to think that within a few years we will be paying to visit the GP,Conservatives consider limit on GP visits

[MiniTheMinx]

The Conservatives have considered limiting the number of times patients can visit their family doctor in a year, it has emerged.

"Labour health spokesman Jamie Reed told the Independent on Sunday: "This paper, hidden away on their website, reveals the Tories' true agenda for the NHS. After throwing the NHS open to ever more privatisation with a wasteful and damaging reorganisation, it seems the Tories want to go even further.
"It's shocking that they are considering limiting the number of times patients can see their GP - changing the fundamental principle in the NHS constitution that access to the NHS is based on clinical need.
"The Tories have already wasted £3bn on a top-down reorganisation of the NHS and overseen a crisis in A&E - now they are consulting their members on opening up the NHS to even more competition, and making it harder for patients to see GPs in the evenings and at weekends."

A Conservative Party spokesman said: "This was simply a topic to provoke discussion and isn't Conservative Party policy."

Yet.

We all know where we are headed with this don't we? or am I being an unreasonable old cynic?

What HopALong said. When I ring my surgery they won't automatically send me to the GP; they will first try to ascertain whether I need to see the GP or the nurse or whether I should be redirected to the local pharmacy.

I suppose under a limited-number system, as I have already had an infection that refused to yield to antibiotics this year, and had to have my smear test redone because it was not clear, I would just have to leave my prolapse hanging until next year...

I was thinking actually that in the past 18 months I have; had a baby, had two smears, had treatment for abnormal cells on my cervix, had raging tonsillitis that meant two trips to the out of hours and a carrier bag full of drugs (and a warning not to leave it so long otherwise I'd end up in hospital), two appointments RE contraception, one about my hideous hayfever and god knows how many visits to baby clinic with DS, I would be well and truly up to my limit until about about 2015.

We don't pay for prescriptions in Scotland HopAlong. I also haven't heard of any receptionise triaging and would be very concerned if they were - they are not trained to, nor is it in their JD.

So why is receptionist's "triage" supposed to be more dangerous than people self triaging at home because they are afraid of out-running their allowance or being unable to afford the charge?

My receptionist is not a doctor. But she has an idea of the kind of stuff the nurses at her local clinic are able to deal with, she can always ask the doctor if in doubt, and if I go to see the nurse or the pharmacist they can always refer me back to the doctor. It is still a safer option than staying at home doing nothing.

They are trained though, a couple of simple questions to see if it would be better for you to see the nurse, or if it's actually something you can pop to the pharmacist about, and if you don't want to disclose why you want to see the GP, then you don't have to. So if I need a smear test, I say that when I book and they send me to the nurse, if they didn't have any appointments that day for something that sounded urgent, they would send me down to the walk in centre, if I think I need to see the GP because I've got athletes foot, they send me to the pharmacist. Some people are exempt from prescription charges, but generally I think it's about £7 something, hardly a huge amount but when you've got two or more drugs it soon adds up.

I think there does need to be more information nationally about what services to use and when, and I have found NHS Direct to be a bit hit and miss so god knows what the new service will be like.

It's bloody nonsense.

One of the important things to bear in mind about changing the structure of the nhs, is that a sales model has a completely different outlook on what is necessary or not.

The parting words to me after I left with newborn dc2 were, "we like you - you're cheap!" I was so lucky to have a baby without surgery, casts of thousands, expensive drugs, long term recuperation etc. The benefits to us both were huge, far greater than financial. However, although I was encouraged to manage uncut, undrugged, unanaesthetised for all sorts of good reasons, one should also note that it was of financial benefit to the hospital and this may have influenced how they supported me.

In the US, were everything is paid for by insurance on an item by item invoice, the more you can upsell, the better.

this whole mindset is horrible not just in terms of the outcomes who can't afford anything, but in terms of those whose insurers will happily pay for whatever and the more money sloshing about in the system, the better.

It is absolutely immoral that escalating a health care issue can increase profits. This is what we are looking at.

Only the private companies who manage insurance benefit.

I was concerned about the description: 'like most GP surgeries our receptionist KIND of triage you"..
Really? What does 'kind of ' amount to?
I would be really concerned too, to feel that there is some kind of unspoken process going in. There is definitely a need to redirect people away from the GP when they are not using the service appropriately but I would be most concerned to feel this is on the basis of a receptionist

I said 'kind of triage' as I didn't mean the kind of triage that a nurse would do in, say, A&E. They ask a few quick questions about what your appointment is for (and you don't have to answer) to make sure you are going to the correct service. It's not unspoken, it's just allocating resources efficiently. If there was more education about what each service can do, then it wouldn't be necessary. And if it's not the receptionist who redirects you, who does? The GP? When you have already wasted an appointment slot AND your own time?

A receptionist has no formal training, and I'm not sure that it would be appropriate for them to ask the patient what the problem is - I certainly wouldn't tell them. A smear is not booked through a receptionist, the appointment card is sent out centrally by the Board with instructions on who to phone, verrucas and other minor things can be dealt with by the minor ailments service at the community pharmacies up here - so triaged by professionals who are trained to do so, rather than a receptionist.

Kind of triage means what HopALong described. So if you ring in to say you have a blister on your left heel, they will tell you to go to the pharmacy (and if the pharmacist feels it is beyond him he will send you back), if you say you need a smear test they will book you in with the nurse. All they do ime is to weed out the most obvious cases of shouldn't-take-up-the-doctor's-time

My dad would probably have used up his annual 'quota' of GP appointments by about this point in the year. By the time he has been seen for his pacemaker, chronic nosebleeds (the cardiologists dealing with his pacemaker want him to go onto warfrin, which he obviously can't do unless they can stop his nosebleeds), hearing lost, cataracts, and Parkinson's disease, then yes, he is having to visit the Dr a couple of times a month at least, with a couple of hospital appointments as well.

However, this is a man who until he was about 86 years of age barely had an ill day in his life, to the extent that when he first went to the GP with heart problems they thought that they had lost his file, despite the fact that he had been registered with the same GP for 30 years - there was only half of one of those old-style note cards, so little had he needed medical help.

Perhaps the supporters of this 'idea' would just say that he should not be treated for the problems he now has, in which case he would be blind, deaf and bed-bound, if he was in fact still alive, rather than still able to travel 100 miles to come to my wedding and make a speech last month.

This country is rich enough to support people like my dad, it is just that there is no political will to redistribute resources so that we can do so without the poorest members of our society suffering.

In our surgery the smear card is sent out and you would then ring the surgery for an appointment. So yes, you speak to the same receptionist.

"verrucas and other minor things can be dealt with by the minor ailments service at the community pharmacies up here - so triaged by professionals who are trained to do so, rather than a receptionist."

This is exactly what HopALong referred to: if you ring the doctor's surgery with a complaint that should obviously have gone to the community pharmacist- which many people do- they will ever so nicely redirect you and your verruca.

I got a letter telling me to book my smear test at my local GP surgery. And RE verrucas - if the patient doesn't know that they can see their pharmacist about it, then they might make an appointment to see their GP. If the receptionist asks and they say verruca, they can be directed to the pharmacist (or if they choose not to answer then they can still see the GP). If you go to the pharmacist with verrucas, then they might send you back to the Dr if there is anything extra happening, but why is that different from going to the pharmacist off your own back or being directed to the pharmacist by the surgery staff?

Since the whole thread is (partly) about whether undue pressure is put on surgeries through minor ailments it seems a fairly good idea that receptionists should be able to provide information about what other services are available for minor ailments.

No, it's a separate service. Community pharmacists are not linked to GP receptionists - although if you wanted to volunteer the fact that you had a blister on your heel (or head lice, or thrush or whatever) then yes, I'm sure that the receptionist would tell you about the minor ailment service. However, that is not a formal triage service and no receptionist should be asking you what you have wrong with you to triage patients herself - that breaches patient confidentiality.

our surgery always asks whats wrong if you want a same day or same week appt. so the receptionist can decide if its urgent. Otherwise its a 5 week wait. it bugs me no end.

Bloody hell! No, we don't have that - we're just asked if it's urgent or if it can wait and then they tell you when the next appointment would be. They would never ask what the problem is.

oh it doesnt get passed onto the GP so I generally say ebola. cos its none of their business

Maybe I'm just fortunate that there is no pressure from the receptionist, they are just trying to see if you wouldn't be better off going to someone else. I know, for me at least, it would be much more convenient for me to see a pharmacist outside of my working hours, then it would be to take time off to see the GP.

Waiting 5 weeks to see your GP is ludicrous, and if more people were going to the correct services, then maybe wait times wouldn't be as long?

we have a high elderly population. thats my guess why wait times are so long for routine appointments.

No pressure here either to reveal information, but good advice given by receptionists if you do wish to ask for it. For instance, they will know what special skills their nurses have (one of our surgery nurses is an asthma specialist so far better than the GP to see about your asthma) and be able to direct you to the right place.

If you don't want to make any explanations, you risk having to go in twice, for the GP to make another appointment to see the asthma nurse.

I can't see that this breaches patient confidentiality: the receptionist only gets access to such information as I choose to share.

"People forget or don't know that the NHS has been rated as one of the most effective healthcare services in the world £ for £"

I read that, but I translate that as "cheap and cheerful", I've lived in a few European countries and the UK health service is without doubt the worst of them, if you live in a big city anyway. They spend more, but the difference is very noticeable.

Five weeks???? well I suppose you would never get to use up your allocated appointments.

If elderly people are routinely blocking appointments partly because of the anxiety of loneliness or other routine checks that are made on the aged, can't some of this be tackled before we discriminate against the working poor.

Maybe separate clinics for the over 70s, with diet, lifestyle, advice about other services, assessments for social care etc, all taken care of by trained professionals not necessarily GPs.

Nurse prescribers are far cheaper than doctors they'll be the gatekeepers to the GP

we have a lot of elderly. they get sick more. its how it is.