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.

This gets my goat. This is not a rant at you because as a patient you deserve a better joined up system. This is aimed at the hospitals not doing their job and somehow the the GP getting the blame.

The nhs hospital contract says that hospitals are required to prescribe all medications needed urgently (under a month) and GPs should only take over prescribing medications if they are non specialist, the patient is on a stable dose and they are non urgent (not needed for a month at least).

The hospital consultant is just as capable as issuing a nhs outpatient prescription as the GP but the hospitals have not invested in the electronic prescription systems GPs have to allow them to do this simply and they don’t want to pay the money it costs to issue fp10s (standard green outpatient nhs prescription)so they pass the job on to the GP. The hospital is being paid by the nhs to issue this prescription and is pocketing the money and not providing the service as well as taking up GP time.

Legally whomever signs the prescription is responsible for it and so the GP can’t just prescribe something because the hospital consultant told them to. They need to check the indication, dose, and have acsess to whatever test results (like an ecg, blood pressure, or blood results) that mean it’s safe and indicated to prescribe as well as ensuring you have been appropriately counselled on any side effects . I would bet the hospital consultant has “advised” the GP to prescribe something that needs a blood test or blood pressure check or something so that’s why you need an appointment. Maybe the hospital did all this and counselled you appropriately on the risks but in that case it would be so much more sensible for them to then prescribe the medication themselves.

Imagine if every hospital consultant did this, if every outpatient hospital appointment then required a GP appointment to prescribe the medication - imagine how many GP appointments that would unsessesarily take up per each practice. GPs have a working electronic prescription system so they get dumped on by the hospitals to do their prescriptions while the hospital pockets the NHS’s cash to do so and then the GP gets the blame for the hospital not fulfilling its contract.

its not good enough but the people that need to pull their fingers out are hospital management who need to sort out an east outpatient prescription system yesterday

(ditto the poster above saying they need the GP to do an ECG for Camhs- you have my sympathy as camhs acsess is terrible. It is worth noting that CAMHS are paid and contracted by the nhs to do all the needed investigations (such as ECGs and blood tests) for them to prescribe themselves and the standard GP contract (GMS) does not include ECGs. Many GPs undertake ECGs out of their own pocket because they want to help patients and understand waits are long but it’s a service they have been providing for free (non nhs) and now there getting negative feedback because a service they have funded for free that the nhs is not paying for is not being done quick enough for an nhs service that is funded to do the ECG!!!

argh rant over

So I assume you've complained to the cardiologist and the hospital for not doing what they are clearly funded qnd obliged to do? Or is it all the GP's fault?

"So I assume you've complained to the cardiologist and the hospital for not doing what they are clearly funded qnd obliged to do? Or is it all the GP's fault?"

The GP was asked in a letter from cardiology to prescribe 2 medications to me. One was, one wasn't. I wanted to know why. Nothing whatsoever to complain to the hospital about. I've not seen the cardiologist or been to the hospital? How would they prescribe direct to me? I have a rare heart condition and they asked for the GP to prescribe 2 additional medications as precautionary measures. Not sure what your issue is here? The problem is with being completely unable to speak to a GP to understand why I haven't been prescribed medication recommended by cardiology.

"The nhs hospital contract says that hospitals are required to prescribe all medications needed urgently (under a month) and GPs should only take over prescribing medications if they are non specialist, the patient is on a stable dose and they are non urgent (not needed for a month at least).

The hospital consultant is just as capable as issuing a nhs outpatient prescription as the GP but the hospitals have not invested in the electronic prescription systems GPs have to allow them to do this simply and they don’t want to pay the money it costs to issue fp10s (standard green outpatient nhs prescription)so they pass the job on to the GP. The hospital is being paid by the nhs to issue this prescription and is pocketing the money and not providing the service as well as taking up GP time.

Legally whomever signs the prescription is responsible for it and so the GP can’t just prescribe something because the hospital consultant told them to. They need to check the indication, dose, and have acsess to whatever test results (like an ecg, blood pressure, or blood results) that mean it’s safe and indicated to prescribe as well as ensuring you have been appropriately counselled on any side effects . I would bet the hospital consultant has “advised” the GP to prescribe something that needs a blood test or blood pressure check or something so that’s why you need an appointment. Maybe the hospital did all this and counselled you appropriately on the risks but in that case it would be so much more sensible for them to then prescribe the medication themselves. "

Why on earth am I getting so much flak for this??!! If you'd read my post you'd have seen that one of the recommended medications was prescribed by the GP but one wasn't. So this stuff about it being the hospital responsibility etc isn't valid. The one that wasn't had actually been suggested by my GP to cardiology, who wrote back to say yes, prescribe it. It's been 4 months since I was in hospital and I've not seen a cardiologist since then. Just letters. Have had blood tests/blood pressure checked 2 weeks ago, all that info is available to the GP. This sits squarely with the GP and the inability to be able to contact them. They could have rung me. But didn't. They could have emailed me. But didn't. Instead I have to join a scramble at 8am to try to get an appointment to just find out basic information as to why a medication that the GP wanted to prescribe, was advised by cardiology that yes, it would be a good idea, hasn't been prescribed 3 weeks after being asked to do so by a specialist who understands my condition. The thread is about problems accessing GPs, not about berating other posters for being pissed off.

again no anger at you because you as the patient deserve a better joined up system and can’t be expected to know the ins and outs of the nhs contracts

but yes you should be angry at the cardiologist for the following reasons:

1. the nhs (with money from the governments from us the taxpayers) has paid the hospital to provide that medication to you for at least one month after your appointment as per the hospital contract (secondary care gets approx 90% of the nhs budget) The money has not gone to the GP to do so. The hospital has pocketed the money and shortchanged you the patient and the nhs/government/taxpayers
2. the hospitals if they so wished could have set up the same electronic prescriptions the GPs have to allow it to either give you a prescription at a face to face appointment or send one to your local pharmacy- there is nothing magic that says only GPs can have green prescription pads (fp10s) or use electronic prescribing straight to your local pharmacy (EPS). Some hospitals do have and do do this. Your hospital has decided not to fund this although as discussed above it has been paid to provide prescriptions to you. GP practices have spent money on setting up these systems out of the primary care nhs budget (less than 10% of the overall budget)
3. Hospital consultants are not the bosses of GPs. They cannot tell GPs what to do. They are not employing GPs. They do not fund GPs. Each doctor is responsible for their own prescriptions even of common standard medications and there is no defence once fully qualified of “specialist told me to do so” so the GP will have to make their own decision if they feel that the medication is indicated and if it comes under their competency to prescribe it, this may mean they need to have a consultation with you to satisfy themselves that it is a reasonable prescription or do some tests if the hospital did not share the results it has - you probably think “well if the GP is going to do the same assessment as the cardiologist why see the cardiologist in the first place - isn’t this a duplication of work?” Exactly why the cardiologist should just prescribe the medication themselves
4. If you have a complicated heart condition then maybe the medications are quite specialist - maybe a GP isn’t trained to prescribe them - in this case the cardiologist needs to prescribe them themselves forever (some fancy specialist medications do come from hospital forever) because as said above their is no way for the cardiologist to pass the legal “I told them to do it so its ok” on to the GP. Some intermediately specialist medications can be started by the hospital specialists and then continued by the GP when you are on a stable dose and all the needed tests etc are done via something called “a shared care agreement” that sets up additional safeguards and usually additional funding to the GP to take on this extra work
5. GPs have enough pressure on appointments and finances with their own work they don’t have the time or resource to take on work the hospital has already been paid to do but has decided not to do.

like many GPs it sounds like your GP is trying to help you get your medications because they have issued one and are trying to make an appointment to sort the other even though they have no contractual requirement to do so and are not funded to do so but with all their other work they are contracted to do they are overwhelmed. Please direct your anger at the hospital who, I repeat, have been paid to provide you with at least a months medication (and maybe longer if it’s a specialist drug) but haven’t done so

@soddingspiderseason

I’m sorry I’m not angry at you. You deserve better more joined up care. With knowlage of the system and the nhs contracts it’s clear to me the mess up is at the hospitals end and it makes me furious at them because this is happening a lot and patients like you suffer and GPs get the blame and hospitals don’t change

It sounds like you remain under the care of the cardiologist (as in your on their books not that your in hospital). They are contracted (as in paid) to provide all the tests (including things like regular BP checks) and treatment you need for this condition and should be the ones seeing you and following you up. The GP sounds like their trying to help by suggesting medications but might have complicated things and blurred the waters about whoes doing what. If I wrote to a hospital doctor saying “Im referring my jones to you as I wonder if he needs x fancy drug for their heart” I would expect the hospital doctor to then assess them and if needed prescribe it themselves becuase if it was a medication I was able and confident to prescribe I would already have done so. If it’s too specialist for me to prescribe so I’m referring to the cardiologist in the first place it’s unlikely it’s going to then be able to prescribe it even if the cardiologist thinks it’s a good idea. They will need to start it and set up some shared care for the GP to take over. I really hope you get it sorted soon.