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.

Our GP surgery have been seeing everyone who has mental health diagnoses or safeguarding notes regularly - sometimes a nurse sometimes a GP. They've also been offered phone calls with the option of "would you like to come in".

Pretty much the only time I havent been seen face to face is when it's been a prescription for antibiotics - and even then any slightdoubt theyve asked me to come in.

So please don't tar all GPs with the same brush; and unless you have a safeguarding history - you don't know what is happening with those patients in your surgery in reality.

Yes, but safeguarding notes come about because at some point, someone has made a F2F assessment.

@SpicyJalfrezi No, not really. They can come about in any form, and it is not just a GPs job to do safeguarding.

No ones saying it is, but they are an enormously important part of it, I would say. Obviously that’s a non expert point of view but who else will an under 1 see regularly?

@SpicyJalfrezi

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.

But the issue with that is not all children would see a GP anyway and let’s be honest the kind of parents who will abuse their child are less likely to be the ones who will take them to the GP.

What we need is much better investment in the HV and social work systems in order to help ensure all families get the support they need and don’t slip through the net. The HV system has been well and truly chipped away over the years - well before this all happened - and THAT is the problem.

@pianolessons1

I'm a GP. We've been doing telephone triage since 2013 and prior to covid I would bring in about 50% face to face, the rest were things that could easily be dealt with on the phone. In March last year F2F dropped to probably only 10%, as we would have been rightly criticised for having rammed waiting rooms (which are already busy with people coming to see nurse etc, most of which can't be done remotely). Now I would say my conversion rate to F2F is probably about one third. The difference between that and the previous F2F is at least partly made up by the ability to text photos - for a young working person with a rash this can be very convenient for them, though probably about one in five of those I end up bringing in if the photo isn't good enough or I think I need a 3D view. So basically, we are more or less back to normal. It is a myth that we aren't seeing F2F and that surgeries are shut. We are all very aware of safeguarding issues and if there is anything that twitches our antennae that way then the patient comes in.

Your antennae won’t be twitching when patients have to first get past the bloody receptionist first. How many patients do they delay or ultimately stop seeing a gp???

It’s completely insane and I don’t know why GPs are allowed to do this. Face to face appointments should be the norm.

You’ll get the usual nonsense posts here about how capable and confident adults prefer them, ‘I’m alright Jack’, attitude and the post from the odd GP insisting they still safeguard effectively and still see f2f, but it’s a load of bollocks. Anyone who has been involved in any safeguarding knows you can’t do it effectively without seeing people face to face - lots of vulnerable people don’t even know they need help, how can they possibly explain over the phone, after the mad scramble to get a phone appt and a million hour wait?

GPs need to crack on with it tbh.

Yes, @Sirzy, we can work on the assumption that abusive or neglectful parents won’t take their child to the GP, so there is no need for GPs to see little children

Or we can say GPs are part of a complex jigsaw including (where relevant) other family members, neighbours, teachers, health visitors, and so on. Removing one part of this jigsaw means that things will be missed and more problems will arise.

If people still feel it’s a better system, that the advantages outweigh the problems, fine. That’s not what I’m asking.

I’m asking if it will lead to an increase in safeguarding issues. I don’t see how it can’t.

I thought about this in regards to health visitors - I had 2 telephone appointments, one f2f visit quite early on, and now there will be nothing until an 8-12 month check up in 6-10 months time unless I want to go for a self service weigh/measure.
Having done safeguarding courses for work I worry a lot about all the vulnerable babies that might slip under the radar for different reasons, the service users at my workplace include a lot of addicts, DV perpetrators and worse so I might percieve there as being more risk than there is but even one baby/child suffering is too much.

Same with the HV. I think some people assume they are on tap and doing what the GP doesn’t: they aren’t.

Mine is lovely and will come out if I ask her to, but that’s no use for me and there aren’t any clinics open.

@Burgerqueenbee

I thought about this in regards to health visitors - I had 2 telephone appointments, one f2f visit quite early on, and now there will be nothing until an 8-12 month check up in 6-10 months time unless I want to go for a self service weigh/measure. Having done safeguarding courses for work I worry a lot about all the vulnerable babies that might slip under the radar for different reasons, the service users at my workplace include a lot of addicts, DV perpetrators and worse so I might percieve there as being more risk than there is but even one baby/child suffering is too much.

I have had the same thought too. I saw mine once f2f shortly after he was born, I then didn’t hear from her again until he was 4 months old but it was a phone call. I was called again when he was 9 months old but it wasn’t even by a HV, it was a nursery nurse who worked with the Hv team?? I told her about my MH problems and she basically told me she wasn’t qualified to speak to me about emotional problems so I should contact my GP . She said she’d get my HV to contact me, the HV contacted me 2 months later over the phone…

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

That is very rare. In most cases, if you miss the call, that's it.

Although I see why a doctor can't give a time for a call, they could give a slot. If they have 20 people to call, they know if you are 1, 10, or 20 on the list.

I agree, I prefer face to face appointments. My physio is hopefully going to call me at lunchtime today to set up a face to face review appointment for September.

Phone call appointments are great if you are sitting somewhere where you can make or take the call.

Trying to get one for my DC who was having terrible trouble with acne was near on impossible. I would phone at 8am-if you were not the first 20 in the queue, it would cut off. By the time I got through, at nearing 9, all appointments for the day were gone. I did this on my day off and I work the rest of the week so unable to call. Eventually, I get through on another day off a week later, they tell me that they will call her between 9-12 that day. She is at school and they aren’t allowed their phone. I eventually managed to persuade them to ring after 4-they were not happy about it.

They then tell me I have to get DC to the surgery to have a blood pressure reading-or I can do it at home. I do it and try to phone through the reading-again, I sit on hold for 45 minutes, twice, in my lunch hour -never get through. They sent me three texts of increasing urgency, demanding the results. There is no way to email or text reply the result. Eventually, DH spends 45 minutes on the phone on the train to work and gives it to them.

Now me. I am trying to get an appointment for me-about something that I have been putting off a bit because i find it difficult to talk about. They say there is an online booking system but that is only for blood tests. I have had the same-three days of trying to get through on the phone at 8-by the time I get through, appointments are gone. Next week-I am back at work-teaching in a school, I get in at 7.30 and phones have to go in a locker. Even if I managed to get through to speak to someone, I won’t be able to answer a phone from 8-12, let alone be in a situation (ie quiet room) where I can talk about something I haven’t even told my own husband.

I hate it, I really really hate it.

Have you been struggling too, @Hemingwaycat

I honestly don’t know if people don’t realise, as if you say on here you are struggling with depression the first things you’re told are see your GP or speak to your HV!

Try the health visitor for a referral.

By the time I got through, at nearing 9, all appointments for the day were gone. I did this on my day off and I work the rest of the week so unable to call. Eventually, I get through on another day off a week later, they tell me that they will call her between 9-12 that day.

This has been a huge issue at my GP surgery as well. Getting through is almost impossible. If you manage to get through, and convince the receptionist that you really do need to discuss the issue Then being able to take the call just isn't possible for many people, due to the vague time slots and not being able to answer the phone due to work.

Referral to who, the GP? I don’t think there’s any solutions to mine, unfortunately - the system is impossible to navigate! But I mean generally really, not just with regard to me.

@SpicyJalfrezi

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.

That's true. Ok, I hadn't thought Of that and the fact there isn't a set time to speak to them.

I think OP has a very good point.

I think this isn’t just Covid. It is a longer term issue with lower number of GPs.An older population meaning generally greater need. Also wonderful medical advances mean that individuals (possibly myself included) survive illnesses but need more treatment.

My surgery has always been really good with quick phone consultations and offering same day face to face where needed. I was really happy until I was sitting in the waiting room. I could hear every word of a phone consultation going on, as could everyone else. Patient’s name, address, details of her condition. The doctor had the speaker phone on. Of course I went to tell the receptionist but by the time the issue had been addressed, half a dozen people had overheard a very private phone call.

I think it's difficult because there are a lot of circumstances where you do just need a quick phone call and that's enough - for example, twice over the last 18 months, I've had an ear infection and I can simply phone up and say I need the same ear spray that I've had before and they automatically send the prescription request to my local pharmacy for me to pick up - often within an hour or two of me making the initial call.

In these scenarios, absolutely phones should be the way forward. When you know what it is you need, but you don't need to actually see a doctor - a bit like a birth control repeat prescription when you have to go twice a year just to let them know your blood pressure.

However. There are so many examples where it hasn't worked.

A friend had a 9 month baby. She was really poorly (not covid) and the doctor refused to see her, kept saying it was just a virus. After a few more days, it turned out that the baby had bacterial tonsillitis - no wonder she was so poorly. That should have been picked up. My view is if the appointment is about a child, it should ALWAYS be face to face. There's absolutely no excuse for that.

I also had an issue last summer. My daughter was having NHS speech therapy. When the therapy started up again, it could only take place over zoom, which basically didn't work because the therapist couldn't pick up whether she was saying her phonics correctly because the microphone wasn't clear enough and he couldn't see the shapes that her mouth was making. She ended up having a few F2F sessions at the end of term this year, and has now been discharged, but I do wonder if she would have been discharged much quicker if she had physically seen a therapist earlier. I remember suggesting that we met outside in a garden to the therapist during one session because it clearly wasn't working online.

I completely agree there are appointments where phone is not appropriate.

I struggle to talk about my anxiety and PTSD on the phone. If I could simply make a f2f appointment then it would have meant I pculd have been treated much more promptly.

All these GPS saying how great working people find telephone appointments. And I agree for a few things they have been great for my baby. But could we not have a system where I could request either a telephone triage or a face 2 face?

And if telephone are the way forwards all GP surgery's must invest in working technology. My GP can't phone me for an appointment because whenever they do I can't hear them. I have no problems with anyone else only the GP. Means I have to borrow my husband phone when I need an appointment and ask them to ring his number. How is that not a potential sage guarding issue? As it happens my husband isn't an abusive twat but what if he was.....

All these GPS saying how great working people find telephone appointments

I don’t know a single working person who likes the system now, as it requires you to be available (not driving), near your phone and able to chat for a 4/6 hour window! The only person who I know can do that is my retired parents who have all the time in the world but can’t hear properly when the doctor rings anyway and need a f2f appointment so they can see the doctor’s lips moving when they talk!

@pianolessons1

I'm a GP. We've been doing telephone triage since 2013 and prior to covid I would bring in about 50% face to face, the rest were things that could easily be dealt with on the phone. In March last year F2F dropped to probably only 10%, as we would have been rightly criticised for having rammed waiting rooms (which are already busy with people coming to see nurse etc, most of which can't be done remotely). Now I would say my conversion rate to F2F is probably about one third. The difference between that and the previous F2F is at least partly made up by the ability to text photos - for a young working person with a rash this can be very convenient for them, though probably about one in five of those I end up bringing in if the photo isn't good enough or I think I need a 3D view. So basically, we are more or less back to normal. It is a myth that we aren't seeing F2F and that surgeries are shut. We are all very aware of safeguarding issues and if there is anything that twitches our antennae that way then the patient comes in.

When my 94yo dad's GP finally did see him face to face he was shocked at his deterioration. This is a patient in his 90s with multiple issues whose consultant had written to that GP to say he was concerned that phone appointments were not appropriate. Dad was admitted to hospital and probably won't come out. BIL ended up in hospital for 2 weeks on IV antibiotics after a misdiagnosis over the phone. FILs GP on the other hand does F2F for them for relatively straightforward issues. Why the difference?