To think a 6 week wait for a GP appointment is totally ridiculous

[fussychica]

Just tried to book an appointment at our local surgery to get something checked out. Not been for ages and I was expecting a 2 - 3 week wait but apparently there are no face to face appointments before the 4th Jan and they are not releasing any appointments beyond that date until the end of next week. There are also no 5 minute telephone consultations available until after 21 Dec. Apparently there is no doctor shortage at the surgery.
I am really shocked and not quite sure what to do apart from go private. It's not an emergency at the moment but at the same time I'm not happy to wait 6 weeks to sort it.
Have written to my MP advising him of the situation, for all the good it's likely to do.

So is this the norm now or are the people of this town alone in receiving such a sub standard service?

I am restricted to the hospital that is treating me because of my other illnesses.

They have given me the painkillers now which is even more of a worry because I will no doubt be addicted by the time I am permitted to have surgery but there you go.

A shortage of appointments is inevitable when GP surgeries (mostly private businesses operated by the senior GPs as partners) get paid by the NHS "per patient". There's no incentive for them to offer more appointments or any quicker.

Pay them "per appointment" instead and immediately watch the number of appointments increase and waiting lists decrease.

Please explain how per appointment would benefit all the patients. I would like to hear this. Also about how there are no incentives, interesting. QOF??

Is this to say that GP surgeries aren’t offering enough appointments? 5-10 minutes per patient (depending on practice), does anyone have a practice that isn’t open for the majority of the week Monday to Friday and runs clinics all day every day? And then probably pays some money into extended hours, and OOH runs via 111 runs overnight? There needs to be more?

Do you understand anything about how patients are cohorted or how the ‘per patient’ is divvied up to target the most vulnerable, at risk or most demand ie mental health or say high incidence of patients with heart disease. Ploughing all the money into providing more and more appointments to the frequent attender cohort of patients - usually the cohort who has unmet mental health needs doesn’t solve the issue - your premises are only so big, you can only hold so many clinics. Where do you put the clinics and the doctors and the patients if you increase your capacity without expanding into new premises at further cost

Do you also understand that payments to practices are weighted against different factors. One side of a town can have very different needs to the other side, resulting in an unequal seeming service but this is paid to the surgery based on their population

Do you understand that the fact that people can’t access what they need from social care, mental health, acute and specialist services is what is driving people to their GP? For instance if people had access to robust mental health services they would not need to visit their GP so frequently. But mental health is on its knees with paltry funding, the referral criteria is extremely narrow for support services and GP’s have become counsellors, drug and alcohol advisors, dietcians, trying to support patients in severe pain due to long term conditions etc etc

The money needs to go into specialist services. Mental health. Drug and alcohol. Long term/chronic conditions. To get those people OUT of GP surgeries

"Pay them "per appointment" instead and immediately watch the number of appointments increase and waiting lists decrease." Interesting idea. Might make evening and weekend appointments more "appealing" too.

"does anyone have a practice that isn’t open for the majority of the week Monday to Friday and runs clinics all day every day?" Mines closed on wed afternoons & only runs for certain patients/conditions on fri afternoons. Closed daily 12-2 "for lunch". And as I said, this is one of the better surgeries I've had! My last one, which a relative still comes under, is closed all day wed, half day fri and also 12-2 "for lunch"

Christmas this year mine is closed from 20 Dec to 7 Jan. There'll be Ooh services staffed by locums for emergencies only.

MH services are overwhelmed but ONE of the reasons they're overwhelmed - and MH hcps are who's told me this - is because people are being referred to MH services when actually what's wrong with them are things like thyroid disease, certain nutrient deficiencies or conditions (usually gastro) which cause poor nutrient absorption m - which has SYMPTOMS of anxiety/depression etc but GP's aren't even considering these as possibilities and so not testing for them (usually comparatively cheap & fast blood tests) OR as is often the case with thyroid conditions what's considered 'within normal range' in nhs would anywhere else be regarded as requiring treatment.

ANOTHER reason is GP's who think they know better than psychiatrists and change the medication the mentally ill are on (and that's working for them) to something else (usually cheaper) resulting in unnecessary relapses.

This is just not true and based on what, heresay? I actually work with these services and people are lucky if they ever get to see a psychiatrist. Mental health services are not overwhelmed with people with thyroid problems. I have heard it all now

We have practices that are only open one or two days a week.

I’ve just signed up to Babylon as waits are just ridiculous. In London you can now swap to Babylon as your main GP surgery. Planning to book an appointment this week so I am intrigued to see if it is as efficient as it seems.

I said its ONE of the factors.

I've personally had the situation with a psychiatrists advice Re meds happen to me!

The referral of patients to MH services who are actually suffering other ailments IS an issue. My own Cmht have brought in testing for certain conditions as a way to address this, I wasn't tested when I first joined the team, they're gradually getting round to everyone and I had mine done a few months ago. Turns out my vit d and calcium are low and thyroid borderline.

I have 2 friends who are still working as nurses that I trained with both in MH in different nhs regions, one her region started this last year, the other it's apparently currently under discussion.

My cpn says roughly 1/5 of the patients she knows have turned out to have something show up on blood tests.

I said far earlier in the thread I think, I've had another thread running for a while on the misogyny in health care.

On that thread there's a huge number of posters who've responded who were Dx with mental illness and even referred to MH services when actually they had CLEAR physical ailments:

Hypothyroidism
Gall bladder disease
Gynaecology issues
Asthma
Various cancers
Lung disease...

But yea GP's are untouchable and don't make mistakes and have no prejudices...

So you are talking about comorbidities in a cohort of patients who have a high incidence or neglecting their physical health due to mental health issues, and when they address their MH issues they sometimes uncover some physical health issues too, and this is the fault of GP’s because they get 8 minute assessments with their patients unlike a CPN who is able to work more closely with a patient over a longer time period (and who is also a trained nurse). It is not physical health issues that are crippling mental health services, and GP’s too lazy to do blood tests. It’s common sense that addressing MH improves patient emotional and physical health on a level a GP isn’t able to achieve alone.

It is not about prejudice. There are also frequently people posting on here with serious levels of anxiety/depression that a battery of tests could well exacerbate. If a patient presents to a GP and in their medical opinion they feel they need MH services, and during those assessments people uncover other possible factors (and potentially recover) can you explain how this is not a good thing for patients?

Wow! You're blaming the patients now? Inc cancer patients?!!!!

No! These are patients that went to their GP's with CLEAR sometimes even visible IF the dr had bothered to do a physical exam - symptoms of PHYSICAL ailments that were misdx as being due to "hysteria" or "anxiety" predominantly because the patients were women.

That in many cases had no previous history of mental illness and knew they weren't mentally ill there was something physically wrong but they were repeatedly fobbed off.

Some BECAME mentally ill as a result of continuing to suffer - because pain and fear will affect people like that!

And you know what else? Mentally ill people get PHYSICALLY Ill too but if you've EVER had a mental health Dx then physical symptoms are often misdx as being due to that too.

Meaning if you're a woman who's EVER had a mental illness Dx you're basically fucked!

Can YOU explain why referring someone who is PHYSICALLY ill to the MH team is good for either patients OR MH services?!

GP's are supposed to CORRECTLY assess what is wrong. A few blood tests first is not going to do any harm to the patient and if the patients symptoms could be down to a physical condition surely a GP should be ruling that out first BEFORE referring to MH team?

In addition even IF these are comorbid conditions given waiting lists for MH appointments, and I'm talking about conditions that affect MH then surely the GP can start treatment of the physical ailment while the patient awaits the MH appointment and that will likely at least slightly improve matters for the patient? Which can also mean it's easier for them to engage with MH services.

I cannot think of a single patient focussed reason this shouldn't be done.

How on Earth is that patient blaming? I am not blaming patients, but the suggestion to have GP’s seeing even more patients, probably for less time as per this thread is not going to solve any of these more complex issues. If patients are seen and treated through whatever route or journey that takes then it will not always be conventional and this is what the NHS is moving towards - multi disciplinary team working. GP’s do not have the time or resources to often delve deeper and probably do refer to MH when presented with a patient who appears to need MH support. But you are basing your evidence on qualitative and subjective data from an Internet forum whereas I have seen raw hard data relating to this exact subject where patients with mental health needs end up on a merry go round of being pushed from pillar to post with all the pressure on the GP - who is not a MH specialist - and the pressure this exerts on the system.

It is a well known and proven that people with MH issues are far more likely to also suffer from poor health. I can link you up to some info if you like? It is deep and complex but it’s real. Often non concordant with treatment, difficult to engage, deep and complex multi faceted issues that could be addressed in a MH setting. But MH has a stigma attached to it, which is why people find it distressing that there isn’t a medicine or a label to place on it - often you can’t just go to the doctor and walk out with a prescription and not need follow up, you may need a lot of follow up and support that GP’s struggle to provide. Improving people’s mental health has multiple benefits

Also ease up on caps lock. It’s not required

I don’t know if you have ever regularly been near to a phlebotomy clinic, where people are queuing around the block from 8am, or tried to book a slot for bloods in the GP, or as I do count phlebotomy referrals sent by GP’s to a service, or know that dementia clinics will only accept patients who have had bloods done, as do many specialist services. Routine bloods is not a bizarre new concept. It happens. Perhaps just not on mumsnet

"neglecting their physical health" blaming patients.

"Often non concordant with treatment, difficult to engage" wow! More patient blaming.

"GP’s do not have the time or resources to often delve deeper" are you serious? That's their job! To get ALL (and I'll use caps AS MUCH AS I LIKE) the relevant information they can to assess the patient CORRECTLY - in the instances I'm referring to the GP's were told the relevant info and ignored it!

Taking an effective history from the patient is day 1 of any hcp training ffs!

I'm well aware that the mentally ill are often more likely to be physically ill too. Both from my training AND personal experience.

It's no excuse for denying or even just delaying treatment for the physical ailments, plus as I said, treating the physical can help the mental health.

And yes I've done a stint in a phlebotomy clinic and have 2 friends who work in one currently. I've also as a patient booked in to have bloods done.

If there's a lack of resources for taking and processing blood tests - again that is not the patients fault and is no excuse for not doing it when the symptoms indicate its necessary.

You're full of excuses when the simple fact is patients - especially women, especially the mentally ill, especially those with learning difficulties are being failed.

Use the caps lock all you like but it’s effectively just shouting and comes across like you have nothing very constructive to add except overly dramatic non points based on heresay

It's for emphasis clearly.

It's just easier than using the method for bolding or italics on here plus italics aren't particularly clear on here I find.

Ok, OP here with an update.

Had a reply from MP asking if he could send my letter on to the Practice Manager for comment. In the meantime I had already been into the surgery again and asked to see the Practice Manager. I was seen by a different receptionist who asked why I wanted to see them and I told her I wanted to complain about the wait for an appointment . She asked what my problem was and I told her. She said that would be classed as urgent and she would arrange for a GP to call me in the next hour, which they did. Following the telephone consultation, which was quite detailed, I have been prescribed medication and booked in for a follow up appointment face to face in 3 weeks. I am happy with the outcome in this instance but have asked the MP to pass on my letter as it seems a strange way to operate an appointment system.

I wouldn't have classed my problem as super urgent but by going in again, seeing a different receptionist who actually asked questions and was probably not keen to be involved in a complaint I secured pretty much the outcome I was originally expecting/hoping for.

Will be interesting to see what the Practice Manager has to say and what happens the next time one of us needs to make an appointment!

Sounds like it's a real mixed bag of experiences out there and if you aren't in London or another major city alternative provision is pretty thin on the ground. The only certain thing is that it's only going to get worse

Glad you've got the treatment you need op.

But I agree I think you only got as far as you did now due to them wanting to avoid a complaint on record.

Glad you got it sorted OP.

It always worries me when you hear that someone's had to complain in order to be treated properly. How many people aren't able to complain and what happens to them? Surely the system should just work? You shouldn't need to make a fuss just to get an appointment.

That's exactly what I said to the MP in my follow up email.

Hands up, I've not RTFT, but...

I'm already so fed up of reading how GPs should not be part time.

FFS a 3 day 6 session GP is working full time hrs.

The reason we have a GP shortage is no one wants to go into a profession where if you work full time hours in 3 days you get shat on by the general public.

Go and discuss the newly qualified, fully financially invested in private consultants who have 30 min appointments and do a 9-5 and drive home in their Porsche. They exist and they are the era in on resource, not a GP.

How about ALL doctors are made to work in General Practice for 3 yrs before they scoot off to Aus/USA/Canada or take the private work job? We'd then have a constant flow of GPs and reinvestment back to the frontline which is not at all attractive to newly qualified docs.

I love the GPs I work with and I'm proud to work with such amazing selfless people who work their backsides off.