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

You won’t necessarily get a face to face appointment with a private GP. I booked a private consult then the hospital rang and explained that they are only actually doing video appointments.

Thanks for the heads up.

It’s still worth pursuing them may just send you further afield for an appointment. I needed an emergency brain scan. Had it done within a week privately whereas I’d been advised it would be months to wait on the nhs 🤦‍♀️L

@Purplerayhan

Genuine question to the Drs here - why is it only Drs that are .We are trying to limit face to face contact with patients to reduce the risk of spreading around Covid-19 when other HCP have to do f2f? Hospital consultants are seeing f2f. Teachers will be in f2f classrooms. Specialist teams doing in house assessments. It clearly isn't ALL GPs, but I just want to see mine.

For real???? Think about it how long it takes to train one doctor.....

For care staff for example, you could train them in a couple of weeks. Yes they’re very important to society etc etc but they are replaced very fast. A GP isn’t.

As has been pointed out already, they are there for serious health concerns but not for non urgent things.

What patients feel is urgent doesn’t equate to what is actually urgent. So obviously you’ve been triaged and they don’t feel like you need to see a GP right now....

Also, I think you’re comments are off regarding nurse practitioners!

I haven't been seen yet, No. As I have explained up thread, it was a phone call to try and get an appointment. My key points about nurses are that they are doing more f2f, higher risk, lower pay, don't have the length/depth of GP diagnostic training and I'd quite like to see a GP about something that can be misdiagnosed. Not sure which bits you're finding objectionable? Surely it wouldn't be reasonable to expect a nurse to have the same GP training?

My very experienced and laid back GP colleague described last Friday as the busiest working day he can remember for many years.
We are working differently; we are triaging by phone or video and trying to minimise footfall at the surgery so that it is safe for our vulnerable elderly coming for tests and dressings and mothers and babies coming for maternity, post natal checks and vaccines etc.
We have had the expected rotation of staff off sick and isolating and a couple of staff on long term sick with long COVID. Doctors , nurses and administrators are plucked regularly from the rota for duty at the covid hub and the vaccination centre.
We have been seeing patients face to face from the start after a triage conversation. It is really busy. Think about the levels of stress on the various boards here, all the worries about money, family, jobs, health, children etc. This has a direct impact on GPs and the usual support services are also stretched beyond a point in some cases where they are useful. Think of your frail elderly relatives. You may feel that they are not being supported as they should be. You are probably right but it is not for the want of trying I can assure you. Every time I visit a frail person I feel the weight of responsibility. I don't want to give them COVID. Is my visit or a possible hospital attendance really in their best interests with the virus flying around.
These threads are depressing to me as I see my colleagues and DH at the end of their tethers but pressing g on and working really hard as they always have done. I am probably biased but laziness is not a common feature of GPs and suggesting that they are hiding to protect themselves is offensive.

@Purplerayhan

I haven't been seen yet, No. As I have explained up thread, it was a phone call to try and get an appointment. My key points about nurses are that they are doing more f2f, higher risk, lower pay, don't have the length/depth of GP diagnostic training and I'd quite like to see a GP about something that can be misdiagnosed. Not sure which bits you're finding objectionable? Surely it wouldn't be reasonable to expect a nurse to have the same GP training?

They triage and decide who is priority. At the moment, you’re not according to them.

Frustrating? Yeah, but with limited resources, that’s the way things are for everyone.

What if everyone demands to see only GP’s? and refuses the nurse practitioner? The waiting lists would be even longer...

Yes, agree. Doesn't mean it's right though or without problems.

TBH, my GP and medical staff are fabulous. The problem is being able to get through to try and even get an appointment with anyone via the phone or inperson. I have been calling regularly (I have several chronic conditions) for an appointment for an issue and the few occasions someone has answered the phone, there are no appointments. Try at 0800 the next day and get the same result. My pharmacy cant give me some of my repeat prescription because I need a drug review. I have called everyday for the past 2 weeks and when I have managed to get through, I am told no appointments. Even when I explain why I need the appt I am told to try again at 0800 the next day. I have enough AF medicine for 3 more days and then nothing.
I would be happy with a phone call with a GP or nurse....anyone tbh

@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.

Any delays in cancer referrals are likely due to patients presenting late, due to Covid fear.

@PurBal

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).

This is hilarious. How long do you think it would take before specialist services collapsed? Imagine every woman with heavy or painful periods sees a gynaecologist? Every person with acne sees a dermatologist? How many specialists do you think there are?

And if you have abdominal pain, which specialist do you want? Gynae? Gastroenterologist? Lower GI surgeon? Hepatologist? How will you know for sure?

GPs are gate keepers for specialists. We filter out the minor conditions, enabling them to manage the serious stuff. How’s a dermatologist going to treat skin cancer patients if all his/her clinics are filled with people with dry skin or mild acne?!

I've often found a nurse or nurse practitioner to be as good if not better than a GP.

1 example is when I was pregnant, presenting with pre-eclampsia symptoms and the Dr tried to check for the babies heartbeat 'There is no heartbeat' she said, and left the examining room! A nurse came rushing in, found the heartbeat straight away and apologised for the Dr leaving without a word... When she came back she was pretty flustered to see I was very upset... I mean she had told me there was no baby heartbeat and just walked out.

1. I'd had increasingly high BP, was put on more and more pills for it and every appointment was the same - take BP, be shocked that it was still very high, tell me all the risks of it being that high, raising the dose of the pills or adding yet another to take. One appointment I saw the Nurse Practitioner rather than the Dr. She was the first to actually ask me if I was 'ok'. I hadn't actually realised that I wasn't ok til she asked and I just cracked. She promptly signed me off work for a month with severe stress and slowly but surely my BP stabilised then finally started to come down.

So yeah, don't dismiss the nurses - they are often excellent at what they do and can be much more empathetic than the Dr might be.

@OwlBeThere

Nurse practitioners are very highly qualified. In some cases more so and more experienced than GPs.

This is my experience too. NPs and prescribing nurses seem, to me, to know so much more, especially about side effects and newer medications.

**This is hilarious.
How long do you think it would take before specialist services collapsed? Imagine every woman with heavy or painful periods sees a gynaecologist? Every person with acne sees a dermatologist? How many specialists do you think there are?

And if you have abdominal pain, which specialist do you want? Gynae? Gastroenterologist? Lower GI surgeon? Hepatologist? How will you know for sure?

GPs are gate keepers for specialists. We filter out the minor conditions, enabling them to manage the serious stuff. How’s a dermatologist going to treat skin cancer patients if all his/her clinics are filled with people with dry skin or mild acne**

This this and this

GPs are gate keepers for specialists.
THIS is exactly why I want to see one, but I can't get to see a GP. Well, not until someone with less expertise in the area, not in general, makes a decision that I can. Surely, as it's the GP that should be diagnosing? In fairness, it isn't all GPs, just my one (and some others judging be here) putting me off. Its so frustrating.

It's so frustratingly frustrating that I can't even punctuate properly anymore apparently.

YANBU in general, but hard to be specific without knowing what it is. Could you see the NP and then see if you are happy with the treatment - if they can't answer your questions then you can ask to see GP.

If that doesn't work I'd consider changing GP surgery. Occasionally I am asked if I could talk to the NP and I say yes if I can - or no, because it's a few different conditions interacting.

The posts on here claiming 'NPs are just as qualified as GPs' are entertaining but bonkers. Diagnostically, NPs are support staff trained to deal with simple conditions. This is a sensible concept but they do not have a medical diagnostic training and there are many situations for which they are not appropriate. Nurses are very important in their own right, but their main focus and the focus of their training is care not diagnoses.

My GP surgery do this, I was made to take the appointment with the Nurse who took one look at me and sent me into the GP next door!

This is not just about the pandemic. Demand for GP appointments far outstrips supply, and unfortunately an awful lot of people can't be trusted to judge when they actually need to see a GP vs when someone else could do the same or a better job.

Totally unreasonable. These people are trained to do what they do. Doctors' time is wasted dealing with clinical issues that don't require their expertise, whilst patients who do are neglected. You know that GPs don't just see patients but deal with many important issues in between?

Anyway you might as well get used to it because that's exactly how primary care medicine is evolving.

THIS is exactly why I want to see one, but I can't get to see a GP
WANT doesn't mean NEED. Patients are very good at wanting, not so good at assessing what they need.

www.bmj.com/content/367/bmj.l6326

We pay less per capital on healthcare than comparable economies: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US.

We also have fewer doctors per capita than these countries.

Despite this the NHS still scores well in many areas marking efficiency. There are other areas (life expectency, cancer outcomes, etc) that the NHS does not score as well in.

If people want a better health service, they need to lobby for higher NI. But they don't. They like to complain about the NHS being "a pile of shit" while it hobbles on massively underfunded compared to healthcare systems in other Western countries, although still managing to provise a service free at the point of use.

I hate the narrative that doctors are lazy.

I work 75% part time because I have a baby. That brings my FT hours (48hours) down to that of a full time nurse on my ward (36hours).

We can see a finite number of patients in that time.

What do the public want? 58 hours per week? 68? 90?

In my opinion the nurse hours are much more sensible and should apply to doctors too. I know I do a worse job when I am tired.

The fact that there are not enough doctors or nurses is not our fault, it is the fault of the government and a population who do not want to pay more NI despite paying significantly less for our healthcare than people in other western countries.