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?

Here you have to go through a triage nurse who decides whether or not you can see a doctor and the doctors will not see any form of injury, you get told to go to A & E 18 miles away. Is this usual now?

Th nurse isn't deciding if you can see a doctor or not, the nurse might be the best person for the job many are more skilled than the doctors depending on the area.

Velma, my problem with the system that my local surgery offers is its complete inflexibility. I could have an appointment at 3.30pm that day or in 3 weeks time. That was it, no other possibilities. It was as if no other agenda existed except the surgery's.

I can complain but as I go to the doctor once in a blue moon (previous visit roughly 3 years ago) I am hardly going to rate as a significant opinion.

Out of curiosity Velma, how many of your 10,000 patients on your list do you see. How many are active patients and how many are ghosts like me?

This really is my problem, most of the time I am simply an income stream for any surgery I'm signed up to. I just feel that on the rare times that I ask to see a doctor it would be nice if I got some consideration. I'm not asking my doctor to stay late into the night just to offer a bit more flexibility when it comes to appointments. A bit of recognition that I too have to fit this into a working day.

At our surgery all the appointments have gone 5 minutes after the phone lines open and you've been getting the engaged tone all the time.

I'm now in my mid-forties, menopause on the horizon. If I am not 'in the system' how will I ever get to find out if HRT might be the thing for me? If you arent 'in the system' it is very easy to be fobbed off - come back in six month's time if you are still worrying about it. Of course you dont go back, you deal with the symptoms and after a while you learn to live with whatever it is.

Velma - When you argued for registering with a GP close to home rather than work you talked about the importance of patients building trusting relationships with their GP. Well I don't know where you live but here in London you are unlikely to see the same GP twice in a row and with a 10 minute appointment they discourage any talk of illness symptoms other than the immediate problem.

Catchment areas still exist for most people. One problem is that the supply of GPs is tightly regulated by health boards so a group of GPs can't just set themselves up in an area and start getting paid money from the health board/ primary care trust for seeing them. If this did happen then seeing a GP would be easier. The existing GPs don't want to work 100 hours a week so control how many patients they see. There is a limit to how many depressed/ill people you can see in a day and still provide a good service.
In our area the GP lists are full so all patients are allocated a GP. The health board has been asked by the GPs to just advertise for more GPs to set up a surgery or to provide a new health centre but it won't because it is too expensive. The town is expanding and existing GP practices have as many if not more patients than they can cope with.
I don't think walk in surgeries are the answer, it's more GP practices in oversubscribed areas.

Ask to speak to the practice manager, and make a complaint. Our surgery now opens one late evening and a saturday morning for those who work.

In fairness to Velma I think what I'm hearing is the frustration of provision, and the rest of us are testifying to the frustration of access. It's becoming clear to me that there is a capacity problem and it's being exacerbated by some people abusing the service ( that's the reason I am not totally wedded to free at point of use, I think a small charge may reduce a lot of time wasters), and doctors time being sucked up by useless make- work.

But big picture the system has to drop this cartelisation of GP practices, and I do think it needs to think hard about working methods that deliver equal access opportunities for working people.

Nothing Velma has said has explained to me why it is such a massive big deal to allow bookable in advance appts.

No one is saying you need to work 15-hour days, Velma. What people are saying is that it is not always possible to 'drop' work on the day and dash off to the GP's. What about barristers/ surgeons - there are many professions where it would be really tough to just announce at 8am 'Oh, I've just got a GP's appt, not coming in this morning, so I won't be appearing in court/ doing your operation'?

People need to be able to plan, and you are not the only one with a long-hours job.

This kind of attitude in the NHS annoys me enormously: staff seem to think everyone is a lady of leisure or pensioner with endless time to rebook, sit around, etc. Like the last time I took half a day off work to attend a hospital consultation only to find they hadn't actually booked the scan I was supposed to have, so the consultant had nothing to discuss with me, and airily said, 'Well, just we'll just book you back in in a fortnight'.

Actually, as a professional, I am not the person worst affected. What about people paid min wage, or just by the hour? Don't you get that they lose money when they have to just drop work to come see you?

I suppose part of the problem is that if you have lots of book ahead appointments then you can't also have the same GP doing emergency slots at the same time - and then there's the problem that people can't get in that day for emergencies.

I would second the poster further up who said that there just aren't enough GPs to go around.

PS I'm having to take time off work to see the midwife because they only see people on Monday and Wednesday mornings with the first appointment at 0900 - I work 40 mins away, midwives are often running late so I've had to tell work that I won't be in until 1100 at the earliest. I don't think that the problem is just confined to GPs.

I think a lot of you forget that most people that post on MN are not representative of your average GP list.

I totally understand that getting appointments when you want them can be very frustrating and some surgeries do have madly inefficient booking systems. But IME the availability of appointments has little to do with the booking system and a lot to do with the patient population.

So many patients have no common sense, no ability to self treat minor illnesses, no support system in place to advise or assist with social crises. There is a big sense of entitlement regarding assessment and treatment, and people feel really hard done by if they don't get seen ASAP and come out clutching that little green piece of paper.

In our area we have huge numbers of patients that really think their problems are just to be 'handed over' to the HCP and we can sort them out. They have neither the inclination or noggin to take some responsibility for their own health, and clog up the system with what are often inappropriate attendances, or DNAs.

That is to the detriment of the patients like most MNers that probably do need to be seen, and should be able to be seen quickly and easily.

There is a big sense of entitlement regarding assessment and treatment, and people feel really hard done by if they don't get seen ASAP

I strongly disagree with that, if anything, it's the other way around in my experience. Stiff upper lip approach, employers penalising self-certifying, people going into work with infectuous illnesses for fear of being seen as slackers, people not going to the GP for fear of being seen as time-wasters even if it means serious conditions are left untreated or discovered too late, people having to raise a fuss and fight and fight and fight for a referral, grown women being shockingly clueless about simple things like how the contraceptive pill works because even though it is handed out like candy to any teenager it isn't seen as serious medication, I could go on and on.

I have the utmost respect for medical professionals (both my parents are medics), I'm not suggesting it's their fault, but there needs to be a massive shift in attitudes towards prevention, general medical 'literacy' and people being able to, and not discouraged from, accessing primary care services. Even if it's just for prevention or putting their minds at ease. I'd rather people have the occasional unnecessary trip to the doc's than missing warning signs that could make a difference between surviving cancer or not etc.

Sidge, I suspect that in fact we are representative of the average GPs list. What we arent representative of are the people who go to the doctor regularly. I would expect that there is the Pareto principle at work with 20% of a doctor's patients creating 80% of the work.

The rest of the patients will represent a steadily declining level of attendance at the surgery with people like me essentially being ghosts in the system.

The problem is that the appointment system is designed to keep the 20% at bay. There is no filtering system to tell the person booking appointments that patient A seldom appears at the surgery so if they do it is possibly something important so it would be worth offering some flexibility so that they can get in.

I agree that the Pareto principle is at work - you see a very similar phenomenon in A&E. DH just estimated that older people (65+) make up about 20% of a typical list but require about 2.5/7 clinical working hours per day. That is not, by the way, to say that older people do not need or deserve care.

I would slightly disagree that we are representative of the average GPs list. None of us is a child, for instance, and our gender, age and education are likely to be relatively homogenous.

I asked him about how he would make the system better e.g. fit in more appointments per day. As it is, he officially sees 32 patients per day for 10 minutes each (although usually more as sees several 'emergencies' on top of it, many overrun and there is paperwork afterwards), plus 2 home visits. He made a point that hasn't appeared on the thread so far: there is a high proportion of 'GANFYD' attendance i.e. people asked to get a note from their doctor by school / gym / weight loss club / insurance firm ... all of which take up appointments that could have been allocated to people with acute illness. It's possible that surgeries should take a hard line on these since the vast majority are not medically warranted. Of course, this is not the same as issuing a 'fit note' which is firmly within the GP remit. Educating people about self-care can only go so far, he believes: often it is the absence of motivation to apply self-care rather than the absence of knowledge. He also suggested (tongue in cheek) that anyone opening their consultation with "I read about this cure in the Daily Mail ..." should be ejected on the spot

"would expect that there is the Pareto principle at work with 20% of a doctor's patients creating 80% of the work. "

I don't consider this to be a bad thing. 80% of people probably don't need a doctor. Elderly, disabled people, terminally ill, pregnant mothers and small children need the doctor more. There are different periods in our lives when we need the doctor more.

Flexibilty needs to go both ways. If someone hardly ever goes to the doctor then surely they can take a day off work for a non emergency.

Frozen, our surgery charges for anything in your list because it comes under the "private" remit. Do others not?

Velma, your argument for catchment areas "until you develop cancer, and require frequent home visits from your GP, district nurse, Macmillan nurse, Marie Curie nurse." can I say that I have never had a visit from anybody, and just about all of my care has been at hospital. Are we talking about the elderly again?

Somebody mentioned waiting - obviously I've had to have tons of hospital appointments and the thing that really annoyed me was that having seen the nurse and the oncologist fairly swiftly to then be kept waiting for over an hour for somebody to take blood. (Then they say "you could go to your GP" except that you've still got to trek to the hospital for the nurse and the oncolgist )

Again I would reiterate that the issue isn't getting appointments in the evenings or weekends or "when I demand"; but getting through to be able to make an appointment for a reasonable timescale. I can go at any time the appointment is for - I don't expect the doctor to put themselves out for me - but I can't sit at home from work on the off-chance I may possibly get an appointment, only to have to do it again tomorrow.

80% of people probably don't need a doctor. Elderly, disabled people, terminally ill, pregnant mothers and small children need the doctor more.

I'd bet that a significant minority of the heavy users are time wasters in one form or another.

If someone hardly ever goes to the doctor then surely they can take a day off work for a non emergency.

No, actually. Most working people can't in 2012. IMO the NHS is still mentally in 1962

I am a GP in a large busy inner city practice. I have read all the points on here and agree with some but not all of them. Some posts actually contradict others showing clearly one size cannot fit all.

Firstly, I think a system that does not allow advance booking is wrong; not only for the inconvenience but also because it makes continuity of care virtually impossible.

The debate about catering to the working tax paying population is more complex. Yes - these are the people that support not only the health service but social welfare, education, defence etc. A customer focus on the issue would ensure these clients were the VIPs....could always get appointments at times that suited them as well as access to ancillary services out of hours.

The problem is that no matter how many private companies, Tories or New Labour like to sell us this notion....patients are not customers. I am a customer when I go to my haidresser as I am on the same level playing field as my 85 year old mother when she goes. When it comes to health, the two of us could not be more different.

In order to introduce a shift sytem with GPs working around the clock, we would lose all sense of a "family doctor" and continuity of care. Some of my colleagues know 3 generations of families and that level of trust cannot be built up over night.

As a GP Trainer, I would like to add that there is more to being a GP than diagnosing a UTI or a broken finger. A large part of our work involves social, psychological and even economical support in a society that is becoming increasingly fractured and unhappy despite being richer in material terms.

I work long hours ( as do many people) and I love my job and think I am lucky to earn a comfortable salary for something I enjoy. However, the drive towards "customer satisfaction" and 24/7 care within the NHS is making a large number of GPs question their role and the reasons they set out on this career path.

Employers need to get a grip too, and sometimes employees as well.

I absolutely loath the culture that everyone brings their bugs to work, spreading them to all and sundry in the office and on the commuter trains for good measure. Yes, it's 2012, use your wireless and your phone and work from home for a day or three if you're so indispensable, I bet the world won't stop spinning.

A mate of mine got major grief from HR once for having taken 1 day off on 3 subsequent occasions, each time because of a stomach bug she caught AT WORK. Yes, it was doing the rounds since nobody else was sensible enough to stay the fuck at home with it. That's hardly the NHS's fault, is it.

norman it is so nice to read such a sensible post from a GP!!!

As a patient I don't want to be a customer. I don't think most of us do! I don't want my doctor selling me stuff. And I don't need to see a GP at midnight on Saturday.

But I do want, when I have mid-cycle bleeding, to be able to get to see a dr in fewer than 5 months I think most people don't want to be VIPs or anything like - they just want not to have to choose between annoying their colleagues horrendously and going to work ill.

In order to introduce a shift sytem with GPs working around the clock, we would lose all sense of a "family doctor" and continuity of care. Some of my colleagues know 3 generations of families and that level of trust cannot be built up over night.

Interesting point - I think that's admirable but I wonder if that's a realistic aspiration in 2012.

I would love to have a family doctor who's known my family for 3 generations, but the reality is that I've moved country (not town or house) 5 times in the last 10 years. And statistically I have a much greater chance of needing a UTI diagnosed than having a condition for which you'd need to know my family history from my grandparents onwards (I can bore you to tears with it if you need to know, but chances are, you don't.)

Same goes for Velma's point about people developing cancer. For every patient that does, there are hundreds or thousands that doesn't. What about them?

sorry about appalling grammar and spelling. Why can't you edit your posts on here?

The debate about catering to the working tax paying population is more complex. Yes - these are the people that support not only the health service but social welfare, education, defence etc. A customer focus on the issue would ensure these clients were the VIPs....could always get appointments at times that suited them as well as access to ancillary services out of hours.

Not VIPs, just "equal opportunity at access to the doctor" would be a very good starter. The dial-a-thon-in-hope in the middle of morning commuting time is f**ng nuts unacceptable.

Most working people are not up for screwing the system, they just want to be seen quickly and effectively. That is what is expected of them daily in their jobs, and i think we find it harder and harder to understand why we can't get that from the medical services.

I also think people, and doctors, in the UK need to know that the NHS - by comparison with most other OECD countries - gives a pretty crap service. It doesn't have to be like this.

I don't think anyone is saying GPs should work 'around the clock', just maybe slightly more flexible hours would be helpful in some cases.

And in my experience in many areas the 'family GP' is a thing of the past - it's often large practices with lots of doctors, so that you rarely see the same person twice anyway. Add to the fact that people themselves tend to be quite mobile these days, having to move around the country for work and study, and I don't think it's so much of an issue.