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?

@aahshurrup What? As the close family member of two hospital doctors I have never ever heard any clinician refer to GPs in that way. What on earth makes you think that GPs have been doing nothing all year? Or, indeed, that A&E has been overrun - I've heard of more calls being put out to reassure patients it was perfectly safe to come because their numbers had dropped so dramatically since the start of the pandemic (especially in paediatrics which caused no small measure of panic amongst the staff who were sure there were children who should be in hospital who weren't because their parents were too scared to bring them). Although there is one school of thought that a silver lining of the last year is that is has reminded patients that A&E is, indeed, for accidents or emergencies, not general ailments. Our GP surgery has a notice up reminding patients they can attend there for minor cuts, burns etc.

I have to say my gp and community teams have been the only constant from the NHS during the pandemic. My family can't thank our primary care team enough.
The NHS is chronically underfunded and has been for a long time and unfortunately a lot of care falls inappropriately to primary care settings.
I'm waiting for emdr already 2 years on the waiting list and I'm told it could be another 4 years.
Should have had complex surgery in November 2019 but hospital stopped all non emergency surgery due to winter illnesses (unfortunately they can't predict this happens every year) got moved to April 2020 (got cancelled), I'm still waiting for a new date.
Dc1 has complex medical conditions and needs to see consultant but has been unable to see anyone in secondary care yet we've had 3 different specialist teams in primary care visit at home to give care.
There seems to be a big disparity between primary and secondary care in my area. There is long term issues with funding, politics, staff morale, people accessing/ expecting care when they don't really need it, historical issues with long waiting lists (my trust gets around the waiting list policies by reassessing you and moving you to another list to stop breaches). We need radical changes from government level but lead by clinicians, we need people's expectations to change, clinicians need to be able to refer on in a timely manner (not having to keep checking in on a suicidal patient because mht can't take over care), people need to be encouraged to self care before they access services. Some of the changes my GPs have implemented recently are better /some not so great, some I imagine cost more some less I hope practices will ask patients what is better and worse when they assess how things will look going forward.
Remember for every disgruntled patient there's probably 100s of satisfied patients you just don't hear about them on here /in the media. Even when patients are complaining its often not about you but about the system.

I can sympathize I am one of those awful NHS nurses who got ripped to shreds on another thread. It seems alot of Mnetters have it in for teachers and NHS staff.

GP services are underfunded and stretched, the public hear about or have a bad experience, and that is it all GP's and nurses are to blame.

I didn't ask to be called an angel/hero/keywords, just trying to do my job in increasingly difficult circumstances.

I have contacted my GP alot over lockdown and had a fantastic service each time. My advice stay away from any thread that mentions HCP or the NHS. I found myself quite upset with the last nurse bashing thread. However it's a bit like a moth to a flame I have to look. Don't dwell on what some random people on the internet say. Do what I do just keep going to work and do the best you can. Hopefully it will be another professional in the firing line soon.

You don’t think they want private providers in doing primary care?

GPs are private providers doing primary care.

I don’t think this is a new thing though one that is perhaps more noticed. As a foundation doctor in 2013 I did a rotation in GP. I had one appointment with a man who complained about how hard it was to get an appointment. I started to explain (after a recent teaching session) that a practice with the number of registered patients we had and the number of doctors and nurses and other HCP we had, the contractual requirement was to provide roughly 1000 appointments a week across all professionals. Before I finished, my patient interrupted and said he understood that that was a huge number and completely unrealistic. I replied that actually, my practice was, at that point offering almost 2000 appointments a week. I didn’t add that people like him still weren’t happy but it wasn’t the fault of the staff. Either the patients were asking for too many appointments or the contract the GPs had funded too few. I don’t know which is the truth but when the practice offered double the number of appointments compared to what their contract stipulated and people still complained about being unable to get one, it wasn’t due to the GPs and other staff being lazy.

[quote Strikethrough]@aahshurrup What? As the close family member of two hospital doctors I have never ever heard any clinician refer to GPs in that way. What on earth makes you think that GPs have been doing nothing all year? Or, indeed, that A&E has been overrun - I've heard of more calls being put out to reassure patients it was perfectly safe to come because their numbers had dropped so dramatically since the start of the pandemic (especially in paediatrics which caused no small measure of panic amongst the staff who were sure there were children who should be in hospital who weren't because their parents were too scared to bring them). Although there is one school of thought that a silver lining of the last year is that is has reminded patients that A&E is, indeed, for accidents or emergencies, not general ailments. Our GP surgery has a notice up reminding patients they can attend there for minor cuts, burns etc.[/quote]
That's nice, dear.

My GP refused to examine my 9 year old with a UTI and abdominal pain last summer. The surgery completely washed their hands of her and said A and E was her only option to be examined.

We'd already had a telehealth appt with a private GP. They (rightly) advised that without laying hands on her they couldn't be certain that it was only the UTI causing the pain so someone would have to examine her in person.

Our GP surgery (literally) wouldn't touch her. Told us we'd have to go to A and E if we expected an examination.

The A and E doctor was amazing, though. So thorough, ended up chasing through results and a scan appointment the GP had not, despite being asked over a period of several months to do.

If only GP surgeries were as efficient as A and E departments.

@ChloeCrocodilei I meant big business, Virgin health or similar rather than GPs being independent contracters. I think the government are quite keen to give contracts to their pals tbh.

Generally on public forums such as this you’ll tend to read about negative experiences rather than positive ones. However, as a GP surely you must recognise that GP services aren’t fit for purpose in today’s society, and that’s one of the reasons that society gets frustrated about the care (or lack of care) that they receive from their GP.

It’s a know issue that GPs don’t receive adequate training in women’s health such as the menopause (unless the GP has a specific interest in that area or specialised in the area at Med school), and that the NHS is underfunded in areas such as mental health.

It happens with most public services though - think teachers, police etc all have been rinsed in mn, the press etc

I think people feel that those in public support roles have some sort of superhuman vocation for their job and should be completely perfect at all times and never switch off or have any kind of personal life or opinion, rather than realising that we are just humans, doing a (often not particularly well paid) job which is not the sole focus of our entire lives.

Plus the rest of it is just exposure- people know (or think they know!) what a teacher or gp does because they've been to school and to the doctors and so feel qualified to think what they personally do so much better. You rarely get people moaning about how incompetent astronauts or senior concept artists or commercial systems implementation leads are....

Sorry I need to head to bed now but thanks for so many nice comments - it’s really appreciated and I think I didn’t realise how many other professions are getting a hard time too, so sympathies to all others feeling this way.

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?

Again, it is sentences like this that made me wonder if you really are a doctor.

As a previous poster pointed out, you (as a GP) are a private provider.

The general public simply have no concept of what really goes on behind the scenes.
When a service is over stretched and under funded, many experience substandard care and feel understandably hard done by.
For every excellent GP there will be one who doesn't care or is incompetent.
I think it's important to get away from the days when we wouldn't dare question our doctor. However, I'm by no means condoning the harsh criticism often faced by hardworking doctors.
There is a perception that they should be some sort of 'super human' who never makes a mistake and knows everything.
As an aside OP, I'm a vet and people love to criticise us too. Just be glad you don't have to charge your patients. Most days I have people telling me I'm 'killing their cat' or I 'don't care about animals' because they can't afford the cost of their pet's treatment and are aghast that I won't offer them my services for free.
I suspect most healthcare sectors have similar problems.

I have always had good care from my GP’s.

The issue is getting an appointment. Pre pandemic I had to wait 5 weeks for a non emergency appointment,which was fine as I wasn’t ill but still quite a wait.

Lockdown 1 was great, quick and easy to get a phone call appointment. Now it’s back to normal,which is very hard.
I feel so sorry for vulnerable or elderly people who will just give up.

I appreciate that it’s not the GP’s fault. I also know that there are loads of time wasters which makes it worse for everyone.

@JohnnyMcGrathSaysFuckOff

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.

This with bells on!

I had to phone this morning and was dreading it. However got through in 10 mins and had a call back within 2 hours from a GP. Amazingly even given antibiotics which normally is a big no no at my GPs, not sure if this is a good thing or bad but we need face to face back as too many people are at risk of going undiagnosed with more serious conditions.

I agree. My local GP surgery is brilliant.

I wonder if communication couldn't be used to huge value here. Our gp used the askmygp service, which I loved. I could email, they could prioritise and reply whenever they could, whether that was instantly or in a few days. Genius. Now the service is only open 8.30-10.30. I teach, school starts at 8.30, I get my break at 11 15. I have no way at all, in which I can actually make an appointment, or try to. I emailed them regarding my concern, asking if it was a temporary thing due to numbers of people ringing about vaccines etc., in which case, good idea, but if it was to be permanent, how did they suggest I made appointments. No reply.

My GPs have been great over covid, and I've been really happy with the service. I understand they are experiencing a backlash now, but some response would be good, as they've made it impossible for working patients to make appointments. When they do things like this, I think they should expect a little flack if they fail to communicate.

I don't think the expectation to make an appt. with your GP is unrealistic, and unless they actually tell their patients what's going on, then how are we supposed to know? Communication could go a long way to solving some of these issues I think, and redressing the balance of the 'my GP is useless' trope.

I don't, by the way, think you are eating biscuits all day. I have lupus so use my GP/ pharmacy services regularly. If however I only wanted to see a GP once every 6 months, and the last 3 times I haven't been able to, the phones aren't answered, online services reduced, does locked, routine clinics cancelled, screening on hold, I could be forgiven for wondering what you are doing maybe?

A graphic released on social media with a break down of calls, consultations, paperwork hours etc., or something equally as simple, could be really helpful in explaining to those people, what you are actually doing.

Anyway, my two pennorth worth. If it's not you, it's us lazy lefty teachers. I don't know if we'll ever change the attitude, but feel your pain.

GPs have to prioritise because there are not enough of them. My relative with serious mental health problems has had brilliant care when it has been needed. That has meant the GP spending an hour talking to him, arranging admission to the hospital and telling me what is happening. So yes if you try and see your GP about a rash when he is organising an urgent hospital admission, or ringing the crisis team and saying they must come out three times a day, then you may struggle to get an appointment.
The issue is a lack of GPs.

My uncle went to his gp with a severe pain in his ankle. The gp told him to just take a paracetamol and walk it off. After a week, no change, the gp just told him not to worry and take more paracetamol .???? My uncle ended up getting a private appointment, the private doctor immediately diagnosed a severely damaged tendon (too much cycling perhaps) and booked him in straight away for a surgical procedure!

Worse is my mother, for a period of five years had awful fevers and tightness in her upper torso. Was diagnosed with chest infections and given steroids. One night, she felt extremely under the weather with awful chest tightness. My father called 111 for her, who advised her to IMMEDIATELY go to A&E, as a heart attack was suspected. Luckily the doctors at A&E were fab, my mother got seen by a specialist who diagnosed... Arthritis in her upper back. This was apparently the cause of her 'chest infection' symptoms. Of course we were all so relieved but my mother had taken multiplie extended periods off work for these 'chest infections' which were nothing of the sort.

Not to mention the time I needed acne medication as a teen, a medication that can cause severe depression. I was reticent about taking it, so the gp said: well, if you know why you are depressed you can deal with it.

Is this the type of care we should expect from GP's? I don't accept that we should put up with awful treatment and misdiagnosis just because GP's are not specialists. Surely their purpose is to have good general knowledge? We don't get to choose our gp (even less nowadays, I have not seen my actual 'GP' for about 10 years, despite being at the same surgery). What help is having a osteo specialist go if you've got a gynae issue? It's ludicrous

I work in pharmacy and GP surgeries have been pushing patients in our direction since the start of the pandemic.
In the last week I’ve had a patient come because their surgery told them we could look in their ear to diagnose an infection, a baby with an eye infection and 2 patients wanting me to check their blood pressure because the nurses weren’t doing it anymore. Well I’m not doing it either, our consultation room is too small to socially distance and our risk assessment won’t allow it because we are in a hot spot area.
At least once a day I get an inappropriate referral from a GP surgery.
It’s frustrating for the staff and the patients, fair enough if you want to continue to use online services but some patients need to be seen face to face in a timely manner not ringing every day for a week trying to get an allusive appointment.

@kindofcoping

GPs have to prioritise because there are not enough of them. My relative with serious mental health problems has had brilliant care when it has been needed. That has meant the GP spending an hour talking to him, arranging admission to the hospital and telling me what is happening. So yes if you try and see your GP about a rash when he is organising an urgent hospital admission, or ringing the crisis team and saying they must come out three times a day, then you may struggle to get an appointment. The issue is a lack of GPs.

How can they prioritise if they don’t know why you’re calling?

My struggle to get an appointment was for something that could leave me paralysed.

@coffeecroissant

My uncle went to his gp with a severe pain in his ankle. The gp told him to just take a paracetamol and walk it off. After a week, no change, the gp just told him not to worry and take more paracetamol .???? My uncle ended up getting a private appointment, the private doctor immediately diagnosed a severely damaged tendon (too much cycling perhaps) and booked him in straight away for a surgical procedure!

Worse is my mother, for a period of five years had awful fevers and tightness in her upper torso. Was diagnosed with chest infections and given steroids. One night, she felt extremely under the weather with awful chest tightness. My father called 111 for her, who advised her to IMMEDIATELY go to A&E, as a heart attack was suspected. Luckily the doctors at A&E were fab, my mother got seen by a specialist who diagnosed... Arthritis in her upper back. This was apparently the cause of her 'chest infection' symptoms. Of course we were all so relieved but my mother had taken multiplie extended periods off work for these 'chest infections' which were nothing of the sort.

Not to mention the time I needed acne medication as a teen, a medication that can cause severe depression. I was reticent about taking it, so the gp said: well, if you know why you are depressed you can deal with it.

Is this the type of care we should expect from GP's? I don't accept that we should put up with awful treatment and misdiagnosis just because GP's are not specialists. Surely their purpose is to have good general knowledge? We don't get to choose our gp (even less nowadays, I have not seen my actual 'GP' for about 10 years, despite being at the same surgery). What help is having a osteo specialist go if you've got a gynae issue? It's ludicrous

Why would arthritis in your mum's back cause fever?

@nancy75 I am sorry to hear that. My GP has telephone appointments and then invites those in who need to be seen. My relative who has serious mental health problems was offered the choice of face to face or telephone or zoom. The GP knows he is at real risk.
Of course not all GPs are great. I had one awful one once. But I have also had lots of really excellent ones.

I'm a teacher so spend my life reading about how lazy, over paid and underworked I am.
Like others have said there are good and bad in all professions and the bad give us all a bad name. We have a gp surgery near us, amazing, dealt with covid in the most excellent manner, even set up so that covid positive patients could be seen. They went above and beyond, to be honest always have done. The other side of the coin is our local surgery, 3 weeks phoning daily to get an appointment, no future appointments are allowed, only on the day ones. All appointments are gone by 8.30am. Only face to face appointments have been with nurse and phone appointments are rare, advice go to a and e.
People will always shout louder about bad service, especially when bad service kills and families are spoken to/ treated like idiots.
Keep being the fab gp you know you are, your patients will appreciate you. People also know that the NHS needs to be totally overhauled, it doesn't work and funding is lost through too many layers, like all government agencies. But, like teachers, we need to recognise and call out people who aren't really doing the job, or a good enough job they are paid to do.

Too many people have had poor care from GP's, women in particular & are getting fed up of banging their heads against a brick wall. 6 weeks to get a routine appointment, doctors who spend more time typing instead of looking & listening. Try to complain about a doctor & then find that the same doctor is dealing with the complaint. Ask to see a female doctor & get told you can't, take it or leave it. Using receptionists as gatekeepers, I had a telephone appointment for 3.10pm, I was still sat waiting at 5.45pm for a call, rang the surgery & got told it could be up to 8.00pm before I got a call, best thing was I hadn't asked for the appointment, it was them who insisted I had to have one over changing medication, result of phone call medication not changed, I had sat waiting nearly 5 hours for a 2 minute phone call that was unnecessary. We get a second rate service but because it is the wonderful NHS we are expected to take it because it is free, if we had to pay we wouldn't put up with second rate care.