Is this how GPs are trained now?

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I have been seeing my GP since early October for a few problems, overall she has been fabulous and has diagnosed me with two underlying conditions I had no idea I had (obvious looking back, but low level - one actually makes me immune compromised!) She has referred me for extensive blood work and has been so patient with me. The problems are though;

1. She said I needed a vaginal examination and a smear, I came to the appointment and then she said she wasn’t trained to do smear but would do the swabs. I ended up having to have a further appointment with a nurse for the smear

2. I need HRT to control my testosterone levels, however I am at an age where a contraceptive pill would be sufficient to control it (and I am not trying to conceive) so in my mind it should be fine for her to prescribe - but she also said she wasn’t able to and “referred” me to a women’s group and a nurse

I am really confused, what kind of GP cant do a smear and prescribe the pill? That must be basic training, she said I would need a follow up appointment with a nurse again, for THE PILL. I ended up asking if I would qualify for a pharmacist to prescribe the pill as I know that’s something they can do now and would solved the waiting around issue. And all she said was “yes you can do that if you think it’s more convenient”.

This isn’t normal is it?

We have a grand total of one nurse in the practise I'm with who is trained and she's semi retired.
I have always thought the same that its surely a thing a GP can do. Surely if someone is medically trained enough to do a pelvic examination they can also do the couple of extra steps for a smear.
It's something that is so rarely taken into consideration that when numbers of women who go for them it may well often be because getting an appointment with someone who can do it is often difficult.

Sorry that should say when numbers of women who go for them drop

I think smear testing is quite complex because a lot of women have anatomical differences or psychological issues with it, so the nurses have to be trained to cope with a myriad of different issues. That's why they have one person who is trained to deal with the whole set.

Are you sure it's a GP and not a physician assistant?

Are you sure she's not one of the new level ones ? Is it gp practitioner? With no proper training ?
Cannot see why she couldn't prescribe medication otherwise
I mean maybe the smear might be something she had never done but medication ?

It's maybe the way the practice is run, doctors don't do things like smears as nurses can do them and it's more efficient use of appointments?
I've had it the other way around, gone for a smear test and they've needed to get the GP in to do swabs as they saw something odd.

Don't forget that training also involves having access to the equiptment, forms being filled out ect... It isn't just about completing the practical aspect of things which the GP will be trained to do.

Sounds like she might be a physicians associate rather than a doctor - was she definitely a GP?

I don’t disagree that some GPs don’t have the time to do smears, but I was requested to go in for a vaginal exam and a smear, so it was strange that she a) didnt also book the nurse at the same time for the smear if she didn’t have time and b) doesn’t have the training

I am more concerned she said she want able to prescribe the pill, and yes a doctor as I have a fit note and she signed it with the Doctor in the title box

I've been with my surgery for 20 years and it's always the nurses who do smears and contraception, not the GPs.

It’s not the training, it’s the paperwork. You need to be formally trained to get a smear taker “number” and the expense (in the many hundreds) comes out of the GP pocket. A smear appointment is also longer than your standard 10 minute GP appointment and there’s no time for it. You don’t get longer for a smear, whereas a nurse appointment IS longer.

I don’t understand the issue about the pill and testosterone. You can’t use a contraceptive pill as an HRT. I think I’ve misunderstood your 2nd point.

You can for PCOS, i have 2.5 nmol/L and from
What I have read the pill can reduce this

I also don’t get your point about expecting the GP to coordinate her, your and the nurse’s diaries to streamline things for you. There’s no extra admin time for this stuff. You can’t have it all!

OP said for HRT.

Haha! You’re the OP 😂

No I am, the pill is HRT, in a round about way, to treat PCOS there are different hormone treatments, since I am in my late 30s and not trying to get pregnant going on the pill is the most efficient way to reduce my testosterone levels

My practice has specialists for everything, which is why the receptionist ask so many questions when you book an appointment. I'm 55 and have had cervical cancer so gave had a lot of smears in my lifetime, never once had a doctor done it, always a nurse. Phlebotomist for bloods, menopause nurse, physiotherapist, family planning, sexual diseases, diabetes all different nurses/practitioners. It's been like that at least 15 years at my surgery

Oh, wow. Now she’s a knob because the system works as it does. Despite being amazing just a few posts earlier.

The smear test thing is because it’s a centrally administered screening programme & only people who have done the specific training for that (rather than having the clinical skill) & have a registration number (which gets sent off with each test) can do the smear test.
Not sure about the pill thing but from the sound of it that could very easily be some sort of local commissioning arrangement around who provides these services locally…

Heaven forfend that the NHS might actually consider the needs of the patient. Whatever next!

My DH who works, an hour away, gets offered appointments in the middle of the working day. My friend, who is retired, gets offered 8:30am appointments. We've decided that it's some sadistic game that they like to play.

You need a smear taker number to send a cytology sample off. To obtain one you need up to date training. As smear tests are usually carried out by the Practice nurses it is rare for a GP to keep this up to date. It's not part of the core training

She might be a GP Registrar so a qualified Dr but not completed smear training / sign off as yet?
Not sure why she couldn't prescribe pill.
Maybe it was more that the appointment was running over and needed more time to make sure you get the right / safe medication for you.
If you'd had an examination etc that could well have already taken 10 minutes ( usual appt length)
Hope you get sorted soon.

I've found this to be a change at my GP as well. If I see her for something and she says well we can get bloods checked for that, I start rolling up my sleeve as it used to be done there and then. But now I have to go to the desk and make an appointment with the nurse, usually about 2 mths later by the time there's any availability. Doesn't seem an efficient system!