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?

The problem in our area is not the GPs.

It is trying to get through by whatever means to the practice reception to book an appointment. It's a nightmare.

If you actually do get to speak to a receptionist they are surly and rude, and talk to you as though you are a total inconvenience, and they are doing you a massive favour.

My GP surgery has been great. As well as GPS there are a couple of prescribing nurses. I have been able to call in the morning if my asthma has flared up. I get a phone call back within the hour and then usually asked to go in so they can check my oxygen levels.

Much better than it was for me.

I think people do focus on negative experiences though

surely people realise that we are experiencing unprecedented demand and the reason access is difficult is there are not enough clinicians available

Well actually I don't. Why is there unprecedented demand? People won't go to the GP with covid symptoms, so other than mental health issues which the NHS is terrible at dealing with, what is the extra demand for which wasn't there pre March 2020?

And why are there not enough clinicians available? Presumably you've all been vaccinated ages ago, are not shielding, and can work normally. Kids are back at school (generally) so no "home-schooling".

I agree with a pp who said surgeries are badly run. Too much bureaucracy, too much "can't do" or "won't do" and too much blocking access. You should be able to contact the GP by whatever method works for you - ie in person as covid restrictions ease, by phone, email, e-consult etc. And you should be able to make appointments in advance, not just between 8am and 8.02am.

GPs vary a lot in their skill sets and interests and some have more expertise in certain areas than others

So in the ones they don't know about, they should refer, rather than telling people not to waste their time, or as a pp said telling women that they should just put up with heavy periods.

I find it isn’t the gps or the hospital but getting access to them is the actual problem!!

For instance I have to go a and e later, I already know I’m going to be sitting there hours just to be seen. It’s a pain! I only need antibiotics!!

OP - it is impossible to get a GP appointment of any kind here at present. Of course that's not the fault of GPs.
I think people talk a good story about wanting a better service - but then vote for politicians who don't care about the NHS.
I wonder if a nominal charge to see the GP might reduce the incidence of time wasters and no-shows?

I think this IS the fault of the GP - and they are lying when they say heavy periods are not an emergency - they can see who they like, when they like: www.mumsnet.com/Talk/am_i_being_unreasonable/4256664-To-think-this-does-warrant-a-GP-appointment

Meh. Don't take it personally OP. What does astound me is that some GP practices in the UK are really good. Lots are ok-ish and some are appalling. I don't get why the bad ones (they must know who they are) don't use the good ones as a benchmark.

Absolutely YANBU, our GP care during the pandemic has been excellent and I take any opportunity to share that as a counterpoint to people’s (valid) complaints about their own poor experiences. Unhappy people shout the loudest and I’m a firm believer in speaking up and recognising good work!

Just last month toddler DS and I took cards and chocolates into the surgery for two GPs we’ve had amazing care from and the receptionists who are fantastic. It’s a surgery that’s really set up for the patient, rather than the staff.

My old surgery wasn’t amazing but the GP I used to see was fantastic so I wrote him a nice card when I moved surgeries thanking him for the six years of care and explaining what his help had enabled me to achieve in my life.

You have an incredibly tough job, most people couldn’t do it. You’re dealing with haystacks every day and can’t miss the needle in case it’s something serious, trying to juggle referring onwards too much or not enough, trying to differentiate the one time it might be stomach cancer versus the 99 times it’s just constipation. I take my hat off to you as a profession.

Having said all of that about GPs, we’ve had nothing but terrible experiences of our surgery’s practice nurses, both of them. Prescribing the wrong medications, making snap judgments within the first sentence of a call, failing to ask for a specific test they agreed to and making us go back again, they are an absolute liability. Of course the surgery tries to book you in with them if they feel it’s appropriate but short of cervical screening I refuse to make an appointment with a nurse.

But that doesn’t mean all practice nurses are terrible. Just the ones we’ve dealt with.

@3scape

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.

Agreed.

Are people not supposed to discuss their bad experiences with GP practices on Mumsnet in case it hurts the feelings of some GPs who are members?

We had a similar issue with teachers for a lot of last year iirc.

Wot, British people moaning about their supposed betters? Gosh, never heard of that before.... #sacasm

That said, there are a lot of statements on MN that basically go like this:

"I have no relevant qualifications but I know so much better what is best for YOU than any possible health professional could possibly know, and especially not health professionals who have actually met you & seen your health records or had any formal education about your health issues."

It feels like concerted effort to disseminate uncertainty & lack of trust.

It's pretty that those statements stay when MNHQ deletes lots of other posts that have slightest whiff of ignorant prejudice.

I'm speaking as someone who has disregarded plenty of medical advice, btw, but at least I see that as my choice not evidence I'm the wiser person for it.

”Wot, British people moaning about their supposed betters? Gosh, never heard of that before.... #sacasm”

@ragged Doctors are not supposed betters and fortunately, most don’t think that way. Is their medical knowledge better than me? Well, I’d hope so but if a doctor had the attitude they’re better, it would probably get the back up of patients.

The truth is sometimes GPs get it wrong, but people also talk a load of rubbish about medical problems.

Yabu people should be allowed to discuss piss poor primary care practices without being shamed for it it quite literally costs lives and if you don't speak up in case you hurt someone's feelings then nothing will change and more people will die or be made worse

I can’t fault the surgery I am registered with, they are absolutely brilliant. It’s the only surgery I’ve been registered to (fair enough I’ve only been registered to 3 in my life) where every GP I have spoken to has a solid understanding of MH issues and women’s health issues. But the surgeries I have to deal with while I’m at work... well. Unfortunately, I have nothing good to say about them.

I’m not trying to be rude so sorry if it sounds like I am, but I would genuinely be interested to know exactly how GPs’ workload has changed massively throughout the pandemic? I know I mention it on every bloody thread I comment on but I work in a pharmacy, so I have experienced a huuuuge increase in our footfall and workload which is largely due to the GP surgeries being closed. We used to have a lull of about 2 hours where we’d only have a handful people coming in to collect prescriptions and buy OTC items/want advice but now, for the whole 10 hours that we’re open, we have a constant queue of people. I’d say around 50% of these people are those who have been inappropriately referred to the pharmacy by their surgery. No, we can’t issue antibiotics for a suspected chest infection without a prescription. No, we can’t do an emergency supply for a controlled drug because the doctor won’t have time to sign the prescription off. One patient was told they were not allowed in the surgery for a blood pressure check due to social distancing and hygiene measures but told to go to the pharmacy instead. Ok, so the patient can’t sit in the well-ventilated waiting room and take their own blood pressure but the pharmacist is expected to do it for them in a poorly ventilated consultation room that is about the size of a Ford Fiesta?

Try not to take it so personally OP, obviously all GPs are not bad, I don’t think anybody genuinely believes that

Op you must be aware that gp services are in some cases not fit for purpose. I have been ill for two months and am finally being telephone triaged next Wednesday by my own dh who is a home visiting practitioner ( ie paramedic) at the surgery ! We think through much reading and googling that I have dermititis herpetiformis. He already knows he cannot refer me for a biopsy or prescribe dapsone. So it is a pure formality and delaying tactic. I may then finally be allowed a telephone consultation with a gp. It's bollocks.

Thanks @DistrictCommissioner I had no idea. I've been lucky enough not to have needed a GP appointment in several years and did wonder.

Sorry op.

I think you'll get slaughtered on here.

I think people dont realise what it is that's happening. And once GP is gone and they have to pay- like what happened with the dentists they will realise what's been lost.

GP services aren’t fit for purpose, it’s impossible for one individual to be competent in every health care issue, even if they have a good understand of anatomy physiology and pathology.

Primary care would be better dealt with as a triage system (similar to being triaged at a&e) whereby a healthcare professional (rather than a receptionist) triaged patients in the first instance and directed the person to the relevant healthcare professional such as one that deals with gyn, mental health, ENT, or for minor complaints a pharmacist for example, and the healthcare professional that deals with the initial triage would also be able to prescribe medication which would cut out the GP role, as GPs would now work in a specialised area.

Also someone earlier brought up the issue that in general GPs aren’t always made accountable for medical negligence and errors, whereby other healthcare professionals such as nurses and midwives live in fear of having their pins revoked and losing their jobs and being struck off the NMC register. GPs in my opinion need to be made more accountable for errors and negligence.

@Lbnc2021

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.

I’m so very sorry to hear this is so common and I hope your brother is doing ok.

A close family friend has had a similar experience. He’s in his 70’s with classic symptoms of prostate cancer. It should have been a no brainer but it took a year for him to be seen. His cancer has also spread and he has been given two years.

The current system is an absolute disgrace and threads like this have a real ‘NAMALT’ feel. It is apparent from the volume of posts from people who are having issues accessing services that good GP services are not the norm for many people. And when I hear GP’s complaining about working 12 hour days (but not weekends, obvs) I get the absolute rage. In my industry this is the norm. In dh’s, this would be practically part time. It’s hardly unusual, particularly when I don’t know of one that opens before 8.30 or after 6pm (my own excellent GP used to offer out of hours services 2 evenings per week, but these have now stopped ‘due to Covid’ and are still offering limited opening hours for the same reason). People are dying as a result of not being seen, and this isn’t acceptable. NHS or not.

He’s doing good today thank you for asking, really think he’ll be ok but it shouldn’t have came to this

@Poppynit there’s a few factors contributing to increase in workload. One is an increase in practice appointments - there were 18% more appointments this March than March 2020 (which was weird because pandemic) but still 11% more than March 2019.
Many GP surgeries are still vaccinating and this takes a lot of staff and a lot of space.
Face to face contact takes longer because we have to don and doff PPE and clean down the room.
Many hospital services are still reduced and some of that demand is shifting into primary care.
In the longer term we had 0.52 fully qualified GPs per 1000 patients in 2015. It’s now 0.46. So the workforce is smaller.
Thank you for a really nicely worded question which absolutely didn’t come across as rude - I hope that answer makes sense

@EgonSpengler2020 thank you so much for making me feel shit after an 11 hour shift because you've got an axe to grind. I'd be feeling more shit if the patient had a cardiac arrest and died because I was dismissive of symptoms and didn't use my common sense to tell his wife to ring for an ambulance. Surely it's up to Ambulance Control to ask the questions of the call handler to decide whether an ambulance needs to be despatched or not.