Aibu but 2 mornings per week isn’t cutting it

[Bythemillpond]

Bit of background
Ds had a telephone appointment with a GP (not his own GP as tbh we try to avoid this dr as we have had some bad experiences with them) and was told he was going to be referred for an ADHD assessment.

About 2 weeks later his own GP sent a form to fill in before he could be referred. Including an alcohol assessment. Ds doesn’t drink as he hates the taste. No idea why the alcohol assessment was included.

Filled it in and sent it back immediately by email. Got a reply the following day to say they had received it and would it take 3 days to process.
We left it 1 week and rang the surgery to check he had been referred

Nothing was picked up on the screen by the receptionist who said they would ask the dr to see what was happening
Left it till middle of the following week to see if he had been referred yet.
Receptionist said that ds had not sent the form back. I said yes he had and found the email and quoted her the time and date it had been sent and also the email in reply to say that the email had been received.

Asked to send it again which I did from ds’s email address and the receptionist said she had received it whilst I was on the phone
I was told that they would talk to the doctor the following day to bump Ds up the line as he had sent it weeks ago.

We rang back a couple of days later only to talk to another receptionist who again said Ds had not sent the form back as there was no email from Ds
Sent it again and was received by the surgery.
Receptionist said they would bring it to the drs attention when they were next in.
I obviously asked when and was told the GP only works 2 mornings per week.

Aibu that 2 mornings per week for what was a full time role (they were supposed to replace a retiring gp who is now back working at the surgery presumably to pickup the slack) is too little and if that is all they work then they shouldn’t be getting involved with sending out forms that they have no time to process.

This is nothing at all to do with the GPs working pattern and everything to do with poor back office processes. Once the GP has asked fro the referrals to be made, in most cases, the admin team will be the ones getting all the necessary forms etc in place and then sending it off, possibly with the odd query to the GP.

By all means speak to the Manager as it is appaulingly bad that they can't gt it completed but don't mention the Dr only working 2 days a week.

Also, in case you're genuinely intetested in the part time GP thing - a lot pracitces struggle to find GPs these days. Some of the practices in my town have had vacancies for over a year with either no or very poor applicants.

DS2 was observed in school at the request of community paediatrics at age 7 and the conclusion was that he met the criteria for ADHD and medication was advised. He was also undergoing assessment for ASD and the consultant thought it was either/or and we should go for ADHD as this was treatable/temporary. We decided to wait and see as we felt uncomfortable medicating a 7 year old.

Fast forward to when he was 13/14 with an ASD diagnosis and the GP wanted to start again from scratch with regard to ADHD. 12 months later with no appointment and we went private before he started year 10.

If this was our experience with reams of NHS evidence, a clear cut case and even we had to go private to get anywhere in a reasonable time, I don't hold out much hope for anyone else without a paper trail going back years, even if the GP is f/t.

No, millpond GPs don’t delete emails either to reduce their workloads nor for lols. That’s an incredibly serious allegation to make, that would potentially have serious consequences for the doctor such as disciplinary action by their employer or report to the GMC.

So, no, not something doctors do even when horribly overwhelmed by work. As I already pointed out, the most likely explanation is the practice email system is not fit for purpose or they possibly have an issue linking the email system patients use to the one that filters through to the doctors and nurses.

No conspiracy against you or DS, just a broken system. Complain to the practice manager as this will log it and raise it formally in the system and get the issue sorted fastest, rather than re-sending again and again. Practice managers are absolute terriers at sorting these issues for patients quickly as they get penalties for unresolved complaints - so this is where priorities have gone.

There are massive recruitment issues in GP that are going to get much worse as it remains an area that is losing doctors at a heartbreaking rate to retirement, Ill health and failure to attract the next generation of trainees. I’m really sorry it’s impacting on your son’s health millpond and I hope he gets a referral soon.

forinborin

I don’t think it is more than a couple of months waiting time in our area. Dd and I were referred and assessed in 6 months but that was because of lockdowns that they were behind.

AutistGoth

Ds had a telephone appointment with one doctor the questions they asked were similar to the ones on the form. This doctor said he would refer Ds
Except this other doctor has put a stop to the referral and created work for themselves when they clearly don’t have the time and has just stopped the process till they can get round to it.

Leaningtoweroflisa
How can you say someone is horribly overworked when they only do 2 mornings per week.
Maybe they shouldn’t get involved in what other doctors are doing and creating work for themselves.
Ultimately we had a referral. No need for this other doctor to get involved. But they did and stopped the referral going ahead because they decided that apparently Ds needs to fill out a form either because they don’t believe this other doctor was competent and needed to check this other doctors work or to delay Ds getting his referral.
Given they don’t have any idea when this doctor will get round to processing this form (receptionists words) then I am presuming that it will never get done.

Good job your DS is an adult - we're waiting for an ADHD assessment for our DS at the moment. - DS2 and 3 both have Autism, LD and both go to special schools - DS3 had a wait of over 2 years for his ADHD, and we're looking at longer for DS2 ADHD assessment. Autism assessments were 3 and 2 years. I'd get used to waiting.

Its over 2 years here too. (Its one of the reasons I've put off asking and would go private if we had money/but aware GpS don't always accept thebcontinuing medication after). I thought that was fairly common from what I've read.

Private of course completely different :(

@Tibtab

I think you are working on an unrealistic timeline for a non-urgent referral. I would assume it would be processed within a month rather than a week.

Why did the surgery say 3 days then?

Just because your GP is only working 2 days a week at your surgery, that doesn’t mean that’s all the work he does! He may well be working 5 other days a week at various other hospitals, clinics or surgery. He could well be doing evening clinics on top of his daytimes too.

So he may well be “horribly overworked” and I think you are being very entitled in judging the doctor without knowing what he/she works. You’re not his only patient and as much as I understand your frustration, you’ve accused him of deleting emails to avoid work and you’re arguing with everyone who gives you advice that you don’t like.

The real issue is with the surgery losing the emails, I don’t think anybody gets a say in other peoples work patterns.

Whilst you don’t get a say in people’s work patterns, I think you have every right to the opinion that this doctor is either incompetent or does not work at the practice for enough days a week to do their job properly.

Your gripe is with the structure and funding of the NHS, not with the working hours of any particular individual, who's hours are down to their particular personal choices and contract, and nothing to do with you.

And in any case, being available for the surgery 2 mornings a week does not mean they are only working 2 mornings a week, there are many other aspects of the job they could be doing at other times.

or might not be doing, but again, it is nothing to do with you

Our GP surgery has a few GPS but only 2 are full time and they really struggle to get cover on a Friday. It's very frustrating for the receptionists.

The GP services are appalling at the moment and I think Covid has made it worse, but I think the current practices are here to stay. Everything in my area is telephone based and with my surgery you can’t get a specific appointment so if you want to talk about something to the GP they’ll ring you at whatever time and you risk talking about it anywhere and in front of everyone. I went for help with an issue and they rang me in the middle of a work meeting and so I had missed the call. I rang back to rearrange and asked if I could just know the time so I could ensure I was somewhere private and also so I could ensure I was not in a meeting etc. and was told strictly no, the GP doesn’t do set appointments.

I agree with posters saying to speak to the practice manager. Focus on the admin errors. It doesnt matter why they are happening. What matters is that they are happening. Be factual about sending the same form 3 times and any other admin failures.

Your DS is lucky to have you to advocate for him.

Total sympathy from me. The admin at my doctors surgery is atrocious. I have had important blood test results lost, prescriptions messed up and a suspected cancer referral not followed up. To add insult to injury I had an unsolicited call from the surgery marked as DNA because I missed the call!

Fortunately I can advocate for myself.

The people who are really left high and dry are the people who cant advocate for themselves and dont have people to advocate for them. Elderly, infirm, not able to use technology so easily.

A persons working pattern is absolutely nothing to do with you. You have no idea what else they are doing - hospital work, doing OOH clinics elsewhere... I doubt they simply do 2 mornings a week and that's their lot. Even if they did - none of your business. I do however understand your frustration at the email issue and this is something to take up with the practice manager.

@GreenWillow

YANBU, it costs the taxpayer hundreds of thousands of pounds to train a GP, they’re really taking the piss by working so few hours.

This is one of those statistics that gets misused horribly.

Yes, it costs a lot to train a doctor, but...

A big chunk of the undergraduate costs (university fees, living expenses...) are born by the doctor themselves.

Almost all of the post-graduate costs are salary. To the doctor. For working long hours. Remember, 'training' includes anyone up to consultant, so the vast majority of doctors you will see are technically covered by this.

We generally don't see wages in exchange for work as a cost which needs to be repaid in more work. I don't know why we do for medicine.

The issue of how many hours the doctor works are between them and their employer. They're nothing to do with the OP, and are unrelated from the ongoing communication balls ups by the practice.

agree the gp may be semi retired/trying to achieve work/life balance, may be at another practice, these hours may be all the practice can afford to have the GP
however the admin is atrocious, go to practice manager and good luck

i should imagine these forms are needed by CAMHS, is it camhs? i assume so, and not just the GPs say so

2 years ago The structure of GP practices changed so several practices joined up to form a group to broaden the services. And also achieve budget controls set by NHS England.

It's quite possible that the Gp is only work 2 mornings a week at your surgery, and remaining hours across other surgery's in the group.

Regardless the GPS working hours aren't really the problem, the process has failed in getting the information to the GP in the first place, or any other GP if the request was urgent and you haven't asked for a specific GP.

There’s a real shortage of gps, so maybe they could only get a part-time one, to cover the retiring gp..

In my surgery, non-urgent (ie. cancer) referrals take two weeks to process. Either the doctor doesn’t him/herself, or it gets passed to the medical secretary. Then the hospital can take anything from a few days to weeks to respond.

You may find that the referral couldn't go ahead without this form, and so the second doctor was actually progressing the referral. Without the form, the referral may have been rejected by the hospital.

It's an unpopular view but I agree. There are many part-timers to replace the full-time GPs who are retiring and they're not hiring 2:1. In the two local practices I've been in, not one doctor works full-time (confirmed). Most are very part-time indeed and of all ages - young and old.

We do need to acknowledge and talk about that because we are putting young people through medical school at vast expense (theirs and ours as taxpayer) and the GPs are leaving the country or taking very part-time jobs. Our general practice situation is not fit for purpose - weeks to get appointments, lost follow-ups, reluctance to refer etc. Move abroad to any other major Western country and see how the GP system is struggling.

OP - I hope your son gets the help he needs very soon.

This is shit OP and adding to the stress. Hope things get moving soon.

my surgery has joined up with another practice, some miles away, and if your surgery doesnt have a doctor to write the prescription, they send it to this other surgery.
prescriptions now take a week from request

My df was a GP and of the general opinion that the GP model in this country does not work well on a part-time work model, as it is based on the notion that you should actually have a GP, not a group of GPs of which you are phenomenally unlikely to get to see the same one each time you visit even if you want that, so that none of them is likely to know you or your medical history, or to feel any particular sense of responsibility for you. Probably better, if moving away from the family doctor (not doctors) model to stop using GPs altogether as gatekeepers and allow more direct access to specialists as in other European countries, imvho. At the moment we have a silly mish mash where GP “specialists” can see people, so you may struggle to get to see a GP at all, they may then refer you to a different GP with a “specialism” and they may then refer you on to a hospital specialist - not great when it now takes weeks even to get to stage 1 and the stage 1 person probably doesn’t know you from Adam.

Agree entirely @Walkaround. A specialist GP who works 2 mornings a week? It doesn't work basically.

A neighbour of mine has given up being a GP after 25 years because she couldn't do justice to her patients with the team and time allocated to each patient. She is now a private doctor and back to actually talking to patients again, can refer without a big fuss etc.

We need to stop clapping and demanding more from the system or overhaul it.

@NOTANUM

It's an unpopular view but I agree. There are many part-timers to replace the full-time GPs who are retiring and they're not hiring 2:1. In the two local practices I've been in, not one doctor works full-time (confirmed). Most are very part-time indeed and of all ages - young and old.

We do need to acknowledge and talk about that because we are putting young people through medical school at vast expense (theirs and ours as taxpayer) and the GPs are leaving the country or taking very part-time jobs. Our general practice situation is not fit for purpose - weeks to get appointments, lost follow-ups, reluctance to refer etc. Move abroad to any other major Western country and see how the GP system is struggling.

OP - I hope your son gets the help he needs very soon.

The cost to become a doctor is paid for by the doctor.

I don’t really understand that argument as many students go off and do degrees funded by the government then never earn enough to pay those loans back.
Doctors do end up paying those loans back.

What’s the solution? Give a minimum number of hours to work? Not allow them to go abroad?