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?

GP's don't benefit financially from writing lots of prescriptions though do they?

Married you obviously got special dispensation because of making a fuss. Trust me, if we started writing prescriptions like that for everyone we'd soon be told off for it.

I can't comment on the phlebotomy service, yours certainly doesn't sound good. Ours is a bookable appointment system. That is something we set up ourselves in the days of fundholding, and has been continued.

Signing forms is not part of our job. We are under no obligation whatsoever to do it, and we don't get paid for it by the government, as it isn't part of our terms of service. The BMA recommend flat rates for forms, as it simplifies it. Some insurance forms can take over an hour to do, some take minutes, but its standard procedure to charge a flat rate. GPs can use discretion with this. For example, adoption Medicals are charged at about £100, but a patient of mine planned to adopt her drug-addicted brother's toddler, so I waived the charge in her case.

Receptionists have a very difficult and stressful job. They see patients at their worst - anxious, worried, sometimes angry and frustrated - so consequently they spend much of their day being moaned at. And yes, it makes them snappy at times, I know myself when I've rung my own GP surgery. They shouldn't be blatantly rude and they certainly shouldn't raise their voice, but they are entitled to repeat to patients the rules and procedure where they work. But as I've said before, it comes back to the fact that everyone thinks their problem is most important, and "it'll only take two minutes", but with 2000 patients per GP the time soon mounts up when lots of people have two minute jobs.

Rookanga, no we don't benefit at all from writing prescriptions. I think pharmacists might but I'm not sure.

Velmadaphne - thank you for your explanation of why a GP's job is more demanding than it used to be. It does clarify the position.

But I'm interested in one of your responses to boffin that she should look at the bigger picture. Isn't the job of the NHS ultimately to provide good patient care? Therefore perhaps we should all (GPs included) be looking at the bigger picture. So perhaps rather than saying "GPs are too busy to make house calls - tough", it would be be better to look at ways of reducing the current burden on GPs. Perhaps the government could reduce the admin required, or perhaps some of the less important tasks could be offloaded to nurses. It seems kind of odd to present this as a war between GPs and patients rather than looking at the whole problem of how we deliver healthcare effectively.

It's more of a war between the NHS and government to be honest!

I used to wonder what it took to get a home visit until my DP was caring for his dying mum last year. Within 15 minutes of a phone call either the GP or district nurses came round to inject drugs/fit and resite syringe drivers etc in order to make a scared, dying woman more comfortable. I'll never complain about home visits again. For every toddler with a temp there will be a family nursing a very ill/dying loved one.

Just to come back to the form velmadaphne. I appreciate there has to be a charge but the charge makes it a private transaction. The form I describe took about 2 minutes to complete - I had done most of it and put tabs on any bits the dr needed to see. I was charged £30.00 for two minutes work. I have no objection to that. However, it works out as hourly rate of £900.00. I have no objection to that - DH's hourly rate is probably about the same . However, his clerk would never ever tell a client to come round at 1pm to see if a document was ready. The client would merit the courtesy of a phone call when it was ready because the client is regarded as important and thus treated with respect. Further, DD (who had smashed her leg) was covered by BUPA so not a burden on the NHS for surgery, follow up care and physio; the form was for our holiday insurance cover because our holiday was cancelled. The receptionist could see DD in the wheelchair and I still think it was bang out of order to tell me to come back at lunchtime to see if the form was ready. It wasn't rocket science to work out that our family had been through "hell" in the previous ten days.

In my surgery I don't see the patients being rude to the reception staff but I see it reverse almost every time I go and it appears to be endemic throughout the NHS.

What is wrong with trying to provide a courteous, holistic and efficient service. GPs may have to follow certain rules and regulations but they are self-employed - no? If the rules and regulations are the same in all surgeries, why do quality standards vary so much? Further, if the receptionists were more polite perhaps the customers would be a little more gracious in return.

Let me give you an example:

"I would like to see Dr x, it is only to monitor my bp and issue an HRT prescription so it isn't urgent. Please can I have the first available appointment at about 8.30am in the next couple of weeks?"

"I got free o'clock tomorrer"

"I asked for the first appointment at about 8.30am please?"

"well you can 'ave 11 on Fursdy".

"I'm sorry but I need an early morning appointment, it can be next week"

"I can give yer 9.15 next Choosdi"

"I've now asked you three times for an appointment at about 8.30am and have explained it is not urgent, can you please give the first available appointment you have at 8.30".

"Oh alright, I can do Fridee, in 10 days time at 8.30".

"Yes thank you" and thinking ........have you got a brain you unhelpful moronic jobsworth.

How many people could they help if they listened and followed the instruction. It is little wonder people get arsy and a vicious circle in formed. It really is not good enough and it is such a shame that the doctors neither listen nor seem to care about the service offered to their patients. If a bill were issued at the end of the appointment I would make a deduction and standards would sharpen up very very quickly. Just my opinion of course.

marriedinwhite Your comment about GP receptionists is ill considered, rude and patronising.

You may have BUPA cover, but you have no class.

And there I was wondering what Dick Van Dyke was doing since diagnosis murder. He's working at married in whites GP surgery. tugs forelock

Zelda, I think your question is a valid one and cuts to one of the major problems with the NHS today - it's not just an increasingly ageing population and one where illnesses are more easily treated and so are living longer, it's also the massive overuse of the service and sometimes the sense of entitlement.

I have two DSs who have had the usual run of the mill illnesses - coughs, colds, chest infections, etc. DS2 is fearless and regularly injuring himself (hits his head, and hard, a lot) but has only been to A&E once when he became unresponsive after a head injury.

I am stunned by the number of people both on here and in RL who go to the doctor every time they or their child is ill. Neither of my boys have ever taken antibiotics in their life and, contrary to popular belief, most illnesses that kids get are self-limiting and don't need them either. A friend actually said to me that she would have to get ABs for her daughter or the chest infection would not clear up . Believe me, it does!

GPs surgeries are groaning under the weight of the 'worried well' and A&E departments are breaking under the strain of people going in with things that clearly aren't emergencies and demanding attention from frazzled staff (my brother works in one of the busiest A&E departments in London and the stories he tells me would make your hair curl).

We need a massive health education programme in this country to try and get people to understand what does and doesn't need attention from doctors.

Sorry, my hobby horse . Rant over . . . .

I think surprisingly makes a good point, every time I take DS to A and E (needed, he is asthmatic and has big attacks and most times we go in he ends up admitted) I never fail to be amazed by some of the cases in. The best has to be the family who came in an ambulance because their child had fallen down 2 stairs and hurt their wrist. I later went outside to make a phonecall and overheard them complaining on the phone "we came in an ambulance and still been expected to wait in the waiting room"

That said, GPs are just as bad for pointless waste of resources. I had to take 2.5 year old DS for a medicine check last week for his asthma. I tried to argue that he is under the care of a respiratory consultant but no they still needed to see him to be able to continue prescribing his medicine? Why? Even the nurse we saw agreed it was mad.

at call an ambulance!! Unbelievable.

OP, when DH was ill and I was away, they transported him to A&E in a patient transport vehicle. Perhaps if you'd mentioned your SPD and it being difficult for you to get there, they may have sent something like that. I don't think not wanting to drag other kids there is a good enough reason for requesting a house call.

Sirzy, we had a pointless asthma appointment with the nurse at our surgery too. She tried to make him do a peak flow, which DS is too young for and then said we should be giving DS a lower no of puffs than our consultant had said, until I whipped out our asthma plan. Total waste of everyone's time.

Goodness marriedinwhite How dare the Gp not sign your form immediately ??
Perhaps they were on a home visit for a patient who was dying or providing emergency care for a patient who has chest pain before the ambulance got there ( both happened at my Gp surgery recently).
It was a form for insurance cover and you think this takes precedence over patient care .Unbelieveably entitled and selfish .

I think you have a terrible case of cranio-rectal impaction -google it

Hope Baby Boffin is better !

Sirzy, I recently had a nasty allergic reaction to something and ended up in A&E (via NHS Direct) because my lips had started to swell and there was real concern about my airway. Dh drove me there through rush hour traffic, a little stressful but fine.

Flicked on the tv a couple of days ago and caught one of these awful day time programmes about the NHS/emergency services and a woman had phoned an ambulance for an allergic reaction to hairdye! WTAF!!!

I think the myth that you queue jump if you arrive by ambulance is a persistant one sadly .

I saw that, when they said the call had come in because she couldn't breath - I have never seen someone unable to breathe talking so well. I could never be a paramedic as I would just want to tell them to find their own way to the GP rather than wasting services.

Posters who continually refer to 'non English doctors' are not exactly helping their own argument with thinly veiled racism

I didn't expect it to be signed immediately and I certainly would not expect a form to be prioritised over someone who is ill. However, for the equivalent of £900ph neither did or do I expect to be told to come back three hours later to see if it is ready. What I expect in those circumstances is the offer of a phone call to let me know it is ready. I really don't think that is unreasonable. Neither do I think it unreasonable if I ask for the first available early morning appointment because I go to work to be offered three appointments in the middle of the day before I get what I have asked for. That means what should be a two minute phone call takes more than five minutes, probably to the detriment of people who might be very ill and who are blocked in call queue. And I'm sorry but it then irks me that doctors say the receptionists are very busy because if they dealt with things more expediently they would surely have more time to deal with very urgent things.

At no time would I ever expect to be put ahead of someone who was an emergency or very ill but I do expect the service to be run efficiently and with some regard for the patients rather than what suits the staff.

I agree Sirzy, I know it was over-dramatised for the viewers but I was honestly expecting the paramedic to turn up and find a semi-conscious patient lying on the floor unable to speak and struggling for breath, not a walking, talking lazy cow who couldn't be bothered to make her own way to hospital .

marriedinwhite - did the form specifically have to be signed by your own GP? Hospital consultants do them too for people who are their patients. As you obviously know, those forms are not NHS work. On one hand I don't think that GPs take any particular pleasure in signing insurance forms, but on the other hand, you are paying for a service.

DS3 is still a bit peaky but getting much better now, thank you. He had a bit of time sitting with me in the garden today, and he played with his Lego quite happily at tea time. He ate some of his supper as well.

I don't want anyone thinking I drag the kids to the doctor every five minutes, because I really don't. Nearly everything gets treated at home, A and E is for fractures and head injuries, and you only get antibiotics if all other avenues have been explored. We have an extensive home pharmacy, plus a variety of home made placebos that usually do the job. In fact my GP friends usually come around mine to borrow home remedies when they have young kids staying. So I don't think worried well really applies here. I had a genuine concern about the blue feet thing, as I haven't seen it in 25 years of parenting, and I would have liked to have spoken to a doctor without a big trek across town.

PS I could have phoned a GP friend or called in a favour but I felt that would be wrong and it would put them in a difficult situation.

rookanga I can't remember now. However, if GPs are happy to sign 11 unnecessary prescriptions a year due to 28 day prescribing I really don't see why they should be unhappy when they are asked to sign an insurance form. They are happy for patients to schlep unnecessarily to their surgeries because of 28 day prescribing and presumably when they are messing about with that, they are preventing sick people with undiagnosed conditions from accessing medical care on a logical basis.

I have been flamed for making an entirely logical point. If the service is run more efficiently and less of everybody's time is wasted there should be more time for the patients who desperately need help. I suppose it's easier to sign a prescription and inconvenience the walking "diseased" than it is to help those who need actual medical care.

I dont think that the timing of prescription forms is entirely in their control. The point that I was trying to make (obviously badly ), was that private work is not NHS work, and so the monopoly aspects of the NHS dont apply to the same extent.

Boffin, I wasn't actually accusing you personally of being 'worried well', mine was a much more general post, but it astounds me how often it happens on MN - someone comes to post about such-and-such an illness or injury (sometimes days old) and 90% of the time at least one poster will suggest A&E !