reason people wanted rates and admissions to stay low as the collateral damage is huge. No fault of GPs.

The more people bash GPs along the government distraction the more will leave and the worse things will get. It used to be the most popular specialty amongst doctors, now no one wants to train as a GP, you wonder why?

@TeaTears,
GPs get a massive amount of shit and I really don't think it's worth the hassle or pay.
I'm not a GP but work in a large and busy practice and it has really opened my eyes to the ever (infinitely) increasing demand for services and ever increasing responsibility/stress/pressure GPs and other clinical and supporting staff.

*faced by

The GP does not see the patient several times a week if at risk. My dd has never seen her gp re her Anorexia.The nurse does the obs, if at risk your GP rings, speaks to the on call paed and you’re sent to A&E or paed ward. They are taking the flack and pressure on top of COVID. There is nothing to see your gp for. The Marzipan procedure is followed. Obs are done by the nurse, if you hit admission criteria off you go to be refed.

@Ashville5

Well let’s pick your Anorexia allegations. Cahms hasn’t broken down it’s under pressure.have an Anorexic daughter who has been hospitalised several times. The GP never does the obs it’s a nurse and it’s not 3 times a week. Medically compromised teens like my daughter are admitted to the local paed wards which are under huge pressure. Don’t think my dd has seen her GP once.

Getting doctors appointments for Calpol. You ring and if you need an appointment you get one. If you need Calpol it’s suggested and you then pick up a bottle of supermarket brand.

You don’t need a doctors not for absence. My daughter has been off for weeks and not been asked for a doctors note once……..

You're exceedingly lucky.

CAMHS referral times in our area are measured in years for some diagnoses and they opening say that for some older children it's not even worth referring because they won't get seen before they become ineligible due to being an adult.

And we have on at least two occasions been asked to monitor (obs, blood tests) for newly diagnosed anorexic children because the local eating disorders team doesn't have the facilities to deal with the physical aspects of this illness. We raised a massive clinical incident about this and it's still not sorted.

Don't assume that your experience is universal.

Yes my dd has had obs monitored by surgery but the GP doesn’t do it or call them in for chats. Most would not need 3 times a week. It’s the nurse who does it. Last time my dd got admitted after surgery monitoring GP never saw her. He was just alerted to obs by nurse and he rang us to tell us to take her to A&E. Aside from all that our surgery has been providing an excellent service for everything else throughout. Lots of surgeries are.
Had no problems seeing my gp for anything throughout the pandemic.

GP surgeries are pretty good at triage. I've been seen face to face with a new problem as has my DP. If you need a physical exam they will see you, but if you need to talk about something eg change of treatment and this can be done remotely why is it vital to have a face to face? I work in a health related field and what I see is that GPs are keeping up. Very few services have returned to pre pandemic working practices IMO.

And yes had loads of phone calls too. Wasn’t necessary to GP several times.

What are GPs actually doing right now?

Well, I've asked my cousin to inform me:

18 patient contacts per "session" they work ie morning or afternoon

Each session is a mixture of telephone appointments & face to face which patients can pre book themselves

Often bringing in patients after a telephone consultation and often this is as an "extra" on their list

Working through the dozens of prescriptions that need issuing each- this is not just a case of pressing a button or squiggle of a signature thus is time consuming

Processing a dozen or more clinical documents/letters and then filing after actioning what is needed- judging by recent experiences, hospital doctors are sending requests out to GPs to do their blood tests, check & send back the results to them. Sorry but GPs are not their community dogsbody

Looking at filing blood results, often a dozen or more each day- often they need action eg an urgent appointment, medication prescribed etc

Dealing with other paperwork which comes their way especially if they are the "duty doctor"- urgent requests for reports from social services, urgent home visits

So yes, I hope this gives an albeit brief summary of what GPs are actually doing right now!

I've had no issues with my GP practice at all, I can always speak to someone and have a face to face appointment later this week.
However, I've had two hospital appointments cancelled this week because of a shortage of staff and no appointment to replace due to a shortage of admin staff.

Staff are off with Covid, they are short of staff and can't recruit more and they are overrun with patients. Cut them some slack.

The other day I called up at about 4pm because my toddler has swollen eye and rash. Was seen at about 430, put dye in his eye to check for scratches, was very thorough. In fact I think every time I've seen a gp in the last year it's been same day.

I sympathize with others, but for balance I must say our gp is brilliant and I appreciate them all

With our practice what I do query is that I'll get a callback, spend 10min having a conversation with the GP, then the GP decides I need to be seen (or my children depending on the issue). So that is then 2 appointments per patient instead of one. If we had just been able to book a standard f2f appointment the first time, that would free up a whole appointment for someone else. This has happened to virtually everyone I know in our area.

To me this is so inefficient!

Because many people triaged can be dealt with over the phone. If patients were able to book their own appointments at will, there would be an even longer wait to be seen for everyone, including those that really needed it or with more urgent problems.

@Sunnycats

With our practice what I do query is that I'll get a callback, spend 10min having a conversation with the GP, then the GP decides I need to be seen (or my children depending on the issue). So that is then 2 appointments per patient instead of one. If we had just been able to book a standard f2f appointment the first time, that would free up a whole appointment for someone else. This has happened to virtually everyone I know in our area.

To me this is so inefficient!

You're not considering the people that weren't seen and were handled telephonically and in higher numbers then previously. The NHS England metrics show more appointments than in previous years (and with fewer GPs and also whilst running the vaccination program).

Eg. 20 phone calls of which 4 were converted to F2F v 15 F2F.

20 people's issues handled v 15.

It's not inefficient at all - but it's certainly not easier either from the GP side.

@cptartapp

Because many people triaged can be dealt with over the phone. If patients were able to book their own appointments at will, there would be an even longer wait to be seen for everyone, including those that really needed it or with more urgent problems.

But they all deserve to be seen properly. They are all entitled to proper GP care!

"The NHS England metrics show more appointments than in previous years "

You're focusing on quantity over quality. To be treated properly you need to be seen, touched and sometimes even smelt by your doctor. A phone appointment isn't the same.

Well pay a lot more taxes , train a lot more GPs , give them better working conditions with maximum of 36 hours a week then you might get what you feel you deserve

This thread is so dispiriting, you'd be mistaken for thinking that it suits our government for people to blame GPs rather than their utter incompetence at governing. Depressing.

Surely now the NHS gets the extra £350m/week things should be improving significantly.

@midgedude

Well pay a lot more taxes , train a lot more GPs , give them better working conditions with maximum of 36 hours a week then you might get what you feel you deserve

Who's that aimed at? As for taxes, you can take away the taxes I pay for nuclear weapons to give to the NHS if you want. I can't train any GPs or give them better working conditions. That's the government's responsibility.

"Surely now the NHS gets the extra £350m/week things should be improving significantly."

I'm sure the cash is on its way, just stuck in a lorry somewhere because of Covid!

But they all deserve to be seen properly. They are all entitled to proper GP care!

They deserve care-this does not necessarily mean a f2f appointment. Many appointments can be down over the telephone-medication and some chronic disease reviews, discussion of complex issues, symptom review depending on ailment. Not everyone needs to SEE a GP in person.
Telephone appointments suit A LOT of busy people and frees up appointments for those who need f2f.

“But they all deserve to be seen properly. They are all entitled to proper GP care!“

It’s quite possible to receive proper care by phone. Following a face to face a week ago, I was sent for ultrasound the same week. I received a follow up call on Weds of this week where my GP gave me blood test results and told me that ultrasound result identified need for biopsy. He also phoned the hospital rather than writing and the hospital called me the same afternoon with appointment for next week.
The telephone appointment with my GP took 2 minutes. His call to the hospital probably about the same and writing up my notes, similar, I imagine. The process was fast and efficient for all parties and I couldn’t be more impressed with it all. There was absolutely no need for face to face at all.

"Many appointments can be down over the telephone-medication and some chronic disease reviews, discussion of complex issues, symptom review depending on ailment. "

But that's not what's happening is it? They're offering phone appointments instead of real appointments for all sorts of things. As I said, you can't diagnose someone properly over the phone.

"Telephone appointments suit A LOT of busy people"

That's pretty irrelevant because it's not something you get to choose because you're busy. It's not like it's a nice service they provide, it's an inferior level of care.