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

PS we are vaccinating every day on site at the surgery tooo now we have the Oxford one. When we had only Pfizer we couldn’t store it on site so people had to go to our sister surgery elsewhere which wasn’t ideal. But lots of GP surgeries are vaccinating on site.

@BuggerBognor

YANBU. My DH (consultant cancer specialist) and his colleagues are enraged by what they have seen from primary care in this pandemic. Patients are simply not being referred promptly because they are not being seen in person - it’s much easier to dismiss lumps and bumps if you aren’t actually bothering to examine, palpate and observe the patient’s condition. OTOH the practice nurses are apparently immune to Covid because (at our practice at least) they are flat out. Whatever GP’s actually are or are not doing, the optics are bad. “We’re far too special and important to see plague rats but feel free to infect one of our nurses”. I’m quite surprised by the lack of insight from GP’s into how it looks from the outside.

I don't know a single GP who would not bring a patient in to be examined who has found a lump. Some things such as skin conditions or arthritis are down to the individual judgement of the clinician whether it is justified to bring them in for a face to face appointment, but everyone knows you need to examine a patient who has found a lump. Far, far fewer patients are calling us about lumps, in part because there is so much disinformation being spread around by people like you that we won't see people and our doors are closed.

Plenty of us are playing a very active role in the care of patients with confirmed Covid-19 infection in the Covid hubs and GP out-of-hours service. I am accepting risk to myself to do my part to help with this pandemic, and while it is depressing that some people's perceptions of what we are doing is so incredibly detached from reality, we are quite busy enough without running a PR campaign alongside everything else we are juggling.

Our gp practice is running the same way it seems op. Except our Gp, if there is a hint you need to enter their building, they will just refer you to the hospital.

One of the Gp at the gp practice died from covid. So I understand their hesitation. The nurses are all available to be seen.

There are however, good Gp’s that haven’t stopped seeing patients. Dm gp for example, she and dsis both have seen few of them in the past year, multiple times each.

I don't know a single GP who would not bring a patient in to be examined who has found a lump
Out of interest would you expect that to be with a GP or nurse?

Nurses & HCP are usually doing Ear irrigations, blood tests, childhood immunisations, smear tests, new patient checks, Blood pressure checks, so can't do virtual appointments, whereas a significant number of dr appointments can be done virtually, at least initially. I'd rather my GP surgery not bring everyone in at the moment.

I agree with you OP. But then I also think I shouldn't need a GP referral to see a specialist and I should be able to self refer (as in some other countries). If I have a skin issue: call a dermatologist. If I have a gynae issue: call a gynaecologist. There's a time and a place for general practitioners of course. When I went private for a skin issue I started NHS treatment within days (only available on NHS) but had I done it all on the NHS the waiting time was 4 months to see a dermatologist to refer me (the same dermatologist I might add, as he did both private and NHS clinics).

@Purplerayhan

I don't know a single GP who would not bring a patient in to be examined who has found a lump Out of interest would you expect that to be with a GP or nurse?

I would not expect a practice nurse to assess a lump, as that is not their role, but a GP or Advanced Nurse Practitioner would be suitable. If our ANPs are in any doubt they will always get a GP to examine the patient too.

Sorry but I have many GP friends and they have absolutely not been working flat out throughout the pandemic. Other recently retired GPs offered their services at the beginning and found they had nothing to do. The strong message was - don't bother the NHS (GPs) and now that some GPs are doing vaccinations the message on the answering machine, if you call the surgery, is very much - don't contact us unless desperately urgent and, if so, call 999.

BuggerBognor... we do understand what it looks like from the outside.. but we also understand what it looks like from the outside ISNT what it looks like from the inside.. I totally understand why your husband is despairing.. so am I.. I have been there seeing patients every day, my suspicion for suspected cancer is sooo high as I know how hard phone triage is... I have seen EVERYONE I have even flickered might be a cancer symptom, I have seen and referred throughout. BUT I know not all my colleagues will have done and it breaks my heart to know that damage that does to individuals and to trust in the profession, at times it feels like some of us are fighting a very lonely and impossible war. . I also know that many many people were so terrified to leave the house, come to the practice or go to hospital that they sat silently on symptoms they should have presented and didn't. We cannot refer what we are not told about.. I know that happened because I have NEVER had a closed door, I have never refused to see anyone at any time and yet after the first lockdown my 2ww referrals rocketed. Not because I didnt/wouldn't see them earlier... they didnt come or tell me sooner because they were so damn scared of covid.

It doesn't help that the public doesn't see what GPs do outside of a rushed 10 min appointment they they're always late for.
I know they're doing other stuff, but what? Maybe the public need more understanding of what a GP job entails on a daily basis.

It's the same as teacher bashing - lots of people think teachers just teach kids between 9 and 3 and that's that.

It's hard to understand why many GPs aren't seeing patients face to face like 'normal' when it's business as usual for some other lesser paid professions.

@Speakeasy22

Sorry but I have many GP friends and they have absolutely not been working flat out throughout the pandemic. Other recently retired GPs offered their services at the beginning and found they had nothing to do. The strong message was - don't bother the NHS (GPs) and now that some GPs are doing vaccinations the message on the answering machine, if you call the surgery, is very much - don't contact us unless desperately urgent and, if so, call 999.

This is certainly not to experience the Gps I know are having. They are flat out and very stressed. My GP was booking in implant fittings on a Sunday. She wouldn't be doing that if she has nothing to do.

I have also bumped into my own GP while at work (I'm a nurse in a different area) in the reception area of more than one care home.

GPs are carrying on their thankless tasks, providing primary care to millions, just as always. The rota absences resulting from covid isolation periods just exacerbates the understaffing

YANBU the G.P’s at our local surgery are still effectively shielding according to their Facebook page. I’m wondering if they’ll ever examine a patient again.
I’d personally see the nurse whilst you wait for the G.P to see you- because who knows when that will be!
Ours are useless anyway, I ended up in A&E because she gave the wrong medication to me. Can’t wait to move surgeries!

@lydia2021

Say no, my doctor only please

Jesus wept. It isn't up to you to demand who you see. The NHS is more than bloody doctors. There are pharmacists, nurses, therapists, cardiac techs who are all really highly trained and might be more appropriate for you to see. It does not take a GP ( sometimes on a salary of upwards of £100k) to treat a bloody fungal nail problem, OA thumb, contraception or a sore throat. GPs are invaluable but expensive consultants and should be used as such, allowing them the time to focus on complex cases. We need better triage, better use of other health professionals and an education programme to enlighten the public about realistic expectations.

The GP's in our area ( community nursing) are working flat out and being pulled from pillar to post.

They are supporting the vaccination effort ( working in clinics alongside nurses).

We ( nhs) as a whole appear to be buckling under the persistent pressure, I have half my staff off with Covid related complications or stress and it doesn't seem like a day goes by without another team member breaking down from the sheer enormity of the workload and the relentlessness of it all.

Just because people can not see the work and the pressure does not mean it is not there.

Nurse practitioner here! I've been qualified 20 years, have a masters degree in Advanced practice, a bsc degree in Emergency care, 10 years as a prescriber and 15 years in ooh and community work. I find it insulting for you to insinuate I am unable to do my job.
If you have an asymptomatic hernia you are unlikely to be suitable for further escalation.
My GP colleagues are working hard. We all are. There are ways we can lighten the load and this is where I step in.
The pandemic had been hard fucking work and we are knackered. How about a bit of love instead of bashing. I still remember people clapping- what a joke!

@Suzi888

YANBU the G.P’s at our local surgery are still effectively shielding according to their Facebook page. I’m wondering if they’ll ever examine a patient again. I’d personally see the nurse whilst you wait for the G.P to see you- because who knows when that will be! Ours are useless anyway, I ended up in A&E because she gave the wrong medication to me. Can’t wait to move surgeries!

Have you actually needed a GP appointment in recent months or are you just assuming they're not examining anyone?

@BuggerBognor

We’re talking GI cancers here *@pbdr* so “lumps and bumps” was a euphemism. Far from spreading disinformation, I’m repeating what my DH (and his colleagues) tell me about the condition in which his patients are arriving at his clinics, which is a big part of the reason he looks as though he has aged 10 years since the pandemic took hold. Please don’t use words like disinformation” to describe what is a perfectly valid point - that is supremely arrogant (and I sincerely hope you don’t take that tone with patients).

DH patients are being “diagnosed” with piles and IBS and told to “wait and see”. They are not being examined. In many cases, they are only being referred to him with advanced disease - in greater numbers than was the case prior to the pandemic. The only difference is that primary care has retreated behind a wall of excuses.

DH sees every patient who prefers to be seen in person (and every new patient irrespective of preference). He’s “taking risk” (to quote your post) because he’s a dedicated doctor and it’s his job. He’s also pretty well remunerated for it.

You personally may be working harder than ever but something has gone horribly wrong in the presentation to the public somewhere. And it looks very bad from the patients’ perspective, which is why you’re copping a bit of flack as a profession.

@BuggerBognor We assess every patient who gets in contact with GI symptoms for red flags, and if they have none then a limited period of watch-and-wait is appropriate. If there are any red flags, or if a patient has symptoms that are not settling in the timeframe expected for something such as piles then they need examined. To quote you; “We’re far too special and important to see plague rats but feel free to infect one of our nurses”. I stand by my statement that you are spreading disinformation as that completely misrepresents what we are doing during this pandemic, and I'm not sure you're in much of a position to criticise someone else's tone.

I have referred more patients with advanced cancers since the beginning of the pandemic, but by far the most common reason for this is patients presenting later. Either because they had been under the false impression we would not see people, or because they had worried themselves about burdening the health system during a pandemic.

You seem to be suggesting that making any sort of risk assessment makes us less dedicated doctors. We have large numbers of very frail, vulnerable patients who would do very badly if they caught Covid. Particularly during the peaks of the pandemic, when few or none of these people were vaccinated, bringing people into the surgery at the drop of a hat for non-essential reasons would undoubtedly have resulted in more deaths. The risk I am concerned about is not to be, but to these patients. Seeing people face to face during an out of control pandemic is not always the safer course of action, which is why we triage on a case by case basis to decide what the right thing to do for each patient is.

@NerrSnerr I needed one. They have a post up on Facebook saying no appointments with G.P’s.
I went for a smear test though as they sent me two reminders, almost didn’t bother. Surgery was completely empty.

@Suzi888 did you call requesting a GP appointment or just took the word from Facebook. They must be seeing patients in some capacity even if they're triaging them first.

I find it insulting for you to insinuate I am unable to do my job
I wasn't, at least certainly not intentionally. Genuine question - why would it be your job to diagnose a hernia (It's v uncomfortable so possibly not asymptomatic) rather than a GP?

we're all going to have to get used not being seen by a GP, but another HCP instead in the coming years. The number of medical student going through the system is controlled, more GPs working part time and demand ever increasing, there simply aren't enough of them.

Nurse practitioners, Physicians Assistants, physios etc will be much more our first point of contact.

The GPs at my surgery are seeing patients. I was very surprised to be given a face to face appointment only recently for my DS (for something relatively minor and which turned out to be nothing) when I expected they’d want to assess by photo. GP had a medical student in with him too. My surgery was pretty crap service and a nightmare to get appointments at long before covid.

I’d make a written complaint to the Practice Manager OP and ask them to explain why doctors are not seeing patients.