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?

There are good and bad people in all professions ive come across both covid has bought out the bad in a lot of situations

The point is the way a lot of surgeries have been operating during the pandemic ISNT WORKING and it needs to be changed

I've not read all the posts as I am currently trying to manage my anxiety enough to stay in practice, in part due to incessant GP bashing making me feel utterly shit. BUT... I get it.. I really do ! Where I work, we have open access e consults and every single e consult will be answered within 24 hrs. We have phone calls all day every day, and when they are full if its urgent we will speak to you. I have seen patients face to face throughout the pandemic, yes I need to speak to you first but if that isn't enough for either side I will see you. I have actually seen and referred MORE early cancers, and more genuine illness then pre pandemic because my face to face appts are not all taken up by stuff that CAN be safely managed on the phone. Then there is the practice I am registered at... 20 mins down the road.. no e consults... 2 hour waits on the phone and no phone appointments at the end. Almost nothing seen face to face. I need to discuss changes in my meds. I have been trying for 4 months and I know how the system works. I am reduced to writing notes and hoping they get through... I needed a referral.. So I KNOW how it feels .. but I also know how many GPs are working so so hard, in utter despair and being abused by the system, the media, the government and the general population... I dont know what the answer is. I know that many GPs will leave or go sick, and the system will fall apart even further as there is no one out there waiting to take their places despite the spiel about recruitment. No one wants to do the job any more. We used to get 20 + applicants for vacancy, now we have places advertising for a year with no decent applications. 'Nice' semi rural area previously prime territory for job hunters. The private sector is already starting to take hold as it takes over struggling practices and it will NOT improve things for patients. Impersonal Corporate companies rarely do unless the clients are rich, so they will look for economies of scale and maximising profit, not local and individual need.

We have phone calls all day every day, and when they are full if its urgent we will speak to you.

how do you know? Who is handling the triage? What about those people who simply can't get through despite calling every day?

We have phone calls all day every day, and when they are full if its urgent we will speak to you.

Why do the few GPs who come on Mumsnet always work at a practice very few of us are lucky enough to be registered at?

The practice you work at might be more like the practice you're registered at than you realise. If someone is desperate and ends up at A and E because it was urgent and you didn't speak to them, you don't necessarily make the connections.

Or perhaps went through great suffering (as it sounds as if you are doing with your own ailments unattended to for months on end) because it was, in fact, urgent that they receive medical care. But there is no yellow card system to report not receiving care when you urgently needed it.

You must be a very rare doctor to offer a face to face to someone who has been lucky enough to get a phone call simply because they feel they need it, even if you don't. You must be aware this is not routine, and to mention that is not bashing anyone.

There is something very self-absorbed about describing patients as GP bashing when the threads that have been up in recent days are about patients suffering without access to GPs in a manner that is heartbreaking and really concerning.

Then those same patients might present at A and E (e.g. the lady who is running a fever, constant d and v, terrible reaction to vaccine period combination/UTI/endometriosis) and be 'bashed' for going to A and E with 'period pains' because they couldn't get near a doctor. My sympathy and concern is with them, primarily.

I have very little time for GPs who post in response to that complaining that publicity like this undermines the doctor patient relationship. It is for the doctor to maintain the doctor patient relationship, or the NHS. It is not for the patient to maintain it by operating some Soviet style 'don't ask don't tell' policy and being abjectly grateful.

I worked as a GP on the UK for 15 years.
Even then there was a lot of blame put onto us for problems caused by chronic under funding of the NHS. This was an easy target for the government and media. I was so fed with the GP bashing and burning out that I left 8 and a half years ago and am now working with in Australia.
Several of my colleagues did too
Hearing what my former colleagues are going through I definitely made the right decision .

I'm sick of covid being trotted out as an excuse now. No other health professional gets to excuse themselves from seeing patients like my GP does.

After 7 over the phone consulations for my 5 month old done by 4 different GP's over 2 weeks, the last bring at 5pm (when I was told that I was being dramatic) my son went limp and blue and we were blue lighted to resus and had a 5 day admission.

I'd begged to see thd GP in person, I'd been told we couldn't, they weren't doing that anymore. We were messed about by multiple GPs who couldn't decide if his illness was viral, or if the antibiotics he was prescribed were the right ones.

it seems to me that a very simple first step would be a much much better public information campaign about when to call the doctor, when to call the NHS line, when to use a pharmacy, and what you can do at home with OTC remedies

GPs may be working long hours, i don't know, and many others are too so they don't get much sympathy for that. But are they working smart? not sure. Recruitment is a problem? In Germany, at least, it is difficult to get GPs into rural areas so the villages & small towns are offering incentives, and showing how living in their area is good, healthy, a great place to raise a family or retire to. What happens in the UK?

The e consult seems to be taking far too much time and is a bottomless workload
I wonder how many of the queries are GP problems - it is overloading the system and was a terrible idea
Maybe emails should go through 111 and GPs do face to face and a small proportion of telephone consultations
The problem is GP s are private contractors and a significant proportion seem to prefer the present style of working - this might work for them but not for the patient

The whole system needs an overhaul so patient need can match the service a normal GP can reasonably be expected to provide

I know lots of GPs. They are all knackered. I bet they are good at their jobs. Some of them work 4 days but only officially work and get paid for 3, just need a day to catch up on the paper work. They are just too stretched. The problem I see though is that NONE of them work full time. One of them only does a day a week. That’s fine if you’re a teacher and there’s lots of other teachers to job share with, but if we can only train a set amount if GPs a year and then they all want to work part time we won’t have enough GPs to cope with the number of patients.

So how about if you want to be a Dr in the NHS (any speciality) you have to sign up to at least 4 days a week for at least 10 years or no pension? We pay to train you after all, we should get some sort of guaranteed return. In that way there will be more GPs around and the job itself will be much less stressful. GPs could get closer to working a 7 hour day.

The GPs I know say they earn enough to be happy working 3 days a week. The other way to get GPs to work more hours is to pay them less, but I can’t see that being popular!

I wish GPs would stop pretending that they are still using telephone triaging and telephone appointments due to Covid. I'm a HCP who admittedly wasnt doing F2F for a while but we've been back in PPE for ages now. Theyve found a system that works for them and presumably for the majority of patients and need to tell us that they wont be going back to the old way of working.

Sorry but my doctor's surgery was already getting bad before covid. And with covid its all just got so much worse. Before covid all on going prescriptions were being sent to the sister surgery to be signed by the 'higher' doctors. Taking extra time and causing errors. All the doctors decamped from the surgery and just left nurses when covid hit. It is still a ridiculous struggle to get an appointment. At one point I was refused my depo injection as the doctors had decided they were not necessary and would have to have an alternative until they deemed i could have it again. So they even stopped allowing nurses to give routine injections. I think the good thing to come out of this should be that if able more things dealt with over the phone but if needed you should be able to see a doctor. And in a reasonable time.

So how about if you want to be a Dr in the NHS (any speciality) you have to sign up to at least 4 days a week for at least 10 years or no pension? We pay to train you after all, we should get some sort of guaranteed return. In that way there will be more GPs around and the job itself will be much less stressful. GPs could get closer to working a 7 hour day

Because as a country we have flexible working. Why shouldn’t GP’s benefit from it too? And speaking as a teacher only a set amount of teachers are trained each year, and it can be very hard to find someone to job share with

@Iwouldratherbesailing

I know lots of GPs. They are all knackered. I bet they are good at their jobs. Some of them work 4 days but only officially work and get paid for 3, just need a day to catch up on the paper work. They are just too stretched. The problem I see though is that NONE of them work full time. One of them only does a day a week. That’s fine if you’re a teacher and there’s lots of other teachers to job share with, but if we can only train a set amount if GPs a year and then they all want to work part time we won’t have enough GPs to cope with the number of patients.

So how about if you want to be a Dr in the NHS (any speciality) you have to sign up to at least 4 days a week for at least 10 years or no pension? We pay to train you after all, we should get some sort of guaranteed return. In that way there will be more GPs around and the job itself will be much less stressful. GPs could get closer to working a 7 hour day.

The GPs I know say they earn enough to be happy working 3 days a week. The other way to get GPs to work more hours is to pay them less, but I can’t see that being popular!

Recruitment would plummet. Disastrously. My DH is a GP who works the equivalent of 4 days a week. That’s 40 hours (morning surgery is 8am - 1pm, lunchtime is home visits, afternoon surgery is 2pm - 6pm) a week.... I think that’s full time enough.

My surgery is doing more face to face now. I phoned on Friday, got through after a short wait and was offered either telephone or face to face appointment in 10 days. I’ve asked for face to face because I know this will need examination. I’m happy things are beginning to get back to normal.

All the GPs at my practice are part time but I don’t think that’s a problem. I’m a little less happy about the fact they close at lunchtime one day a week, so are only open for emergencies. In order to get an emergency appointment you have to phone 111 because reception is closed so the phone isn’t answered either.

YABU. So many GP practices are appallingly run. There’s not enough accountability, and since COVID came along, it has been used as an excuse for the most atrocious negligence. I don’t think GPs have a hard time either compared to so many other lines of work. GPs are well paid, work comfortable hours, have relatively less stressful jobs than other front line services workers. And they are generally regarded with a lot of reverence and respect as well.

@ChloeCrocodile

You don’t think they want private providers in doing primary care?

GPs are private providers doing primary care.

This. THIS.

GP partners run their own businesses, and get paid handsomely for doing so. It’s a business model that relies on the continued registration of all these patients who you have on this thread dismissed as often liars when in fact, they are customers worried about their health whose only access to help is through YOU.

I think the profession need to look a bit closer to home for why public support for them is so low.

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.

This. I have an issue with my joints that seems to be getting worse and I have decided I want to go privately and to someone who specialises in such issues. My husband said why don’t you just go to the GP and I explained to him that my past experiences with them has not been great nor has most of my experience with HCPs in England which he knows. I went to my GP office four times for an ear issue that messed with my hearing for almost a year that I ended up fixing myself. I was even told it was due to a flight despite me repeatedly saying that I had the issue weeks beforehand. One of them even made an appointment to have my ear syringed only to be called back and told they don’t do that there and that was it. Nothing else could be done for me. I’ve found the only way I’m really listened to is if I pay for it. Besides, even if I went, the GP would likely refer me to somewhere else anyway so why take an appointment from someone else.

My issue is that unless you can sit on the phone at 8am day after day in the hope you're one of the lucky ones that makes it through to a receptionist before the slots are gone you have no hope of seeing anyone. I call can't get through for half an hour then told "there's nothing I can do, try again tomorrow". I'm working, I can't do that every day. Then when you do get an appointment it's just that they'll phone you at some point during the day. I can't answer my phone at work as I'm in front of a class of 30 teenagers.

So now I've just taken myself off some long term meds with no oversight as I couldn't see anyone to discuss side effects

@Iwouldratherbesailing

I know lots of GPs. They are all knackered. I bet they are good at their jobs. Some of them work 4 days but only officially work and get paid for 3, just need a day to catch up on the paper work. They are just too stretched. The problem I see though is that NONE of them work full time. One of them only does a day a week. That’s fine if you’re a teacher and there’s lots of other teachers to job share with, but if we can only train a set amount if GPs a year and then they all want to work part time we won’t have enough GPs to cope with the number of patients.

So how about if you want to be a Dr in the NHS (any speciality) you have to sign up to at least 4 days a week for at least 10 years or no pension? We pay to train you after all, we should get some sort of guaranteed return. In that way there will be more GPs around and the job itself will be much less stressful. GPs could get closer to working a 7 hour day.

The GPs I know say they earn enough to be happy working 3 days a week. The other way to get GPs to work more hours is to pay them less, but I can’t see that being popular!

Their three day week is full time though - friend works as a GP, says she starts work at 7am and has on occasion worked through til 2am the next morning catching up on paperwork, dictation etc - usually doesn’t get home until well past 11pm . Frequently works right through her weekends as well . Days off she has to do CPD and training, tutoring medical students and specialised clinics etc (eg contraception, COPD, ante and post natal, joint injections) . That was in a surgery with eleven GPs, 12000 patients, about eight-ten nurses and visiting specialists.

Unless you heavily educate public about self care and pharmacy first and start treating root causes of chronic GP use - ie poverty, health inequalities, inability to self manage, over reliance on GP for minor issues (ie shuffling off with first signs of cold and flu) - and outsource for stuff like mental health (ie anxiety and depression that would respond to CBT or social prescribing) and improve community care for eg dementia, mental illness, drug and alcohol dependancy, and reduce obesity .... that would start to solve the problem - we see the GP as the answer to everything and that’s the first issue .

We also need to be able to self refer to for example gynaecology or eg a one stop breast concerns clinic or something, it bewilders me that you need to see a GP as gatekeeper for services like that . Ditto with child health concerns (eg if concerned about autism or adhd) . Surely self referral to child development clinic could work well .

We do need a huge change . I heard recently of a GP surgery I think London based where they’ve bought an allotment and use it for social prescribing . It’s an incredible idea that could save many, many hours of consulting - when I had anxiety I used GP as a social support almost and I can see if an allotment (or something) was offered with support to engage that I’d have hugely benefited from that . You wouldn’t even need GPs to run it - could get community volunteers ...

Hear hear @namechangingforthis19586

If you're a GP reading this and you're not behaving like this - I.e you are putting your patients first then this thread isn't about you!

We all accept that there are good and bad in any profession but I have little sympathy for GPs and teachers who come on here and moan about people recounting their bad experiences. Why on earth shouldn't they? What should they do then? Put up and shut up?

GPs will never win on forums like this.
Hospital doctors are still in the main managing patients remotely but don't get bashed half as much.
Do what you can OP. Those that appreciate what you do, will and those that don't, won't. Can't win them all.

I agree with you OP. Some of it is unenlightened , or fear of change, some of it plain wrong, and some of it should be aimed at the government. There is lots of false judgement around the pandemic too. Also, I do wonder why I've only ever once had one poor encounter with a doctor, whilst some people report tons of them. Could it be them, some of those times?

@EverdeRose

What an incredibly ignorant comment. Why didn't you read the OP or generally try to educate yourself a little bit.

How is the GP using covid as an excuse. The demand is greater. The resources aren't greater so what is the GP expected to do? It really isn't very difficult to understand.

Is it annoying (and sometimes dangerous) that people can't get appointments? Yes but it's not the fault of the GP surgery. If you want to blame anyone blame people who keep voting in a government which underfunds and undervalues the health service.

And I also strongly suspect wonder some Mumsnet threads are set up by Tories to feed their agenda. Let's not pretend it doesn't happen.