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

Whilst I agree with much of you say, using a 'stick' approach to keep NQ Doctors indentured to the NHS just won't work. It's not enforceable and to be honest not the way to deal with a retention crisis.

Newly qualified Doctors are much more savvy than when I went to medical school 20 years ago. Many of my colleagues that went to Canada, Australia, New Zealand etc "just for a year to see what it was like" have never returned because the working conditions (and pay) are so much superior to the UK. I'm afraid that the NHS has become an abusive employer and has relied on the goodwill of staff to keep the service running for too long. A clap isn't enough.

If the UK wants to retain Doctors it needs to stop the work environment from being so hostile and spend more on healthcare.

And I should add - it's not possible to deliver uncapped GP care for £150 a year. Of course there are going to be access issues. This is bonkers.

This type of gatekeeping causes friction on both sides. It heightens anxiety for patients who may already be in a highly stressed state.

I am struggling with this whole accessing a GP thing. I have health anxiety (I have recently found out it is related to a mental health condition and I have been misdiagnosed for the past 3 decades until I paid privately to have a recent psychiatric assessment). But whilst I wait for treatment for this, my health anxiety persists and I want to speak to an actual doctor not speak to or be grilled by a frosty receptionist (realise they are not all like this). I need reassurance apart from anything else. I want to be able to make an appointment and not have to state my case, my anxiety is already through the roof when I tried to explain this I had no sympathy. Just told to join the 8 am scramble for appointments the following day and state my case for urgency. It is urgent to me when my mental health starts spiralling, particularly as I have others to care for at least when I can make an appointment I feel like I'm doing something proactive to care for myself. Some vulnerable people are not up to dealing with this crap.

My son is going to try attending at the surgery (their website is down today and the internet is full of complaints about it) to see if that means he can get attention - he just wants to re-register as no longer a student away from home but back here and wants his second covid jab. I will report back later! I have used my Gp for 7 minutes in the last 15 years so out of me at £150 a year my GP has had £2250 for just about nothing back neve rmind hundreds of thousands I pay in income tax. I wish I could just opt out and have a 20% tax reduction.

Why can doctors retire at 55 but many people in the private sector have to wait until age 67 or older? Why do doctors and NHS workers get more than SSP and employer contributed pensions? When NHS pay is higher than many private sector jobs the old comments that lower pay in return for the high pension are utterly wrong nowadays.

Luckily my gp receptionists are pretty good but I've heard of friends having similar experiences to you.
It's nonsense about the meds anyway. A couple of years ago my dad came up from England to visit me in Scotland and forgot all of his meds Anyway he phoned my gp practice, explained the situation, gave a list of the meds and the gp wrote him an emergency prescription for.

I had blood tests in May. I keep asking for the results (can only contact our surgery by email or letter as ‘phones aren’t answered and my mobile cuts off after an hour in the queue) but all my communication has been totally ignored. I took another letter to the surgery yesterday and posted it through the letter box as they still aren’t allowing anyone into the building (although I have now started seeing a couple of cars in their staff car park so that’s an improvement). If I don’t get a response by Monday I will dip into my savings and go private.

@Xenia - Doctors can retire at 55 in the same way anyone can. It’s common in the corporate finance firm I work at. NHS employer pension contributions are higher than some other organisations to counter the low salaries and to try and encourage retention. The NHS pensions have changed in the few years and the method of calculation is much less generous. This could be a fact in so many leaving the NHS.

@Xenia

The NHS normal pension age was 65 since 2008 and aligned with the state pension age in 2015. Many schemes allow you to take your pension early (after all, it is money that you've earned) but of course you get an actuarily reduced rate. That's pretty common.

Facepalm if you think £150/year is a bad deal for a retainer. Honestly.

Actually, you're exactly the reason why I think the system needs to fail. That gets just over 1 consultation with me privately (the NHS average is somewhere in between 6 and 8 per year).

I find some of the comments about receptionists on these threads so unbelievably unkind - I've worked in primary care for ten years (not as a receptionist) and I'm yet to meet a receptionist who triages patients and thinks 'she is the doctor' (seriously what a ridiculous notion!)

I get that there are crap staff in any work place, put all the ones I have encountered were kind and professional, they have to undergo constant training and development, they work to simple algorithms such as 'if patient phones with chest pain advise to call ambulance' and so on, they don't triage and none of them would claim to do so - they are legally and professionally accountable for their actions too after all - and they know it.

They are under the most pressure in a primary care setting - think about it, you have fifty patients calling in an hour demanding to see or speak to a GP that day and only two GPs working, they can't just book them all in, think what would happen if they did. One of our GPs has had a nervous breakdown in the last month as it is from the stress of it.

Seriously OP what is your solution if you have so much insight into the complexities of managing unprecedented demand on primary care services facing a shortage of gp's and other primary care staff and chronic underfunding??

I don't think this is GP bashing but i get that GPs and receptionists posting here could feel like that.

But don't worry, all you GP haters - soon you won't have to put up with us. Many of us are leaving.

I'm really sorry to hear that. You know that it's a systemic problem and not worried patients who are causing you the most stress? Even so, it is a dire situation and i can't understand why the government isn't addressing this urgently. (I'm in Germany. There is also a shortage of GPs particularly in rural areas. There is a programme to attract them including more funds and housing etc etc).

As for the GP (I think) who posted above that people should shut up - boil your head. You can see from these posts that there are clearly issues with some practices, and that is definitely not in dispute. People need to be able to write about this.

What i don't understand is that i know each GP practice is its own entity. But so are car manufacturers. Car manufacturers follow best practice and often copy the good ideas from each other (just in time delivery of parts, building to order on the production line, agile management etc) and what this does is make pretty much all car manufacturing efficient and good.

Why when we hear - even on this "GP bashing" thread - about good practices with great systems, don't GPs do something like this kind of benchmarking? Also i wonder if GP practices offer their staff any kind of help over the abuse and stress they're under?

FWIW my mum's practice has been excellent. My practice (in Germany) has been absolutely fantastic, I've had all my regular checkups etc as usual and they set up a mini vaccination centre in our village and got through us and the neighbouring villages really efficiently.

I don’t blame any of the individuals involved (apart from maybe the clueless one who couldn’t find me a blood test appt because she didn’t know phlebotomy means blood test…)

I absolutely do blame the system. Why are all the GPs leaving? Why are they choosing to go private/go very part time/move to Australia/change direction? We need to sort this out fast.

Where DH is a GP, the practice is going to close. We are moving to Canada (DH is French Canadian- has been a GP in the U.K. for 25 years). The other GP’s are locums and are, after many years returning to their own countries where working conditions for GP’s are much better.
As no GP’s want to take on the practice, it will close and the c10k patients will have to register with other practices which is going to put further strain and longer waiting times for appointments.

@Junepassing you say they don’t triage but that’s exactly what the receptionists at my surgery tell you they are doing. Literally “I have to ask as i have to triage all patients so I can decide who you need to see” -and that was before covid!

Of course they’re not very good at it…. telling me that I COULD have a smear test during my period (which the nurse was very cross about), telling my DD that “the NHS doesn’t cover adult vaccinations” when she wanted to get her “university jabs”.

It's awful.

I 1000% understand that GP surgeries are overwhelmed and dealing with backlog, sickness and isolation like the rest of us. I also imagine that receptionists experience dog's abuse at times. However I don't understand why when I'm being polite and understanding they can't extend the same courtesy to me. It's awful that you had to share your job / role to be taken seriously and thank goodness you have background knowledge to counter these ridiculous assertions. As you say, what does the man on the street do.

My recent story. GP surgery calls me. I'm working so don't pick up. I call them back and it takes 48 minutes to get through. Make a phone appt as GP wants to follow up on a letter from my consultant asking for a new prescription. Fair enough. Make the appt, clear my diary to allow for their two hour window and no call. I phone them - wait for another 30-odd minutes to get through to be told the GP had to go home and sorry no one bothered to let me know. They give me another appt (another two hour work diary clearance), GP calls and then questions what the consultant and specialist nurse have written in their letter. So instead of the GP contacting her colleagues to clarify I've been sent on this wild goose chase and then I'M expected to follow up. So dutifully send an email to consultant, get a response a day later and then realise of course I have no way to get this info to my GP as they don't give out email addresses. So you guessed it, back on the phone, another hour wait to make another 2 hour slot appointment in 3 weeks. It's the most infuriating, inefficient system out there.

I found a lump on my breast, asked for a GP appointment, was told there wasn’t any appointments and I had to again try in the morning, this went on for 17 days.... even if I did receive an telephone appointment they couldn’t give a timescale..... I don’t have a job that allows me to be readily available when the GP called.

On my multiple daily phone calls I explained my medical history how Im high risk of breast cancer etc... they didn’t want to know.

In the end I had to go into the completely empty surgery and kick off, practise manager who advised I could have an appointment in 5 weeks time..... I was there for about 3 hours in total and only 1 person came in during that time... advised that this was completely unacceptable as it would be then 9/10 weeks before I was then seen at the breast clinic, PM cited covid, I advised that I should be seen at the clinic within 2 weeks as per my hospital policy, told them I expected an appointment within the week or I would be going through PALS and posting all over social media to advise they were not adhering to referral policy and referral timescales and putting women at risk.

I was seen 4 days later and referred to the clinic and was given an appointment 5 weeks after finding the lump, had surgery to remove the mass a few weeks after the consultant appointment.

My consultant asked why my appointment took so long after me finding the lump, I explained the above and we both put a complaint in to PALS as consultant advised he’s “fed up” with covid being an excuse for some practises negligence.

If you can’t get through on the phone it’s because another patient wanting an appointment or to talk to the doctor has got through first. If you can’t get an appointment it’s because another patient has been given it first. Where DH is a GP they have on average up to 200 patients a day wanting an appointment.

OP, you know the system, you are able to negotiate. English is your first language, you are not in a vulnerable situation (say coercive control), you are not disabled, an older person, neurodiverse. Imagine if you had been any of these and calling.

When you go to the GP offer to appear in person at the employment tribunal and provide evidence to help the GP practice to dismiss the person concerned. As the person concerned fails all reasonable equalities behaviour.

If that is not forthcoming make a complaint.

@Parker231

If you can’t get through on the phone it’s because another patient wanting an appointment or to talk to the doctor has got through first. If you can’t get an appointment it’s because another patient has been given it first. Where DH is a GP they have on average up to 200 patients a day wanting an appointment.

When I can’t get through on the phone for an HOUR with the “you are number one in the queue” and I’m looking through the surgery window and can see the receptionists NOT answering the phone I think it’s pretty safe to say that it’s not just someone who beat me to it in the phone for an HOUR. When I can’t have an appointment but there is NOBODY in the surgery when I post a letter through their locked door right in the middle of their alleged opening hours hen it must be the invisible man who had the appointment.

I’ve had another letter today reminding me to book my very overdue smear test - the receptionist will only offer me a telephone appointment with the nurse! This time I’m writing back to the department and asking how the “telephone smear test” works.

It's incredibly difficult to speak to a person at our surgery, the phone queuing system will only hold 15 waiting callers, so you get cut off several times before you can even get in the queue. By the time you actually speak to someone all today's appointments are gone, can't book for a future date even for eg medicine review. I will admit I have cried at this point, it shouldn't ever get to that stage.

In entirely related news, our local A&E is experiencing record levels of attendances, and a much higher proportion than normal don't require admittance i.e. didn't need A&E and could have been seen in primary care.

The system has been underfunded for too long, it works in a disjointed way and patients feel lost when they can't get the help they need and so turn up at the door that is open, A&E.

Add to that a whole load of new house building with no additional GP list places, and the system is buckling. Layer a global pandemic on top and it breaks. I work in the NHS, I see it from inside and as a patient too.

Precovid the system was creaking but working. Covid hit and understandably things had to drastically change.
At first e consults/video consults we’re working and a lot of praise was given for that as it worked for both surgeries and patients alike. Those that needed a face to face appointment appeared to get one. But a lot of things were dealt with before that option.
Very few criticism was seen on here. People largely favoured such a system staying.
Now it seems you can’t get an e consult. Can’t communicate with a practice any other way then by phone. That’s if you are lucky. It appears that all appointments are only by phone. Worse, those phone appointment aren’t time slots like when you had to turn up in person, but are at times with a several hours window. Not everyone who needs to consult a gp has that kind of free time in a day to allocate to waiting for a call. I would say very very few people do. Why can’t calls be appointment based like physical appointments? Why can’t people book phone calls on other days, why can they only book Same day calls? At least then you would know that within a half hour or so you would get a call.
So, why has a system gone from being improved under covid, to now being a completely failing system.?
This is what I’m taking from all these posts.
It’s not GP bashing.

We have 17m more people in the UK than when I was born which is 17m too many for a start. We now know there are at least 5.6m not 3m from the EU for starters and those are the ones we can count. I would prefer we had a lot less money and many fewer people. Anyway it is what is an the English 2021 census results will be interesting once they are out next year.

I can report back on my son's attempt to go to the GP. The queues were into the street - there were two queues. It was not even worth joining them. I just checked again today and the website is still down. Just let us opt out of the NHS and pay a lot less tax and I would be happy.

The time may daughter was given as I said above was not kept to and the doctor called 2.5 hours late when she was in a business meeting so could not take it. She is now refusing all maternity care by phone as no one ever calls as arranged which leaves her worried for hours before, having to watch her phone and then having to go into meetings later not knowing what is going to happen. It might work for the unemployed but it does not work for full time workers. Luckily they are not yet doing scans by magic over the phone so I think she might well seen in person this week! I will report back.

..although that is the hospital. the GP has not been prepared to see her (she is pregnant)once so far only the hospital.....

I’ve not had a GP appointment for years but have been in my doctors surgery a lot recently as nearing the end of a pregnancy. The midwifery care has been quite shit tbh but what I am shocked at is the absolute vile way people speak to and treat the receptionists at the surgery while I’ve been waiting. I’m surprised they have any staff left as I wouldn’t be putting up half the venom they’ve had thrown their way for things that are frankly out of their control. I completely understand some of the systems are confusing and there may be people who feel like they’re being failed, but it’s no excuse really.

YANBU.. our GPS phones don't work properly. You can sit in a queue for 20 or 30 minutes get to the top only to be cut off as the phone is answered.. not every time but probably 1 in 4 attempts
By the time you get through there are no appointments and you're advised to call the next day..
repeat until you strike lucky at which point a 3 hour slot will be given for a phone appointment.

Oh and they have a wonderful new policy that all repeat prescriptions should be ordered by email. That's fine but they do not reply. The only way of finding out whether it's gone through is to turn up at the chemist.

However they do use the Livi app which is good and allows remote video consultation with a real doctor. I had a nasty skin infection and managed to "see" a GP and pick up a prescription before 10am..Worth checking if your surgery uses it.

If nothing else positive happens from the Covid pandemic, hopefully (although unlikely) government will realise that the NHS and in particular primary care needs significant additional funding for resources in staffing and technology in order to deliver the services the public deserve.