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?

@iminthegarden No once those with money are removed from a public system, then the system gets a lot worse as those without money do not have the same power to campaign to make it better. Look at some state school systems in the US in states where anyone with money sends their children to private schools. The state schools are truly shocking.

And if you think anyone can pay £10 to attend A and E, it shows how out of touch you are with the bottom 20% of people in poverty. I have had times when spending that 310 would have meant no food that week.

Making noncritical services partially payable just means lots of people no longer have access to these services.

I fear this may all happen. And that the poorest will have only access to emergency and critical care services. I know my relative who has serious mental health problems would up shit creek. When their health has been bad they have had visits 3 times a day from the crisis team, many many GP appointments and blood tests because of the medication. If they had to pay for it they could not. And many non-critical services they access help maintain their mental health.

Anyone on benefits wouldn't need to pay. I've lived where this happened and it's worked - the majority of people there are far poorer than this country.

What money would be removed from the system,l?

My GP health centre is close to collapse. That's not scare -mongering, that's reality.

Long-term patients are being routinely cut off from essential medications with no mechanism for re-accessing them. This is putting patients at risk of heart attacks, strokes, thyroid crises, self-harm and worse.

There are no appointments bookable, they won't discuss medication over the phone, and the sainted e-consults & emails go unanswered.

This has got to be a staffing issue.

The only reason I'm still getting my Adalimumab is because it comes to me via a sub-contracted hospital provider, not my GP. And yeah, you have to be pretty bloody fucked to need Adalimumab, so I'm glad about the provider, while being sad what is effectively a private contract is necessary within the NHS.

GP funding needs to be massively increased.

@iminthegarden I am saying cuts would be made running down the system as the well off leave the system. Once a system is only for the poor this always happens.

I am not on benefits. I could not afford my healthcare. And people like my parents who are not on benefits - but only just - are hard enough to persuade to go the GP anyway. Although I am the same to be fair. I would have zero chance of getting my dad to for example get that suspicious looking mole sorted out, or my mum to tell her GP her poo is bloody, if they had to pay anything towards it. For myself, I would never have another smear test. It takes me months to work up to it. Paying is a barrier that would just make me go nope.

I think you are working on the middle class assumption that everyone who needs healthcare seeks it. When actually those who most need healthcare often do not seek it until the problem is bigger. This is particularly common amongst people with serious mental health problems. And do not make the mistake of thinking everyone with serious mental health problems is on benefits.

@AllDoneIn

Try being a teacher 😂 Sorry, I'm joking ... sort of but yes I understand how demoralizing the constant smearing is. It wears you down

The issue you have is that GPs are the link between people and potentially life saving treatment. People are tired of clapping for the NHS when the quality of GP services are so poor in some areas (my own included) and they are frightened and in pain.

I’m a teacher too and this was the first thought that came to mind

@SpindleWhorl I am so sorry to hear that. The issue is massive GP vacancies. Where I am has a low rate of GP vacancies so I have zero issue with getting an appointment. In some areas vacancies are sky high.
There needs to be more training places and GPs need to be better paid.

[quote kindofcoping]@SpindleWhorl I am so sorry to hear that. The issue is massive GP vacancies. Where I am has a low rate of GP vacancies so I have zero issue with getting an appointment. In some areas vacancies are sky high.
There needs to be more training places and GPs need to be better paid.[/quote]
It's a vicious circle, isn't it? Who wants to work at an under-staffed GP surgery?

[quote kindofcoping]@Helenahandbasket1 they have to triage to see who needs an appointment today and who can wait.[/quote]
If you attend your local A&E you are triaged by a qualified nurse, not frontline admin staff.

My point is that it is entirely inappropriate to ask your unqualified receptionist to make that call.

@EgonSpengler2020. As a Receptionist i've told people to ring 999 if what they are presenting could be life threatening. Lately I had a call about someone who although only 36 had central chest pain for 3 days and had the pain whilst they were on the phone. He did indeed have a heart attack. I don't tell people to ring 999 unless it's something serious or referred to GP first.

Scotsdoc123 I hear you sister!
GP here - fortunately I am a kiwi so live and work in NZ.
I honestly don’t know how my UK colleagues have coped.
We are very very fortunate here - we have a PM and government willing to listen to scientists and to have not sacrificed their people and their medical system like the UK
I am a dedicated GP and officially work only part time - part time is 40 plus hrs per week.
An overwhelming majority go into medicine, and especially general practice to make a difference. Medicine and other caring professions attracts people who are often wounded themselves - lots dysfunctional families are represented in med school classes.
In the end we are the wounded seeking to help the wounded.
There are many many things we cannot change for our patients -we can’t change unhealthy relationships, or poverty or the deep effects of trauma. We can try to understand and care. We are often struggling to get secondary care for patients from hospital services - we carry the stress of not being able to access that.
Like me, I am sure you love many of your patients - I was in a local town today and one of my patients rushed across the tea rooms and hugged me - those things must happen to you too, keep all those cards and remember the tins baking, the being with a family as you care for a loved one dying, the joy of greeting a small 6 week human and the proudness of their parents. I hold onto those moments and drink them up - they have kept me hopeful through many dark and frightened moments.
Sometimes I think my job is to bare witness ,and on some level to let patients know they are not alone.
Medicine is not that clever - there are many many things unknown and disease when it first presents is challenging and not always typical .
Feel the arms and love of a colleague many miles away.
❤️❤️

[quote TroysMammy]@EgonSpengler2020. As a Receptionist i've told people to ring 999 if what they are presenting could be life threatening. Lately I had a call about someone who although only 36 had central chest pain for 3 days and had the pain whilst they were on the phone. He did indeed have a heart attack. I don't tell people to ring 999 unless it's something serious or referred to GP first.[/quote]
Which is good for that patient but what you advised is common sense that is widely advertised via public health campaigns. The point is that as an unregistered person working in healthcare if you hadn't told him to dial 999 you would not be accountable for your decision making.

You are NOT a registered health professional and you should NOT be making autonomous clinical decisions in a 21st century health system.

@LunaTheCat you have a minuscule population in comparison cannot compare. NZ was lucky not to have an influx of covid when Europe did, thanks largely in part to Asia locking down in January. You did nothing special, if you'd been inundated with virus in December you'd have been in the same position as the rest of the world.

All the GPs in my practice are great. I feel so lucky. The problem is further down the line, thanks to COVID. I need a Nissen Fundoplication. The consultant, who I know personally, rang me and said the first step is a repeat gastroscopy. I have waited months for an appointment and still nothing. Then that is followed by a manometry. My husband had to wait to go to London for this for nearly a year pre-COVID. I dread to think how long that wait will be. My DD is on a waiting list to go on a waiting list for a hysterectomy. That could be years, meanwhile she has to teach classes of 30 while pouring with blood. Her ablation failed. It's so easy to moan at the GPs, but it's not their fault, but clearly, for many, the sheer frustration is aimed at the most easily accessible person, the poor GP.

inthegarden I completely disagree. NZ is raked among the WHO as having the best response early. We looked down when we had identified 2 cases which where not linked to known cases. We closed borders early. Anybody coming into the country was quarantining do in a hotel for 2 week.
We have done well.

It’s tricky. My brother has been badly let down by his GP, refusing to see him/sort the necessary blood tests/refer him and as a result is quite poorly. Whereas my GP, looking at myself possibly having the same condition, has bent over backwards to help. Sadly their newly introduced processes for one area has left me in pain, and off work, for longer than necessary. Yet a friend was diagnosed and treated for her cancer within a month. There is no consistency really.

I understand they have had a tough time, and some have been better than others but I personally find the constant 'we have had it so tough during the pandemic' is wearing thin. They are not the only job which has had it tough, and from what I can see from an outsiders point of view they shut up shop locally. e-consult or hours on the telephone are the only option.

I have needed to use the above a few times in the past year, for myself mainly to renew prescriptions - I am unable to take calls whenever as my job restricts it but everytime they have failed to take that into consideration - telling them ring anytime on a Friday is obviously not clear enough.

When my son had a suspected UTI we called they issued a prescription, but also wanted to check a sample. I was told to go to the surgery to collect the paperwork - I was then shouted at by the receptionist for daring to turn up, who demanded to know exactly why I was there in the middle of a busy street.

I am relatively intelligent around basic medical issues, but I have been made to feel like I am an inconvenience over the last year.

Can I ask (and I mean this in a curious, not accusatory way) what is the unprecented part for GPs at the moment? Initially having to switch to online I understood... likewise when suddenly your were given the job of coordinating vaccines for eligible people. What's happening at the moment to have such an awful impact on services?

@MilduraS

Can I ask (and I mean this in a curious, not accusatory way) what is the unprecented part for GPs at the moment? Initially having to switch to online I understood... likewise when suddenly your were given the job of coordinating vaccines for eligible people. What's happening at the moment to have such an awful impact on services?

Amongst the aspects you mention, massively increased demand. ‘NHS figures released this month show that GP practices in England delivered almost 5m more appointments in March 2021 than the month before, and nearly 3m more than in March 2019.’ From here www.theguardian.com/society/2021/may/28/staff-at-uk-gp-surgeries-facing-abuse-and-tsunami-of-demand

@LunaTheCat NZ only closed borders a week before the UK did in March, despite its proximity to Asia where the virus kicked off in Dec/Jan. In February the world thought it was an Asian problem so you were on alert earlier. My husband travelled to Uk from Hong Kong mid-feb and we were all talking of how worrying the situation was in Asia, literally a few weeks later it dawned on the world that it had been circulating in Europe for weeks without people knowing. It was too late. NZ is at the end of the world, 12 hours from anywhere so NZ closing borders is not the same as other mainland countries with complex borders and transportation hubs. Europe have remained true to our democratic principles in terms of allowing essential travel, while NZ has adopted China's strict stance, that wouldn't be tolerated in this part of the world. Aside from that, all islands with small populations have been able to keep the virus at bay successfully, NZ did nothing exceptional but stop people flying and locking up its population. Looking forward to flying out to Portugal tomorrow for a holiday

Anyone on benefits wouldn't need to pay. I've lived where this happened and it's worked - the majority of people there are far poorer than this country

And yet there was a report out the other day saying people couldn’t afford dental care. I spent £1000 in a year on dental care ( crap teeth) l couldn’t afford that never mind paying for a doctors on top. I’m not on benefits so have to pay the full whack.

I'm talking about £10 per A&E visit and each hospital stay, would also add it for GP appts too including credit card cancellation bookings for no shows. Things like this.

Well you are often undertrained, OP. You've admitted it when complaining about lack of access to training.

I would prefer not to have unfounded confidence in an undertrained GP than take some of the nonsense I've heard at face value and the patient doctor relationship can go jump.

Like too many GPs, you're very bossy.

It would really, really help if more of you would work a five day week. After all it cost to train you all, it's rather galling that there is a shortage of clinicians partly because you choose not to work full time. But you'd rather complain about patients complaining.

I feel fortunate because my GP surgery is very good. I find the HCPs to be knowledgeable and compassionate most of the time. The receptionists and admin staff are also polite and helpful most of the time. Yes, you have to hold on for ages but that’s not a unique problem. Personally, I think telephone triage works well. My surgery are beginning to offer more face to face. I am usually happy enough with a phone call, save the face to face for those who really need it.
However, the policy of not seeing patients at the height of the pandemic caused issues for me twice. Once, their refusal to see me meant I ended up in A&E, iller than I would have been if the Gap had treated me fully. It was unnecessary and a bit scary for me as I’m clinically extremely vulnerable and would have preferred not be in a hospital environment. Plus, I didn’t need it really, so felt I was wasting resources. The other time, I had an infection that spread from my inner ear to my skin around my ear and it blistered and swelled. Photos didn’t fully show it and I ended up on the wrong antibiotics and it took a while to resolve. In neither case do I blame the GP, I understand they were told to significantly minimise patient contact but I was under the impression you’d be seen if necessary and it was necessary.

Also, it's lovely that you're trained in gynae issues. Perhaps you could have a word with as many male colleagues as you can and drop the following into the conversation:

• Severe period pain isn't normal.

• Breastfeeding isn't a form of birth control (yes, you really need to do this.)