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

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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.

@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.

You can't tell TYPE of bacteria from a urine dipstick, you need a culture, so you start with broad spectrum ABs, these obviously didn't work but the outcome would have been the same.

@Rabblesthecat

My mother used to attend a patients committee at the local gp. They asked her to attend.

She quit after a year- as did three other patient reps

The three main complaints all had the same solution suggested by the non nhs people and every time they were shot down. End result - they quit because what’s the point of having patient reps if nothing changes

Complaint 1 - missed appointments

Solution - either charge for missed appointments or three strikes and your out. Numerous reasons that could
Not be done. End result was nothing changed

Complaint 2 - time wasters and hypochondriacs

Solution as above / agains knocked back

Can’t remember the third but that also fell on deaf eats

I too attended the PPG for one surgery. Our role was not to raise complaints and demand solutions. It was wider/ bigger picture around how wider patient voice was sought and analysed. We looked to how we could support with ensuring all groups of patients (age, gender, ethnicity, working etc) were represented in feedback around patient experience. We supported with generating questions and the modes by which feedback was sought- some of those not working would attend the surgery and fill out the form with those who might not respond to a text. The most vocal feedback was observed to be from one particular group- time on hands combined with frequency of use! It was interesting to find out how challenging it was for the surgery with staff retention/ recruitment of GPs or locums, particularly balancing male / female GP ratio and coverage of hours across a week with aligning to working patterns. It matched with recruitment challenge to other professional roles in that area (high cost of living being one factor). One model that came out was a review of named GPs and gender preference. The GPs took it in turns to attend meetings along with the practice manager. The practice communicated missed appointments as a percentage. This supported the reduction of these over time. I really held compassion for the challenges faced and the effort put in to continually improve experience for patients. It’s not dissimilar to other fields.

Regarding the quoted above ‘solutions’ suggested- where is the means to fine people for non attendance? If surgeries have variable appointment booking systems, they won’t have the admin or technological capacity to administer fines! Patients don’t give deposits or register cards on booking like in a restaurant or beauty salon! They will also work within guidance to refuse treatment / strike off patients. I’m not NHS and can see that’s not at all workable. Regarding ‘hypochondriacs’ - why are they presenting this way? How can this be resolved/ how can their need be supported? There is always an underlying reason to behaviours.

Our local GP is letting down most of the patients. The system is first of all a long winded EForm, asking about much irrelevant stuff, then maybe you get a random phone call or text. No notification, they just might ring. They just won’t see patients, face to face, whatever. The door is still locked with “keep out” on it. They take 40 minutes to answer the phone, they ignore letters and they don’t reply to emails.

This is having an inevitable effect - some of the patients are paying a private GP, in the next village, for £50, a face to face within a couple of days, but the majority, who can’t afford this, are rocking up to our local A&E, with pretty minor ailments (usual see your GP stuff), simply because they want to see and talk to a doctor. Consequently, there’s an average 8-9 hour wait in A&E.

My husband is poorly at the moment, and we have to attend hospital outpatients a lot - none of the fuss we have with the GP, all happy to do face to face , but constant complaining from the consultants that the GP hadn’t done the basic stuff they should have done in regard to my husband.

Things will have to change soon, before winter, or hospitals really will be overwhelmed with patients just turning up.

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

It wouldnt be beyond most surgeries to give a time slot. I think most of us understand urgent cases take precedence. But if I had a message for say a two hour time slot then at least at some point that same day I could phone back and say they have missed me can I have another slot or whatever.

And I have just had a call from my dr on something none urgent just uncomfortable at 8.23 am. This I put through the online thing on Saturday night. So it's possible that there was nothing more urgent this morning, but I doubt it.
But on the virtual online dr thing I was told to wait til 6pm Tuesday for the call, then if no call I could remind them. 2 days for a phone call is a bit ridiculous for anyone. We do still have to do things that may mean no phone signal or no easy way to answer cos driving or child wrangling or whatever other reasons.
And I know from experience that I cant ask for eg after 2pm. My surgery wont consider it so if i miss the call because I'm underground with no signal then tough on me. And worse still i might not know i missed the call because of the no signal. Then I'm left waiting for days wondering if I've been forgotten or missed the call.

@Karmalady

Our local GP is letting down most of the patients. The system is first of all a long winded EForm, asking about much irrelevant stuff, then maybe you get a random phone call or text. No notification, they just might ring. They just won’t see patients, face to face, whatever. The door is still locked with “keep out” on it. They take 40 minutes to answer the phone, they ignore letters and they don’t reply to emails.

This is having an inevitable effect - some of the patients are paying a private GP, in the next village, for £50, a face to face within a couple of days, but the majority, who can’t afford this, are rocking up to our local A&E, with pretty minor ailments (usual see your GP stuff), simply because they want to see and talk to a doctor. Consequently, there’s an average 8-9 hour wait in A&E.

My husband is poorly at the moment, and we have to attend hospital outpatients a lot - none of the fuss we have with the GP, all happy to do face to face , but constant complaining from the consultants that the GP hadn’t done the basic stuff they should have done in regard to my husband.

Things will have to change soon, before winter, or hospitals really will be overwhelmed with patients just turning up.

How on earth can you represent all patients at a practice or know it is ‘the majority’. Ridiculous suggestions.

Some people are busy and can't be expected to wait for the call back? Fair enough for some conditions but in some cases if you're ill then shouldn't be staying by the phone be fairly simple?

A friend of mine is a receptionist and the shift to initial phone consultations will probably stay. They've managed to move a decent percentage of prescription renewals to online and because of this the number of actual medical appointments has increased. It also massively reduces the social call appointments where it's two minutes medical, ten minutes chat.

My practice has been pretty good. Yes it can be difficult on a Monday to get an appointment but when it's been for the kids, no trouble at all. In one case, got through at opening, phone back at 9 (as child), video call and then into practice at 10 as not 100%. Admitted by 11. Can't fault the practice.

Last week my elderly (80+) neighbour fell at home. She had a nasty head wound and I took her to hospital. They were great she was there for only two hours and was glued and steri stripped. She was given a letter which basically said her local surgery (we have the same one) should check her wound in a week. She can’t use the e-system, I can’t do it on her behalf because the “system” recognises my email address as mine. I took the letter in person to the surgery and explained through a cracked open door what the situation was. She has a telephone appointment for the first week in September! a) a long time after the one week the hospital said and b) a wound check on an 80+ year old woman? She only needs to see the nurse! I know that if the nurse was informed she would see this lady but reception aren’t letting it get that far. Fortunately I have some experience so I’ve checked her wound and it all seems okay otherwise I’d take her back to the hospital.

‘How on earth can you represent all patients at a practice or know it is ‘the majority’. Ridiculous suggestions.”

I don’t, just down to local knowledge, speaking to people at the hospital and local newspaper reports about the problem…🙄

To the PP saying if you are ill it should be easy to stay by the phone. What if you have a chronic condition like diabetes/Chronic/haemophilia etc that doesn't stop you working but can mean you need frequent consultations? What if you are concerned about a lump, blood in faeces/urine etc - red flag for cancer but doesn't stop you working. Not every illness is an acute infection.

Memora This was full debulking cancer surgery. Couldnt lift anything or drive, was supposed to have some sort of physio type equipment to help me get out of bed, use the loo etc none of that happened, should have had district nurses to dress wound, none of that happened.

Screening patients with a phone call will lead to unnecessary deaths because things are missed. If doctors can see you they often pick up on other things you haven't mentioned or can see how bad things are. I have heard several cases where patients died as serious conditions weren't picked up.

If the NHS announced that there had to be explicit rationing of primary care to cut down demand - say:

1. Only White British people, no BAME

Or

1. Only people in employment say between 18 - 65 - no children, students or elderly people

Then those of you in the affected groups, or who have children or elderly parents would be claiming that it was disgraceful, discriminatory, etc, etc.

However, relying on telephone triage is equally discriminatory against those with communication impairments such as:

1. Hearing impaired or deaf
2. Visually impaired or blind
3. Learning disabilities
4. Speech, language and communication needs - such as stammers, aphasia, etc and who may need a communication device
5. The elderly, who can't cope with electronic devices

Health Watch Camden wrote a report about this in 2016, well before Covid and before the Accessibility Standard became law, but they said then the way GP practices operated were in contravention of the NHS Accessibility Standard and The Equality Act.

All those of you, who are "able bodied" may well write how well telephone triage works for you; but if you were in an excluded group, would you be so keen?

GPs come on MN and talk about how they like telephone triage, because it cuts down on the time wasters! I cannot recall one GP, who showed any awareness of how some groups are excluded by it; and that their difficulties with access to primary care are magnified compared to the "normal population", which means in turn, their health outcomes are much worse. People with learning disabilities already have life expectancy 20 years less, and thats in part because of poor medical care. Numerous posters have written about how their elderly relatives have had serious conditions missed.

GPs should provide reasonable adjustments for people, who can't cope with the telephone, and/or online systems. I bet no GPs would come on here, supporting race discrimination, yet it seems ok to tacitly support disability or age discrimination?

I might be slightly more impressed by telephine appointments if my dad hadn't been hospitalised 7 times in 12 months because when he has a phone consult with his GP they out everything down to osteoarthritis when he has had 1) urine infection which led to septic arthritis 2) 2 x pneumonia 3) heart attack 4) acute kidney failure. Another family member ended up with a liver abcess because his gallbladder infection was diagnosed as indigestion over the phone. It has worked well for DH to discuss blood test results for his chronic condition but my mum's memory test over the phone was a joke and if her children hadn't kicked up a stink her alzheimers would have remained undiagnosed.

@Rabblesthecat

My mother used to attend a patients committee at the local gp. They asked her to attend.

She quit after a year- as did three other patient reps

The three main complaints all had the same solution suggested by the non nhs people and every time they were shot down. End result - they quit because what’s the point of having patient reps if nothing changes

Complaint 1 - missed appointments

Solution - either charge for missed appointments or three strikes and your out. Numerous reasons that could
Not be done. End result was nothing changed

Complaint 2 - time wasters and hypochondriacs

Solution as above / agains knocked back

Can’t remember the third but that also fell on deaf eats

Hyperchondria is an illness why not treat it

Missed appointments sometimes cannot be helped i tried to call and cancel i simply couldn't get through so they introduced a text service to cancel which didn't actually work so I "missed" the appointment I showed the receptionist that I had cancelled via text but im still classed as someone who "misses appointments" that got me a lecture from the senior doctor he got one back about ineffective systems they withdrew the text service but simply haven't replaced it with anything

Some people are busy and can't be expected to wait for the call
back? Fair enough for some conditions but in some cases if you're ill then shouldn't be staying by the phone be fairly simple

So which person picks up your children/ shopping/whatever when your unwell but not so unwell you cant go to work?
Probably most things you can go to work with, without too much discomfort. But if you drive to work you cant answer your phone, if you use public transport you may not want to discuss the puss oozing from your underarm with everyone else able to hear.
Not all jobs allow your phone with you and still theres a problem with say a teacher who doesn't want to discuss anything in a room full of children (pretty sure teachers are not allowed phones on them in class)
And I and a few others work in a basement with no phone signal.

To be I'll enough to stay by my phone, not go to work or wherever , I'd probably need a and e not a gp.

Some people are busy and can't be expected to wait for the call back? Fair enough for some conditions but in some cases if you're ill then shouldn't be staying by the phone be fairly simple?

Adults with learning disabilities, who can't navigate telephone menus by themselves - they either have to ask their mum, who may work full time, to be with them to make the initial call for an appointment; and maybe take a day off to be with them all day for the telephone triage appointment. Or, they have to ask a floating support worker, who may only support them for a limited number of hours a day; and they have never met before to help them out. They may not want to discuss in front of a stranger, say how they have started a sexual relationship and need to discuss their medication (like sodium valproate, which they may be aware, after the DHSC wrote to everybody on it, causes problems for a baby)?

Likewise, people with visual impairments, who find it difficult to navigate telephone menus on a phone, when they can't see the numbers or take a photograph of a rash, need someone to help them?

I'm private patient, actually.