To think issues relating to safeguarding will shoot up if GPs continue with telephone appointments

[SpicyJalfrezi]

I’ve been unable to get any help for a relatively minor bout of depression. I’m treating it with self care but obviously not everyone has the option to do that.

Women and children must be most at risk due to this new way of working.

@EatYourVegetables

I like phone consultations. At my surgery we can get them the same day. It saves me dragging a poorly child in just so they can sit next to me when I explain their symptoms to the GP.

And where adults prefer them, they should be offered them.

Just not as the default for every patient and every condition.

@SpicyJalfrezi

And are you somewhere safe is far too simplistic.

You can be physically safe but controlled, verbally abused and financially abused.

But someone could still answer "No" - whatever the nature of 'not safe' is? In the same way that someone could go in to the surgery and indicate - or not - a non-physical safeguarding issue.

Which obviously works for you @EatYourVegetables which I can see.

But it could work for someone for rather more sinister purposes, couldn’t it?

I mean, I don’t see how the current system won’t lead to increased cases of abuse and neglect. If we feel the advantages of it outweigh the downsides, fine, but I think it is disingenuous to claim that because it works for some people there is absolutely no disadvantage or problem at all.

I've contacted my GP regarding behavioural problems with my 4yo dd who is unbearable some days and it's having a huge impact on the family and our relationships with one another. I've been so close to smacking her some days. My concern is ASD, we're crying out for some support. I was forced down the Engage Consult route, left a message and unfortunately missed their call. No message was left, no further call back and I had to contact them again. Finally spoke to someone yesterday who was largely ineffectual and said to keep trying to spend time with her. I gather this was because I 'admitted' that she was in childcare 4 days a week so he probably thinks I'm abandoning my duties as a parent by working so much. I insisted on asking him if I could also get a statement from my childminder so he knows her behaviour doesn't just happen at home. That was at my instigation. I'm not sure what he'll actually do with it but I'm not being taken seriously. I've had it with being kicked, scratched, bitten and screamed at. Dh and I are at the end of our tether, she's getting worse not better with age. Yanbu op. I want a happy, healthy relationship with my little girl. They won't listen.

Also elderly people. When I last went into my GP before lockdown it was full of elderly people, and we know that lots of them don’t necessarily have access to carers/are very lonely/don’t have family who visit. If they can’t use online bookings or find it hard to express symptoms over the phone AND don’t have anyone to advocate for them, it’s not going to be good.

@AChickenCalledDaal

Every call starts with "is this a convenient time/place to speak?"

And the honest answer is quite often "not really", but because someone has been on tenterhooks all day in case they miss the call, they are polite and say "yes".

I don't - if not convenient, I say so, or say just a moment, will go somewhere quieter (appreciate that may not be an option for DV) - but the GP never ends the call because I say 'no'

@Whatafustercluck

I've contacted my GP regarding behavioural problems with my 4yo dd who is unbearable some days and it's having a huge impact on the family and our relationships with one another. I've been so close to smacking her some days. My concern is ASD, we're crying out for some support. I was forced down the Engage Consult route, left a message and unfortunately missed their call. No message was left, no further call back and I had to contact them again. Finally spoke to someone yesterday who was largely ineffectual and said to keep trying to spend time with her. I gather this was because I 'admitted' that she was in childcare 4 days a week so he probably thinks I'm abandoning my duties as a parent by working so much. I insisted on asking him if I could also get a statement from my childminder so he knows her behaviour doesn't just happen at home. That was at my instigation. I'm not sure what he'll actually do with it but I'm not being taken seriously. I've had it with being kicked, scratched, bitten and screamed at. Dh and I are at the end of our tether, she's getting worse not better with age. Yanbu op. I want a happy, healthy relationship with my little girl. They won't listen.

If she is in childcare they should be able to get the ball rolling for looking at any extra support she needs. Make an appointment with the SENCO, as someone who knows the child she will be much better placed to help understand and signpost your to next steps.

If the doctor calls you and it’s not a convenient time - for any reason - please do let them know, they’ll be able to say if they can call you back later that day.
Loads of people are driving, on the school run, in the supermarket etc when I call (trainee GP) and sometimes people say it’s a bad time without giving a reason - we always agree on a convenient time to call back, it’s a common occurrence.
Telephone triage is probably going to stay at most practices in some form or another - but if you don’t feel safe to discus on the phone due to other people in the household please please explain this clearly to reception - we will be able to put a note on your file and offer appropriate appointments but can’t do anything if we don’t know.
Also in lots of areas you can self refer for help with depression and anxiety via IAPT - if you google IAPT then your area you may come up with the web page. They don’t prescribe so if you want to discuss medication then you do need to speak with your GP.

@Whatafustercluck depending on your area you may have more success with approaching this via the nursery, rather than GP. Have they raised concerns or arranged an assessment?

Have people been ASKING for a f2f appointment or just assuming they can't have one? I know our GP will see anyone who asks for a f2f

@AChickenCalledDaal

There is no reason whatsoever why initial consultations no for depression cannot be by telephone.

Here's a reason:

Last year, I had a telephone conversation for anxiety and depression. The call came at a very inconvenient time (because you can't book a time slot). So I took the phone to my bedroom for some privacy. But a family member assumed I was talking to someone else and came and perched on the bed. I didn't want to spell out exactly how I was feeling in front of that member of my family. It made everything more difficult and the conversation didn't go as well as I'd hoped, which was very disappointing having finally plucked up the courage to seek help.

That's why face to face appointments, in a private consulting room, are sometimes very important.

I don't mean to be rude, but why couldn't you tell your family member you were on an important call and you would see them after? Regardless of who the call is too, they shouldn't be just sitting on the bed listening.

And in terms of the safe place question, why can't the answer be no? even if it is a safe place, if there is someone controlling/violent/abusive etc, there, the GP would understand the answer no. It doesn't simply mean a safe place physically.

@PinkDaffodil2 they asked about nursery but she only spent a day there every week (she goes to school in September so is no longer attending as it was a preschool) and she showed no signs there (which I gather can be quite normal with girls, who are more adept at masking their behaviour in different sotuations). She spends the majority of her time either at home or the childminder. Other than me, our cm knows her best, which is why I suggested a statement from her instead. Does a statement from a cm hold less gravitas do you know?

I’m in a similar situation @anon12345678901 and without getting into complicated family relations and so on, if I say ‘go away’ round here I am ignored!

Depression doesn’t tend to put you in the best sort of mindset for dealing with these things. I have no privacy at all at home, it is an issue.

I prefer a telephone appointment. If I'm ill I don't really want to leave the house. If I've got a slight concern, I can take the call at work without asking for time off.

I can definitely see how telephone appointments are beneficial. You can't be late for it and make everyone after you late too. You can't forget to turn up or miss it. If you don't answer the call, they can get straight on to the next call without waiting around. If it allows doctors to help more people, I'm all for it.

To me, this is a bit of progress brought about by the pandemic and we shouldn't necessarily just revert back to 'normal.'

However, f2f appointments do of course need to be available for all of the reasons already given, but feel that many do just want them because it's how it's always been and not because they need them.

I don't agree that GPs are being idle either - I only know one personally but she is working harder than ever at the surgery and at the vaccine centre.

I don’t mind telephone consultations but I wish you could book a time slot, even if it was between times like 10-12. I hate having to sit in on my day off, I can’t really take calls like that at work and just endlessly wait.

But if you could have got out of the house to physically go to the GP, can you not leave the house and then do the call somewhere out of the house? Or is the abuser so strict that they would insist on seeing you enter the surgery? (genuine question- I suppose sometimes they might be)

[quote Whatafustercluck]@PinkDaffodil2 they asked about nursery but she only spent a day there every week (she goes to school in September so is no longer attending as it was a preschool) and she showed no signs there (which I gather can be quite normal with girls, who are more adept at masking their behaviour in different sotuations). She spends the majority of her time either at home or the childminder. Other than me, our cm knows her best, which is why I suggested a statement from her instead. Does a statement from a cm hold less gravitas do you know?[/quote]
I would contact the new school now and raise your concerns with them so they are aware from the off and can look at the best ways to support you and her.

My DS orthodontist is the same. He’s under 16 and the orthodontist thinks it’s ok to let children in for treatment without an adults. He was in pain and terrified. The next time I went in with him and she really kicked off

Every case is different, @Grellbunt but as a general rule, it’s easier to be honest face to face where you know there’s no chance of being disturbed than at home where anyone could walk in at any minute.

@pinkstripeycat

My DS orthodontist is the same. He’s under 16 and the orthodontist thinks it’s ok to let children in for treatment without an adults. He was in pain and terrified. The next time I went in with him and she really kicked off

How old is he? A NT 15yo should really be able to attend an appointment. Why was he terrified? Was this during the height of covid or recently, as restrictions relaxed?

@pinkstripeycat

My DS orthodontist is the same. He’s under 16 and the orthodontist thinks it’s ok to let children in for treatment without an adults. He was in pain and terrified. The next time I went in with him and she really kicked off

In general though someone insisting they have to go in with someone who is able to do it themselves could be a red flag in itself.

I am not saying that is in anyway the case here but that will be a tactic used by some to go in in a “caring” way to ensure nothing is said to incriminate them.

The problem with telephone appointments, at our surgery anyway, is the inflexibility. They don't give any idea of the time they will call and if you miss the call for any reason, you have to start the process all over again. Basically, patients are expected to sit around and wait until the call comes, no understanding that they also need to work, or may be driving and unable to answer the call. DS has to have a consultation every time he needs his repeat prescription. But he also has to work. It took two weeks to get his last consultation as the surgery kept calling at times when he could not take the call. Each time he clearly told them when he would be available - shiftworker, so decent sized 'windows' not just a half hour lunch break, but they either didn't pass the information to the go, or they deliberately chose to call outside those times.
I do think there will be some people for whom a f2f appointment could be massively important from a safeguarding POV. I just hope that we won't be reading about them in a serious case review in a couple of years time , or trotting out the old, 'lessons will be learnt' line.

If I’m being honest, NHS counselling services aren’t the best anyway or at least they aren’t in my local area and all a GP will do is offer medication (which can easily be done over the phone) and ask you to self refer for counselling.

I self referred 3 months ago for PND and was put to the top of the waiting list because I have a baby. Had my first appointment after waiting around a month. The counsellor wouldn’t speak to me because I had my baby with me so I waited a week to speak to someone else in the evening when DH could look after our baby. That counsellor was fine but then went on annual leave the next week followed by a fortnight of illness so 3 weeks without an appointment basically. He then told me he could speak to me that week but had a further fortnight of annual leave after that so I sacked him off and was placed back on the waiting list. Had my first appointment with a third counsellor last night. They’re telephone appointments still which I prefer tbh but it’s worth noting if you don’t like them. I didn’t find it very helpful if I’m being honest, I hope it becomes more helpful as the weeks go on (although no appointment next week due to the bank holiday- sigh!).

There’s very little a GP can do in person for depression that couldn’t be done over the phone.

@Grellbunt

But if you could have got out of the house to physically go to the GP, can you not leave the house and then do the call somewhere out of the house? Or is the abuser so strict that they would insist on seeing you enter the surgery? (genuine question- I suppose sometimes they might be)

At my GP surgery they just call you at some point that day - they might say whether it should be morning or afternoon, but sometimes they don't and sometimes they do say and then it isn't that time - so you couldn't arrange to be out of the house for the call unless you went out all day.

Oh I know @Hemingwaycat - to be honest that is another reason I haven’t bothered. I also suspect counsellors will insist on Zoom or whatever which also would be no good for me, so I am stuck!

But it isn’t just that, as I’ve said, I suppose I’m inclined to think now GPs are probably going to be the only ones seeing very young children if they don’t attend nursery or similar.