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?

Such a lot of rubbish being spouted on this thread
Eg the poster who thinks GPs should be forced to work 5 days a week. Most GP partners are doing 12 hour days (at least, often more) so that would be excess of 60 hours a week. How many professionals work intensively for 12 hours a day, 5 days a week without completely burning out?? Maybe they should ban us from taking holidays too so you can get your money’s worth. Plus don’t forget lots of us also work out of hours in evenings/ weekends which may be why they don’t work 5 days ‘in hours’. I don’t know any GP who works 5 days anymore as it’s just so hellishly busy.

Why are GPs more busy...well there is the small factor of vaccinating the whole country, running covid hubs and managing hugely increased demand eg people phoning because they have had a sore finger for 5 minutes etc. Inability to self manage minor stuff takes up a lot of GP time. This makes it much harder for the sick people to access the care they need.
Add onto that the fact that hospital clinics all pretty much stopped for months so the waiting lists are through the roof ... so people keep coming back to see their GP for the same problem that we still can’t fix without secondary care input.
People are presenting later with more serious illness, not helped by the ‘GPs are closed’ narrative. This then needs more input to fix things.
Routine referrals were being refused for a while so GPs also have to keep trying to manage these things eg without access to imaging
We are also starting to see people with viral illnesses that are making them a lot more ill than you would expect, esp in kids. So what would have been a mild illness is making people more unwell, again needing more input.
And don’t forget chronic disease management which we were told we had to stop for the best part of a year is now getting going again and we are having to try to catch up with all of that. It’s a huge amount of work

I agree with others that the nhs is massively underfunded and being set up to fail so that virgin care or similar can swoop in and pick off the easy bits. We are rapidly heading to a 2 tier system and people are in for a real shock once the nhs fails. Look at dental care in this country if you don’t think it’s going to happen...

@LuaDipa

You are very naive if you think a human being is still safely able to assess, examine and treat patients after a week of 12hr days. Even in nursing if you work 12hr shifts you do three per week.

Not sure what industry your DH is in where that’s practically part time but I suspect people aren’t at risk of dying or becoming seriously unwell if he’s exhausted or a bit fatigued after a week of long hours and not at his sharpest.

Doctors, and nurses, and mental health professionals, need and deserve adequate rest in their working week. You seem to forget they are human.

For what it’s worth I spent a year working 80hr weeks on top of full time studying and it shocked me how sick it made me. Chest infection after a migraine after sinusitis after another migraine after a UTI and on it went. Turns out bravado and machismo only go so far when it comes to the human body.

My DH is a teacher so I completely understand what you mean about generalising a bad egg in the whole profession.

There are however huge gaps in GP knowledge, even as a jack of all trades, and no requirement for them to have refresher courses or update their knowledge, which is something that needs to change in the profession.

My DD has had ME/CFS for 5.5 years since she was 14, and the dismissive, and in some cases downright rude, attitude of every single GP I have had the misfortune to meet has left all of us with PTSD. We have had to go private to get anywhere at all at the cost of thousands and thousands of pounds, and had to fight tooth and nail to get her vaccinated when her consultant deemed her to be in group 6 but the GP partners at the practice who have paid no heed to her condition in over 5 years disagreed.

And I have read hundreds of examples of similar stories. One year at an ME awareness-raising event we had a stand called "Things my doctor said to me" and the things written there would make you cry.

If this comes down to lack of education, then there needs to be a requirement for GPs to update their training and do mandatory CPD.

Whereas services, availability of GPs and reluctance to prescribe medication due to cost comes down lack of funding, I can't find any justification in an inability to actually care about individual cases and where it's acceptable to leave disabled patients lying on the floor and telling them if there was a fire, they'd soon get up.

If this comes down to lack of education, then there needs to be a requirement for GPs to update their training and do mandatory CPD.

GP's have to do CPD every year, maintain a portfolio of their work and learning, and have it assessed at their annual appraisal. They are then revalidated every 5 years by the GMC and can be struck off if they haven't proven ongoing learning and development, the same as all doctors.

I am genuinely sorry for all those who have had negative experiences with their GPs.

GPs have mandatory appraisal each year. They need to present evidence of 50 hours of CPD each year (done in their own time usually). Any complaints or significant events have to be discussed at appraisal too (so if you have had a bad experience and complained the GP will have been expected to evidence reflection on that complaint and any appropriate learning). Every five years GPs also need to collect anonymised patient and peer feedback which is also discussed at appraisal.

The issue is arm chair doctors ie (receptionists who think they are doctors). If the receptionist says you don't need to see or even get a phone consultation then you get zero care. I believe that is the true massive issue.

For me it's the dismissive disdain I've been treated with when I finally decide I need to see a GP.
Honestly, it's happened enough times that I'm on the defensive before I go. I'm genuinely surprised and pleased when I'm treated with respect by HCP's.
I'm lucky enough that I go years between visits normally, but I get anxious now before I even phone because I feel I'm likely to get fobbed off.
"What would you like to happen?" Umm... I don't know, I'm not the expert.
"Were you hoping for antibiotics?" head tilt not necessarily, I was hoping for some help. (That one was especially galling because I'd made the appointment due to struggling for breath in the night)
It's the gatekeeper attitude. I'm not a frequent flier, I don't get why I'm never taken seriously. I've lived with a couple of conditions for years that I self manage, when they start to affect my day to day life I seek help. I'm fobbed off.

Yeah - there's a fair amount of "well, we're hugely busy, because covid" which is true now

But this isn't new - not being able to get an appointment because for whatever reason a receptionist won't do it etc etc.

Sure there are nowhere near enough GPs and the workload is huge - but why is it that some practices can be efficient and others are not? Standard practices would be a way forward. So why don't underperforming surgeries benchmark the good ones?

Some surgeries have a much bigger recruitment problem than others - that can be because of the area they’re in or sometimes understaffing leads to a vicious circle where it’s an even harder place to work so nobody wants to work there. Funding is also really complicated and some surgeries end up with more money than others to employ staff.

Generally happy with gps, if issues address directly, which seems ok

I'd like to know how my 88 yr old mil can 'email a photo' of her irritating wart on her arm to her go for review? Surely better to get her in. She's fully vaxxed.

@MrsArchchancellorRidcully

I'd like to know how my 88 yr old mil can 'email a photo' of her irritating wart on her arm to her go for review? Surely better to get her in. She's fully vaxxed.

Ridiculous they expect that. I'd not want to email that either but asking someone in their 80s, jeez.

[quote ChangePart1]@LuaDipa

You are very naive if you think a human being is still safely able to assess, examine and treat patients after a week of 12hr days. Even in nursing if you work 12hr shifts you do three per week.

Not sure what industry your DH is in where that’s practically part time but I suspect people aren’t at risk of dying or becoming seriously unwell if he’s exhausted or a bit fatigued after a week of long hours and not at his sharpest.

Doctors, and nurses, and mental health professionals, need and deserve adequate rest in their working week. You seem to forget they are human.

For what it’s worth I spent a year working 80hr weeks on top of full time studying and it shocked me how sick it made me. Chest infection after a migraine after sinusitis after another migraine after a UTI and on it went. Turns out bravado and machismo only go so far when it comes to the human body.[/quote]
Nurses aren’t the best example here as I have seen many on here argue that they definitely stay longer than their 12 hours and there is absolutely nothing to stop them working extra shifts (for more pay) and many do. Plus I believe there have been attempts to change this shift pattern, but many nurses actually prefer the extra days off. In terms of efficiency and value for money in struggling NHS, surely a better option would be 5 x 8.5 hour shifts, which to most would simply be a normal working day.

I would agree that it’s not necessarily ideal, but it is not out of the ordinary and expected in many industries. People outside of the NHS are human too and most seem to manage working quite standard hours without complaining every time their practices are criticised, which is what seems to happen every time anyone expresses concerns about accessing GP services.

If Drs or teachers are annoyed by what people say on chat forums they need to get another job. You're not up to the job if MN threads offend you. And generalising is jumped on - but people should be free to set out their experiences.

I don't think GPs are overworked (I used to work for a practise). They didn't do 12 hour days, most only worked 2 days and funding wasn't an issue. 1 GP was amazing, 2 were fine and average and 1 was a drunk who didn't work in the afternoons because he was pissed and no, his colleagues didn't think they should do anything about that.

However, I will also say that lots of people come into the Drs when they don't need to. Top offenders are lonely old people and SAHMs who both have the time and inclination to come to the Dr very often for stuff that they could sort themselves at home. Very sad of course but not a good use of the Drs time. Not sure how that can be solved but I'd support being firmer about only coming for actual issues and not boredom or loneliness.

We also need to stop deifying the NHS - it's not free or efficient and without changing some fairly fundamental things, more money would make no difference at all. I've worked in the public sector a fair time now and extra funding without sorting fundamental issues is normally wasted.

[quote chinateapot]@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[/quote]
I’m glad it didn’t come across as rude, it felt really rude in my head! It’s so hard to convey the correct tone over the internet! I understand that GPs are under a lot of pressure generally but during the pandemic, we (my colleagues and I) have been wondering what exactly has changed for them. That’s a very good point about hospital services shifting into primary care, something I hadn’t thought about.

My grandma was on the phone to her GP constantly during March/April 2020 to check whether her very mild hay fever symptoms, that she’s suffered from for about 40 years, were actually COVID symptoms. I had to tell her firmly but politely to stop calling them because other people need appointments for more important things, I felt awful!

Thank you for your comment, very insightful. I only have a month left before I leave my job but in that time I’m trying to liaise with the local surgeries so we all have a better understanding of each other’s model days so we can all serve the community better. I think the healthcare system as a whole needs an overhaul, how? I’m not sure. But I think if we can make a difference locally, it’s better than nothing. Thank you for answering!❤️

Some GPS are great Some less so. What doesn't help the overall picture is this blindly defending the profession. Some are shit. Some are great but you have to acknowledge that some are well below par.

You don't get this in other professions (accountants and lawyers) where people go 'well they are also a .... so much be great'. As a profession you need to hold each other to account sometimes.

Yes often the problems experienced from GPS are actually poor practice management but the partners are responsible for that.

Examples
I can not have a telephone appointment because the phone system is so outdated at the practice I can never hear them when they call me. I can hear them if I call but that doesn't work in the new age of telephone triage.

I have PTSD following the appalling care for the midwives when I have birth. I can't speak about it easily and find it impossible to communicate over the phone about it. I therefore am unable to access a GP appointment about it because of the whole telephone only at first policy. I cam not even plead my case (which I shouldn't have to) to the receptionist because of the PTSD. I would not have been able to access health care if it wasn't for the health visitor who only sees us because of my child have Wright gain problems.

Trying to get through to even encounter these problems is also problematic. Most weeks a message has to be put up on the doctors website saying they are experiencing yet more problems with their telephone line so can't take any calls.

There are advantages to the private/public system in Australia, although I know this horrifies people in the UK. It’s also an accepted system - generally good communication between private and public clinicians and an appreciation that some people may use the public system for one issue and private for another.

Where I live there are 4 or 5 private radiology providers and 2 main private labs. X-rays are reported by the end of the day and public and private emergency departments can log on and review the images from external providers.

Pragmatically, this means that GPs can order investigations and most radiology will be reported by the end of the day and blood tests will be electronically available after the lab has processed the results. Most X-rays and lab tests can be bulk billed (no cost to the patient).

I was horrified to read on here about a baby in the UK whose hips were examined at 6 weeks by the GP and were clinically unstable who couldn’t get an USS performed because the local hospital was limiting services “because Covid”. This was last year and of course may not have been true.

Here, a same day scan could be done and reported by a paeds radiologist. And the baby would have been in a harness within a few days in both the public and private systems with GPs having access to both specialists directly (admittedly via the registrar in public). I appreciate that this was in the midst of the UK lockdown and may not have been true, I hope it wasn’t.

GPs are doing their best but like with many healthcare professions there seems a lot of ‘compassion fatigue’.

For example my GP signed me off for 2 weeks with long covid, and went on about the benefits of working (I pointed out I’ve been working with long covid on a hospital ward for 4 months and can’t cope any longer). I know the guidelines and I’d work if I could.

I need another phone appointment to extend the sick note but can’t get one as they’re all booked up; so I’ve had to go to a private GP (who emailed me the note straight away!)

We need more GPs. We need better understanding of long covid. And please could GPs try to understand most people are doing their best to stay in work.

I’m a teacher and even after 21 years I haven’t developed enough of a thick skin to protect myself from the vitriol on here!

I have had poor experiences with GP practices - not GPS themselves but I think they are poorly run. For instance many years ago I had a miscarriage. A few months later a HV knocked at my door for the 30 week check. No one had informed their Health Visitor service I had lost a baby. My GP is fab but to try and speak to her is a trial. Firstly it could take up to an hour being on hold and then I’m told I would receive an appointment by telephone either am or pm. This is a nightmare for a teacher - we can’t have phones in class or leave a class unattended. I must admit I find it easier to go to A and E for minor care.

I would never openly criticise though. As a public sector worker I realise this isn’t the fault of the GPS, just under funded, under staffed services.

If it's the Govt's fault for not funding GPs properly then why is there such disparity in how practices in similar areas are managing?

When I phoned for a GP appointment last week in severe pain with inflammatory arthritis (after being in remission and not on any medication for 10 years) was told I could have a telephone appointment in 4 weeks time.
I said I'd pay for a private rheumatology appointment and just needed the Dr to do a referral.
The receptionist said she'd leave a message for the doctor who would be back at work in a week's time. Although as he was very busy there were no guarantees and I might have to wait four weeks till the telephone appointment.
I phoned the local private hospital and found I could book an appointment to see a rheumatologist (the same one I'd seen years ago as an NHS patient) in 2 weeks. The receptionist said he was accepting patients without a GP referral because of the current situation.
Although I was relieved to be able get help I feel very worried about those who can't afford to pay and are suffering because our local GP practice isn't fit for purpose.
A similar sized practice 8 miles away is managing much better, triaging and offering face to face appointment for those that need them.

I'd like to know why the sudden change since the pandemic, I could understand it was hard to see a GP last year but why aren't things returning to normal now. GPs just don't want to see patients face to face anymore, why? I don't understand why it's all changed so drastically.

This is nonsense. There are loads of threads re teachers, other NHS staff, etc.

Many areas have behaved appallingly in covid. We have seen peoples true colours. And it's not pleasant. Quite dispiriting actually.

Isn't a significant part of the problem government targets expecting patients to be seen within a certain timeframe, regardless of their condition? For many years politicians of all parties have significantly raised the public's expectations of what primary healthcare can deliver instantly.....