Is this how GPs are trained now?

[Privetproblemshedges]

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?

Thank you! 🙏 I feel like I am going insane. All I wanted to no is new GP training and if they are getting less training so can’t prescribe normal things you would expect x

When I first became a GP back in the mid 90s, we all did smears. We just wrote our names on the paperwork. Now every smear taker needs a number, and those numbers are generally allocated just to nurses and HCAs. The practical aspect of taking a smear is easy, but without the accompanying number, the lab will not process it. So that answers your smear question.

I’m not clear about the rest of your complaint, but was this all done in the same consultation? Because if I’d already done a pelvic examination and swabs on someone, I certainly wouldn’t have time to chat about their pill, advise of the risks, check the contraindications, check blood pressure etc as well.

Many jobs that used to be done by GPs are now delegated to nursing staff, in order to free up GPs to do jobs that can only be done by a doctor. It’s not efficient time management for the most expensive and highly qualified members of staff to do things that cheaper members of staff can perfectly easily do.

OK I’ve been a doctor for over 30 years. I can do consultations, clinical examinations, make diagnoses and prescribe treatment. I can also check blood pressures, take blood samples, dip urine samples, clean wounds, stick dressings on, do ECGs, administer vaccinations, label blood bottles, fill in forms - I am capable of all those things. So if you came to me with a set of symptoms requiring a few tests, I am able to do all of them. However, it would take me about an hour to do the whole lot. Do you think that’s fair? For you to have a whole hour of GP time? Doing things that could be done by other staff members? While other patients just have to wait? Would it make sense for me to clean the windows too? After all, I am capable of cleaning windows. Or would it make more sense for someone else to clean the windows, freeing me up to see patients ?

No this has been ongoing since October.

I had a bad Covid infection earlier last year and couldn’t shift it, I had tonnes of bloods over multiple weeks, if not months. My FBC showed infection each time. I was also having bloods for peri since my periods are irregular but my FSH (think that’s correct) came back normal, and I was actually ovulating. Had a vaginal US clear of cysts, but I have high testosterone, confirmed by bloods and irregular periods. So diagnosed with PCOS. I also have low folate, and vit d and B despite being healthy weight and a healthy diet, and something else wrong in my FBC, so have anemia - taking prescribed supplements (not helping so think I will need injections soon).

All I wanted to know is is this the norm now, but apparently it is, I asked for the pill or some kind of HRT to lower my testosterone as that’s also making me ill and have an compromised immune system- but I now have to be referred to a woman’s suppport group and see a nurse before I can get a contraceptive pill - no other options have been given to me to reduce the testosterone - I just want the oral contraceptive pill so I can at least tick one thing off my health info card 🤬🥲🥲🥲🥲

No but if you told me I was coming in for a vaginal exam and a smear I would expect both

Actually if a patient needs a pelvic exam; swabs and a smear why does it need to be two appointments? That seems a waste of time and money for everyone involved. If a nurse can do smear they can take swabs and also be trained for the exam? I am talking about the one where the doctor inserts a finger or two into the vagina and pushes on the pelvis?

Bimanual pelvic exams must be performed by a doctor trained in interpreting what she feels with her hands. Smears aren't interpreted by the nurses, but by the lab.

"Being trained for the [bimanual pelvic] exam" means knowing what normal ovaries feel like, normal bladder feels like, normal uterus feels like, healthy but tilted uterus feels like, across a wide range of "normal" in a wide range of women's bodies. It involves knowing what "ill" feels like for all these structures.

In other words, it involves going to medical school.

Way back in the land of dinosaurs when I went on the pill the practice had a policy of starting smear tests then. It wasn't a hard, "If you don't have a smear we can't prescribe the pill" rule but I can see it being a policy for a trainee GP.

Maybe she thought she would have been trained in time to do your smear.

GP training (at least at my GP's) takes two years, I assume that is standard everywhere in England.

Not everyone is trained in the same things. My GP has a fantastic health care assistant, she is trained to do lots of things other HCAs are not.

In my surgery, a smear test is a 20 minute slot and nurses do them so GPs are freed up to do the jobs nurses can't.

If you are in your 30s how do you not know smear tests are administered by nurses not GPs?

Everyone is telling you similar things but you are pushing back. Maybe if you want the answer and less hassle in life listen to others answers.

You can use the Pill as HRT.

Perhaps the OP phrased it casually or misused the term HRT - but you can indeed use the Pill as HRT.

If I see a patient about a different problem, and it’s also discussed that they will need a pelvic exam and a smear, I’ll try and book them an appointment with doctor and nurse simultaneously. Doctor can then do the pelvic exam, nurse can do smear, all in one go. But it’s very difficult to find a slot when doctor, nurse and patient are all available.

It’s been explained to you numerous times that doctors are trained to perform and interpret pelvic exams , whilst nurses aren’t. And doctors are capable of the mechanics of taking a smear, but are not allocated the admin number necessary, whilst nurses are. This is due to the way work is distributed. What is that that you’re not understanding ?

Haven’t RTFT but pharmacies can only prescribe some pills. I’m on the combined pill and need to get it through my surgery.

Best use of time. Drs can do smears bit u need to do x per year numbers... so can nurses do smears. So better use of a drs time to do something only they can do eg prescribing referrals etc

They can do pill checks but it's a tick box questionnaire that doesn't really need a drs input so again better use of their time when so many are struggling to get appts

I did both when I did a gp job 8y ago but cos I was a trainee I had 30min appts vs their 10

All gp training in the UK is 5y uni, 2 years Rotational generic training all drs do, them 3y specific gp training scheme

It'll be the surgeries policy rather than a qualified GP being unable to prescribe. It makes sense for a specialist nurse to handle prescribing and doing pill check ups. Same with smears, it's policies rather than a GP not being highly trained enough to know how to do one.

Try and look at it this way OP.
A surgeon does an operation. Once the operation has finished, the surgeon will write the operation details in the patient’s notes, then read the next patient's notes, and get scrubbed up ready to do the next operation. Meanwhile, other staff will count the swabs, throw away the used ones, clean the operating table, get the surgical instruments ready for the next operation. So when the surgeon is ready, everything in the operating theatre is ready. The surgeon is perfectly capable of cleaning the operating table and getting the equipment out. It’s not that the surgeon isn’t adequately trained. But if the surgeon does everything, then fewer patients can be operated on that day, because the whole process will take longer. Have you heard the phrase “many hands make light work”? It’s a way of distributing the workload, to enable greater productivity ie see more patients. Over the years, nurses and HCAs have taken on more jobs, freeing up GP time to try and deal with the ever expanding patient numbers.

Does that make it clearer?

I had a smear attempted by a Dr once who had to call for a nurse to help. He made a mess of it and it really hurt. The nurse said after he left the room that he wasn't used to doing them. It was agony.

I would not want a nurse to do a bimanual exam on me……it’s not as simple as training someone to do it. If it was then the receptionist could have a go. It’s out of the scope of practice for nurses afaik.

I would not want a GP doing my smear. If they are not done correctly they will be declined/not have got the cells needed. It needs to be done by someone who does a lot of them so it’s their bread and butter. That person is not going to be a GP. GPs need to spend their time doing things nurses can’t in order to maximise the effective running of the practice. If they were doing smears and blood tests and ear syringing there would be next to no GP appts.

i get it’s shit you end up having two appointments but I can see why.

The pill thing is odder. I do notice some GPs have on their blurb that they have “an interest in women’s medicine “ and some don’t. Always seems a bit shit because they all know what to do with men without having to specialise! I guess maybe women’s hormones and menopause is a more specialised area which requires more knowledge? Shouldn’t be that way. I’ve found through recommendation which gp to see at my practice regarding HRT and which ones to avoid after getting some totally incorrect information from one GP initially. I think the level of knowledge and training in this area is probably quite poor and indicates how low a priority women’s health is.

Training for smears needs to be kept up to date, this means time out of seeing patients and expense of training. Nurses are also paid less. It makes sense for nurses to do smears.

I wasn't including medical school or hospital rotations. The GP trainees at my practice are registrars.

The combined pill can be a used as a form of HRT for the treatment of perimenopause symptoms (albeit that's not what OP needs it for, but she is still correct that it can be used as hormone replacement).

The doctor might have unwittingly (or even wittingly) done you a favour. If they prescribed the pill as HRT you would have to pay. This way you can rock up to the pharmacy and ask for it as contraception which is free.

That sounds ridiculous! I'm not in the UK and I don't remember GPs ever taking blood here. They send you off with the forms, you go to a lab, and they take the blood, all done the same day.

Yes this is my experience. I've been waiting on an appointment to get bloods taken for 3 weeks, seen 2 GP's, neither of whom could take my bloods. I've now had no appetite for 4 weeks and have lost 4kg. I have an appointment tomorrow, first one available since my initial appointment on 23rd Dec. I'll then have to wait a further 2 weeks on results. Honestly the NHS is broken. I'd much rather pay health insurance, like I do for my pets, where I can get same day diagnosis for a very reasonable amount of money.