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?

I wonder if we need a specialist GP service for the elderly, tbh.

I think what we really need is a specialist GP surgery for children. The GPs I have seen with DS makes it seem to me that to many don't properly understand children. Everything is a virus and they seem to lack the skills needed to get a young child to cooperate.

(I know I am generalising and I am sure their are GPs about who are fantastic with children but my experience of GPs with DS has been poor to say the least)

Thinking about it, my German relatives all go to specialist paediatricians with their kids ... I think this is pretty par for the course.

You can also just make an appointment with any consultant/specialist you like, you don't need to see a GP first to get a letter of referral. There are a lot more consultants and specialists around as well. Most of them seem to have clinics in or near their homes. It's all very simple compared to our system. But the claiming stuff back off insurance thing is a big faff.

I think some of the posters here need to come and work in the NHS for a few days. GP receptionists get a terible press. What's less often noted is that their job is hellishly difficult. Same for A&E staff, ward staff in hospitals, admin support and managerial staff (that's me). The NHS is providing complex services to a demanding and shifting client group. Have you any idea how hard Velma's job is? Anything and anybody can walk through her door - a woman with an ectopic, a child with life threatening infection, an apparently perfectly healthy 20 year old man who's just a bit worried about some swelling under his arm. People take everything to their GP - from their desire for a family to their grief after loss. And yet people who have nothing wrong with them feel entitled to demand home visits and phone calls to say their form is ready? Give me strength.

Are we all getting a bit over-excited?

Where I live, the OP would have been put through to the duty doctor if she told the nurse on the telephone that she couldn't get to the out of hours centre.

I think that telephone access to a doctor might have been the happy medium

Mariam, actually I would have been fine with a quick phone call from the duty doctor. But a bit of me thinks that NHS Direct should be doing that for us, not immediately referring us back to the GP or A and E the whole time.

BTW believe it or not, part of my job involves working with doctors, including time spent on wards, so I am not without insight. Interesting the assumptions some GPs have made on here, that I have no professional basis for my opinions.

From the OP you don't seem to be that clued into the way that GP's work.

I'm not a GP, but I know that expecting 'one of the six or eight doctors from the local practice to pop up the road and do a bit of a Doctor Finlay' does not reflect the way that things are.

Our surgery does do home visits. For really serious cases, like adult patients with pneumonia who cannot be bundled into a blanket and carried out to a taxi. For a child you would be told to get them up there in a cab unless they are actually fitting or likely to be in urgent need of emergency help. They came out for me when I was delirious with pleurisy, because this was clearly a cheaper/more efficient alternative than the ambulance. But they wouldn't come out for dd when we suspected a fractured knee: she was a tall 10yp and we had endless trouble carrying her down the stairs.

Even so, there is a dreadful amount of pressure on them: our GP has recently been off for 6 months after a heart attack- not surprised knowing how hard the man works.

"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."

Most GPs are NOT self-employed.
NHS staff have HARDLY any control whatsoever about how they work, what they do and how services are run.
Most NHS staff, their families and friends have to use the NHS and they hate what's happening to it too.
They get told to feck off and get on with it and often get scapegoated when they complain or try to do something about the same problems everyone else has to suffer through.
Successive governments hoodwink ALL OF US by misleading and blatantly lying about the real problems with the NHS (usually lack of money, lack of the right staff and (literally) a handful of idiots forgetting that life, health and death involve real people and not just a set of numbers).
Oh yes, and NHS staff also get then blame (and self-guilt) when it (inevitably and invariably) goes wrong.
NHS staff are just as frustrated as everyone else.

Every day people demand more and the government gives us less.

Do you really think people go into 'caring' professions hoping to make people's lives miserable? And how good a job can we really do when we're then s* on from all sides on top of it all?

Err... I should probably add that I'm not usually so shouty. I do have a lovely collection of thank you cards and no shortage of chocolates coming my way to prove it!

It's just very frustrating when it's plain to see the NHS is being run down, divide and conquer rules 'their game' and providing decent healthcare is getting harder than waddling through neck-high treacle.

I don't think the presence of lack of ' a professional basis' for your opinions is the issue. The problem is that your opinions are flawed and unfair.

If a GP does just five insurance forms a week at £30.00 with the cheque payable to Dr Jones (not the NHS or a surgery account) that's £150.00 a week in addition to their salary or NHS income. That isn't a bad little earner on the side in my opinion and I'm sure a lot of GPs would miss it if it wasn't there. It equates to £900 ph. I do not understand how, in those circumstances, it is deemed reasonable to ask a patient, with a child in a wheelchair, to come back to "see" if it's ready; not to collect it, but to "see" if it's ready.

My husband also works 12/14 hours a day for about the same income as a top hospital consultant or a high earning GP. He doesn't, however, treat his clients as though they are too much trouble. He nurtures them as do his staff. The difference is that his services are not free at the point of delivery and if he were to treat people as has become customary in the NHS, his fees would not be paid.

The NHS has deteriorated drastically in the 20 years since I started trying to have children. The service and attitude cannot get any worse than it is at present and the entire shooting match needs to be dismantled and delivered very very differently and steam cleaned at the same time.

Off tangent a bit but dh had to have a medical recently - £140 at his Gp's surgery or £30 privately. Bizarre! Lovely GP who does medicals from his home 'on the side' like you say married - thank God for google or we would've paid £110 more than we had to!

I don't think it's fair to say my opinions are flawed. Just because I am nostalgic about healthcare before 2002, and because I really miss home visits.

I'm also aware that changes have taken place in all professions over the last couple of decades, and medicine is not alone in being completely reformed.

Finally I use healthcare systems in other countries from time to time, have done so for years, and I probably have more of a point of comparison that some UK doctors, in terms of the user's view at any rate. We must try to remember that the UK system is not the only model out there, certainly in terms of 'socialised medicine' as our US cousins would call it.

Married I get about one insurance form a month, and the money goes into the practice account, out of which we pay our staff, lighting, heating, fixtures and fittings, toys for waiting room etc.

Northernlurker: "People take everything to their GP - from their desire for a family to their grief after loss."

Do you think they shouldn't? I ask this because I've lost track of the number of articles I've read that conclude with something like, "If in doubt, ask your GP". And I think: really? Why would I bother my GP with that? And good old NHS Direct will always send you off to your GP/A&E if in any doubt at all. I remember once taking my DD (who had a fever at the time) to my GP on NHS Direct's recommendation, and she (the GP) was quite cross about it.

"People take everything to their GP - from their desire for a family to their grief after loss."

I don't actually think this happens as much as it could, or should. I think that a fair amount of the time:

• people don't want to 'bother' their GP (older generation especially)
• people aren't convinced that any help will come of it
• people can't get an appointment without huge difficulty so give up trying

But of course it is very hard to get to know about the above, or to measure the impact of this - how would you measure what people don't do and what doesn't happen, other than by very specific questions to elicit this?

i have no complaints about our surgery. Mind you I average one visit about every five years so I am no expert. I was shocked on my last visit (last year) to see that they had notices up saying, please ring if you want to cancel your appointment and how many 'slots' were lost in the last month due to patients who had booked appointments simply not turning up.

I wasn't shocked at the notice BTW - I mean I was shocked that so many people would book appointments and not bother to turn up. Doctor-patient relationships are a two-way street and I cannot imagine just not turning up for an appointment without ringing in (except in a dire emergency). How boorish and ignorant is that? Maybe doctors should complain more about us patients

Grimble, sometimes it's nigh on impossible for people to get through to cancel the appointments, or receptionists aren't very efficient. That's a two-way street as well.

On the subject of Babyboff again, his temp is right down and he is perky, but today he does have a lacy rash on his limbs. It blanches, so I am not worried about it, more curious. I am wondering if he has German measles, but he's had the MMR so that's unlikely. Any ideas?

Viral rash? Ds1 used to get them after minor viral illnesses. Took 2 trips to logo to dx though!

At our local hospital where it is very easy to get through to cancel appointments last time I was there with DS the peads clinic had a sign up saying they had a 19% DNA rate!

Boffin could it be some sort of allergic reaction? Or as Badvoc said a viral rash

Velma I'm not sure where your practice is, but here in SW London I think the GPs complete rafts of insurance forms on a weekly basis: BUPA, Life Insurance, Critical Illness insurance, probably few holiday cancellation forms like us though. Our GP even has up a notice in the surgery saying "GP's are pleased to countersign passport applications but the service costs £40.00 and there is a 72 hour wait - cheques payable to the individual doctors. Even DH does passport applications for the neighbour's babies foc - but only if they bring the baby round and have a drink with us!

£40 for a passport photo signature? I do loads of those, I could be coining it.