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.

It is interesting that no GP has commented on offering patients narrower appointment windows.

This is about logistics, not resources.

I have been refused an appointment twice and my dh once. One was for terrible cystitis when I was bleeding but they do not see patients with UTI any more and you are just left.

Second was recently for diverticulitis (I have diverticular disease) and I have been experiencing chronic pain. I waited to see if it would pass, but ended up ringing and was told it was fourteen days for a telephone appointment. Apparently it was not urgent because my pain level did not meet the criteria for emergency appointment. Receptionists should not be judging pain levels. It is one particular receptionist and I know I should have rung back for another staff member.

Worst was dh, who made the mistake of falling ill on a Friday. Same receptionist when I rang in urgently asked me why on earth I waited until Friday when they were busy. He was admitted to hospital with pleurisy and pneumonia. Perhaps his pain levels did not meet the levels required.

I would point out I had not been to the doctors for four years prior to this when I was misdiagnosed with a virus when in fact it was whooping cough which I then passed to my pregnant daughter.

My instinct tells me that our practice is not seeing face to face because of staff shortages. I believe that two doctors are off at the moment. Could they not get a locum or is this something so complex and difficult?

I think that the public are losing confidence in their gp's. This is a shame because those at our practice are fine when seen in person. Brusque yes, sometimes rude, but so long as you are seen and diagnosed correctly I accept this. I don't ask for a lot.

@TheReluctantPhoenix

It is interesting that no GP has commented on offering patients narrower appointment windows.

This is about logistics, not resources.

As someone who has an NHS GP and who can book a 10 minute appointment at a specified time, I don't see why other GPs can't do the same. Maybe patients would have to wait for longer to get that slot, but why can't things be scheduled?

We're British. We're good at queuing and waiting. If we can't see a GP the same day, but we can in a few days, fine. People don't typically book GP appointments for emergencies - there are other resources for emergencies. And if they have ongoing conditions, they can generally predict and book in advance, e.g. if they need their condition reviewed, because their GP wants to talk to them every six months to discuss how meds are working.

What we're not good at is scrabbling for appointments at 8am every day. Why does booking an appointment have to be like some kind of gladiatorial battle? A lot of people who need to see a GP are unwell, and not really up to fighting. They just want to book an appointment.

As I said, if you have a phone appointment with a GP (note, not a conversation with a receptionist), the GP can then decide if you need in-person follow up. Many won't. But they will need that conversation with a doctor.

@TheReluctantPhoenix

It is interesting that no GP has commented on offering patients narrower appointment windows.

This is about logistics, not resources.

All practices I know do provide slots, except for same-day emergencies when you will be trying to fit them around everything else.

www.bbc.co.uk/news/uk-england-cornwall-57833708.amp

@ElsieMc - there is a shortage of GP’s and locums. Many locums are from overseas and have already gone home or in the case of the locums working with DH at his practice, have made arrangements to leave the U.K. and have jobs lined up in other countries

In some areas there is a shortage of available GPs for permanent contracts. As too a shortage of locums. It is very challenging or some surgeries, despite all intention to recruit to vacancies.

Like with any public facing or public serving organisation, each presenting member of the public believes/ feels their need to be greater than that of others. Prioritising must be the hardest thing to do, particularly as there’s risk of harm (serious illness) or death if the wrong decision is made from the information shared.

Here in Scotland 2m distancing and face masks are still compulsory in NHS buildings. This means our waiting room that normally seats 15-20 seats 5 so we have to phone triage people first and stagger appointments

Here in SE England, face masks are still compulsory in NHS buildings and the waiting room at my local surgery is CLOSED. IF you get a face to face appointment you wait outside the practice until you are called in. Last time I was there I waited outside for 10 minutes (totally acceptable) no one else was waiting, no one came out, no one else was waiting when I came out. I was seeing the nurse. All the doors to the other consulting rooms were open and the rooms were empty…..

Phone appointments are a great idea BUT need to be more thought out. I work in a school. I cannot have my phone on me. I don’t get “leave” to be taken as and when I want it. So how do I get to speak to my doctor unless it’s the school holidays (which was how I got my recent appointment).

I must admit, I much prefer remote appointments. It takes 5 mins out of my day as opposed to travelling to the surgery, waiting time then travel time back again. I understand that many people also prefer this but at the same time, many prefer f2f.

@MissLucyEyelesbarrow My old practice still does the ridiculous 'ring at 8am and if you manage to get through, you might get a chance at a phone call at a random time later that day to discuss if you need an appointment, but that isn't an appointment in itself' system. I used to cry in frustration. I'm so glad I've changed GP!

We had a face to face at the height of the first wave before everyone started mask wearing. Back to face to face now, but the phone consults are still taking place, but they were before the pandemic.

[quote TheReluctantPhoenix]@MissLucyEyelesbarrow,

But ultimately, for whatever reason, the current system is not fit for purpose. Countries with 1/3 of the GDP do 10x better.

Maybe it is for the best that practices close down and the whole system is reinvented.[/quote]
Do tell which countries have a free at point of access, universal system that pays less than the U.K. in terms of GDP than U.K. but has a better system?

That’s a bit of an urban myth. It doesn’t generally bear deeper exploration.

The problems are
Too few GPs - they are treated appallingly, so we are lucky so many remain. People see it as a Cauchy number when in fact it is the dumping ground for other under resourced serves. No mental health services - go to GP, child not behaving - go to GP, elderly parents not getting social care - go to GP, housing inadequate - go to GP, poverty - go to GP. There are so many people going with trivia and non-medical things, that the system designed to managed the unwell is overwhelmed. If you turn up at your GP to treat minor athletes foot, to say you have a cold for three days or to say your teenager is being rude, you are part of the problem.

Brexit. One of the most significant post-Brexit challenges for the UK is the one raised by the ability of the British NHS to retain qualified health care staff. Thanks to the free movement of people within the EU, among the 1.2 million NHS workers, England had 63,650 migrants of European nationality pre-referendum. Many have now left and are not being replaced. If you voted Brexit it’s on your shoulders.

Chronic underfunding. Funding in real terms has reduced significantly. People expect and want more for less. They expect every test and investigation they’ve seen on google. Meanwhile financial resources for the NHS have plummeted and been used for vanity projects. How much did those ridiculous Nightingales cost? How much was diverted to friends of cabinet ministers through dodgy contracts? How much was promised but never delivered? Where are the forty new hospitals that were promised but not funded? Where is the promised £350 million a week? The truth is politicians insist money is moved around for political gain but don’t provide more money. The nurses pay rise - yay, let’s applaud the government- good old Sunak and Johnson. The truth is that pay rise isn’t funded. It is to be delivered by cutting services. Well done those who voted for a corrupt government and who believe his three line slogans delivered in dressing up outfits.

Then the population demographics and community behaviours are changing. There is an increasingly frail, very elderly population. Not the seventy two year old who sails, but the ninety year old with dementia or a fractured neck of femur or COPD or who are dying.

They are often lonely and the GP is the person they see and can talk to. Social care is so stripped back they get two half hour rushed visits, a microwaved lunch and sandwich left for their evening meal. They get clean pads put on and dressed or undressed. They get their tablets. They develop pressure damage, they fall, they become depressed. They take up a lot of time and need home visits. Their families may have moved away or be busy with their own lives. In the Call the Midwife day’s of the 50s and 60s communities and families looked after their elderly. Society is more complex now and whilst some communities or families do still care for their elderly, many can’t or won’t.
That’s nobody’ fault and certainly not the GPs.

It would be good not to blame hardworking, exhausted NHS staff that were clapped a short while back for political gain, for political failings.

If you want to know the reason why appointments aren’t always booked to time, this is usually because those people who have given a reason to the receptionist are often telephoned in order of priority by the GP by their choice. Rash on hand of adult will be called after UTI in elderly person.

I see a lot of anger on here I understand but some is misplaced. The idea is that the telephone call is a refusal of F2F but it isn’t. It creates a lot more capacity to have majority telephone consults and they are still a consult. Also a lot of people are fixed in the idea that a F2F is the safest way so they want it for their anxiety that a telephone call isn’t good enough. Any consultation is only as good as the clinician carrying it out, if they aren’t good at asking the right questions by phone that doesn’t mean they would be any better F2F? People are harder to get out of their 10 min consultation, they bring 7 other problems to discuss. Before Covid everyone here was moaning about being 1 hour late taken into their appointment and this is why. There will be anomalies - people who did not receive what they should have by phone but the majority do get what they need. Antibiotics for a UTI, signposted to other services. GP’s can’t put drips in you or give you counselling, they are meant to signpost you to other services

"Phone appointments are a great idea BUT need to be more thought out. I work in a school. I cannot have my phone on me. I don’t get “leave” to be taken as and when I want it. So how do I get to speak to my doctor unless it’s the school holidays (which was how I got my recent appointment)."

How did you get time for doctors appointments before covid? This sounds like your employer's issue tbh. Also, mostly when I've spoken to teachers they've asked for calls after 4pm and usually it's not an issue to accommodate that.

The issue with all of this is that demand outstrips supply every single day. We have moved to a triage situation, which is fundamentally different to the old set up. For that reason we can't give exact times for appointments. Patients can request a time, but the reality is that if there is something more urgent that needs dealing with you cannot justifiably leave it for the convenience of the patient who wants to be called before work. E.g. patient who wants to discuss peri menopause symptoms (lots of those just now after the davina documentary) - understandably doesn't want to discuss around work colleagues so asks for an 8:30am call.

However - also on the list are:

1. Man with chest pain - reception have suggested he call 999 but he doesn't think he's having a heart attack and just wants to talk to the gp.

1. Woman with copd thinks she has a chest infection. May need to have f2f arranged, you think. Also, hasn't told reception but is struggling with mental health since her husband was diagnosed with cancer last year, and they're still trying to isolate to protect themselves from covid. Call ends up taking over 20 minutes when she becomes emotional and start to cry.

1. 8 month old child who isn't well, not feeding as much as normal. Mum is worried.

And so on....

How is it possible to predict who else ends up on the list, and how long their (serious, justifiably in need of a consult problems) will take? The reality is that healthcare is unpredictable. You HAVE to attend to urgent situations first. That's how triage works. You often can't predict what other serious issues will crop up during a consultation. This is the reason that we don't make promises about timings for appointments. There is an expectation that if patients were previously able to take time off for a doctor's appointment, they should still be able to take that time for a phone appointment. I realise that is harder without a clear time (although as I said, certainly at our surgery we do our best to accommodate requests and they are usually easier to manage if they are after a certain time rather than before). Unfortunately, as we can't even speak to everyone who wants to speak to us each day, the convenience of the patient does fall down the priority scale. Sorry, but that's literally all the system can accommodate at the moment. There are plenty of posts on here demonstrating the enormous strain GPs are under, nobody is slacking off here.

@Menora

If you want to know the reason why appointments aren’t always booked to time, this is usually because those people who have given a reason to the receptionist are often telephoned in order of priority by the GP by their choice. Rash on hand of adult will be called after UTI in elderly person.

I see a lot of anger on here I understand but some is misplaced. The idea is that the telephone call is a refusal of F2F but it isn’t. It creates a lot more capacity to have majority telephone consults and they are still a consult. Also a lot of people are fixed in the idea that a F2F is the safest way so they want it for their anxiety that a telephone call isn’t good enough. Any consultation is only as good as the clinician carrying it out, if they aren’t good at asking the right questions by phone that doesn’t mean they would be any better F2F? People are harder to get out of their 10 min consultation, they bring 7 other problems to discuss. Before Covid everyone here was moaning about being 1 hour late taken into their appointment and this is why. There will be anomalies - people who did not receive what they should have by phone but the majority do get what they need. Antibiotics for a UTI, signposted to other services. GP’s can’t put drips in you or give you counselling, they are meant to signpost you to other services

But if you call in an unbooked order, surely you waste time calling people who can't/don't answer?

What are working people supposed to do? Or if you work, are you not entitled to basic healthcare?

@sheepisheep

"Phone appointments are a great idea BUT need to be more thought out. I work in a school. I cannot have my phone on me. I don’t get “leave” to be taken as and when I want it. So how do I get to speak to my doctor unless it’s the school holidays (which was how I got my recent appointment)."

How did you get time for doctors appointments before covid? This sounds like your employer's issue tbh. Also, mostly when I've spoken to teachers they've asked for calls after 4pm and usually it's not an issue to accommodate that.

The issue with all of this is that demand outstrips supply every single day. We have moved to a triage situation, which is fundamentally different to the old set up. For that reason we can't give exact times for appointments. Patients can request a time, but the reality is that if there is something more urgent that needs dealing with you cannot justifiably leave it for the convenience of the patient who wants to be called before work. E.g. patient who wants to discuss peri menopause symptoms (lots of those just now after the davina documentary) - understandably doesn't want to discuss around work colleagues so asks for an 8:30am call.

However - also on the list are:

1. Man with chest pain - reception have suggested he call 999 but he doesn't think he's having a heart attack and just wants to talk to the gp.

1. Woman with copd thinks she has a chest infection. May need to have f2f arranged, you think. Also, hasn't told reception but is struggling with mental health since her husband was diagnosed with cancer last year, and they're still trying to isolate to protect themselves from covid. Call ends up taking over 20 minutes when she becomes emotional and start to cry.

1. 8 month old child who isn't well, not feeding as much as normal. Mum is worried.

And so on....

How is it possible to predict who else ends up on the list, and how long their (serious, justifiably in need of a consult problems) will take? The reality is that healthcare is unpredictable. You HAVE to attend to urgent situations first. That's how triage works. You often can't predict what other serious issues will crop up during a consultation. This is the reason that we don't make promises about timings for appointments. There is an expectation that if patients were previously able to take time off for a doctor's appointment, they should still be able to take that time for a phone appointment. I realise that is harder without a clear time (although as I said, certainly at our surgery we do our best to accommodate requests and they are usually easier to manage if they are after a certain time rather than before). Unfortunately, as we can't even speak to everyone who wants to speak to us each day, the convenience of the patient does fall down the priority scale. Sorry, but that's literally all the system can accommodate at the moment. There are plenty of posts on here demonstrating the enormous strain GPs are under, nobody is slacking off here.

This is a good post, it’s not that your issue is trivial but it’s likely less urgent that a young child or older person. It’s actually a pretty safe way of working

@lavieengris

All surgeries are different, prebooked people will likely be routine so less need to jump around the list. Despite this on any given day as we have humans working as GP’s nearly every week things have to be all moved around because of isolation/sickness and holiday they are entitled to. I could get to work tomorrow and have to move everything around. This gives us a lot more flexibility in the working day. To call and cancel/move appointments would mean losing receptionists to do that job and not picking up the phone.
If you call on the day, you will be up against 100 other people also calling and some of those will have much more urgent issues than you, some will have less urgent issues and for the sake of patient safety, those with high risk factors or concerns will be called first.

If you work and need an appointment I understand it’s not convenient but on some occasions they are going to pick an unwell older person or child over you, and that would be similar in A&E or on a ward too. You have to wait your turn

I don't see how it's efficient to have 100 people calling at the same time fighting for an appointment. I've had a practice with that system, and I could never make an appointment - you started trying to phone at at 8am, but by 8.30am, I had to give up and get on public transport to get to work (and there's no phone signal on the majority of the tube).

I couldn't make regular appointments in advance. I ran out of medication on quite a few occasions, and found it hard to manage my health as a result.

The problem with the phone triage system is it doesn't let you book routine appointments. It assumes everything is wildly urgent. That means that non-urgent things do eventually become urgent, because you can't book appointments ahead.

If I went to A&E, of course, I'd wait my turn. You might be in extreme pain, but some people who arrive after you might die if not bumped ahead. You expect A&E to be like this - and if you have to go to A&E on a working day, your colleagues will cover for you, because clearly something serious is up. GPs are not supposed to be the same.

If I want to see my doctor, it's typically because of a non-urgent issue (that only becomes urgent if I repeatedly cannot see my doctor). I don't necessarily need an appointment the same day I call, but I do need to commit to a time in the future so I can schedule life to happen around that time. Such as, holding down a job.

I just don't understand how my current practice can work so efficiently and yet others have to use the archaic system I've used before (and that you are defending).

To an extent, I can self-triage myself at my current practice and make an appointment with someone one who isn't a GP, and that's got to be a more effective use of resources. I've just checked (to prove the point) and if I just need to do a standard repeat prescription review, I can book a slot later today with a prescribing pharmacist. I can do that via video if a bit of show and tell is appropriate. If I take regular medication, it vastly reduces my odds of needing to go to hospital and wasting emergency resources.

If I need an appointment with a GP, I can book a slot in the future from first thing on Tuesday onwards. One working day. Not bad, eh? As it's only ten-minutes, even allowing for the GP running late, I can fit that into my lunch break and no one from work even needs to know I'm seeing a doctor.

I never understood why my previous practice insisted I saw a GP every time I needed new medication and yet wouldn't ever let me make an appointment with a GP...

@sheepisheep

"Phone appointments are a great idea BUT need to be more thought out. I work in a school. I cannot have my phone on me. I don’t get “leave” to be taken as and when I want it. So how do I get to speak to my doctor unless it’s the school holidays (which was how I got my recent appointment)."

How did you get time for doctors appointments before covid? This sounds like your employer's issue tbh. Also, mostly when I've spoken to teachers they've asked for calls after 4pm and usually it's not an issue to accommodate that.

The issue with all of this is that demand outstrips supply every single day. We have moved to a triage situation, which is fundamentally different to the old set up. For that reason we can't give exact times for appointments. Patients can request a time, but the reality is that if there is something more urgent that needs dealing with you cannot justifiably leave it for the convenience of the patient who wants to be called before work. E.g. patient who wants to discuss peri menopause symptoms (lots of those just now after the davina documentary) - understandably doesn't want to discuss around work colleagues so asks for an 8:30am call.

However - also on the list are:

1. Man with chest pain - reception have suggested he call 999 but he doesn't think he's having a heart attack and just wants to talk to the gp.

1. Woman with copd thinks she has a chest infection. May need to have f2f arranged, you think. Also, hasn't told reception but is struggling with mental health since her husband was diagnosed with cancer last year, and they're still trying to isolate to protect themselves from covid. Call ends up taking over 20 minutes when she becomes emotional and start to cry.

1. 8 month old child who isn't well, not feeding as much as normal. Mum is worried.

And so on....

How is it possible to predict who else ends up on the list, and how long their (serious, justifiably in need of a consult problems) will take? The reality is that healthcare is unpredictable. You HAVE to attend to urgent situations first. That's how triage works. You often can't predict what other serious issues will crop up during a consultation. This is the reason that we don't make promises about timings for appointments. There is an expectation that if patients were previously able to take time off for a doctor's appointment, they should still be able to take that time for a phone appointment. I realise that is harder without a clear time (although as I said, certainly at our surgery we do our best to accommodate requests and they are usually easier to manage if they are after a certain time rather than before). Unfortunately, as we can't even speak to everyone who wants to speak to us each day, the convenience of the patient does fall down the priority scale. Sorry, but that's literally all the system can accommodate at the moment. There are plenty of posts on here demonstrating the enormous strain GPs are under, nobody is slacking off here.

Really good post. No one knows the wider picture of what surgeries deal with. Plus we all know in our jobs that you can take or make a call, predicting its duration and then be on it longer. That’s then without the workload actions after it and/ or record keeping of content which needs to occur.

Staff in school can take a call. You just mention it to your wider team so that it can occur. In the same way that occurred prior to covid to release for appointments. Routine appointments are booked for the school holidays.

@Birminghambloke My previous practice didn't let you book routine problems, which was a big part of the problem. Every appointment - urgent or non-urgent - was dealt with via the 8am same-day phone scramble.

No one has yet managed to convince me that the 8am phone scramble is a justifiable way of operating. And yet, it's so common...

@LemonRoses,

I don’t care whether it is ‘free at the point of access’.

We need some kind of system which works, regardless of whether copayments are required.

Everyone looks at the U.S as an unfair system but we are pretty much there here, just conning the average person that they have a marvellous ‘free at the point of access’ service. We don’t.

Want to see a GP, next appointment a month away. If I pay £75 (and an annual membership fee), I see a GP same day, pretty much at the time of my choosing. In pain and need a hip replacement, waiting list now 2 years (?). If I have insurance or have 10-20k, I can go in in a couple of weeks and have state-of-the-art surgery.

The NHS might have had its moment in the sun but, especially post COVID, and with a few exceptional pockets of excellence, it is a second class service.

Why do we keep kidding ourselves it is somehow wonderful?

I think that there is a middle ground between free at the point of service but not very good and the system they have in America, to be honest.

[quote lavieengris]@Birminghambloke My previous practice didn't let you book routine problems, which was a big part of the problem. Every appointment - urgent or non-urgent - was dealt with via the 8am same-day phone scramble.

No one has yet managed to convince me that the 8am phone scramble is a justifiable way of operating. And yet, it's so common...[/quote]
It seems common. I’ve had it in each of the three surgeries for same day appointments. It is very stressful as I’d only call if felt really rough- not usually up for being on hold and then the triage!

However, they did/ do also have a ring after 2 option for routine appointments and, usually, an online booking option. I did online for my routine appointments when undergoing lots of tests/ consultant appointments. One surgery had the online routine appointments available for after 4 pm. Perfect for my work and leaving a bit early. The best surgery offered 7.30 / 7.40: 7.50 a.m appointments via online booking. These seemed to always be available! You’d be there with an empty carpark too!

The system I liked best was in one city where you could turn up from 8 and by 9 and wait and be seen by 10.30! All GPs just saw patients. It meant a waiting room full but you knew you’d be waiting for a definite face to face consultation as opposed to waiting in a phone queue.

Original poster I have a different viewpoint regarding disagree your statement about GP surgeries. In my experience I telephoned my NHS doctor practice a few days ago and spoke to the receptionist to enquire if they were currently conducting in person appointments. As they were, I was offered an appointment later that afternoon. Job done and no biggie but business as usual although obviously masked with strict no nonsense Covid protocols and questioning with few people permitted simultaneously in the building. This is a large practice in central London connected to one of London’s major teaching hospitals. I rarely make use of my NHS GP practice as I normally use private healthcare or just ask a sibling who is a senior head of practice GP or father in law who is a retired hospital surgeon so two family doctors on speed dial if absolutely necessary. I normally use my GP practice for travel clinic vaccinations and keep myself and family trim and healthy to fight against Covid. We are not regular ill patients and so light fair usage of limited NHS resources. Doctors have been under undue pressure since the pandemic and have done an amazing job! It is the Covidiots that have themselves to blame for ill health. The doctors are doing their best to fix the mess.

It seems common. I’ve had it in each of the three surgeries for same day appointments. It is very stressful as I’d only call if felt really rough- not usually up for being on hold and then the triage!

This is one of my biggest issues - the people who are sickest are often not able to compete in the phone scramble.

However, they did/ do also have a ring after 2 option for routine appointments and, usually, an online booking option.

Sensible. Routine appointments can be planned and spread across the year to better manage capacity. I don't know why some practices fail to grasp this. You know how many of your patients have conditions that require regular care. You can schedule those patients. If you schedule them, they are far less likely to need urgent care, because their conditions will be under control. It means you have more certainty over how much time you can free up to deal with unexpected, urgent matters, typically other patients.

Why admin/IT staff can't come up with logistics that are fit for purpose to leave doctors to get on with practising medicine, I just don't know...

If my NHS GP can manage it, so should everyone else's!

@AmIEmptyOrNumB

The GP'S that are too lazy to do face to face should be DEEPLY ASHAMED

No GP isn’t doing f2f for laziness - they’re able to book more patients over the phone so are busier.

No it’s not negligence not to give you a f2f if not required.

No doctor in the U.K. takes the Hippocratic oath you’ve pulled that from American hospital dramas.

If you mean breaching code of ethics, then still no they’re not.

If you feel you’re being gatekept by reception I sympathise I really do, complain to your practice manager it’ll be more constructive to your issues than this.