GP care or lack of it

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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?

But GPs are already private providers aren't they? They are just funded by the NHS. So can you elaborate on what you mean the government want to do, do they want just another private providers to take over?

Hi OP. I am a HCP. As others have said, I have started hiding threads, especially ones about nurses (which tend to descend into outright personal attacks) for my own sanity so I will be hiding this one once I have commented.

Just wanted to say not everyone feels like this. I have huge professional respect for people in primary care right now and, on a personal level, having used the services recently week, am very grateful too. I rang, spoke to a really helpful receptionist, got a call back from GP. I actually missed the call (I did try not to but I was working) but they called back again and I was able to pick up and then we had a thorough phone consultation.

Threads like this for any public sector jobs never go well as PP have said .

My GP has really stepped up during the pandemic. We have a disabled toddler who usually accesses care from a variety of services but they all went online only and some are still not face to face now. His condition is very hard to manage with video appointments as he has an unsafe swallow. The GP has been excellent and seen us regularly face to face all the way through so that his overall care does not suffer.

I really feel for you it must be awful, I have a good relationship with my GP (have lots of health problems) he is obviously absolutely overwhelmed with work but always tries to be compassionate, has donned his full PPE for me, refered me, written a letter for me. I work in mh and feel similar, I avoid mh threads now as they are always about how useless mh services are, we don't do anything, don't care etc..I do totally understand it because the NHS is often v broken and I've suffered because of that too but its heartbreaking for the individuals working hard, caring a lot, fighting your corner from the inside etc to be honest the vitriol has all just added to my decision to leave.

People have no idea of the actual demand in the surgeries is like. I do, I work in this area. I have never seen the demand like this. And it doesn’t matter how many more locums we find and put on, the demand just keeps increasing. We have GP’s off long term with long COVID, stress and other issues. Many of the GP’s came out high on risk assessments or placed on the shielding list. No one stopped working during the pandemic, they just switched the way they worked. We had to look after all the people with suspected COVID and keep an eye on them and send to hospital if needed, 111 just sent them all back to their GP - as they enforced on primary care services that they had access to the appointment ledgers and they are allowed to fill up a % of slots a day with patients. And they do.

At one point you had to queue 1 by 1 to get into every single pharmacy in the U.K., including Boots so many people stopped visiting their pharmacist for advice.

Month on month audits show that the most common contact reason where I work is ‘skin complaints’.

Because secondary care still haven’t resumed proper F2F services (which no one seems to complain about, even cancer services offer a telephone call sometimes on a 2 week wait pathway) a large portion of patients are leaning heavily on GP services to fill the gap. Patients are calling about having to wait for their surgery, their secondary care reviews or their first appointment after referral. The secretaries often say they feel like making a referral to secondary care is like dropping it down into a large black abyss.

I have pretty much stayed off MN for most of the pandemic for this reason alone

I don't believe it's levelled just at GPs but at anyone within primary care. At the moment you're all feeling the heat. I rang yesterday to arrange my vaccine and the receptionist I think was expecting a mouthful as they didn't have the appointment list for the date the text I got said. I could hear her smile when I I thanked her for her time and wished her a lovely weekend.

I saw my gp f2f at the beginning of the week after a phone consult last Thursday. I couldn't have been more pleased with how she dealt with my issues and resolving a coil removal that I was expecting to be denied.

The problem isn't necessarily training and care lacking within gp services. The problem is people don't write a post on a forum when things are being done well. So predictably the seeming consensus is GP services are terrible when it's not really the case. Sometimes if more people opened up to the receptionist about the issue they'd be signposted to the gp that has a special interests in their problem. Receptionist know the gp and who is better at versed in different areas.

I can only say good things about my GP surgery, in fact the last 2 GPs I have had.

I have always got an appointment on the day, or if none urgent within a week. The out of hours 111 service has been very responsive too. The new telephone triage means I can go to work and wait for a call. More efficient for minor problems.

I work for the nhs and feel it's a free for all to bash in the media and generally. Same with teachers. Anyone that has worked through covid and had to make huge logistical changes, whilst dealing with a new disease we knew very little about deserves respect! Then to deliver the vaccine programme in top - incredible.

Public services are vastly underfunded and the current government are happy to do this and introduce more privately run services.

I understand why you are upset, it's a tough job for sure, but it just baffles me that my gp, who is early 40s and gynae specialist trained knew very little of the latest perimenopause/menopause info and medication. To a certain extent gps need to be taking it upon themselves to keep abreast of issues that affect every woman on the planet! You only have to dip in to a few trusted resources, it's not hard! I shouldn't be having to tell her the facts.

My GPs surgery is seven doors down from me in the biggest town in the county. Perfect! Except they've decided not to open it and we have to travel ten miles to their sister surgery in the middle of nowhere. I had to wait three weeks for a telephone appointment during which the nurse practitioner decided I needed a face to face appointment and booked me in the following working day. But I must say that every GP I've had contact with there is bloody brilliant and referrals on for the likes of scans and physio is faster than getting the original telephone appointment!

Of course YANBU. I’ve had some great GPs and some shit ones.
I do think it’s fair for people to point out issue with the system, though. Before I moved surgery I would go to the GP over and over again because I was in pain every day with my hip and knee. I was constantly fobbed off and hit breaking point when a GP didn’t even look up from his computer while I explained, and just said “it’s muscle pain.” Turns out I have an autoimmune disease!

There are big issues with the system and I do think it’s important to point that out, but it’s not ok to take the next step of blaming all GPS for it. At my new practice I get a phone call (or seen!) immediately. My boyfriend had a terrible migraine and they got him in literally ten minutes later, prescribed him medicine and he was sorted. They’ve finally found out what’s wrong with me too and I couldn’t be more grateful to them.

Someone asked this

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?

Secondary care set their own criteria for accepting referrals it is nothing to do with primary care. You can make a complaint to the CCG regarding the contractual obligations and yes many GP’s do this. Personally it doesn’t really do much but it is an option. I believe that in many areas now when you try to go onto the electronic choose and book to choose a hospital and appointment time you are met with a message that says ‘defer to provider’. So you send the referral into the abyss and let the patient know, they then just... wait. And then they call you back to ask how long it is going to be. But we do not know either.

There is to target of 18 week wait for any patient to secondary care and it is counted from day 1. This can be navigated by making a phone call to the patient to ‘stop the clock’ www.nhs.uk/nhs-services/hospitals/guide-to-nhs-waiting-times-in-england/

If you go to this website and put in the condition and then your postcode you can see how long the wait is

I put in ‘hip replacement’ and it is more than 52 weeks
Gynaecology - 36 weeks
Dermatology - 52 weeks

Who do you think deals with all of these patients during those 52 weeks. Their concerns, their worries, their symptoms? Until they can see a specialist

Tbh my gps have done very little for me over the course of the last 12 months. Completely neglected me while I suffered from hyperemesis so bad that I contemplated ending my much wanted pregnancy and indeed at points my own life. When I told this to my gp she just sat there on the phone in silence. Indeed even pre covid over the last ten years I've had so many bad experiences with GPS who either don't listen or truly dont care. I now dread having to call them and face their indifference. I've also come across some lovely gps and infact during my first trimester a male locum made me cry he was so kind , caring and wanted to help me. I do hope you are one of the good doctors but surely you must see that there are some truly awful clinicians practising that are neglecting people

It's not individual GPs that upset people in the whole it's the access to the service and the delivery.
The model isn't fit for purpose anymore. Most people no longer work in the same area they live so can't get to see a GP as it means taking a whole or half day off work. When these people are off so are the GPs. I'd rather a service that started at 2pm till 10pm so I can see someone after work. Saturday and Sunday appointments would be fantastic and a lot more people would be able to get access.
High GP turnover is a concern. Seeing a different GP every single time you visit a GP is not helpful when dealing with a long term condition as you spend 5 mins of the 10 min consultation telling yet another doc what the problem is.
I'm shocked at the attitude of not wanting to refer people or services will be overwhelmed. If that's what people need then that's what they need if you are unable to help or haven't got the knowledge needed. Saying only the sickest mental health cases get help is outrageous. Are you really saying that even though people are asking for help they are fine because they are not at the stage of suicide or death through other causes. You wouldn't say to a cancer sufferer that they should come back when the little lump they have found has grown to the size of a football.
It's up to you as a GP to fight for services for the population as they don't have a strong a voice as you.

Just out of interest, there are 4 partners at my gp practice and they each only work 2 days a week. What might they be doing for the rest of the week? I think gps have fallen into fairly civilised working patterns whereas we need more round the clock care in communities. I know there are drop in centres but these often aren't convenient. It feels as though a gp practice says "sorry can't do" far more times than they offer to go out of their way to help nowadays.

This is a horrible thread to read.
I have personally received explemary care from GPs over the past few years.
However you must see that people's frustration is not coming from nowhere. It's real.
I understand, and I hope other people do to, that mostly its not the fault of GPs personally but a range of issues such as not enough GPs, not enough training or development, not enough succession planning, not enough provision in specialist services and social care...in short years of underfunding of the health and social services. Combined with the over funding of private providers and companies, its no wonder its having a devastating effect on real people's access to health care. But it's easier to blame the person who can't talk to you on the phkne/can't fit you in for an appointment/isn't allowed to refer you than government policy and budgeting.
So try not to take it personally. You can't really blame people for feeling frustrated can you? You feel the same way!

GP’s are allowed to work part time and they do not have to explain what they are doing on their other days! Does someone in ASDA have to explain why they work part time? Those 2 days a week they work will likely be from 8-8.30am to 6.30pm those days and probably admin in between. That is many hours in a day and barely any GP’s do this 5 days a week it is far too intense, for all the reasons in this thread.

I just don’t understand why people can’t grasp the basic principle of supply and demand. There are not enough GPs and too many people wanting their time.
If you go to a supermarket and there are queues at all the tills, what do you do? Do you stand in the queue and think “gosh isn’t it busy”, or do you rant and rave about how the staff at the till clearly aren’t working hard enough? The only difference is that in the supermarket you can see the till staff, so you know they really are working. In general practice you can’t see the GP, but trust me, they are working. An average GP surgery has more than 2000 patients per doctor. Do the maths.

@iminthegarden I work just one day a week as a GP.

I also work three days a week teaching medical students and one day a week in palliative care. Others may disagree but I think both those things are worth doing. I also think it would be ok if I wanted to work part time and only work two days a week or whatever.

I agree that the system is broken and isn’t doing what patients need in many areas at the moment. But it really is underfunding to blame. GPs are working incredibly hard and are unable to meet demand.

Also - I am really sorry for everyone who has experienced diagnostic errors and delay. The reasons for this are really complex and it isn’t just GPs being shit or not knowing stuff - but more people have stories about this because 90% of healthcare takes place with GPs. My own experience of diagnostic delay was nothing to do with GP - my daughter presented with a weird symptom. I phoned the GP surgery. She was seen the next day and an appointment arranged in secondary care the day after that. 7 weeks later she’d been through three different wrong diagnoses, three specialities and finally got her cancer diagnosis. The GP was the only one who got it “right”.

GP Surgeries do vary in their efficiency, but I would have more sympathy for GPs if they took a bit more responsibility for educating and communicating with their patients about when and how to go about getting an appointment and (more importantly) when not to.

Thank you for posting this OP. I understand exactly what you mean about 'feeding the narrative'. I've heard so many friends or family members complaining about symptoms who say they haven't bothered to contact their GP because 'you can never get an appointment' or 'they're useless'. My GP surgery has been great all through the pandemic. The econsult service works really well as you get time to think about what you want to say and the GP has time to read it all before they speak to you. When I have needed treatment quickly (for a UTI) I got a call back within a couple of hours, prescription sent straight to pharmacy). The GPS I have spoken to have all been very helpful and have listened to what I had to say.

I don't think people quite understand that there are only a limited number of GPs and a huge amount of demand.

FIL nearly died in the last few weeks due to not being able to get a F2F GP appointment. He was fobbed off with a nurse and MIL had to call NHS24 at least 3 times before they would send anyone out. By the time he was admitted to hospital he was very ill with pneumonia and had super low oxygen levels. They then discharged him too early after a few days and then he was rushed back in in worse state than before. He has private healthcare but that means nothing when it’s an emergency. The whole system is broken I’m afraid.

@iminthegarden other days they'll be doing Admin and the mandatory training. As with all health are professionals to maintain their qualification, also the regulatory bodies require to you to keep up to date with your training and learn new things. If they don't they lose their license to practice.

Hi OP

I’m afraid I have a very low opinion of the way the UK’s GP surgeries, at least the ones I have used, are run. I’ve lived in various different countries and have lived in different parts of the UK and do have comparators. It frustrates me to no end that I have forced through taxation to pay into a system that doesn’t work for me. I would prefer to go private but my local area does not have a private GP option. I haven’t attempted online private GPs yet, but it doesn’t seem like an appropriate solution. There is no real choice and, in this context, it’s important that everyone should be able to voice their opinions loudly and be heard.

I find the culture of deifying the NHS deeply worrying and dangerous. It’s essential that we should all be able to scrutinise it, for the funding problems to be exposed, for pressure to be placed on the government and on the NHS to do better, and for all of us to speak out about the system that we are required to fund.

Very, very good friend is a GP, she’s working 7-midnight six days a week and sleeping 4 hours a night . I do feel very much for her and concerned she’s going to make herself seriously ill; she hasn’t stopped seeing patients once . It’s a thankless job.

@chinateapot I really don't think underfunding is the overriding problem, govt funding keeps increasing. The problem is the structure of the service no longer works for the far reaching conditions we now have to deal with so our expectations of it will always far outweigh whatever level of funding is brought in, unless it's literally an unlimited stream of cash, of course. It's time we all change the Amazing NHS narrative and have a complete overhaul of the system. I believe every community should have a large 24-hour facility full of all the local gps seeing patients around the clock with 24hr radiology and diagnostics on site. Consultants also on hand 24-7, so we centralise the care in one large superstore style hospital. We could bring in fees for more services as well, such as £10 A&E payments for those not on benefits and so on. No one wants a fully insurance-based privatised model like the US but some countries do well with more of a middle ground. We can't go on like this.