To think gps need to unlock the doors/open properly

[Nousernameforme]

Theres an article on the bbc about childrens a&e being overwhelmed by visits that aren't needed. Aibu to think that these people would have taken their children to the gp had they been able to? I know that they say a lot of them wouldn't have needed to see a gp but the viruses right now are horrible, probably due to everyones immune system being protected for a year, so it's harder to tell what needs help and what will get better on it's own.
My youngest has just got over the most awful virus which if it had not turned a corner when it did I would have got him medical assistance and if I can't get it from a gp I would have had to take him to a&e.

Our gp surgery is locked up the phone lines are only for those who have no internet and if you do get through all they do is put a request through on the ask my gp thing. I or members of my family have tried to see the dr for about 9 things this past year and got in once. 4 times we were prescribed antibiotics having not seen a dr.
Can we not have an official unlocking of the gp surgerys now please.

@PussGirl

NotAll A telephone consult can easily take as long as a face to face in order to take an adequate history and be confident of diagnosis - often a face to face is booked on the back of a telephone consult if a hands on examination is needed, so two patient contacts needing fitting into the system.

It is ten minutes per patient in the system, but trying to deal with often several problems in the one appointment creates delay, and outrage/anger/complaints if we try to limit it to just the one or two - the ten minutes includes writing everything up, organising any tests and these days cleaning the room if they've been seen face to face.

Yes we could give longer appointments, but that would mean fewer in the day or longer days overall - my days are never shorter than nine hours (ten when I'm on call) & I have a life to live outside work. I work full time which is pretty knackering, but for various personal reasons cannot afford to cut down.

Wiping down the consulting room after each patient limits how many we can see face to face as it eats into the time available; telephone appointments and econsults are fitted in between.

Often I'll ring the patient and not be able to get hold of them, even if they've specified a particular time and I'm accurate with that - more wasted time.

My whole day is punctuated with tasks, queries and other interruptions - although these can be grouped into "spare time" between surgeries whenever possible, often they can cause delay.

I have a reputation for running my face to face clinics on time, but owing to all the facts mentioned above, this is almost impossible to do now, which I hate and find stressful.

Yes I agree. As I said, I was expecting a tel consultation to last as long. Delays due to people NEEDING to talk about several issues have always been there . What I thought we wouldn’t see is the patient presenting with a heart attack and delaying the GP by half an hour or more.

However as you said, you have numerous people you need to see twice (tel first then in person): surely it would make it quicker and more efficient to stop tel consultation to be able to see more people?.

Surely the better option is to offer both in the first place to give the patient a choice?

It used to annoy me that I had to have a face to face appointment with my GP to discuss things that could have easily been dealt with on the phone (i.e. regular blood rest results). Same with having to see consultants - a face to face appointment needed just for them to say a test was negative etc wasting everyone's time. Apparently, upto a year or two ago, face to face appointments were "essential" and, no, they couldn't do the basics by a phone call.

Now, it's the opposite. A phone call first, even when it's blatantly obvious that a face to face is needed, thus doubling up the time needed by the GP (or consultant).

We've gone from one extreme to the other and need to find an equilibrium somewhere in the middle.

We are offering a choice of telephone or face to face at the moment to certain types of patient (very old, very young, mental health problems) and obviously some need to be seen such as with a lump that needs feeling, plus anyone who really wants to come in & be seen will get an appointment, although they likely will have to wait a few days if it's not urgent.

More than a certain number of face to face in the day is unworkable though as we have to clean the room after each one, have limited numbers we can accommodate in the waiting room etc as already mentioned above

@PussGirl

We are offering a choice of telephone or face to face at the moment to certain types of patient (very old, very young, mental health problems) and obviously some need to be seen such as with a lump that needs feeling, plus anyone who really wants to come in & be seen will get an appointment, although they likely will have to wait a few days if it's not urgent.

More than a certain number of face to face in the day is unworkable though as we have to clean the room after each one, have limited numbers we can accommodate in the waiting room etc as already mentioned above

Which all sounds sensible and understandable, but comes back to the recurring theme/question on here which is why aren't all GP practices doing the same when they're all supposed to be working under the same rules/guidance/working practices? The big question has to be why is there such a wide difference between GP practices?

We are not under the same rules / guidance at all - there is huge variation between areas but less so between individual practices within areas.

GPs are independent to a degree but are overseen by the local health boards who make the rules we are guided by. I have no idea why it is so different but I imagine it boils down to resources - where I work I think we have a good balance & we are not too badly short of staff, compared to a lot of areas.

@PussGirl

We are not under the same rules / guidance at all - there is huge variation between areas but less so between individual practices within areas.

GPs are independent to a degree but are overseen by the local health boards who make the rules we are guided by. I have no idea why it is so different but I imagine it boils down to resources - where I work I think we have a good balance & we are not too badly short of staff, compared to a lot of areas.

From the first article I linked above:

A spokesman for the DHSC pointed to the extra surge testing and other support provided to areas such as Greater Manchester since the emergence of the Delta variant in recent weeks.

The DHSC and NHS England ‘always maintain an open dialogue with GP representatives to understand issues facing their members and work together to ensure high quality services for patients’, the department said.

It also said the number of face-to-face GP appointments in March, nationally, was one per cent below that pre-pandemic.

Practices ‘should offer face to face appointments to patients unless there is a good clinical reason not to’, it said, ‘for example the patient has COVID-19 symptoms, and practice receptions must be open to walk-ins’.

Seems pretty clear to me. The Department for Health and Social Care are saying we should all have face to face appointments if appropriate (so a telephone call to discuss getting a whooping cough vaccine is not appropriate nor is it appropriate to NOT give an appointment for a lump).

And GP receptions should be open to walk ins.

It doesn't sound - even from the GPs on here who are doing more than others - that many are doing what the Department for Health and Social Care say they SHOULD be doing

So why is that the case?

Where in the system is this message being changed / diluted etc? Are health boards further down the chain saying something different to the DHSC??? Why? On whose direction? Who actually is in charge here and managing this contridiction in what is being done and by whom?

@PussGirl

We are offering a choice of telephone or face to face at the moment to certain types of patient (very old, very young, mental health problems) and obviously some need to be seen such as with a lump that needs feeling, plus anyone who really wants to come in & be seen will get an appointment, although they likely will have to wait a few days if it's not urgent.

More than a certain number of face to face in the day is unworkable though as we have to clean the room after each one, have limited numbers we can accommodate in the waiting room etc as already mentioned above

Why do you need. so much time to clean? Surely the only surface that needs cleaning. is what the patient touched, so a chair and maybe a door handle. That’s taking a whole 30 seconds.

I finally got a different receptionist today by going down.

Explained that I know they’ve asked people not to come down but what’s going on.

Ended up getting an appointment 20 minutes later. Ended up in tears after getting the “you really should have come sooner” lecture. I think the Gp (who is one of the senior ones there) was quite surprised to be shown my phone and how many times I’ve tried.

He’s referred to the hospital and asked me to put down in writing what happened. Hopefully they’re going to at least try and work out if there’s anyone else in my position that’s been blocked from help for so long

@JustLyra

I finally got a different receptionist today by going down.

Explained that I know they’ve asked people not to come down but what’s going on.

Ended up getting an appointment 20 minutes later. Ended up in tears after getting the “you really should have come sooner” lecture. I think the Gp (who is one of the senior ones there) was quite surprised to be shown my phone and how many times I’ve tried.

He’s referred to the hospital and asked me to put down in writing what happened. Hopefully they’re going to at least try and work out if there’s anyone else in my position that’s been blocked from help for so long

JustLyra, I'm so glad you have seen someone and are now 'in the system'.

I also have to applaud you on showing the GP how many times you have tried to get through. Its good he has asked you to put down in writing what happened. Without doing this, and making it in essence 'official' it makes it harder to follow it through and take appropriate action (which is possibly a discipline matter), so do make sure you do it. For your own sanity if nothing else.

@RedToothBrush I put it in an email as soon as I got home because, tbh, I was annoyed that he hadn’t been told. Fortunately (or perhaps unfortunately for the surgery) I keep a very detailed diary (it’s a throwback to my counselling) and never clear my phone call history so it was a long email with dates, times and who I spoke to and what I said.

I mean, I’d just been given an appointment because I basically broke down in reception and begged for one and even that information wasn’t passed on to the GP that I got to see so he thought I was just upset at the lump.

The communication in that surgery is hideous. And I’m surprised because compared to DH’s surgery they’re normally excellent (but then perhaps that’s helped me overlook things because a guy on a street corner with a bag of potions is better than DH’s surgery).

Yanbu.

My dog got ill recently. I was able to get a same day appointment with the vet, who did blood tests during that appointment and called me to discuss the result within a couple of days. She discussed all the different treatments available and then it was up to me how to go forwards (and how much to spend!)

When my child is ill, I can’t get a same day appointment. If I’m v v lucky I might get a phone call then an emailed opinion within a few days. Both me and my child have been misdiagnosed by that GP, with serious consequences for me and a year of discomfort for my child.

How come my dog gets better access to healthcare than my child? I wanna hire a vet to treat us… And yeah I know maybe the answer is to go private but when I’ve done that the standard of service was still way way below what my vet does for my dog. Plus I pay a fortune in tax and don’t see why I should have to pay again for healthcare.

@wherewildflowersgrow

They are obviously seeing people, but the phone and email appointments are screening in the necessary patients. The rest get advice.

Except the rules have been changed and if a person would refer a face to face request they can request it.

Of course Gps aren't exactly making that known.

The only profession completely protected for around 17 months now.

Imagine all the undiagnosed cancers.

How can a Gp assess ongoing abdominal pain over the phone?

They can't but they're still doing it.

Haven’t RTFT but YANBU

I feel like we basically don’t have primary care anymore. Had 3 problems in the family that I wanted a GP for and 2 of them I didn’t even get to speak to a doctor on the phone was told by a receptionist to try a far away pharmacy that offers this service (that is paid for and I don’t even know if that is what is needed because I don’t have a diagnosis from a doctor) try even further away Minor Injuries Unit, try a podiatrist which costs a small fortune, try our e-consult form which takes 20 minutes if you can work out how to use it and then tells you to call 111 where you can spend several hours on the phone not getting the answers to your questions or the help you need. What are GP’s even doing locked in their surgeries? Sitting around drinking tea and eating cake while they reminisce about the bad old days when they actually had to open their doors to patients.

We pay our taxes for a National Health Service free at the point of delivery and for local GP surgeries as a part of that. This needs sorting out ASAP. Makes me wonder if the government actually has a plan to make it impossible to access NHS services…

It's absolutely ridiculous and GPs need to man the fuck up.
My 15 year old has been feeling faint and dizzy recently. I have to wait a whole week not for an appointment, but a phone call. I mean, what the fuck?!

Yes we pay our taxes for NHS free at the point of delivery - a great idea originally but it has become an huge free-for-all buffet of demand outstripping supply.

Of course it is not "free" but it is perceived as such.

Each GP practice receives £130 per patient PER YEAR to provide all care, regardless as to how many times they are dealt with.

It is not sustainable & yes the government wants to do away with the NHS and move to a US model - they just won't admit it openly

@PussGirl

Yes we pay our taxes for NHS free at the point of delivery - a great idea originally but it has become an huge free-for-all buffet of demand outstripping supply.

Of course it is not "free" but it is perceived as such.

Each GP practice receives £130 per patient PER YEAR to provide all care, regardless as to how many times they are dealt with.

It is not sustainable & yes the government wants to do away with the NHS and move to a US model - they just won't admit it openly

How about we move to a model where the GP gets paid "per consultation" rather than per patient. Then they'll have to make appointments available to get the cash. At the moment, they get paid whether they see/talk to their patients or not. No wonder they don't make appointments available - they get paid whether they do or not.

Each GP practice receives £130 per patient PER YEAR to provide all care, regardless as to how many times they are dealt with.

Not strictly true. GP surgeries receive extra money for people with certain health conditions, such as diabetes, so the patients requiring more time/effort mean more income for the GP surgery. £130 for a healthy patient who never goes near the surgery from year to year is actually crazy. The funding needs to be more aligned to how much GP/nurse time is spent on each patient.

I have no issue with telephone appointments but only with some adaptations which my surgery does not do.

Chance to call at any time and make a non-urgent appointment in advance, rather than an 8:30 scramble.

Chance to select an appointment time, not a 'any time between 8am and 5pm - this doesn't work for working people often. I can't have my phone with me in class.

Not having to tell the receptionist personal health details. If they want phone triage then it needs to be someone with some level of medical training who is sworn to confidentiality rules the same as doctors, etc. And personal details not being said out loud in an open plan office which is also open to the waiting room.

Online option to book and request appointments - for some reason this has disappeared at our surgery since covid.

A text/photo service like some surgeries have for pictures of rashes, etc.

Sadly my surgery has always felt behind the times and not quite up to scratch compared to the surgeries used by family and friends elsewhere. Covid has made the gap even wider!

@Abraxan

I have no issue with telephone appointments but only with some adaptations which my surgery does not do.

Chance to call at any time and make a non-urgent appointment in advance, rather than an 8:30 scramble.

Chance to select an appointment time, not a 'any time between 8am and 5pm - this doesn't work for working people often. I can't have my phone with me in class.

Not having to tell the receptionist personal health details. If they want phone triage then it needs to be someone with some level of medical training who is sworn to confidentiality rules the same as doctors, etc. And personal details not being said out loud in an open plan office which is also open to the waiting room.

Online option to book and request appointments - for some reason this has disappeared at our surgery since covid.

A text/photo service like some surgeries have for pictures of rashes, etc.

Sadly my surgery has always felt behind the times and not quite up to scratch compared to the surgeries used by family and friends elsewhere. Covid has made the gap even wider!

I agree with all that. I have no problem with phone calls, but, yes, we need to stop the 8.00 scramble and do need proper timed appointments for the call back.

I can't understand why some GP surgeries still havn't activated the online booking systems. There's no excuse. If they don't want people to go to the surgery, then they need to replace that face to face system with an online system.

I wonder why a consultation room needs cleaning after every patient?
In Secondary schools, classrooms are not cleaned between each class for example.

Yep gp surgery's need to get back open and get on with it.

I can't understand why some GP surgeries still havn't activated the online booking systems. There's no excuse. If they don't want people to go to the surgery, then they need to replace that face to face system with an online system.

I’m frustrated with this also.

My GP’s has had online booking switched off now for the last 18 months, so we’re back to the 9am scramble of every man and his dog calling at once.

I think my record number of redials so far is 132…

The receptionist at my surgery is strictly gatekeeping so I couldn’t even get an appointment to speak with the doctor. She suggested the e consult which she had to talk me through, not user friendly, a total waste of time. I spent ages typing, describing the problem in detail and then again in a second box and a third and then finally it just said call 111, I went back and tweaked answers and it still said call 111. So I tried that but surprise, surprise the recorded message says they are experiencing exceptionally high call volume and then there are an excessive number of questions about covid and we can text you information press 1 or 2 to continue etc. In the end I gave up and drove 25 minutes to the minor injuries/urgent treatment unit (GP is walking distance from home). Minor injuries said GP should have seen her, try again, she needs to be seen by GP for the appropriate tests and diagnosis and complain to the CCG. While I was there I overheard a man at reception apologise for being there and say he also had tried to get an appointment with his GP but had been told to take his daughter to minor injuries. I still haven’t got around to driving to the specialist pharmacist 4-5 miles away for the other issue.

Total waste of everyone’s time. I thought that GP’s were supposed to be our first port of call.

I have only had to call my doctors surgery a few times during the pandamec. They actually did pretty well with getting a doctor to call me back when I expected it would be a nurse practitioner (they usually do that to screen what people actually need)

I wasn't so happy with the local walk in centre who shook their heads at me and said I should have booked an appointment when taking my son in with a head injury that had obviously just happened and we were both covered in blood (they begrudgingly said they would see him).

Ive been moaning about our GP surgery being virtually closed to patients but on Thursday evening I found a mass (not a lump) and emailed them in a panic. The receptionist called me on Friday morning followed by the GP in the afternoon who told me to come straight in. She examined me and was able to diagnose a hernia. Huge sigh of relief all round. More to the point, I now know that if they need to see you they will and that many issues can, and have, been sorted out over the phone.