to think that the reason a lot of people dont go to the doctor when they should

[GnomeDePlume]

is because they cannot get an appointment time which is remotely suitable for someone who goes to work.

If I want to see a doctor then I can either make an appointment for the middle of April (earliest time when bookings can be made) or take pot luck on the day. The pot luck which is available today is 3.30pm, no alternatives available. This would be great someone wanted to take a DC to the doctor outside of school hours. Sadly it is totally useless to me as I would have to leave work at 2.45. My employer is strict, I cant take an afternoon off to go to the doctor.

So would it be so very difficult for the surgery to work out that only offering appointments on the day at fixed times or in over a fortnight's time is not serving a large proportion of the patients well?

I have to say, the only-book-same-day doesn't suit pensioners or SAH-types, either. We can find it just as hard to book things last minute, and sometimes the only appointment on offer is at 9am: right when you need to be delivering somebody to school, or at some other time when a pensioner can't get a lift. Or after school when you'll have extra lively kids with you, or at 4:30pm when child has a swim lesson, or when you have already arranged to accept a delivery, etc.

Luckily we can book in advance where I live now, thank goodness, but had to cope with other system for a few years & it put me off too. DH once turned up in mid afternoon with injured toddler only to be told to go straight home & phone back for same-day appointment instead .

I had to haul my baby + toddler along to things like getting an IUD fitted & cervical screening, but I couldn't ask DH to take the days off in case I couldn't get an appointment after all.

Thanks Hmm. I know it would be up to the practice manager whether they'd take us back anyway, I'm not sure they would without very good reason.

We had a reason for applying to other surgeries and were told that "whilst they had every sympathy and could understand our concerns", they would not make exceptions to their policy over the catchment area. The places we applied to were a little over 2miles away and we are on the very edge of the boundary. So the rational of home visits again, just doesn't wash. Its about protecting bad doctors and resisting change to reflect changes in society.

It seems common practice for places have gentlemans agreements going on to stop patients moving regardless of whats in the best interest of them, even where there are strong arguments in individual cases. Our complaint was minor compared to some I've heard and the problems its caused. The system isn't set up to help patients complain about bad doctors easily either, so we have a situation where you can't vote with your feet either.

Its very much about what is convenient for the doctors and not about patients interests at all, which I actually find very morally wrong.

A few things that would make it easier for people to get appointments:

• financially penalise people who miss appointments (only a few pounds, but enough to remind them that the service is not free, but free at the point of delivery)
• financially penalise people who request and get clearly unsuitable home visits (when the doctor shows up, stated reasons such as "it's raining" or "you can't expect me to pay for a taxi" are not, believe me, uncommon)
• allow telephone appointments for a greater range of minor conditions e.g. UTIs, repeat prescriptions
• allow people to attend GP surgeries close to their place of work
• restrict early morning or late night surgeries to people unable to attend during the day, and publicise them heavily to this population group. The once-a-week 8pm surgery at my local practice is normally half empty and comprised of the elderly.

finally ...
lobby against NHS reform. The job of a GP may seem very cushy to those of you upset about the lack of appointments, but numerous professionals leave or reduce hours because of stress, increased bureaucracy, targets, revalidation and the prospect of a government-enforced commissioning role. All of these lead to decreased time to do what the GP got into medicine for: seeing, and helping patients. On an average week at a surgery round here a doctor will face at least one incident of significant physical or verbal abuse (often not officially recorded) which causes delays, multiple unnecessary home visits during and beyond their lunch hour and numerous DNAs. People will frequently attend for conditions which can be dealt with using OTC medications e.g. mum attended last week about baby teething because she wanted Calpol prescribing for free (would not accept prescription for generic paracetamol). There are usually enough appointments available, but people are not currently using them appropriately which means that other people miss out.

I'm finding our surgery's system very weird - it's new. You phone and request an appointment, the doctor calls you back (at some point) and they decide whether you need to be seen.

After, of course, you've run the gauntlet of the receptionist's "Is it URGENT?"

I cannot for the life of me see how it saves time, since every single time I've been called, I've then gone in for an appointment - so taking up 10-15 mins rather than 5-7.

Frozen I agree with many of your points. The problem seems to be that people who work but just need a scrip for ABs to treat their 3 week old strep throat/chest infection/sinusitis whatever are made to carry the can for the problem patients.

The last time I went to the doctor on my own account was probably three years ago. I havent abused the doctor, demanded an unreasonable home visit, demanded prescriptions for OTC meds (paying myself is cheaper than the prescription fee).

Undoubtedly these things happen but surely when I phone up for an appointment the receptionist can see that I am no bother?

Ours has phone consultations, is open late several days a week (also starts at 8.15 bookable in advance) and offers bookable appointments a few days in advance
Gp doesn't know how to treat my hypothyroidism effectively but there you go - can't have everything!

Outraged: Hackmum, if you are worried enough about a breast lump then you have the choice of either waiting or taking time off work. If you are in pain from an ear infection that does need to be treated quickly, then that is another good reason to take time off work.

Did you miss the bit where the OP said her employer didn't allow her to take time off for GP appointments?

When answering a phone call for an emergency appointment, My sugery receptionist startes by asking for the patient's date of birth and then looking up the patient on their computer before saying whether or not there are any available appointments that day. This is a new and I wonder if it's a form of vetting.ie i have a long term condition and so hopefully would be given an appointment but another person who might be seen as a nuisance or low priority for some reason, might be told that there are no appointments available that day.

The whole appointment thing is a mystery to me and lacking in transparency. We are not told how many appointments are available each day, or how many GPs are in the surgery or what the policy is regarding which gp deals sees patients with emergency appointments. The last few times I have been, I have seen a locum. Even then, the locums don't introduce themselves - I could be seeing the office cleaner for all I know.

I am a Dr's Receptionist for a large (15 partner, 20 Dr) practice. For a couple of years now we have been doing "commuter surgeries" every Monday & Wednesday. These offer appointments between 7am and 8.20am and then again between 6.30pm and 7.50pm. They are very rarely fully booked and we still get plenty of full-time workers demanding (yes, demanding not requesting) appointments between 5.30 & 6.00pm and nothing else. So, I'm not saying all surgeries are the same but in ours it is not a case of there being no appointments available outside of the "normal" working day - but we still get complaints.

People do not want to take time out of work to see a Dr & that's totally understandable - nor do I. But IME, the same people are also unwilling to leave the house 30 mins earlier in the morning or come back out again in the evening. We have 16,000 patients - the 5.30 to 6pm time slot tends to be the most popular and is able to be booked in advance, it therefore stands to reason that it may take a couple of weeks or more to get something during that time.

IMO the 'no time off work' problem is more common than you imagine:

• fixed shifts
• contractors (I'm one, my employer is virtual)
• temp staff

Perhaps it is a right to have time off to go to appointments but in the economy as it is I dont want to be stamping my feet about rights.

mirry2 - I don't know for sure because we don't do it - but - I'd hazard a guess that your surgery are looking for people who routinely fail to attend booked appointments & then ring up demanding to be seen urgently. It happens daily.

As for your other questions, your Practice Manager or Head Receptionist (or any Receptionist really) should be able to answer those for you. Patients do have a right to know these things & I am always explaining "how things work".

Whatme, I can assure you, GPs have radically changed their hours. I have been a GP for 15 years and I am working about 3 times the hours I used to, for virtually no extra money.

Face to face patient time is about half of what we do, probably less. We have so many hoops to jump through now to meet government targets, we barely have time to see patients at all. Trust me, no one regrets this more than I do, as I became a Dr to see patients, not fill in forms and do multiple audits. But that's the way it is now, and each successive government makes it worse. Are you aware of the new NHS bill? GPs are now responsible for all the admin surrounding the purchase of secondary care services. We are all working 12 hour days every day. So forgive me if I don't feel inclined to offer a few extra appointments in the evening to make your life more convenient. I don't get home until 9pm as it is, having started at 8.30am.

Morale is at an all-time low and we are struggling to stay afloat, with many GPs resigning under the pressure. Believe me, the profession is at breaking point.

I used to like the old system at my GP: you turned up at 8 and you got seen. You might have to wait a really long time but you would get seen the same day, so at least you could tell work you would be late, possibly very late, but that would be it. Now we have to ring at 8:35 exactly so I have the choice of go to work, then ring, potentially to get told (even assuming I get through) 'oh can you come in now?' er no, I am now 40 minutes drive away and would have to pick up the child I actually need the appointment for from childcare, OR I stay at home, ring, potentially don't get an appointment and then am late for work for no reason, and have to do the same again the next day. It's fine if I have an actual genuine emergency as then I'll be off work anyway but for niggling concerns which may or may not turn out to be serious it's impossible.

I know what your saying. I changed my G.P when my baby was born due to the fact that I could never get an appointment with MY doctor and if I did it was 3 weeks after than I originally wanted the appointment like I had to plan being I'll around them, when I did finally get appointments I was sat waiting hours after the allotted time and then to top it off the receptionists were little hitlers I swear I've never met a bunch of people as stuck up and rude in all my life! So glad I've decided to move to my husbands doctors much to the dismay of my family but it's nice to see pleasant receptionists and an organised surgery!

Let me explain something about the issue of being registered in the practice area.

Imagine you live in town A and work in town B, a 45 minute drive away. You're young and fit and healthy, rarely seeing the GP. Or maybe you have an ongoing condition requiring regular appointments, but nothing serious enough to keep you off work. So, it suits you better register with a GP in town B, close to your work. That's all fine until you develop cancer, and require frequent home visits from your GP, district nurse, Macmillan nurse, Marie Curie nurse. Your health carers can't spend 2 hours at a time driving from town B to your home in town A and back. 2 hours is 12 appointments. Are you expecting your GP to cut out 12 appointments so they can visit you 45 minutes away? If you truly believe you'll never get ill yourself, ever, then how about when an elderly relative comes to visit you, and becomes ill, and you need a home visit. Again, your GP is based near your work, not your home, so should they drive all that distance to see your relative?

It makes far more sense to have a GP near your home.

I guess moving back again to the surgery nearer home upon diagnoses of cancer would be out of the question would it ?

I spend a lot of time with GP's and don't see many stressed over worked ones, maybe they are good at hiding it but plenty are leaving the profession disillusioned, lots of bright young things coming through the ranks though.

Velma, with respect, that thinking is nuts. the obvious thing you would do - in any "national" health service - is switch your GP when you developed cancer.

What I don't get is why the UK makes it all so hard.

In every other country I've lived in, there is some form of medical insurance, you pitch up at the doctor nearest where you are (work/home/vacation), you get seen that day, they tend to have a lot more stuff on site (X ray etc) and its often sorted then and there rather than the "go to the hospital and come back in 3 weeks when we have the results" palaver here.

It cannot be beyond the wit of man for the UK to develop such a service in this day and age.

TBH I think we should have private GPs for working people and that these should be customer focussed in their service and working hours

Its already the case that working people are pretty much the only ones who pay for their prescriptions.

OK Whatme, you develop a symptom, you see your GP, you have some tests, they show some worrying features, your GP refers you to the hospital clinic, cancer is diagnosed. You're upset, you see your GP for sick notes, general support, you establish a relationship with him/her, and the nurses at the surgery. You have some outpatient treatment, maybe some surgery - all the while not really needing to see your GP because now the hospital has taken over, or seeing your GP but being well enough to make the journey because although you're off sick from work you're basically still OK. But the treatment doesn't work, the hospital says they can't do any more for you, and you go home to have palliative care at home until you die. So now you need home visits. And this is the point at which you think you'd change GP? You could have done it before, but you didn't expect to become terminally ill, you thought the treatment would work, so you had no reason to change GPs sooner, especially as you have developed trust in your GP, who after all made the diagnosis and referral in the first place. Would you still change GP at that point? When your old GP knows you, knows your history, how you came to be ill. And you know the system, the staff. Your family know where to collect your prescriptions from for you. But you'd still change? I'm afraid I would say your thinking is more nuts than mine!

And if you think this is an unusual situation, trust me it isn't. People of all ages develop terminal illnesses.

And in those lovely countries where you've paid your insurance, what about the people who can't pay it? Are you opposed to a free NHS in principle? because if you are then we will never see eye to eye.

Velma if you are going to come up with reasons not to have catchment areas, then make the effort not to have crap ones.

As mentioned up thread, one of the options being looked at was dual membership of GPs for those who worked.

Or if the system of changing doctors wasn't such a complete nightmare you'd be able to change to somewhere closer to home if you suddenly got cancer especially if surgeries had provision for priority patients. How do people who have cancer and move house cope?

As for the unlikely event of elderly relatives, I don't have, suddenly needing such urgent medical attention it needs a home visit; tbh if its that serious I wouldn't even consider calling my doctor anyway. I'd be calling an ambulance anyway or getting in the car to A&E because I'd be that worried about it.

Sorry, but the NHS needs to change. By that I mean, the paper work and targets need cutting, but equally 'can't do it' attitudes need to go too.

I do this job every day, I know what situations arise. How many people have posted on this thread? Maybe 30? There are 10000 patients on our list. I have seen the "it'll never happen to me" attitude many times.

I'm baffled by people who think my arguments aren't valid when I actually do the job, I don't just dip in when I need to.

I'm with you on the cutting paperwork and targets though.

You've obviously never been in the position of having a bad doctor you can not get away from or had the problem of actually getting an appointment then.

Its fine saying about getting diagnosed with something, but theres a step BEFORE that which is causing problems to a very large number of people.

Perhaps you should be listening to that as much as taking the rather patronising attitude of "I do this every day, I know everything".

People are trying to tell you there is major issues that need to be addressed somehow, but you aren't even interested in listening. Sorry but this is all about whats best for the doctor not the patient.

I listen a lot. I hate what recent governments have done to the health service. But it's government policy that has caused these problems, not doctors. We just do as we're told. I'm being defensive because I'm tired of reading attacks on doctors on here, and I hoped that by putting forward the doctors perspective it might give people a bit of understanding and knowledge of the situation from the other side. Frustration is usually eased to an extent by understanding.