So sorry for NHS staff

[6demandingchildren]

Tried calling my GP practice this morning to get a telephone appointment, Mondays is the worst time to call as you can never get through but I was lucky only this time I was met with a different welcome message, it basically said that its not the receptionists fault if their are no available appointments and please do not take your frustrations out on the staff.
Anyway once the receptionist answered (this was around 10am) all the appointments for the day had gone and she asked what was wrong, I have only got pins and needles in my face so nothing major and she advised me to call back tomorrow morning or phone 111.
No wonder these poor people are so stressed out.

I think there is some crossover between GP and a&e. Some a&e’s have out of hours gps based at the hospital running clinics during busy periods.

Named gps are beneficial for people with chronic conditions as they provide continuity of care. People without medical conditions could possibly be seen in walk in clinics - for the acute issues they come with - sore throat, tennis elbow, rash.

Perhaps a downside to this model is safeguarding - as I know some gps liase with social services if they know members of a family need support (something it might be harder to pick up if people usually go to walk in clinics staffed by a large rota of people).

Myself and my family have had a lot of reason to be involved with the NHS this week. Maternity/ Labour services were fantastic as were childrens ward and operating staff. However the Gp and A&E were a complete farce!! No face to face appointment with gp, trying to even speak to out of hours at the weekend was a joke! Then A&E was just as bad, left writhing in agony and vomiting into a bowl in the waiting room for 5 hours! I hate slating the nhs, having worked for them for many years previously but it's actually becoming dangerous now!

This why next yr when the window opens up at work ill be signing up for private medical care. So I can actually see a gp when I need to since I'll be paying for it

Pre covid I was working a Saturday routine GP clinic in a semi rural area. Multiple no shows. Also when I tried to book people into the slots as follow ups they declined as they didn’t want to get up at the weekend/couldn’t get childcare/the bus wasn’t running. Working the Saturday am meant I wasn’t working one of the weekday sessions that were very busy (with no extra funding running a weekend session means stopping a weekend one)

Weekend flu clinics certainly used to be similar - I remember calling hundreds of patients in the 2 weeks leading up to it and we had approximately 30 turn up. Whole teams of Drs, practice nurses, admin staff to do the coding. Literally hundreds of hours wasted

Don’t know what it’s like now - this was before the GP contract changed. I’d love to think that things have improved

The whole NHS system is broken really isn’t it

My GP surgery is practically still in lockdown. You can’t go inside anymore, you have to ring the bell and wait to be spoken to for some time, then wait in the car park until for the GP to come and get you. Phoning for an appointment, the average wait is 30 minutes before speaking to someone. Earlier this year they online services, which had covered lockdown well, was suspended but face to face appointments are still a rarity, the most reliable way to get an appointment is to physically go down to the surgery and speak through the doorbell. Meanwhile the local hospitals are back to normal, I’ve had face to face appointments with consultants, gynaecologist, dentists and physio. I appreciate the NHS but I worry that GP surgeries will not return to the service they were before COVID.

All of my own hospital appointments have been on the phone since the pandemic started. Quite a lot of clinic letters I read are also based on telephone appointments. My 75 year old mum has a video podiatry appointment coming up in a couple of weeks which should be interesting

@Cbtb

Pre covid I was working a Saturday routine GP clinic in a semi rural area. Multiple no shows. Also when I tried to book people into the slots as follow ups they declined as they didn’t want to get up at the weekend/couldn’t get childcare/the bus wasn’t running. Working the Saturday am meant I wasn’t working one of the weekday sessions that were very busy (with no extra funding running a weekend session means stopping a weekend one)

That's rubbish. The Saturday clinics round here always seemed pretty busy. They were a lifesaver for me (FT teacher) as it's so difficult to get to an appointment during the week.

I ran some Saturday clinic pre pandemic, we phoned the patients and they all agreed to the appointment slot. We had specialists visiting from the hospital to review their condition with special tests only available in the hospital , really exciting stuff, to save the patients a long trip to the hospital (very rural area). The ‘did not attend’ rate was between 35-50%. It was frankly embarrassing as I had phoned the patients, explained what was happening, booked them in for a time convenient to them and they didn’t show, no explanation. The specialists didn’t come back again, what a waste of their time. So patients have to travel 1 hour plus instead to the hospital.

@SinisterBumFacedCat

My GP surgery is practically still in lockdown. You can’t go inside anymore, you have to ring the bell and wait to be spoken to for some time, then wait in the car park until for the GP to come and get you. Phoning for an appointment, the average wait is 30 minutes before speaking to someone. Earlier this year they online services, which had covered lockdown well, was suspended but face to face appointments are still a rarity, the most reliable way to get an appointment is to physically go down to the surgery and speak through the doorbell. Meanwhile the local hospitals are back to normal, I’ve had face to face appointments with consultants, gynaecologist, dentists and physio. I appreciate the NHS but I worry that GP surgeries will not return to the service they were before COVID.

Sounds very similar to my Gp practice.

Maassi stats show patients routinely don't show for appointments booked in 'out of hours' in general practice. In huge numbers.
Unless you can magic up many more doctors, nurses, receptionists, hospital transport systems needed for delivery of samples to lab round the clock etc, 24/7 ain't never gonna happen. Plus you'd lose even more staff who stay in general practice for the good hours. Like myself and nearly all my colleagues with young DC.

I ran a flu clinic two weeks ago. Hundreds booked in. About 1/5 didn't show. They're now all ringing in again and trying to rebook in the week.
Weekend clinics were unpopular in my area too. NW.

This is why people should be fined if they don't show. It isn't popular but it'll stop the wasted appointments.

The problem with fining people for missed appointments is when the reason they miss the appointments in the first place is ill health , for example people with dementia often forget if they don’t have someone managing this, or people I’ll due to stress who miss them because they can’t get away from work/caring commitments.

Charging people for GP appointments and/or fining for missed appointments is pointless and unworkable.

Pointless, because on the basis 90% of prescriptions are fee exempt then it is likely the majority of appointments would be fee exempt, which means implementing an expensive system for not much benefit.

Unworkable, because who is going to enforce. As others have said are you going to charge the person who misses their appointment because of dementia? What about the person with serious mental health issues who could not face it? What about children - charge the parents? What if they are Gillick competent and made their own appointment.

So why on earth do GP practices not tell people about them?

This about hubs - possibly because you are referred by calling the GP at the weekend or 111. You are sent to the local hospital outpatients and seen by a GP.

If you tell everyone that there are hubs with an all day GP service at weekends there will soon be queues into the hospital car park as patients decide to call in to have their
checked on their way back from their walk on the beach .

What I would like to know is why GPs are so bogged down in work. Is it ageing population, too much searches on Google making people believe they are ill, preventative treatments they didn't do in the past?
We are in a rural area and almost no houses have been built so I can't understand the problems, though they do also have a local town practice.

The NHS does treat so many more things such as triple by passes, knee replacements that probably didn't get done much in the past, is it that, better medical care?

So why on earth do GP practices not tell people about them?
They should really. I know I did. Sometimes you got a load of abuse for it because people didn’t want to travel or didn’t want a weekend day and “I ain’t fing going all the way there on my day off” makes you unseen to offer again but we should as some people love them - I book at the Hub for my family’s own apts as they are nearer to my work and at better times for me.

Demand is through the roof. It’s multifactoral. Reasons I can think of:

1. Pandemic - it’s still going on and some people are still sick with acute and long covid
2. Aging population- much greater fragility and multi Mobutuy
3. Health anxiety triggered by the pandemic - everything needs “to be checked out to be safe”
4. Litigation fears - 111 etc advise people to see Dr as don’t want to be sued. Your gym advises you to see a dr before you join. Your beautician advises see a dr before a treatment.
5. Other services being cut - lack of health visitors and sure start and funding in schools for behavioural issues - backstop is a GP. Worried that little jimmy is being naughty in class - see your Gp
6. Backlog from covid. Hospitals asking GPs to go through all the referrals made since covid started and re refer in priority order
7. Blood bottle shortage - loads of tests delayed. GPs asked to go through all tests they have requested and decide which can be cancelled and then inform patient and then make a catch up plan
8. GPs having to plan how to give the flu jab while also being involved in the covid booster programme
9. Social care cuts - no respite care for carers equals increasing breakdowns in care needing hospital admissions etc and loads of GP time filling in forms for social services and trying to get a care package asap so Doris who has dementia and no family dosent starve this weekend or end up admitted to hospital where she will catch covid and die

10. Increasing poverty - need a food bank referral - see your GP (no idea why) 11. Complete breakdown in CAMHS services - two year wait for anorexia treatment - plan is for GP to see three times a week and do bloods and monitoring for teens so sick they should be in hospital 12. Still not return of spirometer testing as it’s an AGP - how to montor and diagnose copd/asthma etc 13. Healthcare staff still have to isolate if a covid contact (in most places) so continual lack of staff 14. Staffing crisis due to covid, low morale, brexit and the pensions mess (doctors pay so much into their pension pot they end up paying to go to work at a certain. Point- and before all the comments about gold plates pensions the doctors pension pot is one of the very few where the amount in the pot more than covers the pay outs) 15. Squeeze on household incomes means people can’t afford what they used to - so see Gp for prescription for kids calpol etc 16. So much beautocracy- your kid needs medication in school - needs a dr letter, your kid is off school - needs a dr letter. 17. Other departments of government being closed down - dvla shut and not processing Medical’s - solution GPs can do an energy authorisation for them to still drive (and theirs a driver shortage so they must do this now)

That’s just of the top of my head

Also typing on phone with child climbing on me please excuse typos

And some more
18. Still having to covid clean - say one min wipe down and change ppe between patients - after 10 patients that’s a whole apt gone for cleaning
19. The army outsourceing its Medical’s to a private company whose brilliant plan is to ask the GPs to do most of it……
20. DWP outsourcing its benefits Medical’s to a private company and wait for it their brilliant plan is to ask the Gp to do most of it….(for free)

It seems to me very odd that GP surgeries administer the flu vaccine in anything other than the most remote locations. Why is this not being completely handled in pharmacies? There seems to be a persistent view in this country that a GP is a panacea for all medical/quasi-medical and social issues, rather than a medical professional you see for very specific reasons after self care, pharmacy has been tried. Absolutely a massive part of the problem is appointment blocking by people who really should not be seen by a GP. This also applies to A&E which is beyond a joke. There is something seriously wrong in the public mentality, and getting a handle on this could go some way to relieving the acute pressure on the system

21. Medication supply issues due to covid/brexit/pandemic/transport crisis/fuel crisis/worldwide glass shortage meaning multiple contacts from pharmacists to GPs asking for prescriptions to be changed (prescribing generic would help with some of this but for some meds that’s not clinical appropriate OR to save money the PCT/CCG have mandated a certain brand be prescribed)

Agree that fines or pay to play is not really feasible given the administrative burden. But how else to incentivise people not to abuse this resource? In the places I have lived in the UK I have never seen weekend appointments but maybe if they are offered in the places of greatest pressure, employers will quite fairly expect employees to book appointments on weekend and there will be much less abuse of the system

“ It seems to me very odd that GP surgeries administer the flu vaccine in anything other than the most remote locations. Why is this not being completely handled in pharmacies?”

I am not an expert in this but I would guess:

1. Many pharmacies don’t have space to give vaccines
2. Many pharmacies don’t have enough trained staff to give vaccines (yes there is a pharmacist on site but if they are giving vaccines who is checking the meds)
3. Pharmacies give the vaccine but rely on the GPs telling the patients they need to go get it so GP still doing admin of checking record for who is eligible or suitable
4. Pharmacies give vaccine only to those that come in and request it - GP spend time chasing those that wouldn’t ask for it but really should have it
5. Pharmacies won’t give vaccine to children/people with allergies/housebound/people who are on off medications
6. Pharmacies give the vaccine but don’t have acsess to health record so send Gp a Paper!!!! Slip with the details of what is given and GP still has to do the admin of adding to the health record
7. There is a payment for flu vaccines given. It more than covers the cost of the switched on otherwise health adult with asthma who remembers to book it every year and turns up for their appointment. It doesn’t cover the cost of the vulnerable learning disabled adult who is scared of needles and thinks vaccines have microchips and needs transport to come for the vaccine and monitoring after. Pharmacies cream off the easy ones and make money. GPs are left with the difficult ones and operate at a loss. This would only work if pharmacies were responsible for ensuring all of their population receive vaccine not just those that ask for it.
8. I know you mentioned rural areas anyway but a lot of GPs are still dispensing (patient five miles from nearest pharmacy so GP gives out medications themselves) so this wouldn’t help them anyway

There seems to be a persistent view in this country that a GP is a panacea for all medical/quasi-medical and social issues, rather than a medical professional you see for very specific reasons after self care, pharmacy has been tried.

Totally agree. (And I think most health care professionals would as well)