30 minutes to negotiate with the GP receptionist for a phone appointment

[Gakatsbsk]

Hi,

I am an nhs nurse, and so I realise this is not all GP receptionists but I have just spent 30 minutes speaking to a GP receptionist to try and negotiate a GP over the phone appointment.

It seemed to me like I was wading through excuse after excuse, in a hospital none of these excuses would wash.

The first excuse was that despite registering five weeks ago they didn’t have my medical records (I’ve moved between UK nations) and ‘there was no possible way’ to determine what previous medications I was on, my suggestion that they could be confirmed with me, the patient was of course completely ridiculous and I could be maliciously seeking meds (which are non opioid, non addictive and not remotely interesting to any one).

The second excuse was that I couldn’t have a GP appointment because I’d not had a GP appointment there yet and ✨ covid ✨. In secondary care we haven’t been able to use covid as a reason to not see any new patients, and of course how can I have had an appointment without having an appointment.

The third excuse was an altered replay of the first one, that doctor won’t be able to prepare for your consultation without your medical records. Doctors do this day in day out.

The fourth excuse was a lecture about how busy the nhs is, how covid is surging at our local hospital and how there’s so many covid patients in critical care. At this point I told her I work as a staff nurse in critical care at said hospital, and that this conversation was dragging on and could I please be given a GP appointment, or ANP appointment, or do I need to register elsewhere. At this point I was granted a phone appointment (anytime until 8pm so don’t go anywhere was the warning).

I do realise our colleagues in primary care are stretched, as we in secondary care are but this was ridiculous and it saddens me that vulnerable people probably miss out on health services because of attitudes like this. If I spoke to anyone on the phone in my job role the way she did, I’d end up facing disciplinary action if the other party complained.

Is it just me being completely unreasonable ?

Many thanks

Well, we'll have to disagree on this one bagamoyo.

I have no doubt that there are some, or maybe many GPs, who are doing a sterling job, as evidenced by some of the stories above.
But there are also many people for whom the system seems utterly flawed, and for whom their personal concerns about their health is certainly not assuaged by the "NHS is open" trope we are all being told.

I'd like to tell you my GP is brilliant. Sadly I have NEVER seen him. And I've only asked twice in the past three years, so I'm not a frequent flyer.

DH is a GP - along with his colleagues he has worked more hours in the last year than he did as a junior hospital doctor. It’s never ending - I hardly ever see him.

At his practice the nurse practitioner is working from home as her son’s bubble burst at school so she is home with him and another GP is isolating as a close contact has tested positive. He is also working from home .
There needs to be a huge recruitment campaign for GP’s and funding to improve their systems. If you can’t get an appointment it is because someone else been given it.
Unfortunately government aren’t interested and if the GP service collapses, it will be part of their plan to privatise the NHS.

@Parker231

DH is a GP - along with his colleagues he has worked more hours in the last year than he did as a junior hospital doctor. It’s never ending - I hardly ever see him. At his practice the nurse practitioner is working from home as her son’s bubble burst at school so she is home with him and another GP is isolating as a close contact has tested positive. He is also working from home . There needs to be a huge recruitment campaign for GP’s and funding to improve their systems. If you can’t get an appointment it is because someone else been given it. Unfortunately government aren’t interested and if the GP service collapses, it will be part of their plan to privatise the NHS.

You are absolutely right - if you can’t get an appointment it’s because someone else has been given it - that sums it up perfectly.

I will keep saying it: we need to expand medical training. There has been shortages of doctors for years, and yet it is very very hard to get a place on a medical course. Many acceptably good doctors who are trained and work hours that preserve their mental health is better than the exceptional doctor who you can only see once in a blue moon and is on the edge of a breakdown.

This is not the fault of current GPs, they are doing the best they can. But the system is broken.

I fully recognise the problem is lack of funding and resources in primary care. When I can get through on the phone (it usually cuts off before you even get to the queue of 50 + people), I find the receptionists are polite and accommodating. If I can speak to a GP or practice nurse, I am satisfied with the care. The problem is that patients hitting that brick wall constantly - we can’t get through the metaphorical front door. I understand why some people get frustrated but the anger from patients is misdirected. Abuse is never acceptable nor is the “lazy GP” rhetoric. Equally, GPs blaming patients for needing more care is not fair. We all know people are living longer with increasingly complex medical problems. Some people just do need more medical input than others. That said, I do wonder why people don’t utilise other services more before going to the GP. Despite covid restrictions, pharmacists have remained open and accessible. I’ve had great advice and signposting from pharmacists before, highly recommend. Plus, the NHS website is good - for those who have access to the internet - for general advice and reassurance.

Being a GP sounds like a very tough job and I have respect for you.

Goodness you know it’s bad when an NHS nurse is sharing their experiences of poor care.
Ive had to deal with the GP a lot over the last few weeks for appointments for my self and both children. First my eldest had a swollen eye, I asked asked to email a picture of said eye which I did, this was on a Thursday, an appointment was set for the Monday. Thankfully the swelling went down and we didn’t need the appointment but it may not have turned out that way.
Following that I put my back out, yet again I had to send a message through their website because phoning through was frowned upon. Now the practice says they will get back to you within 6 hours but they get round to this by sending you a standard message back saying “thank you for contacting us and we will respond to your request in due course” how does that help me?
The next day I get a reply telling me to take painkillers and a link to a physio site. The pain got worse and as a result I contacted them again and was prescribed 2 strong painkillers and some stomach protecter pill which I’m not meant to take as the last time I took it I had acute pancreatitis as a side effect. I emailed a complaint that I should not be prescribed anything with out a doctor or ANP seeing or speaking to me.
In the last few weeks my mental health has taken a dive, I sent another message through the online service and the practice manager responded promptly, I said due to my work commitments I was only able to take a call between a certain (quite generous) time period, the GP called me right at the end of this time period where I could not take the call so had to call them back again while also messaging that I really needed to speak to them by a certain time. I was on hold for 25 minutes and in the meantime they called me, tried to get the doctor and then hung up! By the time I got through I was a state, 25 minutes holding time to be told oh they will call in 5 minutes.
Tbf the GP was really helpful once I had actually spoken to them, it’s just all this gate keeping which is so exhausting.

OK, so everyone hates receptionists and gate keeping. What do you think would happen without gatekeeping? Imagine you rang a number and it went straight through to the GP. If you called first you’d get through, all good. But while the GP was talking to you, all the other people wouldn’t get through. Then the second that call ended, one lucky person would happen to get through, while the others continued to wait. And so it would go. You could literally ring all day every day for a month and still not get through.
And what if the people who did get through just wanted to ask when their outpatient appointment might be, or wanted to know what time the X-ray department was open, or wanted to order a repeat prescription? These are all things that can be done by people other than doctors, so would you want the GP to be spending time taking those calls? Or would it be better to have a gate keeper?

I don’t think many people realise the sheer volume of calls that come through every day, and the number of requests for GP time. Many of these can be dealt with by other agencies (counselling, physio, pharmacist) , and it’s the receptionist’s job to direct patients accordingly, hence the questions.
There are simply too many patients per doctor. But we can’t recruit doctors, because no one wants to do it. And this thread sums up why.

[quote Bagamoyo1]@FuzzyPuffling it is NHS bashing. Or more specifically GP bashing. It’s one thing to acknowledge that the system is broken and that the service is unable to meet the demands. It’s another thing to say that GPs have done nothing throughout the pandemic, and had an easy life, which is what many people on here are saying.
Every GP who posts on here says they’ve never worked so hard. Are they all lying?[/quote]
Except is isn't GP bashing. I have no idea why you have taken it that way and why you continue to complain about GP bashing. NO ONE has said that GPs have an easy life. There is a lack of listening to what is actually being said here.

The first point of contact between us, the public and you, a GP, is the receptionist and the shitty, broken appointment system. THAT is what the OP was complaining about, and what so, so many of us are complaining about. We are complaining that GP practices are using receptionists to triage patients, a role that surely even the most ardent NHS clapper would agree they are utterly, woefully inadequate and untrained for.

Therefore unsurprisingly to anyone concerned, a patients very FIRST encounter when he or she needs medical care or advice is someone who has no competency whatsoever in medical matters or even in common sense from some of the cases reported here. A patient starts their journey in distress and then becomes stressed as well.

And even if the receptionist happens to be competent and efficient, then it would appear that they themselves are let down by badly designed and poorly managed systems. This is what your patients are facing and struggling with.

Perhaps consider that your office managers need to be of the calibre and salary bracket that a decent small/medium business would employ?

If you want to ease some of your GP stress, then perhaps plough some funds into sorting that out. Again and again people here have said that when they FINALLY get to speak to a GP, things can get resolved very quickly.

@Bagamoyo1

OK, so everyone hates receptionists and gate keeping. What do you think would happen without gatekeeping? Imagine you rang a number and it went straight through to the GP. If you called first you’d get through, all good. But while the GP was talking to you, all the other people wouldn’t get through. Then the second that call ended, one lucky person would happen to get through, while the others continued to wait. And so it would go. You could literally ring all day every day for a month and still not get through. And what if the people who did get through just wanted to ask when their outpatient appointment might be, or wanted to know what time the X-ray department was open, or wanted to order a repeat prescription? These are all things that can be done by people other than doctors, so would you want the GP to be spending time taking those calls? Or would it be better to have a gate keeper? I don’t think many people realise the sheer volume of calls that come through every day, and the number of requests for GP time. Many of these can be dealt with by other agencies (counselling, physio, pharmacist) , and it’s the receptionist’s job to direct patients accordingly, hence the questions. There are simply too many patients per doctor. But we can’t recruit doctors, because no one wants to do it. And this thread sums up why.

One decent, intelligent high-calibre office manager and one short-term consult with a decent systems analysis company could sort this out for you.

@MinesAPintOfTea

I will keep saying it: we need to expand medical training. There has been shortages of doctors for years, and yet it is very very hard to get a place on a medical course. Many acceptably good doctors who are trained and work hours that preserve their mental health is better than the exceptional doctor who you can only see once in a blue moon and is on the edge of a breakdown.

This is not the fault of current GPs, they are doing the best they can. But the system is broken.

It's getting better. I have a place at St George's and I have no GCSEs

I have an Access to Medicine, Functional Skills Level 2 English and maths, and a Chemistry certificate. All taken within 2 years

"Unfortunately government aren’t interested and if the GP service collapses, it will be part of their plan to privatise the NHS."

Exactly. No surprises to see the case being argued by the true blue Tories, on this thread and elsewhere. Plenty of their mates waiting in the wings, and lots of social media prep going on for the NHS bill.

Many of these can be dealt with by other agencies (counselling, physio, pharmacist) , and it’s the receptionist’s job to direct patients accordingly, hence the questions.

Never in my (semi frequent) experience as a patient, as a mother, as a teen etc has a receptionist ever directed to anywhere that would be a better use of the GP's time, in fact the direct opposite has happened multiple times.

The GP's in general are great, I've found an excellent one and I really like her and trust her judgement etc. Ditto the majority of the nurses I've come into contact with have been great. What's letting them down is how the system is run and the people within that system either refusing to question the illogical approaches (like the OP said about not being able to have an appointment because she hasn't had an appointment before...).

The best and most productive thing I did was to sign up for an online pharmacy so all my repeat medication is dealt with by them, the GP just signs it off and I now use the eConsult system for as much as humanly possible. Quicker for me, quicker for them and leaves face to face time more free for people who need it.

Actually it's despicable that there is so much complaint in the middle of a pandemic, and when the people in the NHS are so hard pressed.

Oh wait-in real life, there isn't.

Actually it's despicable that there is so much complaint in the middle of a pandemic, and when the people in the NHS are so hard pressed

Yes there is.

Oh wait-in real life, there isn't

I’ve not had this issue with my surgery. Since lockdowns started I have had at least three if not four telephone consultations which took place either in the day I called for an appointment or no more than 2 days later as well as my smear test and flu vaccine.
If people didn’t waste so many GP appointments with issues that could be self medicated then perhaps there wouldn’t so big a strain on the system and OP could have been booked in without going through the Spanish Inquisition

@Haffiana I don’t think you realise how many calls come through in a day. It is nothing like a small/medium business.
And I would suggest you read the whole thread, and the many other similar threads, to see where the GP bashing is.

@daisyjgrey

Many of these can be dealt with by other agencies (counselling, physio, pharmacist) , and it’s the receptionist’s job to direct patients accordingly, hence the questions.

Never in my (semi frequent) experience as a patient, as a mother, as a teen etc has a receptionist ever directed to anywhere that would be a better use of the GP's time, in fact the direct opposite has happened multiple times.

The GP's in general are great, I've found an excellent one and I really like her and trust her judgement etc. Ditto the majority of the nurses I've come into contact with have been great. What's letting them down is how the system is run and the people within that system either refusing to question the illogical approaches (like the OP said about not being able to have an appointment because she hasn't had an appointment before...).

The best and most productive thing I did was to sign up for an online pharmacy so all my repeat medication is dealt with by them, the GP just signs it off and I now use the eConsult system for as much as humanly possible. Quicker for me, quicker for them and leaves face to face time more free for people who need it.

Actually on line pharmacies will kill proper full service pharmacies because their overheads are minuscule in comparison. The funding is per item dispensed, pharmacists aren’t paid by the NHS for advice they give you. Apart from a few limited schemes money is made by selling products and dispensing. If you speak to them for advise that’s not reimbursed. It’s quite different to the way that GPS are reimbursed

My doc surgery is ok, I had to phone today at 8, and took 25 mins to get through, I got an appointment at 2.30.
The gp was great, I always thank them and the receptionist, it’s a mess the appointment system ( we need more gps), it’s a sad mess.

[quote Bagamoyo1]@Haffiana I don’t think you realise how many calls come through in a day. It is nothing like a small/medium business.
And I would suggest you read the whole thread, and the many other similar threads, to see where the GP bashing is.[/quote]
This is why you need to employ a professional. You are a gp and you are not trained to get past ' too many calls' or whatever is stressing you out. You are defeated before you even start. Someone whose job is systems or even someone who is a good manager can find solutions not objections. In business this would be dealt with effectively by using someone skilled at dealing with issues such as this. It takes a different skill set than the one currently used, that is all. A different way of thinking.
It won't solve the lack of gps but it absolutely can solve the problems faced by patients trying to access services.

@Bagamoyo1

You're wasting your time, honestly. Much of the great British public displays the wilful ignorance you're trying to fight here. It's pointless.

They really believe that a huge proportion of their taxes are spent on primary care whereas you and I know that it's around £150 per person per year for an average of 7 - 8 consults (possibly more) and that's not even considering the other functions of the surgery such as repeats etc.

I work both private and NHS. £150 privately gets you exactly 1 GP consult and 1 repeat re-issue. It is less stressful, patients are happier and earning potential is higher (and more importantly proportional to how hard you are working).

The problem is that the all you can eat GMS buffet has been propped up by us for too long - we are partly to blame - people don't realise how much they were getting for their £150 and Covid has tipped it over the edge. The system is decompensating and there's nothing to take up the slack. Unfortunately I've come to the conclusion that we now have to let it fail so that a more sustainable system can be set up.

Of course, it won't cost £150 per year any more but patients aren't happy, we're certainly not happy, and I'm not willing to sacrifice more of my sanity and family for a 'customer' base that doesn't acknowledge it.

These threads are great because they always help erase any doubts / guilt about my transition to PP. Currently still 8 sessions NHS but I don't think I'll be keeping that up for too much longer.

Feel free to dive in and join me - the water's great!

@Haffiana

Bagamoyo is correct. You simply don't seem to understand the problem.

Lack of GPs IS the access problem that patients are experiencing.

We have around 10000 patients on our NHS list. Pre-covid an average monday would see about 600 phone calls answered, with about 300 of those acute appointment requests. Normal provision would be about 200 appointments - and that's a lot of acutes for a 10k GP service.

The last few mondays have seen over 1000 calls answered by reception, with about 500-600 of those appointment requests. We've increased capacity slightly to 250 (despite fewer clinicians, so everyone working even harder) but that's still 250-350 people who wanted appointments and couldn't get them.

Cue the moaning on mumsnet, the 1* google reviews, etc etc. And yet our clinicians are working harder than before and are increasingly close to burnout. There's no cavalry coming, there's no 5000 6000 extra GPs, there's nothing.

Most business receive more income when they're busier. GP works in the opposite manner - your costs go up and your income stays the same. So this increase in activity doesn't help you from purely a business perspective.

All the systems analysis and business management in the world won't help this situation (and I've got a degree in health management). There is much much more demand than supply.

@Bagamoyo1

Receptionists shouldn’t be asking any clinical questions, that needs to be done by a health care professional. In many ways triage (and signposting) is the most vital thing to get correct and should be done by a senior member of staff. It’s not appropriate to cut costs and get a receptionist to do it. Non clinical queries yes, no problem
For repeat prescriptions use online ordering and repeat dispensing, there should be minimal need for them to go through reception.
My posts are generally very supportive of GPs who are struggling with increased workloads and definitely not sat around doing very little. However the elephant in the room is that private, profit driven general practice is maybe not always what’s best for patients and the tax payer. I’m not convinced it’s what is best for the staff either, especially not when large companies (including from overseas) buy up large numbers of GP practices and they stop being GP led.

@BungleandGeorge

Yes I don't doubt it to be honest. But the previous system was I had to drive there, pay to park, take my paper repeat prescription in and wait around half an hour to collect it. That's the only process they offered. It just wasn't viable time wise and they'd occasionally not have something or only have half the amount so I'd have to come back a week later and repeat the process.

If the in person service is falling short, people will go elsewhere.

Further to my post yesterday I think this thread is excellent. It carries well-argued, authentically experienced opinion and constructive comment from all sides. It is unreasonable to denounce this simply as mean GP/NHS bashing. This is just the sort of testimony that should be enforced reading for those at the controls.

It is as if mumsnet has carried out a public consultation on behalf of the NHS.

What seems to be widely agreed

Reform of access requirements for medical schools. We need more medics.
GP recruitment and training should be prioritised. We need more GPs.
Triage is a huge problem. It is inappropriate because it crosses the professional line in many cases where receptionists top it the medic.
This type of gatekeeping causes friction on both sides. It heightens anxiety for patients who may already be in a highly stressed state.
It rewards the persistent/ pushy and pushes the vulnerable to the back of the queue. It seems to have been directly responsible for death, long term adverse health outcomes and countless shorter term health/familial/ societal problems. It needs addressing.
Better practice management is needed
There is concern that the system is in danger of collapse or of being hijacked by private commercially orientated groups.

FWIW here are a few of my thoughts in addition to the above

The NHS was a trailblazer. Now it's creaking at the seams and it is held out as this unimpeachable sacred institution and it is sinful to question or criticise it. Organisations that refuse to adapt and change are doomed.

I would suggest looking at other countries' health systems.

Some have a sort of per capital annual budget that is drawn on each time a patient accesses a service. It is not the same as a charging system but users are aware that there are limits (of course there are the usual provisions for extra needs) It tends to deter frivolous abuse.
There is closer mixing of public and private services. I know this is a hugely vexed topic but, with adequate accountability provisions, it seems to work elsewhere . I'm just saying it could be looked at.
Pharmacists are much better respected and used by the public almost everywhere than here. Totally agree that they should be given more responsibility.
Instead of unqualified and unpopular receptionists undertaking triage why not employ nurses? Is there scope to recruit nurses who may have left the NHS to work in this capacity? It may enable them to work flexibly at home or in surgery. I think nursing is another undervalued and misused profession.

Too many NQ medics decamp abroad asap. They don't like what they have seen in the NHS. Perhaps there should be some financial provisions such that those who do move abroad should be required to repay at least some of the costs of their training or there could be a requirement to work in the NHS for a set period post training to offset the cost.