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?

[quote chinateapot]@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”.[/quote]
I disagree completely about GP's working extremely hard because they most certainly are not in my area!

You would need to increase funding an awful lot to have GPs and consultants on hand 24/7.

@chinateapot hence making more treatments payable

@SakuraEdenSwan1 the fact that you can't recognise that your work pattern is one of the reasons the GP system doesn't work is worrying. You are saying you are mainly a teacher and do a GP role on a very party time basis. How can you be an integral part of your community as a gp offering consistent care to your patients, follow ups etc when you're there one day a week!

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.
I don't think people do fully realise. Firstly because it really isn't made that clear to the public but also because ultimately, people are self-centered, focused on their needs and assume that any service to the public means an entitlement to be serviced.

People's expectations have risen whilst the sense of self-responsibility is decreased, which both adds to the pressure on medical staff.

However, it doesn't take away the fact that the system is struggling and patients are negatively affected. There is a lack of consistency and appropriate follow-up. For instance, the recent results of a blood test has shown a sightly high cholesterol and liver results. The GP who reviewed my notes, who doesn't know me, automatically assumed that it was the result of a unhealthy lifestyle, to the point that I was questioned about my honesty when I said that I did eat very healthily and exercised a lot. As it is, I have since found out that my mum, grandmother and daughter all have high levels despite all of us being fit and thin, so it is highly likely we are suffering from Familial Hypercholesterolemia, but this is currently not being dealt with because once the GP ticked the boxes and gave me a lecture, the matter was forgotten. I now have to try to make an appointment and convince the GP I will speak to ,who doesn't know me either and will not have a clue of what I look like, that I really do live a very healthy lifestyle and that it is most likely hereditary, which is fine because I am quite confident, quite knowledgeable of medical conditions and know where to seek reliable information, but this is not the case for the average patient.

I do believe that the way forward is to encourage patients to become more knowledgeable so the relationship patient/gp becomes more of an exchange than a telling what to do, at least for those who are not vulnerable, but it will take quite some time to get there. In the meantime, i feel sorry for GPs, but also understand the frustration of patients.

Haven’t RTFT but OP, did you see this?
www.theguardian.com/society/2021/may/28/staff-at-uk-gp-surgeries-facing-abuse-and-tsunami-of-demand
My DH is a GP & it rings true for his experience in the last year. Yesterday a patient on the phone threatened to find out where we live & kill our kids.

Why don't the GP's in nhs practice's band together and lobby the government? The BMA is a powerful organisation that would have to be taken seriously by the government so why not use that power? Also, were are all the doctors disappearing to? Surely there are doctors qualifying every year from universities, where have they all gone?

Instead of complaining about lack of funding and investment vote with your feet and demand better funding!

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.

Not at all doubting this is your experience, but I was having a read of this survey just because I wanted to understand exactly how it's different in your sector compared with mine (after my Boeing 737 comparison )

https://www.health.org.uk/sites/default/files/upload/publications/2019/2019-THF-QI_GeneralPractice.pdf

It's interesting that you think underfunding is to blame but the survey suggests:

Importance of facilitators of quality improvement
Working well as a team (98%)
Good clinical leadership (96%)
Clinical staff have the skills to assess quality (94%)

Those were the top three.

Financial support from external organisations (42%) was bottom of the list which I find really interesting?

And of course having the time to work well as a team, a good leadership structure and training on QI needs to be funded, so it's my no means black and white as everything overlaps, but it's interesting that "working as a team" is seen as critical by nearly all GPs and yet you work just one day a week as a GP, and think it's okay if you (so I'm going to assume all GPs) work part time / 2 days a week.

Really not trying to make that personal, or a dig, but I think (well, HOPE!) if my organisation were overwhelmingly agreeing that working well as a team was the most important factor in improving product quality, they would be declining more requests for flexible / part time working. ACAS allows a decline for "a detrimental impact on quality" and "a detrimental effect on ability to meet customer demand".

So while I think GPs should absolutely be afforded the same rights as everyone else, there looks to be a mismatch in what GPs overwhelmingly agree would facilitate quality improvement, and how they are actually operating.

That said, can't take anything away from you for training students the other three days and thanks for everything you do.

We have a great GP practice and have been able to see someone throughout the pandemic

@nancy75

Op, it’s interesting that your first thought is that the man who couldn’t get an appointment was probably being selective with the truth.

His experience with trying to get through at 8am everyday, only to be put in a queue & told all appointments are gone was exactly the same as mine, so on balance I think he was probably telling the truth.

The upset that people feel at the moment is not because we think GPS are not good at their job, it’s because we can’t get near one (on the phone or face to face)

Exactly this. I don't blame the GPs themselves of course, but the frustration of not being able to get an appointment AT ALL unless you sit in a telephone queue at 8am (only to reach 8:30 and be told AGAIN that all appointments have gone) is huge and a ridiculous way to run a healthcare system.

It took me months of being fobbed off during lockdown and further weeks of calling to get an appointment for my DS. Not life threatening but he now has facial scarring he'll be stuck with forever.

The issue is funding. GPs simply do not have long enough to spend with patients and there are not enough GPs.
The issue is not the design of the service.
I have lived elsewhere where you do not have a Dr like a GP and as a patient, you have to decide which specialist you see. Not only is it more expensive, but with complex medical issues I do not always have a clue who I need to see! I need someone to advise me.

I also totally agree that there is an attack on the NHS including GPs. I sadly suspect our health service is going to be destroyed over the next 20 years. Not that a lot of people on MN will give a fuck as there are a lot of well off people on here who can afford private healthcare. It will be people like me left to struggle on with subpar medical support.

@QuizzlyBear I am so sorry to hear that. The issue is the lack of GPs. We need way more funding and training to boost the number of GPs.

I don't think people do fully realise. Firstly because it really isn't made that clear to the public but also because ultimately, people are self-centered, focused on their needs and assume that any service to the public means an entitlement to be serviced.

But I don't think people can be blamed for being self-centred and focused on their own needs when it comes to healthcare? Or to assume that a service to the public means an entitlement to be serviced, provided you genuinely believe you meet the demand?

Especially when, as I mentioned in my post, up until maybe a year ago if healthcare was mentioned in front of a group of MPs, it was like watching an auction of how much money they were going to throw at it and how much they loved it.

It has been made into some sort of sacred pinnacle of society, so people expect it to meet their basic needs. Compare this to something like social housing which, while everyone would probably like to be better, nobody really has any expectations of. I would really like a council house is almost universally met with good luck with that dear, because the narrative from the top has made it clear it's just not a priority - unlike healthcare.

People's expectations have risen whilst the sense of self-responsibility is decreased, which both adds to the pressure on medical staff.

I'm not so sure they have risen, but I agree people have expectations. I also don't agree that self-responsibility has decreased - at all, actually.

I'm not particularly middle class or anything, and the vast majority of my friends in their 20s and 30s are regularly at the gym or running, or have dogs and lead pretty active lifestyles. Some have better diets than others but all except one have a healthy BMI, and the one who doesn't unfortunately has PCOS. All of us smoked as teens, none of us do now (couple of vapers). The culture of drinking wine during the week prevalent on MN and amongst my mum's 40 something pals - virtually non-existent. Truthfully seen as a bit cringe to drink at home on your own. Drinks are for nights out or house parties, all other social is dog walks, coffee dates, dinner etc. Much more likely to just buy treatment than bother a GP or a pharmacist - i.e a few of them use private contraceptive services, online STD testing.

Yes, I am one person, but this can be seen replicated when you look at the growth in the health and leisure industry (even gym clothing brands) and death of the pubs long before covid forced them to close. It's also echoed in surveys / studies online that there is a self-care trajectory (the risk being that healthcare is not changing quickly enough to cater to this)

What we do have is an ageing population, with the post-war baby boom coming to the age where healthcare is in higher demand, and the so-called looming "timebomb" of generation X on the horizon behind them (the generation where smoking was normal, working practices moved from physical to desk jobs, and diet was primarily based on the principles of high carb low fat).

Maybe not seeing every criticism as persecution would be a great place to start? If people are frustrated or left hurt by an experience then they will mention that. 500 good experiences do not make a bad one invalid.

I'm a paramedic and realise the the problem is multifactorial and rarely down to individual poor practice (although when these cases do happen they make great click bait and therefore get disproportionate attention).

I think the view from other HCPs is the GMC does not hold there doctors accountable to the same level as the hcpc/NMC do. I have certainly seen this play out in cases I know the details of (HV struck off, newly qualified midwife put on 12 month probation with increased supervision, GP no sanction). So I think they could be improvement in accountability across medicine.

I also have major reservations about GP receptionists acting as gate keepers and triaging patients, both in terms of blocking access to healthcare and also inappropriately redirecting patients into the 999 system. No unregistered and therefore untrained person should be making any autonamous clinical decisions. In ambulance control emergency medical dispatchers work to a extremely strict script which they get regularly audited and pulled up on for any deviations away from the script, the only people in ambulance control/ nhsd/111 making clinical decisions are registered paramedics, AP, GPs and nurses. I know some surgeries do operate a completely nurse led triage system, but this should become the standard across all GP practices.

The use of remote consultations is great for many, but for vulnerable individuals and those with barriers to communication it is affecting their basic right to access health care. This is not acceptable. I have started to submit POVA forms for vulnerable patients that I see who have repeatedly failed to access appropriate primary care.

Improvements are needed, but obviously that includes improvement in funding.

I've slammed GPS on a thread. Am I sorry? No! They let my then 11 month old son end up in hospital with sepsis because they refused to see him face to face and only video consult because he had a temp (of over 40 for 5+ days)!

He had 6 - yes 6 negative covid tests! Kept being told to test again!

It wasn't F**king covid! Yet they wouldn't see him face to face in case it was covid. It was a sorry & poor excuse.

Primary care has been difficult to access, limited by refusal to see patients face to face and unsatisfactory and dangerous is many instances.

Perhaps your a good doctor and your practice is working well but lots aren't!

Am I sympathetic to professions getting a bashing? Yep, I've worked frontline throughout this pandemic and my profession gets a bashing constantly too. Does it matter? No.

Perhaps if you do your job for thank yous and recognition you're doing it for the wrong reason.

Can't fault my GP. They're literally over road from my house and I've walked in off the street with a very sick child a couple of times, in the hope I could see the practice nurse for advice on whether I needed to go to hospital, and been seen immediately by a GP. I've also rung up with a bad chest infection, had a call back within the hour and was seen face to face 10 minutes later.

Now hospital referrals are another matter. When I needed to see a paediatrician with my then newborn, I was told it was a minimum three month wait, so we saw someone privately.

I think the real pandemic will be seen in 3-5 years with deaths from treatable illnesses and cancers that were diagnosed/treated too late due to Covid. All I can do is make sure that my family have excellent private health insurance so that we can skip the queue if necessary, and never ever vote Conservative in the hope that a future Labour government will actually fund the NHS properly.

@mercuree we spend less money on healthcare than most other developed nations. As you rightly point out, we have an ageing population which means we need more money for healthcare.
We simply do not have enough GPs or lots of other medics. We also have a crisis in healthcare and mental health whose effects are pushed onto healthcare e.g. people with mental health crisis turning up at A and E, elderly people without enough social care falling and having frequent hospital admissions.

Just coming on to say that my local GP practice is excellent. No problems accessing care during the pandemic or before. They started seeing patients face to face relatively early if what others post is true.

My GP practice has been brilliant as well.
The amount of work GPs does have really increased. There are so many medical conditions that used to be managed at hospital outpatient clinics that GPs are now asked to manage.

The King's Fund reports that General Practice handles 90% of patient contacts in the NHS and receives less than 8% of the NHS budget.

NHS England figures show that General Practice received 7.1% of the NHS budget in 2018-19.

@kindofcoping on the contrary. If those who can afford private are out of the mainstream system you'll have far better service. Just can't see any govt pulling enough cash out of its arse to realistically support the system we need today the way we need it. Let's stop flogging a dead horse and figure out how it can work better. The system you had wherever you lived sounds ridiculous. I've lived overseas where people pay £10 to get into A&E and the same for hospital stays. Most people can afford that. Non critical services could be made partially payable and the NHS has to stop funding every single non critical medical issue under the sun. I've just been privately for an operation snd various treatments. This is in a lovely hospital down the road from the NHS hospital where most of the appointments are made in the evening after the consultants have finished their day jobs. Why can't these resources be pooled. I enquired about going privately within the NHS hospital and it was more hard work than necessary so I gave up, plus private in an NHS hospital is only marginally better so you may as well be on downstairs on the ward. There must be ways for more integration.

We highly rate our local surgery. We read reviews first and chose a surgery in the next village. Our closet surgery had lot of bad feedback and we continue reading posts of waiting 30 mins on hold to book appointments or waiting +3 weeks for appointments. That is what upsets people.

But my local practice is great - both of my children have needed face to face appointments and have been seen same day.

I really hope phone appointments continue as that works must better for me

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.)

You sound like a very dedicated GP and I'm sure your patients receive great care from you. Doesn't mean the same is true for everyone else! I (like countless others) have had shite experiences with my GP (not just during Covid) and it's perfectly ok to raise those grievances and comment on the issues with GP services we are facing.

Certainly some GPs could benefit from more training in certain areas well yes, instead of fobbing patients off with paracetamol for their 'women's problems'

I really struggle with this because I am an HCP and also a patient. I understand how frustrating the system is for patients to navigate.

Why are you taking these criticisms so personally? Primary and secondary care waiting lists are often unacceptably long - this has little to do with individual members of staff.

I have paid privately for consultations where the NHS waiting time was unacceptably long and I am so angry that I see patients daily who simply cannot access the care they need, who cannot subvert these waiting lists like I did. I do not see this as my fault - it is the system.