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?

If GPs want to avoid criticism then they need to up their game a bit. They could start by devising an adequate appointment system so that the people that they have agreed to provide primary health care for can get an appointment (virtual or in person) in a timely manner. Beyond ridiculous that we are all discouraged from contacting them by the thought of 2 hours on hold.

F1, F2, and GP registrar are jobs. The NHS benefits quite substantially from the labour of junior doctors. It's absolutely a two way street.

I agree that the appointment systems at many surgeries are terrible, but there's too many patients, not enough GPs, and targets to hit. I'm sure some surgeries could improve how they handle it, but at some point they can't.

However, I really think from reading social media, and our own experiences, that the real problems with GPs for patients are:

1. Relatives and friends who have gone to their GP for months or years, to be fobbed off until they find out at A & E that it’s cancer or some other serious condition.
2. Surgery doors have been closed during Covid - when retail, delivery people, bus drivers, etc mainly on NMW have worked throughout; and now most customer facing businesses have reopened; but GP surgeries still haven’t!
3. The failure by GPs to recognise that people of working age, the elderly, disabled, etc cannot spend up to 55 minutes in a telephone queue to get an appointment with a GP, and especially if they are in a customer facing role like teachers! Then there is expecting elderly people all to have a smart phone!

Doctors are supposed to be intelligent people - could you spend 40 minutes in a telephone queue, and then have a telephone triage appointment, while in the middle of seeing patients? Why then, set up this system for patients and be surprised when they complain?

www.bbc.co.uk/news/health-57229848.amp

GP’s are seeing more patients than ever

1. If most people were really being misdiagnosed by their GPs with cancer then more would be getting struck off for incompetence and it would be national news. Bad news is always a story but far more people are being correctly diagnosed than misdiagnosed it's just that's not news. A&E are not somehow any better. They misdiagnosed my serious condition and sent me away in renal failure despite me actually telling them the correct diagnosis.

It really isn't true that most GPs are incompetent and that perception is just what the OP was sick of hearing. We could have a system where every person who thought they had cancer was just referred to hospital for batteries of tests but that would result in a huge waste of resources and would take them away from the people who actually have cancer.

1. Surgery doors being closed. Surgeries are where people go when they are ill. As such they are ideal hubs for Covid transmission far more so than a supermarket or a cinema where people do not specifically go when ill and symptomatic coughing over everything. You can tell people not to do this but the do it anyway. At the very start of the pandemic if you recall a GP was instrumental in spreading Covid for just this reason. That's why they have stayed shut because they are high risk for super spreading. Maybe they should be more open again now but they were not wrong to close.

1. I hate the 8am hanging on the phone too but People of working age are not the majority consumers of GP services. You are not the target audience therefore services are not designed for your convenience. The great majority of people using GP surgeries are elderly or babes in arms with mothers on mat leave.

There exist private online GPs who cater fairly exclusively for working age people and recently I've been surprised how many of my friends have gone over to using these for their fairly infrequent needs for some antibiotics for a UTI etc. It's probably a good idea for that kind of stuff. I think more of these will spring up if there is enough demand. GPs majority clientele these days are older people who are retired and who have multiple conditions eg diabetes, heart disease, COPD I suspect in the end the private GPs will cherry pick all the largely well people and NHS GPs will be left to deal with the difficult stuff.

I am not a GP. I am a hospital Dr so I don't hugely have skin in this game but I just felt those points out to be made.

And yes from F1 Drs are working and being trained on the job. Post qualification training is more than paid for by their labour. Yes medical degrees cost more than history degrees. So do science degrees but this country needs more Drs and scientists than it does history grads so I guess that's why these degrees are relatively subsidised. They could allow unis to charge the real costs of degree courses and see if people will pay but that would not do much for the already piss poor diversity in medicine.

It's no coincidence that many of these part time GPs are women

I don't know a single GP practice in this area at least where there are not as many part time men as women on the list. I think it has far more to do with primary care being the gatekeeper to health care in the UK. Its inevitable that it will get the most attention - for most people its the only health care they try to access.

You are not the target audience therefore services are not designed for your convenience

Seriously? Can you think of any service or business where this attitude of "tough shit, you just pay for the services, we don't have to make it available to you" is acceptable?

Do you really think that its acceptable for receptionists on minimum wage to be used as cheap triage by GP businesses? Or that people should have to lose a day's pay and then not be called back? Even 40p per parcel couriers can give me a better delivery window than that and don't tell me they have big budgets.

I get the funding problems and the cost limits on services. However many of the problems people complain about are the result of bad and inconsistent business practices and the attitude that patients should be "grateful" for a service they are paying for rather than appreciate when good care and service is provided. Good customer service actually saves time and money for busy professionals but to introduce it you have to accept that just sometimes, medicine can learn something from other sectors.

Good practices end up being overwhelmed with demand, bad practices just carry on regardless. How does that help the NHS or patients?

That was my point
You are the target customer of the courier service. You are actually not the target customer/ majority service user of the GP surgery
If all the courier company's customers were elderly, infirm, retired and home all day then they might not place such an importance on giving a tight delivery slot. They might prioritise other factors more important to the majority of their customers
If you were a housebound 90 yr old or a retired person with poorly controlled diabetes and angina you might think it was in fact a good service because it's designed for you.

How often do you or I go to the GP?
For me it would be maybe once a year or once every few years
I actually didn't even realise the place had moved and that was over a year ago
When my kids were tiny I probably took them few times a year for various minor ailments. Now they are teens and I can't recall the last time either of them needed a Gp either.
Most stuff I manage myself. I buy over the counter meds from the pharmacy for my reflux and occasional UTIs or thrush and emollients and 1% hydrocortisone for my DDs mild eczema.

There are people in the GPs every week with ongoing conditions and most of them are elderly and/ or don't work so it's hardly a surprise to me that services are more oriented to those that use them the most.

I know lots of people will now pop up and say they work and are in the GP all the time but statistically it's still going to be a tiny minority.

If I am not tge target audience of my GP practice maybe they should advertise as 'for the old folk' and someone could set up an NHS practice which caters for those of us who are working who also need to see a GP.
I think GPS should more ne ashamed of themselves that their service is so bad people have had to turn to private GPs.
As a mother with a baby on mat leave I will tell you this telephone at 8.30 and pray you are lucky system don't work for me either. Iam about to turn to work with a baby who needs much on going monitoring by my GP surgery.
My GP surgery is paid just as much yo have me on its books as the elderly lady down the road therefore the service should also cater for us.

If it were a proper private business it would work that way but it isn't

If the GP surgery needed to attract more business from working people then I guess it would change the way it works but the last thing it wants to do is actually attract more business as it can't cope with what it does have already and, as you point out, they get paid much the same whether you consult them or not in fact.

If your local surgery doesn't meet your needs then you could register with a different one and then maybe they would get the picture because ultimately they are paid by the head and if everyone defects to the next place over they will be less viable. However if the better place had a full list they might not take you. Demand exceeds supply so competition isn't going to work to drive better standards of customer service.

The government as the monopoly payer would need to put incentives or penalties in the GP contract if it wishes to drive a particular appointment system. As it stands I can't see there is any incentive for GPs to make appts more convenient for the minority of their patients if the majority are OK with the status quo.

Possibly if significant numbers of easier to look after patients defect to private practice they may change but likely they will have enough to do anyway looking after all the old infirm retired people. A two tier system is likely to develop as already exists in NHS dentistry.

DH is a GP - he always says the reason you can’t get through on the phone when you want is because so many other people are ringing. You can’t always have an appointment when you want as someone else has already booked it.
The major problem is that the population has grown in each GP area but the numbers of GP’s decreases each year.
DH is the partner in the practice, the others are locums. DH is leaving and the locums are returning to their own countries. They haven’t been able to get any other GP’s to take on the practice so it will close and 9,000 patients will need to find another GP in an already overcrowded area.

The boomer generation are apparently the problem (as with everything)
There are loads of them and they are now getting old enough to get sick.

Plus the expectations of healthcare have hugely expanded. Just in my own field Adult ADHD and autism were not recognised things at all ten or 15 years ago. Now loads of people are recognising that they might have symptoms, want to be diagnosed and have a service. Nothing wrong in that at all. I'm not saying they don't have needs but that is all extra health demand for a service that just didn't previously exist at all and there was no expectation that it should do.
If such services are additionally going to be provided then something else has to stop or there has to be more funding. We are running out of stuff we can cut and stop. No-one ever wants to cut or disinvest a service but demands for more and new services keep rising and there is no more money to pay.
People are outraged that there is no proper adult ADHD or autism service in our area but in order for us to create one we'd need to cut or stop other services for our traditional clients people with severe psychotic mental illness.

It is perfectly reasonable to criticise GP or GP surgeries when they under perform, they should be held to account the same as any other professional service provider. I have a friend who is a GP , worked in both the prison service and A&E during the pandemic and had an absolutely torrid time. I have nothing but respect for him. That does not give Carte blanch for poor service in every GP surgery across the country. At my local practice the receptionists, nurses, paramedic and health visitor have been seeing patients in person throughout the pandemic. No sign of a GP though, I had to take my baby daughter to A&E on several
Occasions, when she needed to see a dr. Is the GP more at risk of contracting Covid than the practice nurse doing my smear test or giving vaccines to my baby? I fail to see how that is reliving pressure on the NHS and in particular Hospitals. The NHS is a wonderful institution, however it is not perfect and it is ridiculous to suggest that it cannot be criticised.
Have you ever considered that patients may have genuine cause for complaint?
I don’t believe in private healthcare: I have had a BUPA plan , through work, for 8 years and have n bet been able to use it. It doesn’t cover A&E , or having a baby or pre existing conditions.... in fact you need an NHS GP referral to use it! Private healthcare is not the answer... but the NHS primary healthcare is a mess.

Plus the expectations of healthcare have hugely expanded.

This in bucketloads. Over the past 30 years there has been a consistent effort from charities to raise awareness about various different causes. Most types of cancers and sepsis, to name but a few. Of course its great if these illnesses can be caught early, IF that means a better outcome for the patient (and contrary to popular belief, it doesn't always). However, the reality is that the majority of patients who consult because they have symptoms that could match these illnesses, do not actually have the illness. How often do you see people on here saying "if you're worried, best to get it checked"? So this, right here, is a big reason about why you can't get an appointment with your GP. The demand from people who want referral/reassurance for these things is staggering, and mostly, people do not have the disease in question.

So how do we manage this change in society's demand for healthcare? No additional funding has been allocated from the government for managing this change in the way society accesses their GP. Additionally, the charities who raise awareness often also raise lots and lots of money for their chosen cause which gets filtered into research or secondary care. But the brunt of screening for these falls to primary care who receive absolutely none of the proceeds.

That doesn't even cover the amount of health anxiety these charitable campaigns dredge up in people who are already health-aware, nor the impact that that health anxiety has on the people who have to manage it - primary care again.

These threads always go the same way. A few supportive comments, then more and more anecdotes about how some GP at some time failed them or their family member, without any context about the consultation, what the GP actually said and what safety netting there was. Then it descends further, into people trying to justify why doctors don't deserve the same employment rights as everybody else. If this is actually your opinion you need to take a long hard look at yourself, and start asking more probing questions about what is going on here, because I will add my voice to the chorus of doctors who are telling you that it is nothing to do with laziness or inefficiency.

@Parker231 what is your DH going to do next?

DH is buying into a partnership (probably) - not at all convinced it’s a good idea. They recently advertised 2 jobs, no applicants for the partnership, 2 applicants for a salaried post...

DH is French Canadian - came to the U.K. on a scholarship. Our DT’s have finished Uni and have got jobs overseas. As a result of Brexit we decided we didn’t want to stay in the U.K. so are moving to Quebec when travel is more normal again.
Good luck to your DH.

I'm a HCP and I'm sorry but I've lost all respect for GPs over this pandemic.
I have watched patients and my colleagues in community being fed to the lions, when Prima Donna GP's repeatedly refused to do any home visits to houses where covid was even remotely suspected.
I've lost count of the number of referrals I've had where someone has "gone off their legs" (because of covid usually) and couldn't get out of bed, can I go and assess for a hoist? Oh and while I'm there can I do basic obs and ring them through (on a line thats always engaged), because the GP is too busy or too precious.
They are the biggest waste of space ever. You do not need all that training to prescribe antibiotics for a sore throat or eczema cream for a rash or sign another sick note. ACP nurses are more than capable of doing that, in fact, I watch them do so much more than that every single day.
I've watched ACPs and district nurses argue with GPs a lot (usually where the GP refused to diagnose a rare disease that the ACP has spotted) and they are usually right.
From what I see GPs have become a signposting service, the most expensive triage service in the world.
Primary care is a disgrace and it needs sorting.
The move away from heavy handed prescribing to social prescribing and wellbeing is a good one but it's what physios and OTs have been preaching for decades.
We need to stop glorifying GPs and we need to stop paying them as if they are surgeons, because by contrast, every hospital doc I've worked with has been utterly dedicated.

@Serin - you may know of a GP like that - I don’t. The decision to restrict f2f appointments was decided by NHS England, not the GP’s. However my DH has done visits to care homes and patients (without PPE when it wasn’t available). He also volunteered and worked on a Covid ward in a local hospital. He has worked on average 70 hours a week seeing patients remotely and in person.

As mentioned earlier, he is leaving and9,000 patients will have no GP. Perhaps you would like to do the training and become a GP?

Nice post Serin.

I think the world of my fantastic GP. She’s amazing.

Nasty bitter post.

DH is a GP - he always says the reason you can’t get through on the phone when you want is because so many other people are ringing.

See, this is why they pay em the big bucks.

I cannot thank my GP enough. I’ll never know for sure but I’m pretty certain he saved my daughters life earlier this year.

I’ve had a number of GP and hospital appointments for myself, my daughter and home visits for my frail elderly father and have nothing but praise for both GP surgeries.

My Dads cancer was diagnosed very late but that was due to repeated cancellations of scans at the hospital , nothing to do with his G.P.

I hate the 8am hanging on the phone too but People of working age are not the majority consumers of GP services. You are not the target audience therefore services are not designed for your convenience. The great majority of people using GP surgeries are elderly or babes in arms with mothers on mat leave. There exist private online GPs who cater fairly exclusively for working age people and recently I've been surprised how many of my friends have gone over to using these for their fairly infrequent needs for some antibiotics for a UTI etc. It's probably a good idea for that kind of stuff. I think more of these will spring up if there is enough demand.

We are not the target audience?! Perhaps someone should consider providing primary health care for us then as if we snuff it, you have lost your funding.

I use private GPs when necessary but I shouldn't have to. Blithely informing sick tax payers they aren't the target audience for an NHS they pay for, then pointing private GPs are available and work well, is rather corrupt IMO.

parker

I think it's a pity you are describing your partner making a career choice that will leave thousands of patients the worse off at a time when doctors are desperately needed, without a word of regret or compassion for those who will suffer. I'm not saying he doesn't have the right to do it, but your lack of compassion is striking. If it were my partner, this would be a very, very difficult thing to do.

People are outraged that there is no proper adult ADHD or autism service in our area but in order for us to create one we'd need to cut or stop other services for our traditional clients people with severe psychotic mental illness.

Which also barely exist. Those services have been cut year on year until there's almost nothing left, just a clozapine clinic and an emergency service for those at risk of imminent death. These services get cut to the bone whether you set up an ADHD clinic or not, it makes no difference when someone sees cuts to be made.

DH has worked as a GP for 25 years and will continue to do do, just not in the U.K..

He has spent today meeting with the local Iman at the mosque to try and increase vaccination rates. He spent yesterday at a care home with a patient he has known for years who is dying. She wants to remain at the care home and DH is working with the care home staff to see she gets her wish - hardly the actions of an uncaring GP.
The fact no one wants to take on the practice is a bigger issue - GP’s are leaving and not enough doctors are deciding to train as a GP.

I’ve had really good experiences as a patient and professionally with GPs over the pandemic.

I’m a doctor in psychiatry (psychosis team) so a lot of my patients are a particularly vulnerable group who have a high rate of serious medical conditions and are not always able to advocate for themselves. Some also have concerns about being tracked via electronic devices so don’t like virtual appointments for that reason. The GPs in our locality have been great at providing them care over the pandemic.

From a personal viewpoint (I’m less than full time because I have a chronic medical condition- which is another reason not all doctors work full time!) they have been great with still providing me care and regular blood tests for my condition during the pandemic.

My mum had a breast lump, was initially phoned by her gp, who then saw her the same day, referred to breast clinic, who saw her within a week.