To want to see a Dr at an appt

[Purplerayhan]

I can see a nurse, a care practitioner but a Dr? No. It's so frustrating. Without going into details, it's something that needs examining but because I called up with 2 non connected issues, I got told to lets see how the first one goes, they do a referral for a specialist, SALT oversubscribed team, to get in touch at some point in the future (no time frame given, understandable but frustrating) and they'll have a look at the hernia after that. Sorry, just frustrated. Why is ok for lower paid nurses and care practitioners to have to see patients face to face but not my Drs?*
*rhetorical

Our practice nurses are also doing as much as they can remotely, but by the nature of their role there simply is no option but to have face to face consultations for e.g. blood tests etc.
From the letters that I have been getting from hospital consultants, it is clear to me that they are doing exactly the same as us, with regards to using telephone consulting wherever possible and only seeing patients face to face where it is necessary.

I also do shifts outside of my surgery where I do face to face assessments of patients with Covid-19 infection at assessment hubs or on home visits. I can assure you my triaging of calls during my in-hours GP work to limit face to face appointments with patients is much more to do with protecting them than me. I am young and healthy, so I am willing to accept the relatively modest risk to me to help protect patients, but I am much less comfortable with the risk that unnecessary contact with healthcare professionals or environments can pose to elderly or otherwise vulnerable patients, and I feel a responsibility to limit that where I can. We have already had too many patients die of Covid, I don't want to contribute to any more.

In fairness I certainly haven't intended to suggest that ALL GPs aren't seeing ppl. In just want to see one.
To the ppl suggesting that nurses have the same depth of knowledge, I can't see how that can be the case. A better bedside manner, undoubtedly in many cases. If they are as qualified to act as first instance Drs, surely they can do the jabs to free GPs up,?

I’m also a GP and am not “hiding behind telephone appointments”, I hate this GP bashing and the implication that we are letting lower paid staff do all the work. Like others have said it’s a bit hard to do a dressing down the phone but I can sort your sick note or letter request over the phone no problems so why would we bring people in unnecessarily in a pandemic causing increased infection risk to staff and other patients? I see people face to face every day and have done almost every day since the pandemic began. The job has been much harder and more stressful since the pandemic and it was already difficult, please don’t forget we are also human beings with the same worries and concerns and trying to home school etc during the pandemic as everyone else.

I acknowledge that not all GPs are the same and there may be valid reasons why you are struggling to see a GP at the moment (perhaps your GP died from COVID or is off sick or is ECV and shielding or simply off site doing COVID vaccinations etc), or less valid reasons, of course there are a few rotten apples in the profession.

It’s not unreasonable to want to see a GP to confirm a suspected hernia which I agree needs examination and likely referral if confirmed. A lot of nurse practitioners are well trained in this sort of area nowadays so I wouldn’t pass up an appointment with them if you can get it as they may well be able to deal with your problem effectively and efficiently. I do think if you prefer to see a doctor you should have the option personally. Around ten years ago many GPs would have been very pleased to hear that their experience and qualifications are being appropriately recognised and that the public understand that NPs etc cannot replace doctors. However the hard truth is there simply aren’t enough doctors in the UK. We need NPs and the like to keep the system running right now. And they are good at what they do especially for single issue acute problems (like a hernia) but yes you are right that it’s not exactly the same thing and I still believe some more complex issues or dermatology and mental health type issues in particular are better dealt with by a good GP. Which is not to denigrate my NP colleagues but it’s a matter of training as you say.

Anyway I dont quite understand if the issue is that you asked about other problems and then brought up several problems in the appt and were asked to rebook to sort these (we’re not superhuman and don’t have endless time per patient), or if you were only offered an NP appt when you wanted to see a GP (understandable as maybe more available but as I say I do think patients ought to have a choice if they feel strongly about it or for certain types of problems) or if they are telling you to wait until the other issue is dealt with before they’ll even look to see if you have a herni (obviously unreasonable and indefensible in my book).

If it’s the second or third one then I would suggest you call and ask to speak to the practice manager or submit a formal complaint and I’m sure it will get sorted. If the first then just book the appt. And yes consider changing GPs if this sort of thing is a recurrent problem and the practice can offer no reasonable explanation.

I always swear never to read or engage with these threads as it just pushes me further and further the the brink of bring another Gp who has jacked in as the cant take any more. But then I do as I desperately want people to understand how we workout everyone seems to think they know it all already. My nurses are brilliant . But they have a fixed number of appointments per day and they they go home they might fit am extra blood test or ecg in if urgent. Yesterday my surgery slots were full by 8.30... thats 25 appointments the amount we can safely handle and still have time for referrals, results, home visits etc.. however people still called in needing care/advice etc. So I added them on... and on... and on... I had 58 patient contacts.. and still had referrals, letters to read and action (72) , prescriptions to check and do (about 200 ) and home visits...which i ended up doing at 8 pm when I finally got time. At any one time I had about 2-3 jobs in my head and on the go simultaneously... any one if which could be pretty catastrophic if I got in wrong. Also at any point I could have walked out in tears but that's not an option as there was no other bugger there to do all of the above because guess what... our nurses don't do that stuff. So when you get cross your GP isn't available maybe think why...

but they WILL see you IF it’s necessary. After being assessed by a highly qualified and presumably experienced nurse practitioner

@pbdr

Our practice nurses are also doing as much as they can remotely, but by the nature of their role there simply is no option but to have face to face consultations for e.g. blood tests etc. From the letters that I have been getting from hospital consultants, it is clear to me that they are doing exactly the same as us, with regards to using telephone consulting wherever possible and only seeing patients face to face where it is necessary.

I also do shifts outside of my surgery where I do face to face assessments of patients with Covid-19 infection at assessment hubs or on home visits. I can assure you my triaging of calls during my in-hours GP work to limit face to face appointments with patients is much more to do with protecting them than me. I am young and healthy, so I am willing to accept the relatively modest risk to me to help protect patients, but I am much less comfortable with the risk that unnecessary contact with healthcare professionals or environments can pose to elderly or otherwise vulnerable patients, and I feel a responsibility to limit that where I can. We have already had too many patients die of Covid, I don't want to contribute to any more.

In which case why aren't GPs at least seeing them after triage before sending them in to secondary care as an acute referral? The incidence of nosocomial COVID infection in hospitals is several fold higher than the community. My take yesterday of 26 patients referred by GPs 3 patients had been seen face to face. 95% of my consultations over the last month have been F2F by comparison.

Oh also the hospital doctors around here seem to be seeing nobody face to face and keep sending me letters suggesting I should bring people in for the examination part of the consult! Which I do if nobody else is doing it as it’s just shocking otherwise. But unreasonable that they aren’t doing their own work.

And yes my typing is shit on my phone when supervising my autistic child (my down time)
i type much better at work.. .Before the pedants tell me I am also a troll as a dr would be better educated...

@Iceskatingfan thought provoking, thank you. The conversation was on the phone to GET an appt, not bringing up multiple issues in 1 appt slot. The intention was to wait until 1, utterly unrelated issue, was investigated with a likely long time lag before even addressing the 2nd. So frustrating. Thankfully it seems as though other people aren't having this same issue.

A good nurse can be better than a GP to see.

GP's seem t have locked their doors and be refusing to see patients- and no doubt hoping this state of affairs becomes the norm.

As for vaccinating- no one I know has been vaccinated at their own GP's premises, it's always somewhere else like a newly opened centre, or some large site maybe nearby- and not by their GP, who as I've said don't see any patients, but by a nurse.

YABVU.

Say no, my doctor only please

To CushionsandCandles, most GPs DO see patients after telephone triage if it is appropriate for a GP setting and isn’t obviously going to end by still needing to send someone to A and E regardless of the examination findings. Obviously if someone sounds like they are having a huge heart attack or a stroke etc then it makes no sense to waste time by bringing them in (remember we might already have non urgent patients booked so it could be a few hours before I can see them) and causing unnecessary delays to life threatening medical issues. Even more so because once they are worth us the ambulances respond less urgently as we have oxygen and defibrillator etc but still not the right setting for someone in that situation. That is not a pandemic issue, I’d have done the same before the pandemic. I agree if the history doesn’t suggest an obvious acute life threatening issue they should be seen before being sent to A and E of course and I’m sure there are a few rotten apples out there but we’re not all the same. I’m sure the same is true of secondary care, I can tell you none of our local secondary care clinics are seeing anything like 95 percent F2F. More like about 3 percent if I am being generous.

Daphnise, GPs have not locked their doors and refused to see patients, as many GPs on here have pointed out. Please don’t spread false and potentially harmful information to others. If your GP is really doing this, change GP. I’d love to know why I’m so stressed out dealing with all this imaginary work I’m doing!!

Cushion and candles...because you aren't in the community seeing the other several thousand patients seen by the GPS in the area your hospital serves during that time and if someone rings me with cardiac sounding chest pain, I'm going to tell them to call 999 not going to give them an appointment for 2 hours time... or get them up to my surgery where they will wait 4-6 hours for an ambulance as it is deemed acceptable of safety while the blue light ambulances get redirected away from someone who has already been assessed as being in need if urgent transfer to hospital..i can assure you we don't want our patients in hospital either and do not send them lightly and generally speaking your patients have already been filtered as needing f2f care. Ours haven't and not all do.. it is a different job...

OP yeah that’s shit service from the sound of it and I don’t think there’s any excuse for that, honestly either ask to speak to the PM to resolve your issue and/or raise a formal complaint. You should definitely have the right to be seen face to face by a GP if you want about something clearly needing examination and no reason that you should have to wait until an unrelated issue has been resolved. The only caveat is if you are one of those patients that calls almost every day with some new mad and usually imaginary health concern as there’s a limit to how many times I can reasonably be expected to see the same patient in one week especially when the issue is usually completely in their head 😂 But you sound quite sensible so I suspect the issue is with the practice and not you.

Daphnese... I have spent every weekend and my weeks annual leave vaccinating patients at our gp hub... not our own surgery as we do not have the space if facilities to enable safe distancing.. if only I could lock my doors..my life would be so much better
Yet again people who have absolutely no idea state utter crap as fact..

@CushionsandCandles Those figures really surprise me, as certainly my colleagues and I see the large majority of patients who we end up sending in as acute admissions. There is the occasional exception if I speak to a patient who, from the history, very clearly needs admitted and a face to face assessment would not change that but would simply delay the inevitable admission, but at least 90% of patients we send in are assessed face to face by us first.
An exception are patients who have become unwell with suspected or known Covid, as we have been explicitly told by the health board not to see them face to face and instead to refer them down the Covid assessment pathway. While this might seem silly, as in my out-of-hours role I do face to face assessments of Covid patients, it is what we have been instructed to do. Even more inconsistently, if a patient with Covid needs seen face to face for a non-Covid related reason (bloods for an INR for example) we are allowed to see them.

We are doing the best we can in difficult circumstances. I have no idea why the number of patients being admitted to your unit without face to face assessment are so incredibly high.

I don't know about sensible, but I go very infrequently, couple of times in the last decade so not a frequent flyer

YABU- I'm not a GP but a hospital doctor and we get referred patients all the time by GPs who have seen patients and sent them in to hospital.

GPs are working damn hard. We all are. Nobody is hiding away- just trying to operate as safely as possible.

Nurse practitioners are not better or worse than doctors they are just trained in a different way for a different purpose. They have areas where they have an in depth specialist knowledge that could be really beneficial to you. It's not as simple as saying you need to see a doctor. You might, but I wouldn't write off NPs. If you really do need to see a doctor, the NP will likely ask the front desk to arrange that for you too, or if they are around they might get them in for a consultation there and then. What do you have to lose by seeing a NP?

I think it's surgery dependent.

Mine always offered phone consults way before covid. And my GP was amazing at this. As ds sees 2 neurologists and it was usually about his condition but more needing a referral she'd ring me evenings as understood as school staff it was daft to miss teaching kids for hours to see her to ask for a referral to podiatry for new insoles!

During covid ive seen the nurse for blood tests and smear and GO and nurse together twice to have coils fitted (first one came out!) I've also had a ultrasound.

I prefer a phone consult for results/ consults for long term things etc. And if a quick call between a gp I trust and me means more time for people with new concerns to have f2f I think it's a great system.

So I'm really sorry you aren't getting a good standard of assessment and care.

I don't agree that nurse practitioners etc aren't as valid and good though and would see one of i needed f2f.

I can’t wait for things to calm down so I can see my regular GP again. She is well versed in a rare condition I have and I won’t have to explain why I use a wheelchair every single appointment to someone who doesn’t have time to read my notes.
I do echo your frustration and have a hernia appointment with a nurse tomorrow who has already mis diagnosed 2 things with me. 1 of which later required a 111 call which resulted in a GP call from my surgery and she berated me for not being in touch with them earlier yet I did try!
I fully understand the GPs are busy and overwhelmed but that doesn’t make the situation any less frustrating.

To didiplanthis I feel your pain! Stepping away from the thread now for the sake of my blood pressure, I suggest you do the same! We know we are working ourselves into the ground for the good of our patients but it’s a pretty thankless job these days. Not that we expect or need thanks, a reasonable workload and reasonable pay for what we do plus lack of abuse from the public is what is needed. One day when there are no GPs left anymore people will realise just how much we once did. And secondary care don’t understand. Just as much as I’m sure we don’t understand their pressures in this pandemic either and I give them grace for being under such stress in hospitals. Go and have a glass of wine and put your feet up xx

To be fair if you have an asymptomatic hernia you wouldn't get an operation in my area anyway so I'm not sure there would be any point in a face to face consult at all.