GP practice "not offering appointments"

[Darkestseasonofall]

This is a new low. Just called to make an appointment to be told they aren't doing any for the foreseeable future.
If it's an emergency you can call on the day and try to get a telephone consultation, but that's it.
I can see a huge rise in people attending ED in appropriately or just becoming very ill with avoidable things.
This isn't NHS bashing, I'm a nurse, but I can't understand how primary care can just opt out of 90% of their contract.
AIBU to think this is just silly?

And just getting on with it Like us in dentistry. - we work all day every day literally 6 inches from patients mouths

Very true.

It's just frustrating. They seem bemused when I can't take a call back. I'm not unwell, or I would be off work and could answer, I just need my thyroid meds!

Pre Covid I had some post menopausal bleeding. I waited longer for a GP appointment to be referred to the hospital than I did for the hospital appointment.
My local GP’s practise has a severe lack of doctors and only survives by using a string of locums which seem to have dried up during Covid.
Pre Covid a routine appointment would be a two week wait now go get a phone call usually within 24 hours so that could be seen as an improvement but other stuff is running behind as no flu jab has been offered yet when usually I have had it by now and my mammogram is over due and no call up yet( but this would be the hospital not the gp)

@peasoup8 I'm not a GP so not sure about me being "in the wrong job". Dont make assumptions.

@gypsywater I copied and pasted the wrong poster - but yes, you missed the point of what I was saying as well. Mind you, it’s hard to take anyone who still hasn’t mastered the apostrophe seriously anyway

@peasoup8

OP please complain about the attempt to fob you off on the first occasion. As a nurse you will know how to respond in a way that an older or less confident person may not. Perhaps say this to the doctor when you finally speak to them.

@Proudboomer see if any pharmacies are offering flu vaccinations and book with them. You would still get it free.

@Ineverdidmind

I can't get a smear test done. They sent me a letter reminding me it was due, then when I called said they have no appointments. I've called three times now and they've pretty much said its not going to happen. Not sure what to do next, a backlog is just going to build surely?

My practice is doing triage type calls. I had a smear test 1 day after requesting it. What is SO frustrating is the lack of consistency across practices and the NHS in general. I hope you get sorted soon

My GP surgery has been amazing throughout - although I know that others in the area haven't.
It's the hospitals here, all routine referrals rejected. All 'urgent' referrals taking 6-8 months for first appointment because of the backlog. When you get that appointment it is telephone only, even if you really need examining. My GP is very frustrated with them because it puts more work back on the surgery.

My surgery has been utterly useless. I had a kidney infection a couple of weeks ago and was told I could have a telephone appointment 5 days later. I was in total agony. I ended up resorting to Facebook to ask if anyone had any amoxicillan lying around. It's an absolute shambles that I have to break the law to get medical treatment.

Drive through injections. Very Macdonald's

Truly shocking! No decent hcp would support shit like this!

Any number of things could go wrong, indeed for a b12 injection some patients may experience effects that make them unsafe to drive! That’s in the advisory literature on the treatment! And just because they’ve been fine other times doesn’t mean they’re fine every time.

Not to mention the hygiene aspects of such practice I mean wtf!! Not to mention it likely makes patients more stressed which can impact certain procedures

It really is luck of the draw it has been for many years, this current situation has just made the differences far more apparent

Also, I’m sure some GPs do work hard (though I’ve yet to come across one myself), but so do lots of people in many other jobs for far less pay. Cleaners, to give just one example!

Yes, I too am over the narrative that gps have it so much harder than others, it’s simply not true

YES this govt have acted appallingly - on that see attached pic!

Not everyone can afford private investigation. ⬆️

Surely the doctor will prescribe antibiotics without seeing her if they know it's an ear infection? so you’re advocating blanket antibiotic prescribing when it might be viral? Or fungal? Which if it’s not a bacterial infection antibiotics won’t do sod all anyway! In fact even when the infection IS bacterial antibiotics often have little effect

I've heard consultants saying they are expecting to have more advanced cancer cases in the future as a side effect of the pandemic see my earlier post on some patients slipping through the net, potentially fatally so

@butilovehim32 you’re absolutely right it’s not just patients being let down it’s other hcps

@cptartapp I still think it’s an unreasonable request of patients, there are things that could go wrong and it is unreasonable to expect patients to buy medical equipment.

Practice nurse numbers declining is a major issue we should all be railing against, the vast majority of practice nurses in my experience are invaluable members of their surgeries. Not saying I’ve had a perfect experience, but generally most of them are amazing.

They are a health care professional and I feel they should be providing proper care to their patients

Absolutely

But the attitude of gps has been declining for many years!

I can remember when they still worked nights and weekends, did home visits, provided continuity of care by sticking to their “own” patients for routine appointments...

That would have been when I was a teen some 30 odd years ago.

Gradually they are willing to do less and less, seemingly generally for more pay and better conditions and their tasks and responsibilities parped on to mainly practice nurses but also opticians and pharmacists who don’t remotely have the recognition or appreciation they should as a result!

Frankly Nye Bevan should have been better supported to ensure gp’s and gp surgeries were properly part of the nhs.

This not happening has been pivotal in leading us to where we are now.

Not signing off prescriptions and similar basic admin tasks is plain unacceptable!

Ditto tasks that can be completed by phone - like discussing test results!

@marriageoffigaro - then imo she should be endeavouring to put you in touch with someone who CAN explain things to you. As for the ptsd response, unfortunately while shocking doesn’t surprise me in the least!

Perhaps an annual patients' survey of experience by each practice would be really useful for feedback and GPs / practice staff will know if there is an issue / issues or if they're doing well.

Unfortunately it would need to be possible with patients remaining anon, because (and I fully expect gps to rail against this comment but it’s my and others I know in real life real experience) if you dare as a patient to really complain you risk ending up without registration at all and having to fight to even have a gp!

The other thing for people to understand is that GP practices are small independent businesses that have been contracted by the NHS to deliver primary care services to the public yes - as I said upthread and referenced earlier in post but bears repeating and emphasising I feel.

There is no consistency of service or standards, it’s incredibly hard to deal with even outright abusive gps let alone neglectful or incompetent ones.

@whitewidow001 that’s horrific and disgusting! I suggest taking the matter up with your mp. I’d be livid if that was my child

So get angry at the people in your profession letting it down. Don’t get angry with the people who are having to fight for the basic level of care. THIS!

Not seen any sweeping criticism of gps just criticism of NHS staff who are using Covid as an excuse to give a shit service and “ work from home” indefinitely agreed

Also, this attitude of people wasting surgery time is beyond blood boiling! If you read the cases we are talking about there is people with existing conditions getting worst, blood tests results not passed to the patient, blood in urine, EPI pens not provided, and so on. It is not a silly pain in my leg for 5 min after walking 10 miles case! almost always happens in threads criticising gps though, the “time wasters” excuse is wheeled out.

I’m not saying they don’t exist but the vast majority of patients have legitimate concerns and/or are unaware that their pain/symptom is of a minor and home treatable nature.

I notice there’s been no public campaign educating people as to what symptoms are minor and which need seeing and treating.

I’m very much someone who has been raised and much prefers to err towards home treatments first and only approaches my surgery when symptoms are really bad or worsening/not improving despite home treatment. The result of this though is the gps at my surgery aside from my own don’t know me certainly don’t know me well, and so, often assume that I won’t have thought to already have tried basic treatment. That in itself is time wasting and even when I start the consultation with “I’ve already tried x y z” they then suggest “have you tried x y z” proving they didn’t even bloody listen! If I’m fortunate enough to get my own gp, she knows I’ll have already tried basic home/otc treatment, she’ll briefly double check this and for how long and then move on to more advanced treatments.

I’m also more aware than many patients (and again I put this down to lack of info disseminated by the authorities inc individual gp surgeries) just how capable and qualified practice nurses, especially advanced nurse practitioners are and how many primary care issues they are able to deal with. So if it’s something that can be dealt with by the anp then that’s who I’ll request an appointment with.

But at times I’ve also had the frustration of being told by a receptionist that something I’m trying to make an appointment with a gp for (because additional medical history means anp isn’t in a position to deal with and the nurse and gps know this and have told me to make a gp not a nurse appointment) is dealt with by the anp, even when I explain we’ve been told to do otherwise they have at times insisted we see the anp first which means wasting an anp appointment and delaying access to treatment.

I have no issue with most things being done virtually infact I am a big advocate for it carrying on long term in most cases

Same indeed for myself this has made things easier (housebound, used to have to explain at length why I couldn’t “just pop in”)

But I can absolutely understand why telephone/video call/econsults are not suitable for every patient on every occasion

@Coffeeandaride

The website is saying you cannot book a routine appointment. If you ring and say you need to speak to a GP, you will get to speak to a GP. If you need to be seen, you will be seen.

So DESPITE a lengthy thread where not only patients but several non gp hcps have posted that this is NOT what is happening in their part of the Uk, that patients ARE being denied service YOU know better?! When you don’t even know where they are?!

Don’t be ridiculous!!

If it’s safe for us it’s safe for them

Exactly! Barring if they have conditions themselves that place them in shielding categories they need to stop being obstructive and do the job they’re being paid for!

We have been lucky with our GP - the system is working ok .
But this is exactly what annoys me about all those who think there should be no lockdowns and we should just live with the virus.

in some countries they have also had a second spike and their health systems are close to breaking point - plus they have health personnel off sick or isolating and this has now run over into work places so they can not produce goods as they are so short of staff - so businesses may go bust . People just don't think it through when they break the rules or think it will just go away.

My surgery stopped doing appointments in March and hasn't been open since.

@CallmeMrsScavo unless your surgery has completely and totally shut, this is simply not true. If it has shut, you will have registered elsewhere.

Mine have been offering telephone appointments initially then offering a face to face if clinical needed. That’s the same for most practices around here. Could you contact the practice manger about your concerns.

@Heatherjayne1972 you work in dentistry. Have you been seeing patients throughout?My GP has. My dentist and children’s orthodontist didn’t until July.

I think there ARE some very sweeping/generalised statements made about GP’s on here. I think that is very unfair. I’m a Dr but not a GP. I do have many friends who are though. I am aware there is a postcode lottery for many NHS services though.
In our area, vast majority of GP’s are busy. Other services are not- but I do not come on and give them a bashing on here like some have done. In our area for instance, all mental health teams are doing video or telephone consults only, as are our community palliative care nurses. The physiotherapists are not doing face to face unless urgent (and video appt failed). Our community rehab teams only restarted seeing patients in July. But I realise many individual HCP’s won’t be happy with that, but have to do as they are told. And in many areas they will be seeing patients. I try not to tar and feather a whole profession because it’s not fair!

Actually, being a GP is a bloody hard (often thankless) job and in my experience most GP’s try to do their best for their patients, are often working short-staffed and doing long hours. If it was as easy and as lucrative as many posters blithely suggest, I doubt we would have the issues we currently have with under-recruitment into training posts, lack of qualified GPs and many leaving in droves due to burnout or going abroad.

I’d like to correct a few misunderstandings some posters have regarding GP services. GP practices we’re ORDERED to “lock the doors” so that only people who needed to be seen face to face were in the practice (and so they knew who had been in the building). They were told they had to turn to telephone and video appointments and only see in person those patients who absolutely had to be seen face to face. They were (and are still) actively encouraged to try to minimise the number of patients in their surgeries to only those who must be seen in person. They are limited in the number of patients who can be in the waiting room due to social distancing (unless lucky enough to have a large waiting area) and extensive cleaning required after patients have been in a consulting room- as is the case with the out-patient clinics I do. I see fewer patients than I used to, and do more video consults/telephone reviews. I know my waiting list is longer than I would like for those reasons. GPs are no different- if they have to phone/video consult to decide if you need to be seen, then have to offer appointment face to face- that’s doubling of workload right there.

Both “locked door” policy and minimising patients seen in person feature in the current guidance.

GP’s were TOLD to stop doing smears (and even if they had done them they would have been rejected by the labs), also told to stop minor surgery, joint injections, mirena/coil/implanon insertion or changes , B12 injections and so on. Initially, they were also TOLD to stop routine monitoring of chronic diseases (though many practices resumed chronic disease monitoring some time ago, they will be dealing with a significant backlog). They are still not allowed to spirometry or peak flow monitoring/readings. They aren’t even technically supposed to look in a patients mouth/throat without the extra FFP3 mask! They have also been doing quite a lot of bloods and care that used to be done in secondary care. The Covid assessment hubs have been staffed by GP’s in our area, they’ve been doing the triage assessments and in person assessments. This means the practices have had to release GP’s on a rota’d basis.

Flu vaccinations are another issue mentioned by PP’s. Many accuse GP’s for not doing for these soon enough. But it never seems to occur to people that the may be to do with factors outside the GP’s control. For instance, in our area the vaccine’s were not being sent to GP’s until last week. And they are being limited to how many can be ordered. They may not ha e enough to vaccinate everyone ego is eligible (not their fault). GP’s in some areas of Scotland were not due to be giving flu vaccines at all this year as health boards were to be doing them (despite pilot studies of that process showing vaccine uptake was lower and costs higher than the GP’s doing them. And against the wishes of many practices)- until at the last minute it was realised they didn’t have the staff or infrastructure to give the vaccines and then they asked (demanded) GP’s help. But at the same time, have said doing so must not impact on the day to day provision of practice service. My friend’s practice have calculated that to give every patient who is eligible their vaccine will take nearly 275 hours of clinical time ( given the guidance is that for obvious reasons they can’t do the usual busy drop in clinics- do by appointment only, 5 minute per patient to allow for cleaning, socially distances waiting rooms limiting number of people in at any one time and so on). Square that circle- give the vaccine, in a safe way and do it ASAP (with not a huge amount of notice)- but don’t allow it to impact on the number of appointments available to patients for other things! So done GP’s are doing weekend clinics (and having to bring their staff in, which needs to be paid for) without additional costs being paid. And patients are now wondering why they aren’t all getting their vaccines as soon as they usually do, lots of calls into the surgery and a lot of angst all round. Also getting lots of calls asking them to chase hospital or scan appointments or asking why the GP has not contacted them regarding results from investigations requested by a specialist or can the GP that are the responsibility of the specialist (and as one, I am fully aware that I am responsible for communicating and dealing with the outcome of investigations I request, not the GP). It all adds up, and a lot of it is due to understandable anxiety and/or frustration on the part of the patient.

I have no doubt some practices are using this as an excuse to do less- though I suspect many of those practices will also be ones with GP and/or practice nurse shortages and Covid is being used as a cover for that, rather than the gp’s having a nice jolly time watching Netflix or something. If there are individual failings or systemic issues, patients (or other HCPs) should raise concerns/complain. But please, be careful re sweeping statements. Primary care, and GP morale, in particular is not great so being called useless when you are doing your best with the resources you have and within the guidelines you’ve been given is soul destroying. I have experienced it extensively in quite a few of the places I have worked in secondary care and it’s not fun.

Every single one of my GP friends are busier, more stressed and working even longer hours than before. I know a few who are on their knees. Definitely not sitting around twiddling their thumbs.

Our local surgery have been brilliant- you may wait 24-48 hours for a call about a routine matter but if you say it’s urgent call that morning or afternoon. My mum was straight through to the GP when she asked. No set time for call- but if you have rigid times for calls, I suspect this would not allow triage which is usually useful and safer. It’s not perfect, but then there is no perfect answer. If you need to be seen, you will be seen (that day if urgent, usually in 2-3 days of routine). They are still doing chronic disease reviews (some modified e.g. no peak flow measure for asthma), though there is a delay due to a back log. They are doing smears, coil fittings etc (though fewer per week than before, so yes a bit longer wait than previously). My GP is calling more people than they used to see in a day face to face and still seeing patients in person on top of that. I know they are doing home visits on a daily basis. She is also the partner of a friend, and is regularly doing 12-13 hour days and logging in from home at weekends to do paperwork.

@LadyWithLapdog
Yes went back 8th June. Working totally normally in both practices with appropriate ppe and within the guidelines obviously
Offering everything Check ups fillings etc Invisalign hygienist treatment- although I’m only handscaling We can’t do anything that involves water spray yet unless we use enhanced ppe

This is why I’m astounded doctors think it’s ‘unsafe’ to be working normally
If we are deemed safe enough to get within 6inches of a patients mouth then they need to ppe up and crack on

I think that Covid has really throw a spotlight on the disparities that the age-old system of having GPs as independent contractors has created in terms of access to healthcare. This was an issue before COVID, but has been brought to the fore as some practices seem to have just tried to get away with doing as little as possible.

Of course these concerns were raised earlier in the year, but they just prompted the GPs to circle the wagons and claim that every one of them is working hard and doing their best. Yet the fact is that I have two friends with the same chronic health condition that have experienced totally different levels of access to their GP and support in managing their condition over the Covid period. How can the GPs really say that all of their number are really putting the same effort in here when some practices have practically shut their doors whereas others are trying to deal with "routine" appointments as much as possible.

@Heatherjayne1972

My dentist hasn't fully opened yet. We have had all our appointments cancelled with no word as to when they will take place. Of course denplan is still taking the direct debits...

@jacks11 wow! Patronising much!

Most of your post is condescendingly telling us stuff that we are already aware of and fully understand re face to face appointments

BUT you have completely failed to address the many posts where patients have been unable to even access a gp to TALK to!

And patients are now wondering why they aren’t all getting their vaccines as soon as they usually do,

Please do tell us what's stopping gps or indeed health boards or even govt from keeping patients informed? Because surely that would prevent the time spent on answering individual enquiries about the same thing many multiple times?! Surely that's just common sense?

Some gps are conscientious, professional and practical but not all.

A lot ime are entitled, patronising and disinterested.

[quote Heatherjayne1972]@LadyWithLapdog
Yes went back 8th June. Working totally normally in both practices with appropriate ppe and within the guidelines obviously
Offering everything Check ups fillings etc Invisalign hygienist treatment- although I’m only handscaling We can’t do anything that involves water spray yet unless we use enhanced ppe

This is why I’m astounded doctors think it’s ‘unsafe’ to be working normally
If we are deemed safe enough to get within 6inches of a patients mouth then they need to ppe up and crack on[/quote]
Quite.