AIBU to wonder why it has become so impossible to get a Doctor's appointment?

[Bluebananas01]

I remember when I was a child in the 80's, if you were ill you could always get to see the Doctor the same day. I even remember the Doctor doing a home visit when I had the measles. I called up this week to try and get a Doctor appointment and it is a three-week wait (South East).
Everybody seems to talk about there being no Doctors appointments but what is the real reason? Is it just down to underfunding? Are people not turning up for appointments? A sicker population?

Even when I get to see a Doctor it is as if they are trying to get me out of the surgery asap and heaven forbid if you need a referral. Two years ago I went to the Doctors with joint pain, shooting pains, weight gain etc. I told him that autoimmune disease runs in my family and it felt AI as it came in waves (like flare-ups). He pretty much told me I was a hypochondriac. Asked if I exercise (because of the weight gain) and when I told him 6 days a week he told me to take up yoga and sent me packing.

Fast forward to this year when I was going overseas with my husband to his place of birth where it is super cheap to see consultants and have blood tests done. My symptoms had been progressing so I have blood tests etc and saw a Doctor there and discovered that it wasn't all my mind as suggested by the Doctor and that I actually had:-

Hashimoto's Thyroiditis (Autoimmune underactive thyroid)
Pernicious Anaemia
Severe Vitamin D deficiency.

How the hell did my Doctor miss so many warning flags about my health? I only ever go to the Doctors for smears and pregnancy so hardly one to visit the Doctor for the slightest sniffle.

It makes me wonder how many other people are being fobbed off and are living with a poor quality of life because their Doctor just can't be bothered to give a proper consultation.

It must definitely vary
Never not been able to get a same day appointment here

Our surgery specifically leaves space to only be filled that day as 'people don't always know they are going to be ill 3 weeks in advance!'

Only advance appointments allowed are for blood tests, smear tests, injections, follow up referrals, repeat prescription examinations etc.

IMHO many of the public are now getting a service they deserve- they are wasteful fo the resource and bash GPs at every opportunity.
Many don’t and have wonderful relationships with their family doctors but the over riding feeling these days is that GPs are ripe to be hated and consequently very few want to do it anymore. Who can blame them?

I’m sorry, but this is ludicrous.
GPs treat you like crap so you criticise them so they’re entitled to treat you like crap? Brilliant. Just because the NHS is free at the point of delivery doesn’t mean that we should just accept substandard care.

GPs can’t possibly know everything about every condition. It’s not humanly possible. And yet there seem to be very few GPs willing to admit that their knowledge is not infallible. There seem to be few GPs willing to actually listen to their patients, and few GPs willing to employ critical thinking skills.

I waited ten years for an endometriosis diagnosis and that’s about average. My symptoms were absolutely textbook and yet I was gaslighted, fobbed off, mocked, and treated terribly by doctor after doctor. For ten years.

If you had been unable to work for 8 years, your hair was falling out, you were gaining weight, so fatigued you’re mainly housebound, a constant burning sensation in your limbs and altered sensation in your back, and you had no answers whatsoever for 8 years, do you not think you might be a tad disllusioned with GPs as well? The current attitude is not about listening to patients, looking at a patient’s clinical signs and symptoms in combination with blood and other tests and figuring out why they’re suffering. It’s about running a few cursory blood tests and telling the patient there’s nothing wrong with them and that’s that.

I’m 36. I have no life. I had to stop working properly at 29. It’s soul destroying. A good GP could give me my life back. Is it any wonder I’ve come to feel completely let down by them?

On top of this, it’s always conditions that mainly affect women that are so ignored and for which we have shocking guidelines in this country.

When I was younger, the diagnostic process for pelvic pain in my PCT was to refer for an ultrasound and, if that was clear, refer for mental health assessment... despite the fact that 10% of women have a condition that causes debilitating pain and doesn’t show up on ultrasounds.

Take hypothyroidism - most developed countries now treat patients once their TSH exceeds 2.5 or 3. In the U.K. the diagnostic cut off is 10, and if you have a very good GP they may trial treatment once it exceeds 4, but they don’t have to. That’s years of suffering endured mainly by women. The NICE guidelines for thyroid issues state that women who are trying to conceive should have a TSH below 2.5 - but even if a higher TSH is uncovered it’s rare that anything is done.

Or B12 - there’s so much information out there from experts stating that the serum B12 test is not fit for purpose, and that if patients have neurological symptoms and five other affected body systems, they should be started on treatment regardless of blood test results. Does that happen? Nope.

If you’re suffering from any symptoms related to these things and your blood results are not conclusive, you end up trying to figure it out yourself. There are huge communities of undiagnosed patients online taking matters into their own hands - self injecting with B12, sourcing thyroid medication online and monitoring their own results. It’s absolutely unacceptable that people feel pushed to do this, but that’s where we are at.

Yes, GPs are under huge pressure and have a tough job, but that is no excuse for forgetting that your patients are human beings and treating them as such.

I used to have the most amazing GP, before I had to leave London because I could no longer work. She saved my life once by recognising how ill I was and calling an ambulance, when a locum had fobbed me off a few days earlier. If she were my GP now, I guarantee that at the very least she would have spent the last 8 years trying to help me. Wanting a GP to help you when you’re unwell is hardly expecting the moon on a stick, is it?

@hostesstrolley your DD needs to stop being so precious and realise that it isn’t appropriate what she is asking for- if she wants to consider GP she will get plenty of time to spend in community medicine during her training- she doesn’t have to decide on which route to take for specialism for at least another 6 or 7 years.

Having kids (basically) sitting in on consultations or wandering around surgeries where so much confidential and personal information is around is simply not appropriate. Imagine how many six formers would fancy work experience. Hundreds.

In my surgery we get asked weekly to have six formers or younger come and do placements.
Patients find it hard enough sometimes having an actual medical student sit in let alone a 17 year old who isn’t even studying medicine.

Plus a GP working day is around 12 hours non stop- there isn’t time to chat to loads of school kids about the job we are too busy doing it.

Your attitude (and likely your DDs from what you write) is disrespectful and inappropriate and shows again the total lack of realism or respect we have come to expect from the public.

I wish your Dd well in her training and suspect once she starts CBM she will see why her request was turned down and might eat some humble pie.

For me, I think the biggest problem is the ever increasing amount of bureaucracy.

The Tories back in the early 2010s introduced the ‘purchaser-provider split’ which now effectively means that different areas of the NHS (e.g. GP surgeries, hospitals), are competing with each other not to have to pay for stuff.

For example, frequently I will refer a patient to a specialist, and then that specialist will write to me asking me to prescribe whatever drug they have decided the patient needs - because they don’t it coming out of their budget. But a) we don’t want to pay for it either and b) regularly it’s a drug that we, as GPs, can’t prescribe.

And it always ends up taking hours on the phone & on hold to sort out.

Obviously there are times when you need a same-day appointment, but what irks me is the difficulty of getting a planned appointment for a medication review, as if you are working you can’t stay at home every day on the off chance you might get a same-day appointment. My doctor only does same-day appointments as a general rule because I assume people forget their appointments otherwise.

Saying too many people/too few GPs misses the point of why the ratio is off. The reason there isn't a perfect supply of GP appointments is because it's not determined by market forces. If there were no NHS and people paid the entire cost of an appointment, everyone who wanted an appointment would be able to get one as soon as they wanted.

(People who couldn't afford appointments would not make them, and people who don't make appointments are counted here as not wanting them! Their unmet medical needs are therefore correctly classified as being due to a shortage of money, rather than a failure in the supply of GPs.)

4,000 new houses have been built near me, all going to my surgery but a new doctors surgery will not be built for a couple of years, how can you say it’s not population? I know it is also greed from the council not making sure there is a doctors surgery in the planning. I live in the SE, 3 weeks is the norm, I have family in Wales, they can easily get a doctors appointment and a home visit, so it is bad planning and population growth. I also know of families who live abroad but come back and say they live here with a family member to use the NHS which is unfair, this is for cancer treatment which is costing the NHS a fortune but the worst is the drug companies charge the NHS a fortune which shouldn’t be allowed. I think eventually we will loose our NHS 😞

I've heard the same question elsewhere. People vote for a government that doesn't care about the working classes and actively cuts services. Then they seem perplexed when cuts actually happen and the effects are felt.

Immigration is an easy and useful blame-mechanism that governments hide behind to gloss over the annihilation of services. Austerity has come home to roost. Ironic that so many immigrants actually work in hospitals..

I imagine it's very expensive to study medicine so perhaps that option is also available to fewer people now. Is there any incentive, really?

I know some people who just pay £35-50 to see a private GP. I guess that's how it will mostly be soon enough, whilst those who can't afford it will just have to wait 3 weeks for a GP appointment + rely on a crippled NHS

I have the opposite to him, Hashimotos (Autoimmune underactive thyroid) and was treated and pretty much told that all my symptoms were just because I was a woman over 40.

I’m 36 - I was told it’s completely normal for women to have no sex drive at all (and feel completely unable to have a physical relationship) at my age, especially when they have small children. I’ve had this problem since I was on a hormonal medication in my 20s. They don’t bloody listen. They are more than happy to hand out anti depressants despite the recent info that longterm use can use permanent neurological damage and with no biochemistry proving they’re needed. It’s bizarre.

It’s also about the way we treat the medical profession and the rewards they get. A newly qualified GP can go to the UAE for two years and earn enough to pay off their mortgage. If they stay here, it’s hard to get a deposit for a mortgage without parental support.
We don’t have enough GPs. It takes a lot of training. It’s why we’re using more less qualified people in practices. GPs caseloads are ridiculously large. We can’t recruit from EU so easily now because of Brexit and the cultural changes that has caused.

Caseloads are too high.

You could frame this as too many people, or as not enough doctors, or as too much work-per-person. All of them would be true so it just depends what angle you want to go with.

It's not really easy or feasible to reduce the number of people, so ranting about immigration or population increase is a bit pointless. Therefore to alleviate the problem, we need more doctors, and/or to look into whether the amount of work per patient can be reduced by way of cutting out bureaucracy, reallocating tasks, health initiatives aimed at reducing the incidence of certain illnesses, etc.

Plenty of countries have higher populations than the UK and aren't falling apart so I find this argument that we are overpopulated to be a bit irritating. Yes, we are a densely populated country, particularly in South East England. So? People act like there is a finite number of doctors/schools/hospital beds/roads/houses - alright there is a finite amount of physical space, but everything else can be funded, built, trained, recruited, if it's prioritised correctly. Whingeing about population numbers isn't much use, just provide the services for the increased population, then it will be fine?

Yes minesasausage, also bme ppl, those with learning difficulty or mental health issues. Low status, must be making it up. Drugs tested and research on white men, not suitable or need modification for majority of us!
To be fair to doctors, gps work hard, and long hours, many leave or go part time (still long hours). They are well paid but training leaves a lot to be desired.

I don't think it is necessarily down to population growth. I think the NHS is mismanaged. Unfortunately, I have too much experience of being a patient and the waste and bureaucracy that I witness makes me angry.
If you ring my doctors you have to listen to an automated answer system for almost 3 minutes before speaking to a receptionist.
Last week I rang to find out if I had been referred to the local hospital 2 months after the GP had told me that she would. The receptionist couldn't tell me but offered me an appointment I didn't need or want in 4 weeks time. I politely pointed out that maybe the waiting time was so long because they were making appointments that weren't necessary.

It's such a horrible job to be a GP they are leaving in droves and the government, who have partly caused the problem by under funding, are making it hard for over seas doctors to come and work here.
Anyone who works in the NGS is a hero in my eyes.
Thanks to any GP/any NHS worker reading this - you are angels.

She’s neither precious nor rude, but thank you for your judgement on someone you know nothing about. She’d have been happy to make tea and tidy up or whatever, she just wanted to gain an insight, not to make anyone uncomfortable. She was 18 at the time of asking, and was eventually able to go and learn about roles etc at an A&E department and with a community physio where presumably confidentiality isn’t an issue

There seem to be two issues here; the length of time it takes to get an appointment, which is down to funding and people booking when they really don't need to (coughs and colds, 24 stomach upsets etc) and the treatment we receive when we get there.

As someone whose worrying symptoms were put down to anxiety for seven years, when in fact I have an incurable heart condition, and who has been unable to get proper treatment for hypothyroidism, I can empathise with posters who have received similar poor treatment. That is the more worrying aspect for me, I no longer have confidence in the NHS at all.

I'm the original poster and I just want to say that this is in no way GP bashing. I am grateful for our NHS and fully aware of how challenging conditions are for GP's, Nurses, Healthcare workers etc. I would not dream of ever being rude to my GP. I keep appointments to an absolute minimum and won't book an appointment when I can do self-care. Prior to going to an appointment, I review what I want to say that I can get my point across in as short a time as possible with no unnecessary details. I try not to be emotional. All I want is to be listened to and treated with respect, not like a Hypochondriac. Aside from smears and pregnancies, I have had 2 appointments in the last 12 years! Two! Hardly
putting a strain on the NHS am I?

May I give an example of the system being an ass; three actually.

1. I was diagnosed with graves in 1990, privately when it became so severe my manager sent me to the company physician and my lower legs swelled enormously. Private phtsician sent me straight to a hospital based endocrinologist because they suspected it was affecting my heart. It wasn't, it was a rare presentation. My bloods however were through the roof. My GP had previously told me I was exhausted due to my dysfunctional lifestyle, to stop socialusing so often and to have early nights. Privately I had a sub total thyroidectomy and started thyroxine 100mcg (because the diagnosis coincided with getting married and wanting to start a family). Back then it was annual blood test and an annual prescription. No problem time wise for me or the NHS. All fine and dandy until about 2004 when 28 day prescribing came in. At least I got 56 days for thyroxine. My dose had never needed changing. So suddenly the GP and I were expected to have six times the pfaff annually and a grossly increased administrative burden. I have questioned this and the administrative burden and been advised the GP has to ensure they properly look after and monitor me. I asked how they monitored an additional six times a year if they didn't take additional blood tests - response - a frustrated look and irritation. Not my choice to give them extra work abd there should be licence to deal with this on a case by case basis. Notwithstanding the time I have to spend on sorting out orescriptions that don't arrive and additional trips to the chemist (can only do this Saturdays as work full time) and the calls to resolve often to a surgery that doesn't answer the phone for 20 minutes and god forbid if the 20 minute hold takes you over the 11-1 slot for prescription inquiries. I haven't given the NHS additional work, it's given it to itself.

1. Recently I completed a three year course of zolendronate for osteoporosis. Afted the third course I was automatically discharged. A follow up dexa scan was required to see if it had worked. Routine. But to get it my GP had to refer me back. I was sent an apt with the rheumatology consultant which was pointless without the results of the dexa scan but only the consultant could order it. Waste if gp time, consultant's time and my time. Dexa scan should have been automatic and further advice could have been provided seamlessly and more economically effectively by letter.

1. CAMHS dd oresented with depression, anxiety abd self harm cutting and overdosing. Offered an inadequate and inaccessible intervention that woukd have made her worse but refussd to negotiate so privately I engaged a consultant psychiatrist, she had an endocrinology screen, 6 sessions of counselling and was put on fluoxetine and propranolol privately. While waiting for the asd/adhd test results/report and just before exams dd took 11 antihistamine and a swig if benylin. Two days later she went to A&E to make sure she was physically ok nd hadn't harmed herself such was the presence of suicidal ideation. A&E didn't contact me for four hours, reported to ss, arranged an overnight acute paediatric admission with a 1:1 nurse due to following a protocol at an estimated cost if £1000 to facilitate a CAMHS review the following morning. The paed consultant actually said he didn't think there was much to worry about and she seemed fine in herself. When I objected to the modus operandi he went and found out a mn assessment could be arranged with the adult MH Liaison team as she was 17. We were able to go home. CAMHS review took place a few days later and resulted in 8 sessions of mediocre counselling delivered 3 months later. They closed dd's case after delivery of the first session - so mych for the integrity of assessed outcomes. In the meantime dd was diagnosed with ADHD, medicated and made a full recovery. Nithing constructive was provided by the NHS but they clearly had a lot of money to spend on doing nothing. Lest I forget at the start imof that GP told me to get her a therapist off the internet because CAMHS are useless!

The NHS has become a behemoth channelling money back into its iwn disorganisation. Somebody needs to sort it out and I for one am sick of the overarching view that I shoukd be grateful for crap service standards because it's free. It us free only at the point of delivery
and almostvall those in it or around it need to shape up, get it organised and get the concept of service back into it.

Too many people not enough money. Unfortunately the government is already up to its ears in debt. The only way to tackle this is to address the top msby people issue. NHS services should be means tested so that those who can afford to pay either pay or go elsewhere.

Well I’m in the SE and at our GP they have a walk in clinic every morning , you just turn up and can see a GP of your choice . If you want to book an apt it’s normally a 2 week lead time unless you can get a cancellation . I have multiple health issues and my GP is absolutely fantastic unfortunately the local hospital is what let’s us down ( repeatedly) .

You should also reconsider your gratitude, the NHSis killing people though it’s inadequacy. Obviously the doctors who stick with it aren’t to blame but the organisation should have shit itself down years ago.

Agreed - my mum’s ovarian cancer symptoms were disregarded for over 12 months before she was diagnosed. The biopsy was inconclusive but they continued to treat her for ovarian cancer.

Only a year later did they discover that the primary was actually stomach cancer. Too late to remove it by this point, so she died six months later at 61, basically starved to death in front of us. It was horrific.

Old (native British born) people not immigrants are the main users of NHS. Blame the dastardly old people for living so long & getting the high medical needs that come with advanced age. How dare they. The immigrants are the ones working in NHS & paying taxes to keep NHS propped up & still treating the native oldies.

I paid for my own treatment overseas in the end and within 48 hours I had seen GP, had an array of blood tests, seen an Endocrinologist and been given a prescription.

How much did you pay for all those services? I'm all for copay, too.

Antibiotics are dispensed like sweets in many countries. Patients believe that antiBs are cure-alls, and after all, they paid to get something tangible from the doctor. Which is my way of saying that lots of treatment dispensed outside UK is... proactive. Not clearly clinically justified. My dad has been on statins since he had a stroke 13 yrs ago. Dad shows zero signs of clogged arteries high cholesterol or any other justification for statins, but you know... just in case. He agrees it's absurd.

Lack. Of. Funding. In. NHS.

Not all pretty graphs are facts, but... this is one is great if the data are accurate. Vast majority of foreign-born citizens in UK are 15-30 yrs old. Did I already mention this is the age that uses NHS least?