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?

I can never see a GP these days. They are all these assistants who are paramedic trained so they have quite a bit of clinical knowledge but are not the real deal.

Yes, exactly. Many of these jobs have been farmed out to other practitioners of every sort and the whole healthcare system is peppered with all these roles. There’s a whole essay to write about this. It can be so confusing. I met someone the other day who said she was a “X” speciality clinician. I asked doctor? No. Nurse? No. She wouldn’t be drawn in to explain what the hell a clinician in that speciality did. Not a technician. Not a “practitioner”. It was a social encounter, at least I wasn’t a patient, but annoying.

Thank you! Like I said she has been amazing but not prescribing the pill was a bit strange to me, I thought GPs where able to prescribe a range of medicines, we agreed in the end I would see the pharmacist first and then call the survey back if I couldn’t get the pill.

It’s crazy to me though, I got the pill aged 16 seeing my family Gp and off and on again my whole life, I am in my late 30s and never ever not been able to get the pill was so alien to me!

This. Doctors rarely do smears so they bang around up there and its very unpleasant and often painful. I would always choose a female nurse to do my smear.

Bloody hell. That’s totally uncalled for.

Obviously the GP is legally able to prescribe contraception in most cases by virtue of their training. But it may be that local commissioning has said that they don't want GPS prescribing as it's not a good use of their time and other people could do the same but be paid less. Or there is something particular about your case that made the GP think that it was beyond the limits of their competence for whatever reason and they wanted you referred to someone else which is a good thing surely.

The pill thing may be related to GPs having to sign up separately to offer contraceptive services. Not all Drs can prescribe all drugs, so if your GP hasn’t had enough or recent enough training, it may be that they aren’t competent with hormonal contraception drugs and so can’t prescribe.

you were effectively telling OP she was being entitled to expect the doctor to provide the service the doctor had arranged the appointment for. Which is a pretty knobbish thing to tell someone.

I'm a GP. In some areas they won't accept smears if you're not doing 20+ per year and as nurses do most they won't accept from a GP.

only GPs with a particular interest in menopause tend to initiate testosterone and in some areas GPs are banned from doing so.

I said I wasn’t thinking the GP would be the organiser of 3 diaries. She has an amazing GP, by her own words. I was also acknowledging that. Name calling is pretty shitty, though.

It was a woman’s group for people with disabilities I was referred to and the nurse for the pill. I know GPs are private businesses and have an iSight into how things operate (I work for central NHS IT) it was so crazy that my GP couldn’t prescribe the pill. It’s must be a practise / money thing reading the replies, I would say I am shocked but I am not.

Hopefully I can see a pharmacist before I grow an actual beard lol. And get some extra female hormones into my body!!!

That’s shocking! Especially since I am only 36 and have high testosterone that’s actually making me ill. I am normal weight but have some weird insulin stuff going on and have a b12 anaemia.

A school mum friend I am no longer in touch with quit being a GP due to the pressures of the job and this thread is making me more empathetic of her decision.

@GoldenSunflowers stated that there is no extra admin time so you can’t have it all - I wouldn’t read that as calling someone entitled but even if that’s how it has been interpreted do we need to stoop as low as calling each other rude names ?

” @GoldenSunflowers was giving her opinion and actually admitted she didn’t understand some points OP was making. OP could have clarified. This is a public forum and I don’t think it’s fair to call people rude names because they challenge or have a different point of view.

With regards to the AIBU - other PPs have correctly answered question re smears as you need to be on the national database and some GP practices would prefer to prioritise nurses having this training. Although I agree would be better experience for all if it could be a one stop shop and you didn’t have to have multiple appointments.

I can’t get my head around the contraception but unless it is a commissioning thing as others have stated. I would have thought even if the pill was being used for another indication testosterone suppression that the GP could still prescribe it. And a bit strange that she then signposted to the pharmacist.

Could you've been hit by,
Could you've been hit by, a Physician's Associate

I also wonder if the pill thing was about sufficient use of GP’s time. In our practice you can only do one thing at the appointment so if the other issue arises you will be told to book another appointment for it. Also the first pill appointment involves blood pressure taking and answering lots of questions so depending on resources your practice might consider that a nurse appointment is more appropriate. Yes, it’s 2 visits for you but nothing you can do.

@Theboymolefoxandhorse thank you.

That’s really graceful you would give that poster the time of day - it may be brain fog but sunflower caused an argument with themselves by accusing the Op (me) as saying something when they posted it themself! I think they need to go to bed and a have time out from the internet.

I am truly grateful of my GPs advice, but like my OP says, my doctor called me in for a smear and a vaginal exam, the exam included putting her fingers inside the opening of my vagina and pushing down on my pelvis, as a lay person I would of then expected her to do the smear test but she informed me she wasn’t trained so I had the indignity of going through a similar procedure again 3 weeks later. Something I wasn’t expecting as she said she had booked me in for these exams.

I then wasn’t prescribed the pill as she said she couldn’t - my GP is possibly around 4 years younger than me and I was asking is this normal for GPs to defer such routine and normal things to nurses etc, considering for my whole life I could see my GP for the pill etc.

The pill can now be prescribed a pharmacist and I have had it before - she flat out told me she wasn’t able to prescribe me it. I have zero health issues other than anaemia caused by b12 deficiency and PCOS. She agreed the pharmacist would probably be able to, but she couldn’t!

OP - this is getting mega-tedious. i have all night.

You said a contraceptive pill as HRT. I replied to that post saying you can’t use that as HRT, maybe I’ve misunderstood.

Then OP you said you take if for PCOS. Not checking the poster name, I thought you were another poster, and I mistakenly replied saying the OP wanted it for HRT. Yes, I didn’t check who I replied too. Big deal. You came in all guns blazing with insults. I was so confused I didn’t even realise it was addressed to me as it was so out of proportion. i hope this clarifies matters. Uncallled for, when I just wanted to be helpful. I didn’t say anything others haven’t but I’ve obviously rubbed you up the wrong way as you didn’t hear what you wanted to hear. Somehow. I don’t have brain fog but I also don’t clutter my memories with usernames. Consider yourself forgotten.

I think op is stating she has *high testosterone from PCOS and wanted the combined oral contraceptive trovhelp her symptoms and reduce testosterone levels.

i don’t quite understand the comparison to HRT as usually that’s for low testosterone levels and a prescription is given specifically for testogel by a specialist for low libido.

there may be some miscommunication or understanding and there’s no harm discussing it with your gp.

but to clarify- we can all do the process of smear tests it only nurses have the registration to fill out the admin. There will hardly ever be a time where you can see both a nurse and a doctor for a smear and swabs so unfortunately if both are required, it will require 2 appointments and 2 speculum exams.

The prescription may have been deferred because only 50% of women with pcos tend to respond to the pill and she may have wanted you to discuss other lifestyle modifications or medication with the pharmacist before making a decision.

Like all jobs, there are time and admin restrictions on certain things but no harm in asking. Especially if someone has taken the time to help in the past and you have built a good relationship with them

No read my OP I said I need HRT to help but because I am in my late 30s, and no longer wish to have any more children I can use contraceptives to help control my hormones and reduce my testosterone levels. There is nothing tedious about reading comprehension when it comes to my health care.

The only person I have been impolite to and called a name is you. Because I actually found YOU quite cruel and impolite

And if you think I am angry, it’s because perhaps I have unchecked testosterone hormones raging through my body and I am ill and fed up!

GPs are leaving the NHS in large numbers. Funnily enough, if you take intelligent educated professionals with transferable skills, and treat them like shit, they don't stay. Odd that.

In terms of not prescribing the pill, it does sound like she isn't able to prescribe as at your age it would still be a practical option (& as you correctly say the pill & HRT both can lower testosterone).
On the issue of facial hair. I shave and use an IPL, I find it really helps. Mine started in my 40s and linked with the menopause I think.

Thanks, I have been speaking to the same doctor since October, and I am normal weight, healthy relationship, diet, good career etc. I do think there has been a misunderstanding on my saying HRT as I would include the combined oral pill to be HRT (since it contains hormones) when prescribed for something other than being a contraceptive. Its not replacement so maybe just HT. I was shocked I just couldn’t get a prescription.

It’s not anything to do with any addition risk factors, I said I am not interested in waiting for a referral and could I just go to the pharmacy and ask for the pill over the counter. As it would mean I don’t have cystic acne and chin hairs. She said yes it might be more convenient and if they won’t give you the pill to make another appointment- I wish I was lying or sensationalising but it’s the whole truth.

When i collected my last contraceptive pill prescription, the pharmacist asked me if it was for contraception or hrt. i asked what difference it made and they said as a contraception its free but i'd have to pay if it was for HRT so it seems it can be both.