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?

"A doctor in psychiatry"? You mean a trainee?

Nothing wrong with being a trainee if you are, but that's a really weird turn of phrase and makes if sound like you're trying to hide something.

Like, you're actually a dermatologist but, drawn to the glamour of community mental health, have managed to smuggle yourself into an EIP team and spend every day hoping you won't accidentally correctly diagnose a physical condition, revealing your non-psychiatrist status.

Namechanging I'm not a primary care Dr I'm just debating a point on a sunny Bank Holiday day off on Mumsnet. I don't make any money out of it either way so I think corrupt is a bit of a strong word to use.

People talk about GP practice as though it's a normal business subject to competitive forces when it isn't and that's all I was trying to explain. Someone was comparing it to a courier company.

Is the existence of private schools or private dentistry despite people paying taxes for state education and dentistry corrupt? These seem to be accepted matters.

I'm just telling it like it is. There will be a 2 tier health service in this country before too long where those who want to will pay to get a convenient service via private GPs and those who can't will have to slum it in the NHS. That's my prediction.

Staff grade?

My usual GP 'isn't taking appointments' for whatever reason at the moment. Instead, I got a phone appointment at a non specified time in 3 weeks time - yay!

The thing about private GPs is that they make it easier for the individual patients, but since the system as a whole doesn't really have more GPs (perhaps some would quit altogether if private weren't an option) it doesn't produce a net benefit and private medicine can wind up taking resources from the public sector. Canada tightly restricts private pay in part for this reason--most services that are paid for by provincial healthcare can't be provided via private pay.

Doctors in the US and Canada were providing services via both telehealth and in-person this whole time. What I am hearing from family and friends back home has been worrying to me.

Not trying to hide anything.
Specialty doctor after core training, having a bit of a break from having little say over where I work and the commute, portfolio etc, before higher training. I thought it explained enough for the topic of the thread.

Fair enough, it was just a kinda weird way to say it

I never really know how to say it, as other than “junior doctor” or “consultant” there is a lot of confusion over what the grades are, even amongst allied health professionals.
When I was a trainee and told people that (which obviously I did) I got a lot of people thinking I was a medical student , and lots of people thinking only foundation doctors are junior doctors.

Yeah, it's all very opaque to an outsider.

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

GP’s are seeing more patients than ever

Presumably because there’s a massive fucking backlog of people needing to see a doctor as they’ve been denied the chance to do so over the past year.

You are the target customer of the courier service. You are actually not the target customer/ majority service user of the GP surgery

No I'm not the target customer of the courier service. I'm a customer of the retailer who subcontract services to couriers.

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

Nope they treat all customers as customers. The reason I used it as a comparison is because its a subcontracted service with clear SLAs and services around delivery.

If you are going to rubbish a business comparison its not a bad idea to know something about it.

How often do you or I go to the GP?

Nowhere near as often as I'm supposed to. I'm disabled with a couple of chronic conditions. Some of us manage to hold down professional jobs you know, many more are on zero hours and can't afford to lose a day's pay because GP practices decline to use basic customer contact protocols.
I noted that the hospital department consultants/staff all managed to give actual appt times and call within an hour of that timeslot. Its only GPs who apparently find this an insurmountable problem even for scheduled appts.

When I was healthy I rarely visited, my now adult DC have rarely visited (although point out to me that whilst practice nurses are doing F2F appts their GPs were not and that family planning services were pretty thin on the ground).

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.

So basically your argument for poor service provided by some GPs is not to look at what works in good practice or to learn from other industries but to protect antiquated business practice and tell the main funders of the service "sod off, you don't matter".

I've voted all my life to pay more tax for state backed health care. I'm fully aware of the problems of funding. However this persistent attitude of nothing is ever wrong, the NHS can learn nothing from outside because its so "speshul", the only problem is money, if you have a lousy GP practice it must be something wrong on your side because they can't possibly be wrong etc etc will be its downfall.

If primary care doesn't modernise and reward good practice whilst holding bad practice to account support will wither and die. And probably blame the patients for having the temerity to want a service.

Incidentally the most vociferous complainers about poor practice I hear amongst my own family and friends are doctors and other HCPs. A cousin is retiring after decades as a GP - she is frustrated beyond words and the lack of consistency in her area which results in good practice being overwhelmed and poor practice escaping any penalty. They all get the same budget model.
The consultant in the local big A&E department can give you a list of good and bad GPs in the area without batting an eyelid simply from who comes through his doors. I bet your A&E staff and many other specialities could do the same.

I am a secondary care Dr of course I can tell you who the good and bad GPs are

There is variation because each is its own separate small business. They all have the same contract and very little variation in SLAs. However market forces don't really operate because demand hugely exceeds supply and whilst some people do avoid registering at worse practices there are enough who can't or don't to keep them going.

I do not think the NHS is perfect and cannot learn anything from anywhere else
There are 2 threads like this so I can't recall if it's this one or the other that I said GP partners have expertise in diagnosing and treating illness and not particularly in management of a practice and that it's likely they would benefit from more management expertise but that isn't funded or easy to attract. In fact the general public likes to lambast any spending on management as wasteful

I also think it's the other thread where a GP explained why secondary care can offer appt slots and primary care can't which is fairly obvious really it's because of unplanned vs planned care. If you phone on the day for an emergency then a clinician has to triage the order of urgency so the receptionist can't tell you when the call back will be. A&E don't offer you a slot either do they? For non urgent appts they used to give you a slot but this has gone by the wayside in the pandemic because they are overwhelmed with everything being urgent and have been asked by NHS England to do 'total triage' apparently (that but I understand less well)

I am not saying how I think things should be but rather how they actually are. I think that comparing NHS GP services to an ordinary commercial company doesn't work. GPs who do provide a better customer experience don't get paid any more than those who don't
The sanction for providing a really bad service is getting shut down by CQC but that is only if the practice is really really bad.
Private GPs obviously can and do have a workable business model based on excellent customer service for those who can pay. The NHS is more like the Post Office than a private courier. It cannot pick off the more commercially viable clients it has to provide a service to people who chew up a lot of resources for the same income.

I expect that in the end the private sector will cherry pick off the easier to manage stuff and a two tier system will develop like there is in dentistry or indeed education. I don't want that to happen because my patients are the ones who will be left behind

I think just telling GPs that they 'must do better' is not going to resolve any of the problems which are to do with demand vastly exceeding supply and a lack of incentive in the contracts to reward the things that people in this thread want to be improved.