To think that is a miracle that gp's can suddenly diagnose and treat patients over the phone?

[thewinchesters]

For the past 5 days I've had abdominal pain, bloating, and a couple of other symptoms. I spoke to my gp over the phone who diagnosed me with a uti and sent antibiotics to the pharmacy.

They're not making any difference so far (day 3) and the pain and bloating is getting worse.

For the sake of a simple urine test, or even just a quick appointment where the gp checks my actual body, I don't understand how we're at the point of now just guessing and hoping for the best!

Why haven't they resumed normal service??

GP’s don’t do hearing tests

Boots does free hearing tests.

This isn’t true. There are issues but that’s not why.
Their contract is changing with regards to their extended hours and extended access. They already offer X hours per patient out of working hours and now these contract elements are both combined. Some will contract this out to other providers. Practices in good PCN’s are managing this well and some PCN’s are not. Overall GP’s are uneasy about the devolvement of their independent businesses into a primary care network model inside acute hospital trusts eventually, and also worried about the new ICS’s across the U.K. they aren’t sure what it’s going to look like or whether they will lose independence. Our CCG has merged into one huge mega ICS across a huge area

with regard to telephone consults, they are as good as the trained clinician. They should not replace face to face. If a patient should be examined, they should be seen. Tel triage does have a lot of benefits to everyone, you can see a larger number of patients. Despite what you read in the daily Mail, GP’s are seeing more patients per 1000 than ever before and it’s due to telephone and video consults. Patients don’t see this though as they can’t see it, as it doesn’t translate with the old style face to face system

correct 🤣

I ended up in hospital with pneumonia at 28 weeks pregnant, because the GP was sure it was a virus so I didn't need antibiotics. How they could tell that over the phone is a mystery, especially as I have moderate/severe asthma and have had pneumonia before.

I usually defend GPs on here but two things have happened today to make me rethink. My niece was in agony with what turned out to be appendicitis - gp said it was period pain following a phone consultation. This was only sorted when DSis took her to A&E. And a local man has died due to a blood clot, which was misdiagnosed as pleurisy at a telephone appointment. The local paper said the gp had confirmed that, if he'd seen him in person, he'd have known it was a blood clot. I know they are overstretched but surely people in pain should be seen.

it is awful, sorry to hear these stories. The surgeries are not using telephone appointments to get out of seeing people face to face. That argument doesn’t make sense, it would mean they are seeing less people per day which if they were lazy, they would be? It’s because it increases capacity. They cannot physically cope with turning them all back to F2F as it would mean a drop in capacity with the demand ever increasing. The government are pressuring them to see and do more and more on the same number of staff or less. A Gp in a session can get through 1/3 more patients at least if they are calls, bringing in the face to face ones who they think needs an exam

Diverticulitis?

I had this, and bowel infection caused by it, never heard of it before and the pain radiated down into what felt like my bladder and urethra but it was nothing to do with that area

My very rural CCG are doing video consultations and I think they are fabulous.

I rang up around 5pm on a Friday evening, was given a slot for 7pm that night, had a video consult with a lovely doctor who confirmed the suspected diagnosis over the video with help from an image I had sent in advance and sent an electronic prescription to the pharmacy of my choice to pick up on Saturday morning.

In the pre-covid days a trip to the GP would have been a 16 mile round trip.

I think there is definitely a place for virtual appointments leaving the face to face appointments for the cases where it is needed (although I agree you should have been seen OP)

"They cannot physically cope with turning them all back to F2F as it would mean a drop in capacity with the demand ever increasing."

I'm not trying to be argumentative. Our surgery has been excellent over the years and fantastic through covid. But I don't understand why they can't go back to f2f, or why demand is increasing. The catchment area for our surgery hasn't expanded, no new houses.

Surely they are seeing similar numbers of patients as they did pre-covid? I myself would prefer a video or phone call as I could do it from work, or from home without the drive into town/cost of parking. But people in pain should be seen imo and if people are dying, and GPs are admitting that a f2f appt would have allowed for a correct diagnosis, then it's not working.

GPs have been taking the piss since Covid. Get them back to work, if they refuse, strip them off their medical accreditation as they are clearly breaking the Hypocratic Oath.

No i think it’s good to ask because you can’t see it from the outside

• GP’s are getting old and retiring (as are many nurses)
• a lot of HCP decided to retire or cut back when the pandemic was just overwhelming for them with new tech and so many changes in an older demographic
• Many people left the U.K. after Brexit to return to their country of origin leaving gaps
• U.K. is not training as many GP’s and nurses as we need to and that is scary

• Demand has risen exponentially. It is all manner of things.
• Since Davina McCall did a menopause programme, the rise in HRT and menopause calls are off the scale. GP’s need to start the HRT. Nurses can review
• Many peoples mental health has taken a huge toll on them. Every day the emergency list is full of people who aren’t coping and needing help. Mental health services are not helping people. GP’s are trying to help them
• there is a 52+ week waiting list to even see a consultant in secondary care for a knee op, let alone have the op. Who do you think cares for these patients’ pain and associated issues until they get treatment?
• during the pandemic people would call all day asking about vaccines now they call asking about travelling
• Long covid also added a new layer of issues to primary care that wasn’t there before, in a demographic of people who wouldn’t usually use the GP (younger)
• tiktok has created a huge growth in the number of young adults asking for an ADHD assessment

I can go on too.

-Many areas in the U.K. (and not all cities) have taken large numbers of refugees or asylum seekers and they need longer appointments as they need interpreters

-Medications are often out of stock or taken off licence due to global shortages or manufacturing for instance There was a huge Ranitidine issue in 2020 when it was taken off completely, and all those patients needed to be prescribed something new by a prescriber

-111 in my opinion are terrible value for money, they are paid and contracted to help patients out of hours but push them all back to their GP

-we have an ageing population in the U.K. who statistically need a lot more healthcare than a younger demographic and use a lot more resources

I cant even get to a GP here, first you have to grapple with the receptionist, then if you're lucky you get a telephone appointment with a triage nurse, the nurse I spoke to diagnosed me with vertigo. I knew she was wrong but she wouldn't accept it and as I refused to bow down to her and agree I had vertigo there was nothing more they were prepared to do for me.

Luckily I took myself off to A & E well my son took me as I couldn't stand up the first thing they did was take my blood pressure 230 over something or other I was having a stroke.

If I had listened to that triage nurse, I'd be dead now!

Do you know how many patients a GP sees in 4 hours (a session). Usually around 18-20. That’s 36-40 people at least, without emergencies or assisting other staff with patients, like helping a nurse. The emergency duty doctor might see twice that many people in a day

GP’s work 6-8 clinical sessions that’s just physically seeing the routine patients. Not the admin. They also then have to do all the admin on top. They have to deal with urgent emergencies, call outs, action urgent results, read every single routine result, read/code/action all the relevant incoming clinic letters, sign repeats, write referrals, deal with queries that admin staff can’t do, help with training and supervising Gp registrars, manage the business and clinical side practice in terms of clinical safety, finances, complaints, incidents, protocols

Gp surgeries are expected to offer a set number of appts/sessions per 1000 patients and it is monitored. If they do not do this they will get a call from CQC and the CCG and it is a risk to their practice - essentially they are an independent contractor and it is their livelihood. No one is giving Gp’s free money to play golf. Stop reading the daily Mail. Yes there is a crisis. But it is not what you think. It’s what the government wants you to think, so they can point the finger elsewhere and slowly privatise and merge everything together. Don’t be blind

GP’s are also expected to meet endless targets every year for long term health condition reviews etc

My sister’s GP recently diagnosed her with a calf sprain over the phone and told her to rest and apply ice to the affected area. She was in an increasing amount of pain so later that day went to A&E where it turned out she had a DVT.

Our GPs have been seeing patients when necessary throughout the pandemic - with a triage system. My family have been into the GPs for examinations on a few occasions. So it's obviously very dependent on how much the GPs care. I don't understand why some of them think they should be so protected from seeing people when so many other people have been back at work for ages. They're not exactly underpaid either.

GPs are gradually being deskilled when it comes to performing a proper clinical exam.
They're going to start missing serious conditions.

I can't fault my GP the other day. Rang up, got a telephone triage. "Can you pop down?" She said
I'm 500m from the doctors so go straight there, get seen, she rings the hospital, speaks to the on call haematology person, I get different antibiotics and all sorted

@Menora Thank you for that information, you have explained the problems very clearly
I work in a GP surgery as a non-GP member of the clinical team and am a patient at a different one. Both practices are seeing patients f2f and are doing as good a job as possible in difficult circumstances but this is not consistent. My mother, in her 90s, is a patient at a surgery that is far less patient-friendly.

The practice I work in had 240+ patients miss appointments last month so over 40 clinician hours wasted and other people unable to be seen

I had that. I tried to make an appointment as my baby had had a raging fever for over a week. They made me an appointment then called me back to cancel it, because they wouldn’t see us without a PCR test (he’s been tested at the beginning of the week and it was negative, but apparently they needed a second one). Then that afternoon he had a tonic clonic seizure and choked and I wound up calling an ambulance, which arrived in five minutes. We were in hospital for a couple of days. It was all so avoidable and would have been so treatable, if only they’d seen him. In the end I wound up using an ambulance, acute care in the Emergency department of the hospital and spent two days on a paeds ward, when it would have been picked up and dealt with inside ten minutes in a GP appointment.

It was such a shame, my surgery had always been brilliant.

This is a depressing read, as usual. I have an acquaintance who's a nurse in Switzerland. She says that there you can choose whether to see your GP or to go into hospital for any reason (essentially A & E). She says they are totally caught up after Covid already. People choosing to go into A&E complain if they're not seen within an hour. If they don't like the diagnosis, they are free to go to another hospital for a second opinion. If any treatment is needed, it is started pretty much immediately.

80% of diagnosis id on history. Examination is only a very small part and often not needed at all.
What else can GPs do? They can’t possibly see everyone face to face, they are dreadful understaffed.
Blame the Tories. Support the GPs.

They also avoid testing for anything, apparently they now have xray eyes and can use divination rather than bloods.

Your GP followed best practice here - you prescribe antibiotics for suspected UTIs straight away as if you delay treatment it gets worse v quickly. If the ABs don't work you then explore other options.

Best practice?
Even if it is a UTI, which sounds doubtful in the op’s case, without a proper urine test, it’s just guesswork as to which antibiotics the infection will be sensitive to. If the guess is incorrect, the infection will persist. Why waste time guessing, waiting a few days, then ‘exploring other options’? Cut to the chase, offer to take a urine sample, which involves a visit to the surgery then prescribe the ‘best guess’ antibiotics while waiting for the result. At least if the guess was wrong, the correct antibiotic will be flagged when the result comes back.