GP Surgeries are NEGLIGENT if they're not doing face to face appointments

[AmIEmptyOrNumB]

My GP surgery never stopped. They just triaged so 90% by phone and those essential face to face appointments carried on but with masks etc. Why is the government not doing more about this? These Surgeries denying all face to face appointments are failing the hippocratic oath.

@LemonRoses

In her practice, one salaried GP has now resigned to leave medicine altogether and one is moving into private practice where the workload feels safer.

Private GP is a MUCH nicer place.

It's unhurried, patients are generally much nicer (even though they're paying nearly a year's worth of GMS funding for one appointment) and there's time to deliver proper care. There's also no NHS England bollocks micro management.

In comparison I dread NHS days.

@PaddingtonsHat

I am a GP. I have worked so fucking hard over the last 18 months. I normally work hard, but apart from a month or so where nobody wanted to ‘bother us’ demand has gone up. We have in many cases delivered the COVID vaccination programme (certainly been the case locally) on top of our day to day work, implemented huge changes in technology to try and facilitate access for our patients, introduced the unlimited capacity system of e-consult alongside our existing appointments, and kept up with the shit show that is the government ‘announcements’ with very little notice. Our doors have never been closed, but the entire nation seems to think I’ve sat on my backside twiddling my thumbs and sending people to the ED because I can’t be arsed. I wonder why no one wants to be a GP.

This mirrors what my DH is saying. He is French Canadian and came to the U.K. on a scholarship when he was 21. He trained as a GP as he thought it would be more family friendly after our DT’s were born and I also have a full time career. How wrong he was about the working hours. He has always worked full time for the NHS. I’m Belgian and we decided to leave the U.K. following Brexit. Unfortunately Covid delayed our leaving but we are relocating to Canada when travel restrictions are lifted. His locums are also going back home so the practice closes as no one wants to take it on.

Both my partner and I have seen doctors and nurses face to face during the pandemic. I have also had an operation (non urgent). I much prefer the current system. I can step out of the office to take the call and a 10 minute 'appointment' is 10 minutes, not 15 minute travel time, 10 minute wait, 10 minute appointment and another 15 minute travel time., don't have to leave work to travel etc. Obviously if they need to examine me that's different but still happy to do the initial by phone/video. I think our GP's are able to take more people now than previously which can only be a good thing?

I don't want gps to feel "attacked".

I want assurances that what happened to my mum won't happen again.

Or a note on her records that usually she needs to be seen f2f due to her many health conditions which complicate even "simple" infections.

Apparently most feel that's Unreasonable 🤷‍♀️

[quote TheReluctantPhoenix]@privateandnhsgp,

‘The public’ (I.e not me) is such an othering word.

You are not making a good case for GPs, regardless of the systemic failure or the pressure they are under.

A little empathy for patients, generally scared and ill, would not come amiss.[/quote]
I don't need to make a case for GPs, I'm telling you (my view of) how it is. Take it or leave it, up to you.

I'm plenty empathetic in clinic where it's needed but I don't feel the need for that on an internet forum. I also don't give a shit about what you think. Hope that's clear.

...anyway I'm off to make sure mums taken her 10pm meds....

Goodnight all

Ok not all gps are negligent but honestly the ones I’ve dealt with over the last 10 years (village practice) have been horrendous. Pre covid I was diagnosed with ‘Cat flea bites’, went back to gp as I was in horrendous pain and itchy 24/7 thankfully saw a locum who referred me to dermatologists that afternoon as I had a very serious, life endangering rash like condition that they said if it got into my mouth or eyes I could die. That’s just one of the many many foul ups that my gps have done. I cannot move to another gp office as I have lots of long term (mostly since birth) health conditions that mean it is an extremely complicated situation to move to another gps office. The main problem for me with phone calls is, I’m profoundly deaf and can’t use a phone, they said only way for me to get any medication or diagnoses is to get my mum to ring on my behalf, which I’m pretty sure breaches several disability rights laws 😒

@Mrs08

If thr Dr had called her in, dipped her urine they would have seen how chock full of bacteria it was and prescribed more suitable antibiotics. 5 day stay in hospital avoided. Mum says that many people on her ward are there because they didn't get to GP/GP refused to see them.

I am a Dr- not a GP. It is not true that simply dipping the urine would not have told any Dr that your mum had pyelonephritis as opposed to a UTI. I don’t know if the GP seeing your mum would have changed the outcome- it may well have done. But a straightforward UTI is one of the infections that could well be treated over the phone- using empirical antibiotics if symptoms fit. That being the key, really- did they check the symptoms your mum had and did they act appropriately on the information they were given.

Sometimes it would be better to have a urine sample to dip and send for culture (for example, if there is a history of recurrent UTI or or any doubt as to the diagnosis). Sometimes it would not change the initial treatment.

A simple UTI will generally present with pain on passing urine, going more often, urgency, perhaps feeling under the weather or some very low abdominal (suprapubic) discomfort (not severe pain). Someone presenting with those symptoms may well be appropriately treated with a 3 day course of antiobiotics without physically being seen. It is always possible, for a variety of reasons, for a seemingly UTI to become an “ascending infection”- pyelonephritis- and it’s not always obvious when that will happen.

However, patients with ascending UTI/pyelonephritis present with UTI symptoms, but usually have one or more of back/loin pain, fever, rigours/shivering, nausea or vomiting. I.e. systemically unwell. Any of those symptoms should have triggered a GP review. If your mum had those, had told the doctor and not been seen- I agree, they were negligent. Or if they did not ask about those m, they should have done.

Both UTI and pyelonephritis will provide positive urinalysis (showing white cells, nitrites, protein and blood)- you simply cannot reliably differentiate between the two based on that alone. What differentiates them is the signs and symptoms.

@privateandnhsgp,

Abundantly clear and no, you cannot show ‘empathy’ at clinic, that is called acting and I bet your patients see straight through it.

Thankfully I can afford to be one of your ‘nice’ patients, I see a reassuringly expensive (though not £150/appointment) private GP.

Would hate to spend one of the worst days of my life at your NHS clinic.

I hope that is also clear.

My daughter got misdiagnosed and ended up I hospital for three days because the gps didn’t think she was worth seeing with her symptoms.

When people say Primary Care is failing it needs to be replaced - I'd like to know with what.
There are so few GPs out there that our CCG is looking to commission virtual locum GPs from another part of the country.

For every person having a poor experience- and I do not doubt they are - there are 30 people demanding F2F same day acute appointments because their shoulder is hurting, they have a wart, sore throat 3 days. This is the unnecessary pressure. There are also loads of mental health and social care issues and GPs are expected to mop these up because the Tories won't fund these areas properly. A Tory government wants to privatise health care - then we'll have to pay £99 to speak to a GP. Then people will use the NHS more appropriately or the poor will become more ill. This makes me desperately sad.

@LemonRoses

PaddingtonsHat Absolutely. I had my daughter on the phone in tears throughout her 45 minute drive home yesterday. She thinks she might want to give up being a GP having nearly finished her first year.

She was two hours late leaving because all her admin time had been used for patient contact. She was going home to work some more at 8pm, having started at 7am. She’s worried about complaints and referrals to GMC because people are being so rude and unpleasant.

Her practice has APNs and a pharmacist but they add to her workload not diminish it because they see people and decide they need a GP to review them. The F2 also adds to her workload. People have no idea. The Gaps weren’t even given PPE to start with. We had to source FPP3 masks for use when certifying deaths in care homes or seeing acutely unwell patients.

The negligence is the government not resourcing healthcare properly. It’s also the fault of all those who voted Brexit and made our many European medics feel unwelcome here.

@LemonRoses your poor daughter. Bloody awful time to be a trainee. Sounds like she needs to speak to her training programme directors- there should be support available.

My GP practice has been abysmal.
First instance. I have hypertension which I have medication for. A few weeks ago I received a letter from them saying that I didn't need to go in for my annual check as my BP has remained stable.
Quite how they know that as they've not measured it since just before the first lockdown, I have no idea!!
Second instance. A small freckle on my breast developed into a very itchy mole. They did a phone consultation and told me to place a tape measure alongside it and take a photo.....have you ever tried to do this? Impossible!! Turned out to be cancerous and was removed.
I had to return to my GP in my home country last summer for examination and procedure.
Third instance. I was having problems with unexpected spotting and bleeding. I phoned for an appointment, the receptionist told me that the GP would phone me for a consultation the following day. I asked what time and the receptionist said it would be at some time in the morning as she couldn't give an appointment time.
I told her that wasn't possible as I was at work and I didn't want to discuss it around my colleagues. She refused to back down.
Again, I ended up travelling back to my home country to see my GP about it.
It's disgusting that they're allowed to get away with it.
They need to get a hold of themselves and get their doors open to the patient's now.
Casualty units and hospitals are straining under the weight of patients who either won't be seen by their GPs or with patients who have developed serious illnesses because they can't see their GPs.
Shocking, absolutely shocking.
The government put us in lockdown to save the NHS, yet the GPs are overwhelming it with patients that they're refusing to see!
Forgive me if I'm not shaking a bloody tambourine for the poor hard done by GPs.

@PaddingtonsHat

I am a GP. I have worked so fucking hard over the last 18 months. I normally work hard, but apart from a month or so where nobody wanted to ‘bother us’ demand has gone up. We have in many cases delivered the COVID vaccination programme (certainly been the case locally) on top of our day to day work, implemented huge changes in technology to try and facilitate access for our patients, introduced the unlimited capacity system of e-consult alongside our existing appointments, and kept up with the shit show that is the government ‘announcements’ with very little notice. Our doors have never been closed, but the entire nation seems to think I’ve sat on my backside twiddling my thumbs and sending people to the ED because I can’t be arsed. I wonder why no one wants to be a GP.

I am a GP partner, I agree. Demand has escalated over the past 18 months. We have 6000 patients , we are not understaffed, and we have more GP appointments available than we did pre-pandemic. We have recently changed our phone system to one which counts calls, and we have been getting near 300 calls on Mondays - that’s 5% of our practice population calling on one day. If you can’t get an appointment quickly, it’s because there are not enough hours in our day. My morning clinics are overbooked routinely, I will deal with 20 patients or more, finishing seeing/ speaking to patients around 1pm, after which there are letters, queries, phone calls and visits to deal with before I start the afternoon patients at 3.30. We deal with all urgent problems on the day. I usually go home around 8pm , because by that time I can’t think any more. As well as dealing with the appointments requested by patients, we are trying to provide all the annual reviews for our chronic disease patients. We are also getting work dumped on us by hospitals, asking us to do ecgs, blood tests, listen to chests because the hospital appointment was a phone call “ because of Covid” - or discharging the patient when they couldn’t get hold of them for the phone appointment and asking us to refer again. Nobody has had a good time in the past 18 months, and I am concerned about the patients who have not had treatment when they should have done. But most of us are working flat out and doing our best.

[quote TheReluctantPhoenix]@privateandnhsgp,

Abundantly clear and no, you cannot show ‘empathy’ at clinic, that is called acting and I bet your patients see straight through it.

Thankfully I can afford to be one of your ‘nice’ patients, I see a reassuringly expensive (though not £150/appointment) private GP.

Would hate to spend one of the worst days of my life at your NHS clinic.

I hope that is also clear.[/quote]
And yet I'm fully booked both NHS and Privately despite some random on the internet saying I'm not a good doctor. Maybe internet posts attention a good way of judging consulting style?

...and now they said they wouldn't see me.

Wah wah, I'm so sad etc..

Attention=aren't

PaddingtonsHat She’s not a trainee but salaried.

@jacks11

I'm not a gp or a Dr but my mother suffers from the following;
Bladder prolapse (failed repair)
Recurring UTIs
Bowel prolapse
Chronic constipation
Coeliac disease
PVD (occluded fem 2 fem bypass)
COPD (emphesema)
Unstable angina
Osteoporosis
Cardiomyopathy
Previous MI

Surely the 1st 2 alone should have triggered a f2f appointment with the gp bearing in mind her symptoms?

Less than 8 hours after the phone call she became very, very unwell. I've never seen her so ill.

I've no idea if the gp would have px stronger abx or sent her to a&e due to her 02 sats but its clear to me she should have been seen f2f.

So i guess we will have to agree to disagree on that one.

@LemonRoses I thought it was odd she was supervising the f2! The first few years are tough, I hope she has someone in practice she can talk to. Make sure she is taking her annual leave!

Forgot to mention in my post that it actually takes up to 2 hours to get to talk to even a receptionist for my gps surgery.

@Quincesorbet

That's pretty horrific sounding (it used to be similar here until we made some changes).

Can you really think straight at the end of the day. Decision fatigue is a major concern and there's a real risj with processing results at 8/9pm when you're likely to miss that high a1c or low Hgb

It's unsustainable.

@Becca19962014

I’m sorry, but I don’t know if you have a medical background or not but your information about nitrofurantoin is factually incorrect. At least in the UK.

It is perfectly acceptable to prescribe nitrofurantoin for 3 days for straightforward cases of UTI in women. It is only in men that antiobiotics (trimethoprim or nitrofurantoin or any other antibiotics) should be for 7 days. Our local antibiotic formulary states 3 days trimethoprim or nitrofurantoin as first line antiobiotics for uncomplicated female UTI.

You can also see that BNF suggests 3 days is perfectly acceptable. See here: bnf.nice.org.uk/drug/nitrofurantoin.html

[quote PaddingtonsHat]@LemonRoses I thought it was odd she was supervising the f2! The first few years are tough, I hope she has someone in practice she can talk to. Make sure she is taking her annual leave![/quote]
It’s a good practice and they’re kind, but like GPs everywhere they are overloaded. She does have a practice mummy too, but is just exhausted at the end of the day, I think. She’s always had ‘head girl’ nature and is terribly conscientious, so frets about not seeing things through properly in a timely way.
I’ve friends at other end of their careers who feel very similar at the moment. A year of working incredibly hard in difficult circumstances to be told they’ve not been seeing patients or are just making excuses.

Shocking the way we treat primary care.

I have to say my practice has been amazing during the pandemic, I had a baby last year and they have seen both of us for many routine and emergency appointments more often than not on the same day and have done the jobs that both our local adult & children's hospitals point blank refused to do.

My local maternity hospital on the other hand, completely negligent and pushed me to the point of being suicidal at 41 weeks pregnant, and the management of the hospital and the trust still won't accept responsibility for what they did even though I'm being treated for PTSD by their own trauma team. Disgusting.

However all these problems have one root cause and that's the government, it's not the fault of our overworked health care professionals working in a broken system that basically sets them up to fail.

@nhsagreed, thankfully I have reduced my hours a bit, so I only do 2 long days per week, plus 2 mornings ( ie finish by about 3pm! )