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?

All of this. I want GP's precious time used up doing things only they can do. Also specialist nurses are much better and more efficiient at doing smears. If pharmacists can prescribe the pill and you've already used up your appointment time then the GP is totally in the right not to run over.

I do get that, up to a point. But surely it differs by case and there's an element of professional judgement? In my example, I spent around 90 seconds of my GP appointment explaining that the ongoing issue was still on going, and as we'd discussed previously, the next step would be to take a blood test. She agreed, in around 20 seconds. With the remaining 6 or 7 minutes of my appointment I could have had a blood sample taken.
Instead I had to go back to reception, take up their time arranging another appointment, come back a few weeks later, see the nurse, therefore taking up her time, I was in her room for around 2-3 minutes and the tests were labelled ready to go before I had my coat on.
Of course I was then suffering the same symptoms for a good few weeks longer with that delay built in.

Had it been something that would have taken longer, or if I'd already used up my GP time in the original appointment then I absolutely agree with you.

Op sorry not intending to derail! I hope you get some support soon.

Gp training is still 3 years, they do an additional year in hospitals covering gp related specialties

She can prescribe the pill, for contraception. You're looking for off label usage, so it should be prescribed by someone specialising in that. ..

She could be a poorly supervised trainee GP. A good one if so. But I would have expected them to be able to do a smear test.

Short appts are used to catch up on patients that are there for 35mins despite having a 10min slot so it has less impact on those waiting (or order/review tests etc).

Most gps haven't taken bloods on a regular basis for years so will naturally deskill at it, and have many other things they need to do that only they can do

I did take the bloods myself whe I did my foundation placement in gp but that was only because a few weeks earlier I was taking bloods daily, and my appt slots were 30m per patient initally so I had the time to do so

It's not the ability to take a smear any one that can do a cervix exam can take a smear, they have to do them regularly to be given a pin to be officially allowed to take them

It's not whether they can, it's whether they should. Obviously if there are no knock on effects then not inconveniencing patients is desirable but optimising clearly scarce resources of GP's time is definitely more important.

Have people who are whinging about this not seen threads about how overwhelmed GPs are and how difficult it is to get an appointment?

My GP does smears/swabs and also fitted my coil when I had one, her specialty's or interests are/were gynaecology

But I think she’s the exception to the rule as generally the nurse does it.

Our surgery only has 2 nurses and one very part time person to do bloods it a royal pain especially as they normally try and get you to see a nurse first

@Helpagirlout222 OK - imagine if you went to a hair and beauty salon for a hair cut. Your hair was quite short so it didn't take long to do. You were also planning to get your nails done. The hairdresser did nails in her original training years ago, but for the past 20 years all she's done is cut hair. Would you say "my hair cut has been really quick, so can you do my nails now too, to save me coming back another day and seeing the nail technician"?

It's reasonable to complain because they didn't properly communicate what needed to be done, how and when. It's not reasonable to expect the GP to be a one-stop shop for every procedure. It can't have escaped the attention of anyone who attends any sort of clinic or surgery that numerous jobs which were once done by GPs or hospital doctors are now being done by nurses or other practitioners. That's the only way that the NHS is in any way managing to keep going.
And I have to say, just as an example, I would far rather have a blood test taken by a phlebotomist than a GP or a newly qualified doctor (and definitely not by a hospital consultant!)

Good grief! People complain about the health system here, but it seems you have it much worse. I saw my GP in mid-December, he wanted a raft of tests done, an hour after seeing him the bloods had been taken and I was on my merry way.

That does make more sense when you put it that way...I just wouldn't have thought it would have been 20 years since a GP took bloods! But maybe that's the case. And when they're so busy, taking up one appointment slot rather than 2 seems preferable?

The smear thing is possibly administrative rather than skill. In our area you need to have a code to send a smear test and seems only nurses were given the codes and it’s a ball ache to get a code.

its very possible that your vaginal exam and swabs took more than her 10-15 minute appointment time, and therefore rather than not being able to prescribe your contraceptive she just didn’t have the time so was signposting you to other options?

"The smear taker needs a code" has become the "cancel the cheque" of this thread.

I am baffled by GPs now. Ours has had 3 different systems to see a GP since Covid. It's like a system designed for GPs to avoid patients.

Example- I've had a bug since a few days before Christmas. Assumed it could be dealt with by pharmacist at chemist as loads of people have it- respiratory, wheeze, blocked face, sore throat runny nose, cough. He advised Lemsips and cough lozenges, steam, rest, fresh air. It worsened then has gradually improved but my sinuses are really blocked with yellow/green gunge and are just awful in the mornings- tissues full of gunge (sorry!). Went back to pharmacist who said I needed to see GP re: antibiotics.

Rang GP on Monday morning - only allowed to speak to receptionist who said to go to pharmacist.

I explained I had been twice and been told I now need to see GP.

Receptionist said I could have telephone appointment with 'Physician's Assistant' on Monday. I said no - this is a person who I was recently given an appointment with after some unusual bleeding and who said ' wait a few weeks and see what happens.' I knew that wasn't right and insisted on seeing GP and was referred immediately under two week wait protocol to Gynae oncology for investigations incase it was cancer of the womb. A scan revealed other concerns and I had further investigations, a minor op and biopsies just before Christmas which thankfully revealed an explanation and it wasn't cancer. But I wasn't seeing the 'Physician's Assistant' again- who could not even correctly pronounce the word uterus.

So re: this bug, I was then offered an appointment with a nurse on Monday afternoon. I went and she said I do need antibiotics but she can't prescribe them and I need to see a GP but she couldn't make me an appointment other than a general appointment which would be in 3 weeks time at the earliest. I need an 'urgent appointment'.

I now have to ring every morning at 8am to get an 'urgent' appointment that day with a GP . Two days so far and I have had no luck.

It's just pathetic. If I can't get an appointment tomorrow (Thursday), I can't go on Friday as I am running some training for 40 staff 25 miles away. So at that point I will just give up I think . I can't go to A and E with it- that would be mad.

All I want is a prescription for anti-biotics, which the nurse and pharmacist both say I need. Why can't the nurse tell the GP she has seen me and seen the evidence of the gunge and have the prescription sent to the pharmacy?

@Privetproblemshedges Wow OP you have a massive, massive attitude problem if your posts on here are anything to go by. No wonder many of them have been deleted.

Nobody on here can give you medical advice but I suggest you learn to take constructive criticism and stop being so defensive

If the government chose to fund enough GPs (rather than cheaper, not fully trained staff such as PAs), these systems would be necessary. Make sure you understand where to lay the blame, and be fully aware that the new administration has chosen not to make any significant changes so far, despite being aware of the issues.

sorry, these systems wouldn't be necessary

You can't judge the NHS by one GP practice. I had my annual blood tests done just after the Xmas bank holiday with a phone appointment to discuss the results on Jan 3rd.

As it happened on Jan 2nd I got a text asking me to book in for weekly vitamin B12 injections, I go for my second one today. The pharmacy dropped off some pills for me to take after the jabs.

My carer had similar symptoms so he booked in for blood tests on the 6th, he got a similar SMS on 7th and had his first jab yesterday.

I know I am lucky to have such a good practice but some of the NHS, at least, is working well.

My GP has stopped issuing prescriptions for contraceptive pills. I put in my usual repeat prescription request and got told they weren't doing it any more and to go to a pharmacy instead. Assuming it's a commissioning decision based on costs/reducing demands on GP time or something.

I do understand.

As a patient, the system is terrible .

Gp training is 3y long, they only work in hospitals for the 1st 2 yrs. Excluding mat leave, GPs that went to uni at 18 and no gap years ... are fully qualified at 28 so depending on the age of who you saw it could easily be the case. There's often way more nurse/hca appts available than gp appts

Most drs don't do spears it's been delegated to spec nurse. You used to use to have a smear number and do a certain number per year so most people aren't signed up as it's something that can be delegated.
It's like that with contraception/ HRT stuff too