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?

@kindofcoping, mine has telephone appointments too, I can’t have one until late June.

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.

I can’t believe you are an ‘avid mumsnetter’ and have failed to note the absolute smear campaign against nurses and midwives on here. It is rivalled only by the derogatory attitudes towards teachers and GP’s receptionists.

There are good GP’s and not so good ones as in every profession. It is highly problematic that you instruct your receptionists on minimum wage to triage/interrogate patients who just want an appointment. I live in Australia now and the only question my GP’s receptionist asks me is if I would like a standard appointment (one health issue) or a long one (multiple issues).

@Helenahandbasket1 they have to triage to see who needs an appointment today and who can wait.

@Scotdoc123 anyone who deals with the public in their jobs will say the public are shit.

No excuse for any GP to be hiding away during this like you all have been, it put extra pressure on A&E when patients turn up after struggling so much to see a GP.

In my experience even today trying to adjust my medication after 2 weeks of trying to get any help, the pharmacist who is attached to the surgery but is admin only, he is working from home when he should be back!

My doctors are fantastic in the care of my children one has a life limiting illness and I have nothing but praise for them however I suffer with complex mental health and very recently my GP told me I wasn’t satisfying my husband as we don’t have a sex life ...: my mental health boils down to being raped and sexually abused as a child by two different male family members so yes I do think that GP is crap but I also see they are great in other areas
No doctors shouldn’t be all tarred with the same brush but there are some shocking ones out there

Oh, OP, I'm sorry you feel this way. I've had rather more contact with my GP than I would like of late (cancer scare that thankfully turned out to be a false alarm), but I absolutely can't fault my GP. They acted quickly, contacted me promptly when results came back from the hospital and they were so kind and compassionate through it all. I am immensely grateful for our excellent primary care services, and indeed for the rest of the NHS. I'm sure that there are crappy GPs out there, but my experience has been nothing but positive.

IME my main issue has been GPs dismissing my concerns about my mental health and refusing to refer me to a specialist despite years of struggling and coming to them repeatedly when I had reached a crisis point. I know that a big portion of the blame rests with funding and local gov (there are NO resources for adults with ADHD in my entire area, for example) but it's still very distressing to be rebuffed and dismissed over something you know you're struggling with.

Not to say that you're wrong to be frustrated about your professionalism and skill being questioned by the general public, I'm sure it must make a very difficult job even harder.

I get it but honestly I think a lot of people are really institutionalised, and this includes some HCPs and need to realise the NHS can't treat their needs in a timely fashion and they need to specialist care and the GP isn't going to get them to it soon enough, if at all.

We were badly let down by a former GP and we got off lucky, I know people who've been far worse.

I think the paradigm needs to shift, on the part of both HCPs and people.

Personally, I mistrust GPs so much I'd turn tricks to pay private if I had to.

I'm going to play my top trumps most hard done by professional card... drumroll...

Psychiatrist

I don't think any teacher, GP or nurse bashing threads can get close to how shit the whole of 'mental 'elf services' are according to Mumsnet.

No-one ever had a decent experience or any help from us sorry shower. You would think we would easily be able to deal with the fall out of shitty relationships, poverty, unemployment, crime, child abuse, addictions, all kinds of trauma and now the pandemic with our generously funded services.
But no we can't which is entirely because Mental Elf services are officially shit and don't do nothing apart from push damaging pills at people. You heard it here first.
In fact you've pretty much said yourself that MH services in your area don't see everyone you think we should which must be because of laziness and biscuit eating surely.

Fortunately for me I don't especially mind what people say. You wouldn't choose psych if your ego is dependent on people liking you. When was the last time you saw a box of chocs or a thank you card on a general adult mental health ward? I think I'm about as likely to get hit or verbally abused as get a thank you.

So my advice is to woman up a bit and stop expecting to be liked. Hide any and all of threads mentioning your profession (I hide the whole MH board) or if you do engage then know that people will give you a hard time and bring up every bad experience with a GP they (or indeed their aunt Doris) ever had.

If you know you do a good job for patients to the best of your abilities, you genuinely try to listen and act on real life feedback, you keep up to date in your practice and you haven't managed to get struck off yet then you know you are doing OK and you don't need people on Mumsnet to approve.

I'm a GP too and the comments on this thread make me feel like packing the whole lot in and giving up.
Why the hell fo I work over 12 hours days to the detriment of my family and my mental health when nobody (at least it feels like nobody) even recognises or cares?

Maybe if we all hand our contracts back to NHS England posters here would be happier?
Then general practice would be run by Virgin care etc. Not sure who they'd get to see the patients though as they're not going to magic extra gps out of the air so can't see how they can provide a better service. Also if I was working for a company like that there's no way I would be putting in the multiple extra hours I currently do daily.

This is the result of years of underfunding and it's taken a pandemic to come to a head.

Honestly I fucking give up and when I leave this profession the ones who suffer will be the patients under my care who I feel I've gone above and beyond for over the last 10 years ( the phone calls at the weekend because I can't stop worrying about a patient, the late home visits at 8pm meaning I won't see my children at all that day.)

Less than 10% of total NHS funding is spent on primary care, you can't poorly fund a service and expect it all to be perfect.

@Scotdoc123 have you seen all the poor nursing threads? 'Don't deserve a pay rise the sadistic bitches' is basically the gist

Oh, I love DS's psychiatrist. We're private patients due to NHS failure, though. And tbh, the GP's failure and attitude was far worse. I have a really hard time trusting GPs after this and one other failure, which could have been fatal. I know that's my issue, but it's now a barrier. I won't bother bar the basics, I'll do whatever is necessary to bypass and go private. Again, I wouldn't state that openly but it's there. I don't trust them.

Well as I type this my brother is in hospital recovering from surgery he had earlier today for cancer. The cancer has spread. Only took a year for a GP to refer him because they wouldn’t see him in person and said he was too young when he told the GP he was worried it was cancer.

Funnily enough my father had exactly the same issue 15 years and when he was told for 9 months that his bowel cancer was piles and it wasn’t until he was collapsed on the street with blood pouring out his anus that a doctor would take him seriously so forgive me for not wanting to sing your praises.

@sunshinewinetime i agree, I have 2 jobs, one in paeds icu and one in a gp surgery as a part time practice nurse this thread is horrendous. Really bloody demoralising; especially with how hard primary care doctors have actually been working during the pandemic. It's 100% harder to diagnose over the phone than in person and people still saw drs in person if they desperately needed them. I don't envy you and I know my job got harder x don't give up

[quote thisisbull]@sunshinewinetime i agree, I have 2 jobs, one in paeds icu and one in a gp surgery as a part time practice nurse this thread is horrendous. Really bloody demoralising; especially with how hard primary care doctors have actually been working during the pandemic. It's 100% harder to diagnose over the phone than in person and people still saw drs in person if they desperately needed them. I don't envy you and I know my job got harder x don't give up [/quote]
But it's becoming patently obvious that many were not permitted to see a doctor in person even if desperately needed.

OP I'm sure you are a wonderful GP, so none of this is directed at you or a reflection of you but rather the points you are making and mostly the system in general. I am sure you like many of your colleagues are doing your absolute best.

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.

100% agree with that opinion, and there really is no excuse for this. Jack of all trades, master of fuck all? I can get on board with that absolutely if they send me to someone who is semi-skilled at the thing I need help with.

You cannot run it like a lottery where if you end up with a GP who has an interest(?!) in your thing, happy days, and if they don't, better luck next time. Call back at 8am tomorrow, pal. It's completely unacceptable.

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.

Then surely the services do not cope with the demand, people become more and more outraged as they're waiting 2 years, 3 years, 5 years, 10 years etc? Is that not why we have A&E waiting time targets that are reported on? 12 weeks waiting time for outpatient appointment on knee replacements etc? Where is the political will to apply waiting times (with funding and plans to meet them) if we don't get to the stage where someone assesses the list and says "shit guys, this is going to take 10 years".

And if it's the case of you actually cannot get them onto a waiting list because someone doesn't accept them... then what are GPs doing about that? Who are you reporting that to? Why isn't that person fixing it?

In my line of work as a Quality Manager in aerospace, if a process wasn't working or resulting in defects, they would be reported to me. From an 'unskilled' operator to an exec, they had to tell me and I had to investigate corrective and preventative action. That could mean ripping down an entire process, rewriting countless documents, and spending practically unlimited amounts of money if the cost analysis warranted it.

Would you expect anything less in the aircraft industry? We are talking about people's lives. Can't have planes falling out of the sky left and right killing people because an operator didn't speak up.

And yep, I am absolutely aware I am coming across as naive here, I have no clue about the problems and the processes. But neither does the general public. The general public who work in pharma, or aerospace, or manufacturing, christ even banking and finance, have basic process improvement initiatives and requirements to implement corrective action. Why hasn't your industry? And if it does, why is it clearly not working?

Can you imagine me coming on here to tell mumsnetters that a Boeing 737 fell out of the sky because "if we tested every single printed circuit board we wouldn't have enough test kits or technicians to keep up with the demand."

How much faith, exactly, would you have in Boeing? And would you accept my excuse? Would you speak kindly of Boeing if they ever came up in conversation?

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.

So the Royal College of GPs accepts there is a problem then. And their initial suggestion of corrective action has not been acceptable after cost analysis. So maybe the Royal College of GPs need to get creative and come up with something that is acceptable. A way of qualifying Mental Heath GPs, or GPs who only treat women, or the elderly, or skin or whatever else GPs aren't taking enough interest in. People who specify in one particular area of "general" practice (I know) during their initial studies? Thus freeing up the GPs who need to be GPs? I don't have a clue, I'm just a member of the public, but somebody must have a better idea.

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.

You literally just admitted the Royal College of GPs has already identified they are undertrained. But seriously even if you hadn't, surely a lot of people have learned this through experience of using the service. Are we expecting them to never talk about it because... it might put other people off? This just breeds even more distrust and lack of confidence. Have you been sleeping through the Astra Zeneca debacle - which was only a debacle because the figures on AZ website were 100% disingenuous and people had the sneaky suspicion (rightly or wrongly) that somebody, somewhere, was hiding something?

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.

I think you are maybe underestimating how much public opinion is shifting on the entire healthcare system in general. A few years ago it was "the thing british people are most proud of". People were almost feral in their defence of it. Watching MPs discuss it on Question Time was so fascinating you could practically have David Attenborough narrating it.

But there has been a tangible shift. I believe privatisation in some form is inevitable and when they write the Wikipedia on how it happened, Covid will be a catalyst for sure, but it's been crumbling for some time now. Have a look at any thread mentioning maternity care. When I compare my mum's experience in the 90s (in a crumbling old victorian building) to mine in the 10s (in a brand new "super-hospital" the difference is shocking.

At 29 years old I've been in ICU after being fobbed off twice by a GP when google literally tells me women are at risk of blood clots after birth. I've watched an elderly relative bleed out on the floor while I waited an hour for an ambulance. I've had to pay privately to see a psychiatrist because I could not wait 2+ years. I've witnessed a relative get completely lost in the hospital system because nothing ever happens unless you kick up an absolute fuck and demand and demand some more. I've given birth twice and received care that can only be described as fit for animals. Slops to eat, disgusting showers, enforced sleep deprivation after surgery, absolutely zero dignity or privacy, inadequate pain relief, "get on with it" attitude.

So.... on reflection, do I believe the current system is not fit for purpose? Absolutely. Do I believe we need to move to at least a semi-privatised model and actually pay for healthcare? Yes. I do not have enough good memories of the NHS or my "family doctor" to be sentimental over them.

I am incredibly lucky to have a truly wonderful, kind, hard-working GP, who consistently goes out of her way to provide fantastic help and advice, whenever I need it.

My GP practice is a great place, the Receptionists are kind, helpful and approachable and all the GPs I've seen have been excellent. I have never had to wait more than 24 hours for an appointment, they do online consultations and they answer the phone quickly - I'm not sure I could ask for more! Even through the shitshow that was 2020, I always had an appointment if I needed one.

OP - I see the threads slagging off GPs, where people have been unable to get appointments for months at a time, and I feel sorry for them. I feel sorry for the GPs too - I'm sure it's not their idea of being professionally fulfilled to not see patients. I'm clearly very lucky (and apparently in the minority) to be so impressed with the service from my GP, but you have inspired me to write to the Practice Manager and give her some positive feedback - it sounds like it might be sorely needed at present.

My experiences with GPs in the UK was literally 80% awful. Don't get me wrong, the other 30% was great (obviously a few different GPs); but the awful ones were truly horrific, almost ruined my life, made me feel utterly humiliated for no reason, (not even unusual health issues either, or difficult to treat). I can't even put into words how awful they were. And this was all pre-covid.

A good GP is a real gem - very rare and precious. I have spoken to people about this a lot, I am, sadly, not the only person who has had this experience. In fact, I don't think I know anyone who doesn't have a cruel/dismissive/humiliating/nasty GP story.

If covid has made it worse, I shudder to think what it's like now.

Oops - i initially wrote 70% awful (hence the mistake where I wrote "the other 30%"! Cringes But when I considered it, I thought 70% was too generous. Forgot to change the 30% to 20%.

OP said: 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.

This is completely true. That’s how market forces work. That’s how Conservative and New Labour health policies around ‘giving patient choice’ and ‘cutting waiting lists’ work. Not by finding existing practices more generously or creating more funded GP posts. But by employing their mate who runs a private health business to do all the simple common x procedures at once in the area. The more complicated y and z procedure and all the complications from x procedure are handled by the NHS which loses its own budget to pay the private company.
So overall the caseload of more expensive more resource intensive cases sits with NHS to manage and on less money: Overall the private co sees the easy patients once and their simple work is done.
I don’t know what current Labour policy is but they don’t seem to be health specialists particularly. Let’s look what the health think tanks are saying: because they seem to show an NHS workforce calling for funds to innovate and working with NHS IT systems, for example, that are years out of date and only ever worked in isolation to the hospital systems in the first place. A modern NHS GP system requires NHS infrastructure and staff and skills investment which is a responsibility of voters to demand on everyone’s behalf.

I absolutely agree with you. My GP practice is great, I honestly couldn't wish for better care. Some GPs provide poor or inadequate care, but that's not representative of the entire profession.

My GP is so kind and responsive and it's been easier to see someone since the telephone triage / econsult system came in.

I do believe that GP surgeries are very underfunded though and blame the current government. That's to me the clear reason that GPS are overworked and people are also not always experiencing good care.

I think lack of attention to public health is a big problem too. The burden of T2 diabetes is huge but we live in an age of cheap processed food. I think covid has shown how unhealthy and stressed out as a nation we are, which is sad.

Try being a dentist! Everyone hated us anyway and now blame us for the operating procedures that we have to use.
My GP surgery has been excellent this year. I never ring as e consults are so much better. I’ve had phone appointments and F2F when needed.