This again! Becoming almost impossible to make a GP appointment. Surgeries system restricted even further...

[PunishmentRoundupWithJoon]

Just a rant.

When my GP surgery introduced the online system for making appointments (and it's not even that, it's a system whereby you give your details and then you're triaged - someone may call you or you may receive a text) it was at least available 24/7, and at weekends. It was then changed to a cut off time of 8pm. So if you were planning to do the online consult once you'd finally sat down after the kids were in bed - forget it.

Tried to make an appointment yesterday to find they've now narrowed it even further with a cut off point of 12 noon. So patients only have four hours (8-12am) of this service.

They really are committed to making it as difficult as possible to make an appointment, aren't they? And god knows what you're supposed to do if you don't have access to the internet!

I realise this has been done to death but just had to rant about it. I used to think my surgery was one of the 'good' ones, even after the online system was introduced but now, not so much. Not that it will make a blind bit of difference but will be emailing the practice manager (who won't give a shit, I'm sure) but as someone with medical issues that mean mornings are rarely seen and if they are, I'm unable to function, I'm quite worried about these further restrictions.

My 87 year old mother would never cope with having to access meds via a website

And having to fill in an online registration form which would not submit without a landline no for the next of kin is ridiculous and to say so is not GP bashing. The next of kin in this case ditched her landline a while ago. There was no multiple choice You had to put a number in and no you couldnt substitute her work or mobile no cos the form had already asked for those so they had been filled in. Phoned for help but in the time it took for the phone to be answered the form timed out and i lost all the information i had put in. Told them i was not prepared to go through this ridiculousness again So the patient (who has had a stroke) went to the hospital and they filled in a paper form.

There was also a online medical questonaire which went on for ages and would have literally taken all day. Information they could have got from the GP. Since when was the patient also their secretary.

Does anyone know what these online only places are going to do about people who haven’t got internet access?

The initial letter said the online forms HAD to be filled in There was nothing in the letter about a paper option. As these online forms time out after a certain length of time someone with cognitive impairment would not be able to fill the form in in time. Clear Equality Act breach

eConsult is only open during opening hours at my GP but it works well. I used it this morning, I did have to go back and tweak a couple of answers so I could complete the process. A couple of hours later I got a text with a probable diagnosis and some advice and instructions to go and have an urgent blood test. Blood tests are now mainly appointment only, but if needed urgently you just turn up and the wait was less than 10 mins for me today.
I find the current system works well.

Another issue to do with access is the litigation issue. A doctor can’t be sued for patients they haven’t seen but they can be for ones they have seen but managed incorrectly. The system is set up to reward you seeing a few patients well not lots of patients not so well.

negligence cases require you to have provided safe care - not safe care within the limits of the time you have

nhse complains prosess requires you to have given good care with no understanding of the limits of time

gps are trained to consult safely in 10-12 minutes per patient
most would generally says they provide good care at 15min a per patient

lots of research showing that when you go over 16 patients per session (half day) the level of care drops so 32 patients a day at 10mins each is most people’s max (5.3hrs of consults, a few hours of results and paperwork, a home visit or two and a practice meeting makes up your 8-10hour day)

if we as a population want GPs to increase capacity without increasing the number of GPs we’re going to have to accept that they will go over 32 patients per day and possibly under 10min per consult - something we know makes for unsafe care then more errors are going to be made

a change in the law to support things only being negligent if they were actually possible to do with the time resource allowed by the nhs would be helpful, otherwise GPs will continue to to limit access to the amount of patients they can deal with safely in the time they have rather than risking being sued by seeing lots of patients not so well

Qaz can you provide a link to proof we won’t face litigation over econsult. We did a lot of work with our defence union before we launched it and it was never suggested that it was a way to avoid litigation. For us, it’s the best way we can ensure our patients are able to get through. We have phone lines too but it’s unmanageable with the phones alone. The patient population keeps going up while the GP population shrinks. Everything we do is for our patients (remember we’re humans/ patients too) but it is like trying to square a circle.

I don’t think I said you can’t be sued over an E consult- I think I said you can most definitely be sued if some idiot says they have crushing chest pain it’s not picked up and they die?

Bullshit. You can be sued over your actions about any patient who has contacted you.

My friends London surgery only opens its online system from 8.30-9.30 every day. Sometimes if too busy they close at 8.40

Ok.
To correct a few wrongs here.
Average surgery has had an increase in patients of appx 2k patients over the last 8 years.

There are fewer doctors to deal with the issues.
Part-time GPs are mostly working F/T hours, they just aren’t in every day of the week.
There have been changes over the years. Different roles because not enough GPs.
Recent change announced by NHSE in April has forced practices to change their access arrangements.
The core GP contract does not deliver enough funding to support the service.
Secondary care ( hospitals) are swamped so will resort to saying the GP will do it, even though it is secondary care work.
The NHS is under pressure, funding does not match demand.
Write to your MP and ask why none of the major parties have an understanding of what the issues are and how to sort them.

It’s an absolute joke and they shouldn’t legally be allowed to get away with it.

They must have to provide accessible platforms for people with disabilities who cannot access or use the internet surely?

I couldn’t get through on the phones recently, couldn’t even get into a queue. I just drove down there and walked in, the dr had already wasted 3 mths referral time by fobbing off my DC and then giving us incorrect information. I loudly complained and she gave me a phone appointment for that day.

I appreciate you may not be able to physically get to the surgery though. If you can I would just go and say you don’t have internet.

All of this might be true but they need to give accessible options for making appointments.

many people don’t have the internet or cannot use it. some people can’t use the phone due to hearing or speak impairment. Many people work shifts which don’t allow them to get into a queue at 8am.

It’s absolutely understandable that the surgeries are busy and it might be weeks to get an appointment but they need to ensure people can even ACCESS the appointment system to start with.

There will be alternatives. We run our surgery entirely through phone and econsult, but some patients (deaf, homeless, elderly, chaotic) etc have unofficial other ways to contact us and we'd never turn away someone vulnerable who pitched up at the desk.

(I mean phone and econsult triage, obviously we see F2F as well)

There is a push towards digital. Not necessarily driven by your practice.

I know that it’s frustrating, but honestly, practices are not actively trying to be difficult. Much difficulty is shoved on them from above.

@HundredMilesAnHour

If you are working so hard between 7 am and 3pm that you can't stop for a wee, then May I suggest you've got bigger problems. No work should be like that.

Ours is open for one hour in the morning and that's it. If the GPS are overwhelmed they shut it down sooner than that.

It's impossible where I am.
E consult forms required. System reaches capacity 2 mins after it opens at 8 am.
No queuing system, no saving of the form that you completed yesterday.
And for some reason my repeat prescription of omeprazole ( which I take following surgery resectioning my oesophagus and repositioning my stomach , so my requirement for it isn't going to go away) has now to be reviewed every 6 months.
And I'm sent a text telling me to complete an e consult form to make an appt. for the review.>

My practice have done their very best in difficult conditions and have mostly served me well. However, you have to be very strategic - understand how the system works, be alert to any changes the practice make to their appointment system, use 111, make sure I know the hidden rules (like there's an appt queue in the surgery certain times of the day). I am also unfailingly polite and grateful to everyone at the surgery because you get people on side easier. It's exhausting

Not so easy if you're frail, not digitally literate or feeling physically or mentally unwell,

Excellent post@ spiggydit.

Spare a thought for our pharmacy staff who are swamped. Welsh government and health boards bang on all the time to use them. Phone your pharmacist, visit your pharmacist. Get advice from the staff. Their back log dispensing wise has grown considerably. We're not to bother a GP before we've explored our issue with the pharmacy.

Previously I had pointed out a 50 day wait for a non urgent appointment.
Checking this week several times there are none.

No option for any appointments via the app.

Husband's spirometry appointment has been cancelled as the machine has broken. The chance of him getting another is probably zero.

The ads and social media advice from one part of the NHS with no capacity that prompt us to go and visit another part with no capacity does seem a bit like a sort of public gaslighting doesn't it?

For GPs and teachers and (insert other careers here which I know less about) absolutely part time lazy work shy fuckers*

For everyone else don't be stupid that's full time!

• Sarcasm and not my views.

Formatting went wonky there!