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.

@Sirzy

professionals will be able to word questions during a telephone triage in such a way that people can answer without giving anything away “are you somewhere safe” is a simple yes no answer.

Telephone triage can also help them ensure that those who need to be seen are the ones that are. Plenty of things can be dealt with virtually.

Can doesn't mean they do.

It's not acceptable!
My dad had a brain tumour last year and sadly passed in August. He had several phone consultations where the go kept repeating urinalysis tests by post despite the fact he had lost all his balance, was losing his function of speech and looked seriously unwell. When we finally got an appointment they told him to use a walking stick.
No requests for MRI or scans.
We took him to a and e in the middle of a global pandemic absolutely terrified that he would catch covid.
4 weeks later he passed away.

It still angers me that they were so unbelievably "meh" about the whole thing!

Go - GP

@sparepantsandtoothbrush

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

With my dad not only was my dad asking, a consultant had written to the GP, my brother was phoning in his behalf and they were calling 111 who were contacting the GP. And still the GP thought that a phone appointment was appropriate for an extremely frail, deaf, partially sighted old man with complex co-morbities that had previously been misdiagnosed over the phone leading to multiple hospital admissions.

Sigh. There was another thread about this just a day or 2 ago, and many more before.

The trouble with all of them is that nobody pays attention to what GPs are saying in response. We know that some people don't like tele triage. We know there are issues getting through for appointments. They are 2 separate issues.

The 1st is down to the pandemic, and a lack of space for social distancing in waiting rooms, where vulnerable people need to attend. Covid is still here, the pandemic is ongoing, the numbers of infected people are huge. GP surgeries could easily still become a hub for covid transmision without telephone screening.

The 2nd is down to reducing GP numbers and increasing demand. Recent reports have shown that some practices are being contacted by 4-5% of their population in a single day. That is unmanageable in any scenario, tele triage or f2f.

Difficulty accessing healthcare is basically down to terrible workforce management by the government, 10 years of austerity, and now a pandemic which has meant that we have neither a fully functioning primary nor secondary care service. People who are waiting for treatment in secondary care end up leaning on their GP for help with their symptoms more and more, which means less space for traditional GP patients who then end up in A+E. None of it is working.

My post isn’t ‘blaming’ GPS, @sheepisheep. I won’t pretend to know the intricacies of a system I know nothing about. What I do have the right to do is to say it will have a negative impact on some, and as always, that negative impact will be disproportionately felt amongst the more vulnerable members of society.

I absolutely see there is the place of telephone appointments.
I think the system would be fine if you had to have a telephone triage appointment first but ...

1. The appointment must be bookable in the same way as f2f appointments used to be (or at least, say, specified within a 1 hour time slot)

1. If necessary, following tiage, a f2f appointment within a short timescale is made available.

I suspect with those tweaks the system would become much more usable for a larger number of people.

I like the telephone system. Used to be 3 weeks to get a standard appointment now I can send a request via econsult and have a phone call within 48 hours. Quick chat, get prescription sent in or arrange a time for a f2f visit in the next couple of days. Much better than either a long wait or having to try to call at 8am and then get down there for an appointment that always ran late, sat in a room full to the brim with people coughing, sneezing and vomitting. No thanks.

That said having had a baby in lockdown my 6 week check was woeful and I've not seen a HV at all, there's one baby weigh clinic open but it's referral only.

professionals will be able to word questions during a telephone triage in such a way that people can answer without giving anything away “are you somewhere safe” is a simple yes no answer

But ultimately, they do need to be able to say, ‘what is wrong/what can I do for you today’ and the chances of the working patient being able to answer that question easily at all times during a given 5 hour slot, is potentially low.

What I do have the right to do is to say it will have a negative impact on some, and as always, that negative impact will be disproportionately felt amongst the more vulnerable members of society.

That's possibly true, but as you say yourself you have no idea of the intricacies of the system. I am a GP trainee and would not make such a sweeping statement without evidence. Are referrals to social services dropping? You are choosing to take your own (as you admit, uninformed) opinion plus anecdotal evidence from people who generally feel aggreived about their/their relatives healthcare in some way to suggest that GPs are failing vulnerable people. It's textbook GP bashing.

GPs are not solely responsible for care of vulnerable people. They actually have relatively little input beyond their immediate medical needs. Childcare workers, teachers, health visitors, midwives, care workers are all typically more likely to see more of these people and all have the ability to report to social services. I'm more than prepared to concede the possibility that things may be missed by tele consult, but I suspect that we will only be able to properly assess that in retrospect, and then it will only be 1 part of a much bigger picture as I've described in my previous post.

I like the telephone system. Used to be 3 weeks to get a standard appointment now I can send a request via econsult and have a phone call within 48 hours

That is not solely a telephone system though , that is an econsult/telephone system. My problem with the telephone system is that I just can’t get through in the first place. If I could book the phone call online, that would be a different matter,

@sheepisheep if something isn’t working, we don’t need pages and pages of studies. We just know it is not working for us.

I know it is frustrating when your profession is perceived to be under attack, but I don’t think that is what is happening here. I think the system is not working at all for some and is working for others. But it does not take much thought or consideration to realise those it doesn’t work for are likely to be those who need it most.

We thankfully live in a free country. We do not have boarding schools offered to all children because some have less than ideal home circumstances, we do not tell people how they should raise their children, religion and personal beliefs are free. With that, it is impossible to completely ensure everyone is safe.

If therefore, the current system is the only one that will ‘work’ (although it doesn’t!) fine.

But let’s not pretend that it won’t cause massive problems for many. That is my point here. If we are saying ‘it’s shit but it’s all we’ve got’ that’s one thing, but I do refute the insistence that it’s actually a great system and it’s us who aren’t using it properly!

@Sirzy thanks for the advice about contacting dd's school. I'll definitely do that. Our cm has just sent me a statement of her observations which is just brilliant, albeit it brought both dh and I to tears. I've sent it to the GP and I think they'd be neglectful if they don't sit up and take notice.

I don't think the school will notice and problems, at least initially. But I'm going to send them the statement too and tell them we're seeking support. I just want them to be aware at this stage. I'm hoping that somehow we'll get advice and support.

Sorry to hijack the thread.

I like the telephone system. Used to be 3 weeks to get a standard appointment now I can send a request via econsult and have a phone call within 48 hours.

That's nothing to do with the telephone system though. I still wait 3 week (if I'm lucky) for a standard appointment. Only now the "standard appointment" is by telephone. I have an appointment in 2 weeks time - it was made on the 29th July and was the first available.

if something isn’t working, we don’t need pages and pages of studies. We just know it is not working for us.

Are you someone in need of safeguarding? Because that is what your thread is about.

I'm sorry but your responses are really not holding together well. I, (and nobody as far as I can see) has ever said it's a great system and it's only down to people not using it properly that it's falling apart (although that may be one aspect of it). I think I've been fairly clear throughout that circumstances beyond the control of GPs have forced the current situation and that we know that some people aren't happy with long waits and tele consults. Meanwhile, GPs are still trying to deal with record demand for their service while working within the constraints of a pandemic and a secondary care service in crisis.

Your lack of engagement with people who are trying to explain this to you is the issue here, and all your thread is doing is directing people who also want an uninformed moan about their GP. As I said, it's GP bashing. Just because we are the most visible service doesn't mean that we are the only ones to have changed - many other primary and some secondary care services are running some tele consults too - including health visitors and paediatrics. Are they putting vulnerable people at risk? You don't know the answer to that. I don't know the answer to that. But you're the one who has started a thread choosing to focus your blame on GPs, and who is refusing to concede that your opinion is on shaky ground despite admitting that you don't understand the system.

I don’t consider someone in need of safeguarding. I do consider myself someone unable to access services due to the current system. That’s not great for me: it is much worse for a child being abused or neglected or a woman in a controlling relationship.

I am not ‘blaming’ GPS. I have been clear about that. I am saying the system is failing those no need it. That does of course apply to other areas too and no one is saying it doesn’t, but yes, GPS are an important part of that system.

Pompously telling me my responses don’t come across well is missing the point entirely. Either you think the system as it stands is not a problem for safeguarding, which I disagree with, or you concede it is a problem but is the best we’ve got, which I sympathise with but doesn’t mean we should put up with it and shrug off the needs of those in dire need.

Are you in the UK?

You can self refer for therapy for depression by googling your local NHS IAPT service, calling them up and registering. They'll book you in for an initial assessment and discuss what help they can offer.

GPs can offer antidepressants, so by all means keep trying to get an appointment with them, but for depression they'll just be referring you to IAPT anyway so you might as well cut out the middle man and do it yourself.

Thanks - I’m not really looking for advice on my personal situation, as there isn’t really anything I can do other than self care, which I am already doing.

But it does go to show how easy it is for things to be missed.

Do you have a child under one, or are you currently pregnant OP?

I'm happy to post some really good quality free self help workbooks for depression if you feel you need more help than just basic self care at the moment. Let me know.

Like I say I’m not looking for advice for me, but thank you

Apologies, that was supposed to be a

I use a private GP service these days. It isn't cheap but it's the only way I can see a doctor, and I work for the NHS !.

I’d posted that before I saw your comment saying you didn’t want advice :)

No worries - I gathered. It did make me realise how if I was unable to access help, how much harder it would be for someone on the fringes of society. And they are those most in need.

My son was poorly yesterday, I tried ringing my GP 19 times and still could not get through. It's absolutely scandalous.