to stay home rather than trekking across the city with DS3 to see a doctor? (Long)

[BoffinMum]

DS3 (age 3) has a kiddie virus, all the usual symptoms, but with the slightly concerning addition of ice cold feet, so I looked on NHS Direct for advice. He does not have a headache and he can look at light, so I wasn't hugely worried, but I thought I ought to take it reasonably seriously, considering the cold feet thing. NHS Direct advised me to ring my GP, which I did. I have been instructed by the Out Of Hours service to trek across the city with my very sleepy, poorly DS3 to get him looked at, which also incidentally means taking two other children with me (one of whom is knackered and may be going down with something himself) and causing a great faff. I am knackered too, and my SPD is bad today. And they told me that 'illness is dynamic, so even if the GP thinks he is OK during the appointment, you will need to keep him under close observation'.

Here's the thing. I actually want a home visit for once. I don't want to trek across the city in pain, with DS3 in pyjamas and a blankie, and sit around in some remote suburb until some doctor deigns to see me, patronise me and probably just send me to sit at A and E all night anyway, after being triaged by about five nurses, all of whom ask us the same things, before we are sent home at 3am feeling like complete idiots and slight abusers of the NHS.

I know all the arguments about how inefficient home visits are, how greedy we all are for wanting them, how terribly BUSY and IMPORTANT doctors are and how they can't be expected to pander to the social needs of their patients, with all they have to do, and, most crucially, how feckless people demand home visits because they have coughs or hangovers, and ring for ambulances because they have run out of Tampax or whatever. I really do know all that.

But just today, I would really, really like someone to come to have a look at DS3 in his home, in the context of his family, and tell me how worried I ought to be.

That's all. Just one of the six or eight doctors from the local practice to pop up the road and do a bit of a Doctor Finlay.

AIBU?

valium I am in a village near a city. Taxis are less forthcoming than they might be at some times of day, especially if a taxi driver is worried a child will be sick in the back of the car during the journey.

Hackmum it's due to many factors.

An ageing population means there are far more elderly and housebound people needing home visits, so less capacity for other patient groups.

More developments in medicine mean that more people take drugs than they used to (eg cholesterol lowing medication is now prescribed far more than is used to be), so there are basically more people on medication who need regular review, so more appointment time is needed, leading to longer surgeries.

Hospitals have transferred huge amounts of care to GPs - for example, there is a BP drug that used to be initiated in hospital, requiring a 2-3 day stay, and this is now done in primary care. That's just one example.

I could go on and on about the multitude of changes which have made the job totally different from the old days, but the single biggest issue is the admin. We have vast amounts of paperwork to do these days, and it gets more and more every week.

A typical day for me would be to do a surgery from 8.30 - 1pm, then a home visit (we always have at least one each), then a meeting (we have to have daily meetings to discuss referrals, admissions, prescribing stats, medicines management, etc etc) during which time I eat lunch, then straight into afternoon surgery until 6pm, then 2-3 hours of paperwork (going through results, reading hospital letters, doing audits, writing reports).

I'm really not sure what more I can do.

By your own admission it is a kiddie virus and you are not worried - so what is the problem?

Am I the only person who has never taken their kids to a+e or walk in clinic? Of course luckily they have never been so ill i've had to consider it, but for a run of the mill illness (cold, cough, fever) i've never thought it necessary to go (both are within 5 minutes from here) I think i've only had 1 emergency docs appointment too, and that was for dd1 when her finger went really septic and needed anti-b's pretty quick.

Velma, to me that sounds like hospitals need to start opening well-staffed GP centres to cover the grey area in between hospital and primary practice, rather than just farming things out to GPs al the time. Hospitals are good places for OOH services, IMO, as it takes the pressure off A and E, and there are good transport routes. There are also very many empty clinics sitting there after 5pm that could be used.

Meanwhile it's clear from your post that some patients are going to experience a degree of neglect in the current setup, no matter what individual GPs attempt to do.

So tell me Boffin, given what I've said about a typical day, what would you do in my position? Is 12+ hours not long enough?

I have taken ds twice to A and E - once for a really bad reaction to nuts and once after an operation and he had an infection.

To those of you who wonder about why a GP can't just 'pop' round to see you...my BIL is a GP who used to do home visits and in the last few years of doing them he became increasingly annoyed at the types of things people would expect home visits (or ambulance calls!!) for. The final straw so to speak was the gentleman who called him on Xmas day afternoon for severe stomach ache. When BIL arrived at said gentleman's house, it was his friend who had a 'sore tummy'....they had had a large Xmas lunch and were sitting on the sofa drinking beer. This kind of thing was not unusual.

Im jealous zelda! Ds is 2.5 and I have lost count of the number of A and E trips or OOH (before a and e told us not to bother with them anymore!)

I do think sometimes it hard to know when to ask advice and who to ask though especially with young children.

Yes Boffin, it's a disaster waiting to happen, all GPs know that. We are now limited in how many patients we can refer to hospital. That's Cameron's special contribution to the NHS.

Valium, here's the story.

1. He was drowsy, had a temp of 102.5F and rising, and his feet went icy blue and stone cold, and I looked on my Meningitis Symptoms card that I keep in my medicine cabinet, and it said this was potentially serious.

1. I went on the NHS Direct website to use the diagnosis tool, and it went all red on the screen and said I should phone my doctor immediately.

1. I phoned my doctor's number and the surgery had just closed, and it directed me to the OOH service.

1. I rang them, and left a message.

1. A nurse phoned back pretty quickly and said I should bring him in to the emergency clinic. I said I couldn't get there until my DH came home (mobility issues), and she said, "OK, just come in when you can then, but just to warn you, illness is dynamic so even though you have brought him up here doesn't mean a doctor will see anything, and he might get iller later".

1. After a bit, DS3 woke up and we had a coherent conversation, and I checked whether he was able to look into the light and so on, and he seemed to be able to do that. So then I thought I might as well be my own GP and do my own checks, so I looked up what they would be on the internet and effectively did my own home consultation for him.

1. Then having done that, I wondered whether I really needed to cause a major drama where I live and somehow get the entire family up to the medical centre and sit up there half the night with a load of grumpy children and a poorly DS3.

1. I then decided it was going to go one way or the other and in extremis we would be put in an ambulance anyway, so I decided to cut out the middle man and just wait for the illness to take its course.

1. I then found I was very annoyed that home visits had gone the way of all things, and I wanted to vent this on MN.

10. Next time I'll just send a jpg of his feet to the Embarrassing Bodies programmefor diagnosis - much quicker and more efficient

Velma, stop being a ruddy martyr. You're being annoying now.

You see nothing you have posted would have me ringing NHS direct etc but I am very much of the 'wait and see if it gets worse' school of thought.

Valium, I think it was because the blue feet thing was a new one in this house and I had a bad gut feeling. I would actually have been fine talking to a doctor over the phone and asking 'How worried should I be about blue feet?'

Boffin if you don't like the answers, don't ask the questions, and don't post in AIBU! I'm just telling you it as it is. And there's a teeny tiny possibility I know more about it than you do, what with actually being a GP and all that...

Velma, if you feel you work too hard for your money, why don't you find another job that pays £110,000 a year plus with fewer hours?

All except my son have been to A&E, two with head injuries followed by being sick, two with suspected broken ankles, one with meningitis, one dislocated toe (much better when put back in) and one visit for stitches.

I am also obviously very fortunate that when DH had meningitis the Doctor visited.
Admittedly our OOH is next to A & E, and closes at times, sending its patients to A&E (which makes the waits horrendous).

I am not a GP, but all the money in the world wouldn't be enough to put up with the smug, uninformed and entitled attitudes of some of the posters on here.

Velmadaphne if admin is killing the NHS can you please explain 28 day prescribing for all patients. I have Hypthroidism. Have had for more than 20 years. Had the same dose for 20 years. How does the insistence on 28 day prescribing of a drug that doesn't need varying, requires one blood test every 12 months, costs pennies, acceptable or efficient. I don't have time to much about with something monthly when I could do it one a year. GP's however, appear to be perfectly happy to waste both their own and especially my time.

I paid for the last blood test at the local private hosp because my GPs surgery has contracted phlebotomy to another surgey and if you aren't queueing by 7.50 there is an hour wait, because of course they won't run an appointment system - patient's time of course is not important).

GP's are exceptionally highly paid, self employed professionals. I would expect a little more attention to be paid to basic organisation and a little more respect for the time of their patients if they are to retain that position. Respect is a two way street and I do not feel there is a great deal of it for the patients - not at my surgery at least. Perfectly happy to respect my GP and their staff but that respect is limited to the amount that I receive. You can't take more out of a relationship than you put in and I am sick of the "f off attitude that emanates too frequently".

I have never been shouted out by my solicitors' staff, my banks' staff, my accountant's staff or the school secretaries I have come across. It is common place however to be shouted at by my doctor's receptionists and in a hospital setting; they also have any uncanny knack of making me feel they are doing me the most enormous favour. They aren't they are doing their job and if I spoke to my clients in that manner I would be dismissed. Grrrrrrrr

marriedinwhite I am also hypothyroid and I got cheesed off with having meds for 28 days only (as if I have nothing better to do but go to collect prescriptions) so when I was in seeing the GP I asked if this was really necessary. He agreed that it wasn't and my next prescription was for 3 months, so it might be worth your asking the question.

I also pay for my blood tests now. To get them done at the hospital I would have to get up at 0530 and leave home at 0630 and would still be late for work.

I would be very dubious about going to our OOH now after I went there and was diagnosed as having had a series of strokes - I actually had toothache!

D

I have my thyroxine on a repeat prescription so I only have the blood test once a year, and that's it. Personally I don't understand why we can't just get scripts for things like that from the pharmacist once we have been officially diagnosed.

Zelda, mine don't go to the doctor's much either tbh. We are talking broken bones or major chest infection. I am really not a twitchy parent, never have been. I've got a massive home pharmacy stash and that sorts most things, in fact I have even been known to treat the house guests of my GP friend from time to time.

28 day prescribing is nothing to do with GPs. It's a government rule, to get more money, as each prescription is paid for separately (although obviously not for thyroxine, but for many other drugs). That's the logic behind it. It's not great for us as we have to sign more prescriptions. You can ask for 3 prescriptions though, but you'd have to see your GP for that as the receptionists aren't qualified to check that your dose will be the same for that
length of time.

Boffin yet again your lack of knowledge of this subject comes out. I don't earn anything like that amount of money, nearer half that in fact. I'm guessing you got your figure from the Daily Mail?

The fact that many of you don't seem to appreciate is how little control GPs themselves have over how they work. We are very tightly controlled by government mandates, we have very little autonomy these days. Its a myth that governments have perpetuated, to divert attention from themselves and the cuts they make to the NHS. Getting the public to believe it's all the fault of the doctors was a stroke of genius.

Boffin I don't want to leave my job. I enjoy being a doctor, it's what I trained many years for and get a great deal of satisfaction from. What I don't enjoy is mountains of unnecessary paperwork and seemingly endless gripes from uninformed people on Mumsnet!

marriedinwhite - if a receptionist shouts at you then that would be a good reason to make a formal complaint. It is no more acceptable in a GP or hospital receptionist then one working in any other industry.

Velmadaphne I don't think I am particularly uninformed. You say 28 day prescribing is nothing to do with GPs. I raised it again and again at my GPs and was told it was because of the government. When I made a formal complaint to the PCT and insisted on speaking to the PCT's pharmacy adviser (or something similar) as part of a formal complaint oddly the next time I went to the GP, he looked at me, looked at his screen and wrote out a prescription for 365 thyroxine. It isn't nothing to do with GPs, it is their lack of interpretation and they ought to be bright enough to work out that someone reliant on thyroxine is exempt from prescription charges; as well as intelligent enough to work out that me asking for prescription after prescription is a waste of time.

Please will you also answer my previous questions about lack of phlebotomy appointments (disrespect for the time of the patient), rudeness of reception staff - I recall being told I could come back at 1pm to see if the doctor had signed the insurance form for dd for which I was charged £30 for 2 minutes of the doctor's time and getting snappy when I said that for £30 she could telephone me to tell me it was ready. The patients don't cause the mountains of endless paperwork so why be rude to the patients?