A way to streamline NHS

[FairytalesAreBullshit]

With most of us having access to the internet, I know this does exist privately, but maybe surgeries use the internet more to help patients.

Like the patient with a UTI, reflux, skin complaint emails in and the Dr goes ah yes, they need this. Or even a nurse practitioner.

The child with an irritating cough is triaged further with questions, then the typical linctus is suggested. Or the child with D&V is triaged further, if necessary, they're bought in when the surgery isn't full of unsuspecting victims to avoid transmission.

The patients with more complex symptoms get booked into surgery.

A lot of the time if you have several health issues, you fear the GP will have a nervous breakdown if you mention everything you want to ask. Plus a lot of us forget, so emailing ahead, the Dr has the full picture and can deal appropriately.

Or the patients with other chronic diseases, who pretty much know what is needed, say what it wrong and suggest this has worked in the past. GP decides if they need a face to face consult.

For a few patients, it's quite ironic but doing the littlest of things is a big deal, so being able to email the GP with 'ok this is happening,' they might be able to prescribe there and then, or want to see the patient.

Say blood tests have come back, a nurse practitioner could get the results, if we focus on TSH, low or high, patient is told that bloods have shown hyperthyroidism, prescription has been send to your chemist for meds you need to take at a certain time, plus a new bloods form will be posted, so they get retested in so many weeks.

Or the person with a borderline fasting blood sugar, nothing imminently wrong, please book in to have a GTT.

It could streamline how services work, it could make it easier for patients who work and commute. Say John went in and was found to have slightly high BP, they gave him a BP monitor for morning and night, email or write down results and bring back machine. GP / NP takes it from there.

I know some surgeries may use it, I think I read of a woman who ordered meds online for her husband, there was the example he said he had something he didn't to get anti biotics. You'd have to trust that it wouldn't happen often.

For those who love being at the Dr's Surgery, it could really transform things. So say you started a new med, all seems ok, there's no further in person checks required, all sorted quickly.

Leaving appointments open for those who really need to see a Dr ASAP.

They do have the telephone triage system, but with an email triage system, you can get it all on email, instead of losing your nerve as some do and getting cross as the triage Dr/NP is dismissive.

It could work well in hospitals too, with patients checking in with consultants / specialist nurses. Asking any questions they may have forgot or cropped up.

Maybe it's not as simple from an insurance point of view. But last example, Ellie is waiting for ENT surgery, has another bloody infection, Mum knows the signs well. Sorted quick.

Would you use it if it was available?

We have an email triage system in addition to the telephone or wwa
K in one. It's good but over sensitive with pre doctor looking at it advice. Like 111 it defaults to call an ambulance when you know you don't need that. Once through to GP it works well.

I think you are assuming all GPs are the same as yours.

Having moved around the country and having a few medical issues I have probably seen more different surgeries than most.

There is variation in the way they work. My current GP will always see someone who says they need to be seen, you may have to go after all appointments and be seen at 7pm on Xmas eve, but you will be seen.

If you want an evening appointment priority is given to people in work, which sounds bad but where the surgery is the majority of patients are not in work, obviously this could not happen in a place where 90% of people work.

The GP I had in London had 'telephone appointments' you could call and request a GP call you back, very useful for things like chronic conditions when you need a stronger painkiller or a referral to physio.

Current GP also uses email for repeat prescriptions.

GPs are individuals and they have individual expertise and interests. Some do minor surgery, some do acupuncture, some do... well they are all different.

My doctors surgery has just changed the process for repeat prescriptions.

Patients are strongly encouraged to order online and collect direct from pharmacy. Appointments are also available to book online.

They have a service where you are reminded by text about appointments which must be reducing the amount of no shows.

Technology will definitely improve and streamline things.

Sorry haven't read all the post on this thread but pharmacy2u and others offer this service. It's very good.

Both primary and secondary care are using virtual clinics etc. It's not a fix all.

I think what depresses me most about this thread is the lack of acknowledgement of the level of skill and knowledge a qualified doctor is required to possess. Patients really, really don't know what's wrong with them. Of course everybody has a story about the time the doctor said cholera and you said migraine and you were right. That's fine. Overall though we need the diagnostic skills of doctors and nurse practitioners. Accessing those skills may take a bit of effort on our part. My daughter is training to be a doctor. So far she has spent hours percussing and examining and no time at all answering emails of symptoms. There's a reason for that.

I wouldn't use it. I go to see my GP about a problem, discuss it, then I get up to leave and get told 'now sit back down, how's your BP? What has your moods been like lately'
Love my GP by the way :)

I use boots repeat prescription service. They keep my repeat slip, get it to the gp when I'm due, it gets signed and boots prepare my meds. I get a text to let me know when it's ready. No more faffing about dropping forms at the gp, then back to get the signed form, then waiting at pharmacy for it to be dispensed.

I'm a Dr (not a GP though), and while I agree there are areas that can (and must!) be streamlined in the NHS, emailing GPs could be downright dangerous IMHO.

I deal with lots of sick patients, and even when another Dr refers them to me over the phone, with all the relevant obs and details, I still go see the patient as there are things that you can pick up face to face (even if it is that sinking feeling in your stomach that "Fuck - this person is really sick") that you would never get over the phone or via email.

The way the patient smells; the way they hold themselves; a box of medication by their bed; a walking stick; a partner in a wheelchair; a particular way of breathing.... all give Drs clues as to what the problem is.

At least as a hospital doc I get access to scans/blood tests/monitoring the same day. Not for any ££ in the world would I be a GP seeing viral kids in the community and trying to work out which of the 10 I'd seen that morning was the one with potential meningitis!

My surgery has this - e-consult. You email in via a form and the GP rings back within 24 hours. Seems to work for things that just need advice and don't need face to face. Then appointment made if necessary.

Question anotherbadavatar. Do you think the NHS should be all first name terms, including doctors or all titles? I am happy for my first name to be used if the Dr introduces him or herself a Jane or John, otherwise I'm not. I really don't like it when nurses refer to me by first name and the Dr by title. The Dr and I are equals in a professional relationship bt it never feels like that. Nobody asks either. I work in academia which is the last bastion of pomposity but even the most arrogant of profs asks before assuming.

I think it's a huge equality issue and that the NHS can't really change for as long as patients are subordinated by those who work within it.

The NHS needs more money. I am happy to pay more tax but if I do there has to be a cultural change otherwise I'll pay what I pay now and supplement with private care where required.

As for patients not being advised to google symptoms, etc, I quite agree but NOT for as long as my GP, a Primary Mental Health Worker and the CAMHS manager advise me to get my escalating teenager a therapist off the internet. And have the audacity to call me "mum" to my face and to refer to me as "mum" in writing.

There might be some small place for such a service but only very small.

The very elderly might struggle. Many people have poor literacy skills. Many are very poor at describing symptoms. Lots of people speak quite poor English and would struggle even more with medical terms.

But for very straightforward requests from a known patient to a known GP it might be of some small use though as pp said, probably wouldn't save much time for the GP. However, for those who struggle to get an appointment and need to work during surgery hours there could be a convenience factor.

Yes, the needs of working patients are always disregarded. They are after all the people who fund the NHS and need to keep working to keep funding.

Pharmacy2u are well dodgy, they've already been in trouble for selling patient information to third parties. I'd stick to your local pharmacy. Most do prescription ordering for you if you ask.

Doing this would be so dangerous. It's bad enough triaging on the phone where there can be a dialogue, but via email it's much more difficult to get the information you need.

The OP mentions using email for things like skin complaints (knowing what a rash looks and feels likes hugely important), cough in kids (what's the respiratory rate? are they in respiratory distress? what's the heart rate? do they have additional sounds in the chest? etc), reflux (do they have an abdominal mass causing reflux? are they anaemic? etc). It's a medicolegal minefield for anything more complicated than repeat prescriptions and very simple queries relating to recent consults IMO.

I'm a GP and work in Australia now where there is virtually no telephone or email work and it feels hugely safer to be able to see the patient. Often there aren't many symptoms as such, but the patient just looks sick, or you get a sense that something isn't right. I prefer it as a patient too.

I have never posted before but thought I should say that whilst I think that drs shouldn't prescribe meds that are easily available OTC, there are some instances where they are needed and it would make it difficult for those who actually need them.

For example, I have complex medical needs and I need my paracetamol prescribed by a dr as I have it 4 times a day and it has to be a particular brand and it has to be a liquid, so sometimes its actually not quite so simple. Plus I will have to pay for a certificate for all my medications soon even though money is tight and these medications enable me to be able to have a life and 'treat' my incurable conditions so its not like I'm not paying at all.

Also some of my medications are very expensive, should the NHS just stop these medications on that basis? Well they did and it was disaster and I ended up costing the NHS more money probably so I think sometimes its not so simple as it may seem

GP will do some things by phone consult and it would be helpful if I could do more online - currently I can book an appt for about a month's time or get a repeat prescription for meds that people are allowed on repeat, but the main ones I take I'm not allowed repeats for, which means booking an appt, usually has to be at least 4 weeks before I'm going to run out as that's when the next appt is, and say "Hi GP, please give me more xxx, I promise I'm not addicted", and they hit the computer until it lets them.

I've just had a letter from a consultant saying "suggest a referral to gynaecology", so it would be nice to be able to just email and say "please do this" rather than again having to make an appt for next month and then ask.

But mostly if my child has xyz, the GP will say "Hmmm... best bring them in to check". I'm very glad I changed GPs to the one round the corner.

They could save thousands on postage, paper and printing costs by emailing letters back from consultants to both GPs and patients, though. It shouldn't need an extra sheet of high-quality paper to tell me that my letter is being copied to me as I requested it and if I don't want letters in future, I can cancel it. DWP moved to cheap brown envelopes decades ago - why does the NHS still use 80gsm lovely white paper and envelopes most of the time?

The practice where I work has a good balance I think; online appointments (making and cancelling) and requesting online prescriptions. There is a daily telephone triage clinic run by the Nurse Practitioner who can then book people in to the assessment clinic with either the GP or NP depending on the nature of the problem.

Patients can (and do) email the GP via the general practice email address rather than directly but only for fairly routine stuff such as querying referrals, medication questions, clarifying things raised in a previous consultation etc. As a practice nurse we get emails regarding things like travel health questions, contraception questions, queries about smears etc. Usually patients will phone and ask the receptionists, who will either answer them if it's something straightforward or pass it to a clinician.

I do not and would not want to do email-based clinical assessments. There is IMO no substitution for having a patient in front of you. There is FAR more to assessment and diagnosis than just matching symptoms to a possible problem.

@icy121. Anything that saves money could be suggested that's linked to lifestyle choice IMO. Child benefit (not part of NHS budgets) has already been phased out for higher earners, and IVF/IUI is pretty selective. Perhaps I've got it wrong, but don't single people who want a child have to pay?

GPs increasingly spend much of their time dealing with elderly patients and those with mental health issues. Due to the lack of social care and big cuts in this area smaller problems that could have been dealt with or managed at an earlier stage now escalate to being bigger problems for the GP or hospitals to deal with. The fact is leaving elderly and vulnerable people with little support to save money is a false economy.

OhTheRoses

I'm surprised you have never been asked, I worked in the NHS for years and we would always ask.

For in patients the patient's name would be above the bed, if it said Mrs Jane DOE she would be referred to as 'Mrs Doe', if it said Mrs JANE Doe she would be referred to as 'Jane'.

Being called mum - well often mum and child have different names so this does happen.

No never. In fact when I had ds the board above the bed had Mr xx xxxx for consultant. No title for me. I added mine. I got told off because it was important to think of the unmarried mothers! Why give the consultant a title then.

I totally disagree about the use of mum ever. Only my children may call and are entitled to call me mum, mummy, mother. In writing xx and mum is just lazy. Xx and her mum or mother is at least grammatically more correct.

Would it be appropriate for me to call a consultant doc? If not, it is mot appropriate fir an hcp to call me mum. Teachers don't call mother's"mum". Why should HCPs.

Our doctors surgery has recently introduced online consulting and it's fantastic. You complete an online questionnaire which covers the type of questions the GP would ask you in an appointment and then the surgery get a GP to review your responses and provide a diagnosis and offer a prescription if necessary based on your responses.
It saves the doctors surgery an appointment and also means you can answer the questions at your own pace at home rather than feeling like you are being rushed as you know the doctors are busy.
I guess would be great for those issues you would be embarrassed about discussing face to face too.
I don't know if all practices will be adopting it but hope they do as it really does make a difference.
The product is called eConsult. There may be others out there too but this seems to be the market leader.

We don't have e-consult, but our surgery has a telephone appointment with the drs, who make their own appointments, plus online appointments for all services and online prescriptions/telephone services.

This makes it much more efficient, so now always has appointments on the day, booked between dr and patient themselves so fewer missed appointments and usually on the day or the next day.

I appreciate they are using more than one method of communication, so those who don't want to telephone/go online can still go into the surgery and get prescriptions, although I don't think they can book an appointment as my husband went in and they refused so he stood outside and called them from 2 metres away!

What hettie said:
We could tinker with all sorts of efficiency savings but the bottom line ix we pay much less (relative to GDP) than most European countries into the NHS, so we get what we pay for. We want Scandinavian public services on a USA tax system and we simply can't have our cake and eat it

Some of the things you mentioned should not be taken to a GP anyway - UTI's etc are best taken to a pharmacist.

Plus, some surgeries already do things over the phone even if its not an official appointment. Once when I was panicking about a problem my 2yo dd had, and the GP didn't have any appointments available the receptionist put the GP on who reassured me that I didn't need an appointment unless things got much worse.

My consultant does telephone consultations. I think it saves time. The appointments seem quicker than my face to face ones.