to think you'll miss your GP when they're gone...

[macdoodle]

I have been roundly criticised on other thread for trying to express this. And whilst I admit that highjacking someone's thread may not have been the best way to do it, the crisis in NHS GP is very real.
I have bee around MN for a very long time now, and sometimes the anti GP sentiment is astounding and utterly depressing.
So read this...he is not a GP (I am), but this article absolutely sums up the current problems and morale in GP at the moment.
I have been a doctor for 20 years and a GP (or in GP training) since 1999 and can honestly say that NHS GP is in very real danger of being gone very soon.
For those who continually slate GP's , please tell me what your better suggestion is, because I trained in a country with no national GP service, and it really isnt better in any way.
www.conservativehome.com/platform/2014/03/from-adrian_hilton-the-looming-manpower-crisis-in-gp-land.html

To reiterate, the survival of brain tumours is abysmal whenever they are diagnosed.

Oh well that's alright then, just leave the poor woman crawling along the floor because she can't stand up and going through competency assessment/dismissal at work because she can't function and yet her venerable GP swears blind that she "just" has an ear infection?

My GP is excellent, I can always get a same day appointment if necessary or one within a few days the rest of the time. They are kind, thorough and professional. And I have already put this in writing to the practice manager so they know all this. It would be a tragedy to lose them.

The lack of compassion for those who have died needlessly due to misdiagnosis on this thread is shocking.

Absolutely. And my DP is called "an arsehole" for expressing the view that GP's are most competent to manage geristrics with various conditions/co-morbidities, but that everyone else would be better served by self-referring to a specialist just like they do in pretty much every other advanced healthcare system.

I think my concern is that there seems to be so little standardisation in the providion of the service. We have moved around the UK a few times in the last five years and the variable quality of GP service delivery really does suggest that the "postcode lottery" is alive and well. I don't know what the minimum standards should be or even if there are minimum standards set. Every surgery being able to set its own rules on opening times, appointment booking systems, what is judged as suitable for practice nurse / what is GP only does not help users of the service do so efficiently and effectively.

Is there a mechanism for sharing good practice? I don't mean from the medical side; I would assume there are CPD requirements for GPs, but from the administrative perspective. Do practice managers have a forum for QS/QA? Perhaps if there was a little more standardisation, so the general public knew what to expect from practice to practice, there would be fewer wasted appointments, less bureaucracy and more time available for GPs to spend with patients.

I think that's a good point. What about some professional standards? At the moment, patients are at the mercy of the idiosyncrasies of individual doctors. If a doctor wants to sneer at you for making a fuss, and refuse to refer you to a specialist, it's just your bad luck. And if you then die as a result, just your bad luck again.

Well if Mr Hunt was to be reading this he would be hugging himself with joy at the sight of HCPs slagging each other off.

(I'll admit here I've only read the first couple of pages of this thread!)

In reference to all the people saying they've had bad experiences with GPs, did they all complain? That's the only way you're going to flush out the bad.

Just also wanted to add that while you're worrying about what GP services will be like in a few years, I'm worried about what Pathology services are like now.

Certain pathology disciplines in my Trust are on the verge of imploding. Not in a few years, but now.

Nobody ever really thinks about pathology, but you're not going to get any test results therefore diagnoses etc without it.

The NHS is just fucked.

Of course we share things we learn! Compulsory learning time, CPD, evening lectures, courses, online learning, study groups, appraisal, revaluation, journal club, meetings, GP updates, social media..... It's not optional!

I am very surprised at the outpouring of shortcomings of GPs.

fwiw, we used to have an excellent service. They did their best, and when started to creek, more doctors were taken on and all was well once again afaik.

Now it is getting creaky again. But the GPs seem more concerned quite frankly. A little more tetchy perhaps.

Not quite suer what I am saying exactly.
I suppose what I am trying to say is that it seems to me that the system will indeed crack at some point if nothing is done.
And for those surguries where it is already more cracked, then service is indeed already not good enough.

If there is to be a different system, we could go from the frying pan to the fire. Or it could be better for quite a number it would seem.

I suspect the former sadly.

But probably what will happen is that the richer folks will be quite happy thank you very much. Everyone else, less so.

Zebra. It seems to be more of a whole system complaint, than merely individuals.

getting to actually see them.

I have had to recently move from a fantastic surgery who always had appointments available within a week and at a time which didn't impact on my work for routine things, I rarely have medical needs that I would count as urgent - I am lucky I don't get sick very often. They had 3 doctors registered with them and I was always given the same one on the whole.

The surgery I have now moved to doesn't seem to have the ability to understand that others work at all, they have about 2 appointments free a day, or I can turn up at 8 and sit and wait until about 11 to see someone. There is no way to book for a routine appointment within a 2 week window. The receptionists have a horrendous attitude - ranging from telling me they aren't there to provide a service, and most recently telling me to change surgery and see if they could fit me in! What is more frustrating is this practice is in a smaller town and has a lot more doctors than my previous practice has but seeing a doctor is impossible.

After my recent dealings with them when I was told by the midwife to see the doctor and getting an appointment was impossble I have complained to the practice manager basically for the lack of provision - I asked to see a doctor within a 3 day window and at any time at all as I was on holiday but still nothing. I have also complained to our local MP so I don't just sit back and moan.

I do think the idea of GP service is great and we are incredibly lucky to get it but there is a lot of improvement needed in the service to make it work, maybe not having to only go to one particular surgery. For example I work 45 mins from home, so if I could see a doctor closer to work for an emergency appointment it will make having an appointment in the middle of the day have less of an impact on my work - currently if I am given an appointment at 12 o'clock - that is a day off work and I do not get holiday I can take as a teacher. If it was just round the corner from work I could miss maybe one lesson and not five.

It wouldn't work for ongoing complaints but those odd times when you actually just need a prescription it would help - for example as I am 6 months pregnant I needed a prescription on Friday for piriton as the pharmacist wouldn't sell me any for a bite reaction - I knew what it was as it happens regularly and normally I take anti-histamines during the summer to prevent a reaction but am not this year due to pregnancy - it ended up being a 2 and half our round trip to OOH surgery in order to get the prescription.

Sorry first part of the post was missed - it started by saying - I have no complaints with the care from my GP's is the actual getting to see them that causes me the most frustration.

For individual problems Appraisal and Revalidation has been brought in. For whole system failures well it is either down to the surgery itself or to reorganisation from the govt in the future. Secondary care is equally tight so open access to referrals I don't think would be possible without a huge influx of funds and extra consultants to review the referrals and urgency of them etc.
To improve a system, funding needs to be increased with increased numbers of specialist nurses, increased numbers of GPs and Hospital services. We all want that... Unfortunately this is a time when funding is being dramatically cut as a govt decision. This means stretched services will be reduced and lost. We are legally governed by EWTD hours and we work in secondary care up to the max hours possible, usually much more .

The health service does need some restructuring such as elderly pts fit for discharge should have immediate access to community flexi bed etc... Instead of being on an acute ward for, in some cases, up to a year! So once again it comes down to funding,... Get the flexible beds and keep the small community hospitals for discharges to stop clogging up the system for eg. Oh slight problem...the govt lied and said it was shutting hospital services and investing in community care, so they are shutting hospital services but have not invested in any community care yet...I think it's down to money and they may be waiting for a way to increase those bed numbers via private funding.

I don't think the system would be better under state backed private insurance payments because individual providers would be of variable standard and could choose which patients and procedures they take. Look at private care homes... Have they raised standards?No.

Oldfart I'm so glad your oncology husband has sorted itout for us. Just the complex oldies we can see faberooney, so they don't deserve decent care? Who is going to see all the children, all the 20/30/40/50 year olds with their myriad complaints/gynae/depressions/minor illnesses/bowel problems etc etc etc.
I am all for change what vested interest do you think I have ? Im all for being in a fixed contract with a limit to workload rather than the never ending access to do everything currently. Most GPs are actually concerned about the future for our patients. I suspect we should just stop really and just let the system collapse. And let the government do as they will. I shall try not to be bothered after all I will always have a job, I suspect filling the cracks after will be extremely lucrative.

This thread has made me really sad as a patient because it reveals I think a huge gap between patients and doctors.

• I was someone saying earlier that many other professions are stressful. By that I do not mean that drs don't have an extraordinarily difficult job and should be remunerated and treated accordingly. However some drs on here do seem to think of their jobs as exceptionally hard and badly paid! and I think in a time of recession! many patients find that hard.

• lots of drs here seem to be very angry with patients. There are lots of flouncy comments like "when the NHS goes tits up my family will be fine but you won't be" or "I'll just emigrate to Oz then" or "you'll be sorry soon".

I find that attitude childish and adversarial. The general public invests huge amounts in training drs - those complaining about the cost of training, fancy doing it at Harvard? We then expect an enormous amount from drs and the NHS - and by and large, we get it and should be grateful .

We are all in this together. I don't know why there is so much anger between drs and patients here. Most of you do a great job. Most patients love and prize the NHS. If it goes tits up you will not all be able to emigrate. It will be bad for all of us.

So again, the question not one dr on this thread has answered - what can we do?

Sorry, for ! read , above, sodding ipad

In reference to all the people saying they've had bad experiences with GPs, did they all complain? That's the only way you're going to flush out the bad.

There are major problems with the complaints system itself though. You are supposed to raise the issue initially with your GP too, which poses problems for some. GPs have a certain status within society that many find difficult to challenge and the actions of GPs can actually undermine self confidence. There is an imbalance of power which I think is extremely difficult to tackle.

Personally, in hindsight I wish I had complained, but at the time I wasn't in an emotional state to do so. It took me several years to get to a point where I thought maybe I could and by this point I felt it too late to do so. I still struggle massively with trusting HCPs as a result, to the detriment of my health and its taking extra efforts from other HCPs to restore that trust.

In the end I do manage to vote with my feet. I feel frustrated that all attempts by this government and the last to try and open up GPs so you can choose which one you want to go to, have failed because they are have been repeatedly blocked by the profession. I do appreciate there are massive cons in allows this, but I also thing the pros far out way them. The problems I had changing GP shouldn't have been there. Not when one of the places I tried to change to was only 2miles from my house, I was only just outside their boundary and was accepting patients - they just refused point blank because they had an 'agreement' with other surgeries not to intrude on their patch!! This hardly says much about putting the patient first and says everything about the fact that GP surgeries are privately run enterprises and effectively are run like cartels.

I strongly object to the idea of naming and shaming GPs which has been proposed despite this too. The problem is, if you find yourself with a GP on the bad list, what as a patient can you actually do anyway? You can't change, and its going to further break relationships with doctors and patients. Not to mention its only going to result in too much referral, clogging up waiting lists, and then delaying treatment for those who actually need it.

I do think there needs to be better practises put in place, but they MUST be flexible, because rigid practice within healthcare really is one of the things that has caused it to become so unfriendly and so dehumanising. Targets and systems are one of the key things that have caused so many problems in the first place. Whilst they have their place they have completely taken over and become the focus of healthcare rather than what the patient actually needs.

GPs are under pressure to hit certain targets with their patients in order to get funding and this has effected bedside manner hugely. We have a massive issue with the worried well, which is also meaning that the sick and more vulnerable are finding it more difficult to access care which they need so much more.

I do agree that to a certain extent there is room for self referral, but perhaps not quite as much as it extents in the rest of the world as it comes with its own issues. There must be a way of moderating this, or restricting it to certain areas. Perhaps for patients with chronic issues, who are very familiar with their condition - perhaps more so than their GP themselves. Is there room for a way of allowing some patients in this situation to opt in to this, if they feel confident enough, if approved by their GP to do so?

The real issue is not that the health service and GPs are bad. They aren't. Its that the system itself does understand the relationship between doctors and patients and isn't often isn't willing to look at itself critically and understand that change is needed in certain areas, because there are shortcomings. The closing of ranks between GPs is one of the things that has created this 'them and us' mentality. Criticism is taken personally rather than looking at the causes behind those criticisms and why patients get angry because they feel so powerless as a result of being on the receiving end.

I do think that GPs need to recognise that even if they are doing an amazing job, that there are a hell of a lot who really aren't under the same conditions as them. Its these individuals that need tackling, not criticising the public's reaction which is very often based on all too poor experiences.

Nonsense not a single medic has said that (other than oldfart). We have all said we are concerned about what will happen to those patients who will lose out under an nsurance based system. Is it so impossible to see that we are concerned for the system and patients. But that the marked increase in demand, complaints and doctor bashing in the press (government driven) are making it worse. I am not sure fighting to save the NHS is worth it any more, and there are a lot of very good very hardworking and caring doctors trying to do so.

There have also been many alternatives proposed but they government has their own agenda. Go and see how many MPs have their grubby fingers in private healthcare pies and ask who has the best interests at heart, them or the doctors. Who has the most to gain bya privatised health service.

macdoodle, I agree completely with what Revolting Peasant has said as that is how I have read posts on here too. And whilst I disagree with most of what old fart has said, and the way its been said, I don't think that everything they have said is wrong either.

GPs are already privatised....

...this is part of the issue imho!

Ah oldfarticus I was wondering when you quoting your amazing all powerful knowledgable husband were going to turn up.

Someone mentioned 'doctors seem to think they have an exceptionally hard job'...er yes, we do! It's very difficult! That's why to get onto the damn course requires top grades and why throughout your postgrad training you have to do loads of exams. Also, as has been shown throughout the thread, our actions and knowledge are responsible for the health and well being of the general public. It's a very demanding job! And very difficult. No one is saying it is harder that anyone else's job. Just that being a doctor is an exceptionally difficult job.

Another thought has occured to me and this isnt GP bashing at all but some of the practice policies dont help in enabling patients to access the service they need. I tried to make an appointment with the midwife when I was first pregnant, I was told I had to see the doctor first then told there were no available appointments and had to call 5 times at 8am to finally get one two weeks later . That appointment was not necessary, no medical checks were done just referred me to midwife and said congratulations and it was a lovely end to the day. It wasted two peoples time!

However when asked was told the doctor had to ok you going to midwife!

Just the complex oldies we can see faberooney, so they don't deserve decent care?

Macdoodle, was that an admission that some GP's don't provide decent care at the moment? It sounded like one. Freudian slip perhaps.

Nonsense not a single medic has said that (other than oldfart).

I can't work out what point you are referring to. However, I am not a medic.

I do think we can learn from countries such as France, Germany and Switzerland where there is a sliding scale of premia for patients according to income, with private provision. Theoretically this means that poor providers/doctors are winnowed out (because they get no business) and I like the idea that patients get to choose. There seems to be real resistance from medics on this thread to empowering patients and allowing them to vote with their feet.

FWIW I am as nauseated as the next person by the present government greasing up to private healthcare providers. There is simply no advantage to be gained in privatising healthcare in a way that retains a single provider, because it does not give the patient any choice and it leaves the NHS to pick up the pieces of the patients that the selected provider chooses not to treat. It is the worst of all worlds. Equally, I am sure most people who understood the difference and had had experienced the alternatives would rather get sick in (say) France. I know I would.

You seem full of rage OP. All that most people want is to be able to acess healthcare on a timely basis and to be referred appropriately (and urgently) when required.

Revolting we can invest! Invest in practices and services that will improve people's health and lives, train and support more GPs and practice nurses, phlebotomy and other community services. Remove targets and pointless administration and let people just get on and do their jobs. Support more GPs in specialist training so they have skills and expertise in other areas. Treat staff like adults and with respect rather than pounding their morale. Reward good service and excellence.