GP care or lack of it

[Scotdoc123]

I’m a GP and sometimes too avid mumsnetter (NC for this).

It’s very dispiriting that every time I look at the boards lately it feels like there is constant criticism of my profession. I fully understand the frustrations people have with not being able to access primary care and sympathise but surely people realise that we are experiencing unprecedented demand and the reason access is difficult is there are not enough clinicians available and not enough funding for practices and staff. It seems like the narrative is that the reason people to struggle to access a GP is that we’re all lazy and too busy eating biscuits to see patients. Is that really what the public thinks?

It feels like every bad encounter with a GP is used to smear the profession as a whole which I don’t see with other professions like nursing or secondary care docs. Of course there is no excuse for poor care but nobody is perfect and doctors are included in that. If you have one or even several poor encounters by all means complain and post for support but you should not generalise across a whole profession. Remember people who are satisfied with their GP care will be unlikely to post about it.

The other common complaint is “GPs are useless at mental health/gynae/etc” GPs vary a lot in their skill sets and interests and some have more expertise in certain areas than others. I am interested in both those areas for example and have undertaken more training in my own time and at my own cost. Certainly some GPs could benefit from more training in certain areas but the fact remains if we were to refer every patient to specialist services the services would not cope with the demand. In my area psychiatry services for example is reserved for the most severe mental illness, everything else is bounced straight back to us. The Royal College of GPs have been calling for GP training to be extended for several years - that would allow more training in specialist areas, this has not happened because the government won’t fund the extra training time. There are many postgraduate courses and diplomas GPs do in specialist areas but these are almost invariably funded by themselves, not the government or health boards.

Constantly stating on the internet that GPs are undertrained or not good enough in a particular area destroys the patient’s confidence in their doctor which can be detrimental to the clinical relationship.

The government want to run down primary care so they can get private providers in who will cherry pick the easy patients and the rest will be stuck. I firmly believe this will not offer a better service nor more value to the taxpayer. These threads are feeding exactly into that narrative.

AIBU to ask posters to consider this?

Try being a teacher 😂 Sorry, I'm joking ... sort of but yes I understand how demoralizing the constant smearing is. It wears you down

The issue you have is that GPs are the link between people and potentially life saving treatment. People are tired of clapping for the NHS when the quality of GP services are so poor in some areas (my own included) and they are frightened and in pain.

Teachers get it in the neck too, sympathise as my brother is one and works very hard. Feels like swings and roundabouts sometimes.

I just wish people would take their ire out in a positive way. Write to your MP, ask them to visit your local surgery and have a look at what the demand is like.

It feels like every bad encounter with a GP is used to smear the profession as a whole which I don’t see with other professions like nursing or secondary care docs.

Have you seriously missed the 'poor nursing care' threads? It's not just general practice that the people of MN have stories about. Did you not know these 'degree nurses' are useless, OP?

I don’t know how anyone has the energy to be a hcp or a teacher tbh. Anything involving that much contact with joe public! Fwiw I’ve been really happy with how our (doubtless overworked) surgery has managed things. Have been diagnosed with a chronic condition since the pandemic began and although I haven’t been seen face to face (except by phlebotomists!) I feel well taken care of. So it’s not the case that everything’s rubbish. I really appreciate how hard our gps work.

Thank you. For me personally my encounters with my GPS have been more than satisfactory: for example I had a nasty skin infection on my arm which needed antibiotics. I sent some photos to my doctor who correctly diagnosed the problem. I did not need a face to face for this and it avoided time off work. Many appointments do not need a face to face.

GPS are incredibly busy and I for one appreciate the work they do.

I was in hospital yesterday, a patient nearby was asked if he had discussed his issue with his GP - he replied it would be easier to get an audience with the Pope than a conversation with a GP.

I’ve been trying to get a GP phone appointment for 10 days, I can have it on 21st June at an unspecified time, it is any wonder people are upset?

Sometimes being ill can be very frightening, having to wait a month just to speak to someone can be the final straw.

I have missed the threads about nurses tbh I guess it’s selective attention, i thought the public narrative was nurses were all wonderful angels, thanks for bringing it to my attention it’s not just GPs. I would hope people would also think about how nurses feel if one bad experience is generalised across their whole profession as well.

Only time I’ve ever been unhappy about my GP was when they wouldn’t see my 2 year old son, rang for an app at 8am, I got booked in for call back from GP at 19:00 between then we ended up in hospital with him, got a call from GP to say it’s viral give him 7 days, so when I told them were currently in hospital and he’s being kept in on a drip he didn’t really know what to say and wished him well 🙄

@Scotdoc123 It is frustrating but I wouldn't take it personally because I've seen examples of poor nursing care and I'm sure you've disagreed with some of the work of your colleagues too, OP. Having the title and the job doesn't make you great at it, in any profession and peoples expectations are sometimes unrealistic. It's all subjective.

These threads usually turn into people sharing their stories of poor care though.

I've been happier with my GP since they introduced their covid telephone system thing. Most my issues can be dealt with super quickly on the phone and when I have had to go in it's been the same day.

@nancy75 sorry to hear you were not able to get an earlier appointment. The patient you quote in hospital may not have been able to speak to his GP but he may also have been selective with the truth. Very common for patients to allege their GP will not see them when that may not be entirely true. Last week I spoke on the telephone to a patient with a non-urgent problem going on for months. He has been referred for further investigation but not had the appointment through yet. He got angry and said he wanted it sorted now. I offered a F2F appointment the following morning which he accepted. He then went to A&E that night and demanded to be sorted there and then as he said he couldn’t see his GP so had been forced to come down.

He then did not attend his appointment the next day and didn’t contact to cancel. I phoned him about the A&E visit and he was at least apologetic. This is not uncommon and a GPs are useless narrative feeds into it.

Yes. Yab v v v v unreasonable.

Don't you feel guilty for hiding under the bed for a year while your A and E colleagues picked up your slack?

@aahshurrup I’m assuming that’s a joke? I worked in the community covid assessment centre as did many GPs and carried on doing emergency home visits all through the height of the pandemic. I do the odd shift in A&E and thankfully not the attitude of any of my colleagues to most GPs.

Perhaps you are the absolutely amazing GP that I had a few years ago that was kind and compassionate and helpful and never made me feel rushed (and even did home visits to my sick mother who was also her patient). If so, frankly, you should be teaching your skills to all new GPs because you are exactly what patients want.

However, YABU. Yes, the public generally do think you are too busy eating biscuits, as you suggested in your OP, to see them because the public have seen doctors walk into the surgery twenty minutes after their appointment time, take ten minutes to get a coffee and chat before starting to see patients (ok, the general public was me in that example).

It is human nature to take one example and create a rule from that. Bad example stick out more than good examples. So, yes, one bad encounter is often used to smear the profession. But don’t feel victimised. It happens to nurses, teachers, mechanics, social workers, bankers, and all those stroppy cows working the checkout in shops (you ‘now they are not all stroppy, right?).

With regards to ‘GPs are useless at ...’, you do understand that a GP is supposed to be a generalist? They don’t have to be good at everything. They just have to be good enough to pass things that are beyond their expertise to someone who can deal with it. Too many people have experienced being fobbed off only to suffer longer before finally receiving a referral. You see people who are at their worst and not always able to advocate for themselves. Many, many patients don’t want to bother their doctor and will go to see you when they are really, really struggling. They want you to understand that and help them. Too many don’t get the help they need in a timely fashion. You, yourself, have described rationing healthcare in your post. As the person with the authority to get an individual patient across the line to the treatment they need, yes, you are the person they will blame first. It might not be fair but it is entirely understandable.

The government want to run down primary care so they can get private providers in who will cherry pick the easy patients and the rest will be stuck.

Bullshit.

This is the sentence that made me wonder if you really are a doctor.

[quote Scotdoc123]@aahshurrup I’m assuming that’s a joke? I worked in the community covid assessment centre as did many GPs and carried on doing emergency home visits all through the height of the pandemic. I do the odd shift in A&E and thankfully not the attitude of any of my colleagues to most GPs.[/quote]
Correct, Gp services are a joke and have been since March 2020

I’ve had such a amazing care from my GP over the last year - Mainly mental health related. Unfortunately I’ve needed numerous phone calls and also had f2f. I also saw a GP f2f when I found a lump in my breast. Yes they are busy and sometimes I have to wait for an appointment but i can’t fault my surgery.

[quote Scotdoc123]@nancy75 sorry to hear you were not able to get an earlier appointment. The patient you quote in hospital may not have been able to speak to his GP but he may also have been selective with the truth. Very common for patients to allege their GP will not see them when that may not be entirely true. Last week I spoke on the telephone to a patient with a non-urgent problem going on for months. He has been referred for further investigation but not had the appointment through yet. He got angry and said he wanted it sorted now. I offered a F2F appointment the following morning which he accepted. He then went to A&E that night and demanded to be sorted there and then as he said he couldn’t see his GP so had been forced to come down.

He then did not attend his appointment the next day and didn’t contact to cancel. I phoned him about the A&E visit and he was at least apologetic. This is not uncommon and a GPs are useless narrative feeds into it.[/quote]
Gosh, why are you talking about your clients on a public forum?

Exceptionally unprofessional. Perhaps it's time to stop tithing about your ego and start thinking about your patients?

@DifficultBloodyWoman services have referral criteria and will bounce things back to us if we send referrals that don’t meet the criteria. I never refuse to refer a patient on if that’s what they really want apart from a few very specific cases where I really think it is not appropriate but I would always discuss these with secondary care colleagues, I will explore with the patient what we can do to manage their problem in primary care if I think that would be more appropriate but if they really want to see a specialist I will dictate the letter. The problem is we don’t have control over waiting times or referral criteria.

Why is my post about the government bullshit. You don’t think they want private providers in doing primary care? Or you think the private providers will offer a better service? I am a doctor, what is your background?

Don’t worry OP, I dislike nurses and teachers too

Op, it’s interesting that your first thought is that the man who couldn’t get an appointment was probably being selective with the truth.

His experience with trying to get through at 8am everyday, only to be put in a queue & told all appointments are gone was exactly the same as mine, so on balance I think he was probably telling the truth.

The upset that people feel at the moment is not because we think GPS are not good at their job, it’s because we can’t get near one (on the phone or face to face)

@aahshurrup it’s not unprofessional to discuss work in general terms. Doctors have written books about their experiences.

@nancy75 it’s not my first thought but I’m just saying it happens

OP the thing is, many GP practices are very badly run.

This is not the fault of all GPs. But hospital drs do not organise their working practices in the same way that GP surgeries, which are basically independent contractors, can do. If you read the threads here you will see that many surgeries engage in silly wasteful practices like making all patients ring at 8am, only operating same day services, and making phone appts with no assigned time so that people cannot work their day around it. These things result in people being unable to access primary care when they need it.

It is absolutely possible to run things better in many cases. That is why GPs get stick IMO.

Thanks for all the supportive comments everyone.