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??

During covid GP's worked harder than before. They had additional hot shifts where they were exposed to covid patients. Now they have a huge backlog from covid of people who didn't come forward or who's hospital treatment was postponed. Hospital doctors- dare I say it- had it easier than GP's with covid. So shocked at the trashing GP's are getting here.

What sort of places? Genuinely?

What sort of targets for long term health conditions?

Im on blood pressure medication, havent been reviewed for nearly 18 months.

My son studied the history of the NHS as part of his schooling. The fact is that right from the start it has NEVER broken even.The idea of it was great, but it has never balanced the books with NI contributions.
Now that medicine has advanced it has become a self eating monster and it will never keep up.
It doesn’t have to be USA or nothing, we could have a European model, but “free at the point of use” is no longer viable. It could still be free for those on the lowest income but the rest of us should contribute to our appointments. Mind you, if I was doing that I would expect a decent service.

There are private clinics all over the place offering ear syringing and microsuction.

As well as Specsavers, Boots, Superdrug (I think) and maybe Vision Express.

Well, my daughter went in with a cough and the doctor gave her a prescription for inhalers. The doctor did no tests for lung capacity or anything else. She doesn't have asthma. I told her to throw the prescription away. Thankfully she did it, other people would have been using an inhaler needlessly. They aren't good for you and certainly shouldn't be used if not needed. This was when she was a teenager. If that happened now, she would trust the doctor and use them.

I had no idea. Its fine if you can pay for it. She can afford it thankfully , but many elderly people can't.

@TequilaSunriseforme inhalers can be used for symptomatic relief. Not just for asthma.

@Menora what’s the deal with hayfever in primary care?

last year dc suffered with severe hayfever for the first time ever. Only Montelukast sorted his symptoms. The few tablets that we hadn’t used went out of date at the start of this year so about a month ago I called our GP (midweek on my day off as they state that just before and after the weekend are their busiest times) to ask for a new prescription in anticipation of the pollen count rising. The request was declined as he wasn’t symptomatic at the time.

Guess when he became symptomatic? Last Friday - in the middle of the 4 day closure and 3 days before he starts his National tests at school. I called 111 on Saturday and finally got a call back from a nurse on Sunday lunchtime only to be told that it needed to be dealt with by a Dr and their call would likely be in the middle of the night as they were so busy. Instead I was advised to call the GP on Monday morning. In the meantime I noticed that our community pharmacy said they could prescribe for hayfever - great, I thought but when I asked they couldn’t prescribe montelukast.

So all that I could do was call the GP on Monday. It took hundreds of redials to get through only to be told that they were only dealing with emergencies. I told them I felt this was an emergency as I’d not been able to get help over the weekend, his symptoms had continued to deteriorate and he was sitting his National tests.

I got a call back from the nurse who agreed over a 2 minute conversation that montelukast was appropriate and sent a prescription to our pharmacy.

All of that could have been avoided if I’d had been listened to and taken seriously when I tried to get organised at a less busy time for them. It’s hugely frustrating all round.

Not opening up the surgery pre covid. Why is that?

The system here is to phone surgery at 8.30 and usually when you can get through all appointments are taken .
My 87 year old mum has felt unwell for about a week now, Dh and I tested positive for covid on Saturday so can’t visit her . She slept for 24 hours Saturday to Sunday evening which has never happened before and now feels unsteady on her feet.
Mum rang the surgery today only to be told no appointments, no gp available to call her, phone 999 if you’re worried.

She’s been in bed all day too scared to get up, she doesn’t want to go to A and E which I understand.

I think possibly this is just a general decline in her health as she has a heart condition and maybe nothing can be done but how do we know without seeing someone?
As soon as I can see her I’m going to pay for a private gp appointment , I can’t see an alternative but it seems inhumane to treat an elderly person like that. I know the whole system is broken and that the gps are working full out but it’s just so hard .
Obviously this wouldn’t be so bad if we didn’t have covid , praying for a negative test soon .

Keep telling yourself this lol.

Yes that’s not OTC and if it is on ‘acute’ script (not an ongoing repeat long term) it needs a review before re-prescribing as time has passed, which a nurse or clinical pharmacist can do. I can’t really call the situation of preemptive medicine it’s down to each clinician, if someone isn’t symptomatic then they may feel that there is no benefit prescribing a medication that has its own side effects. I get a lot of UTI’s but I am not at the point where it is beneficial to treat me on long term antibiotics as they have their own side effects

If someone is diagnosed asthmatic, they will get regular reviews of their meds and condition and this drug is often used to help asthmatics. It is definitely not a first line hayfever treatment, as you probably know - it would be OTC antihistamines and now you can buy fexofenadine which a lot of people like to use.

I can’t really comment on your child but hayfever isn’t a life threatening allergy or emergency - unless someone has a serious underlying health condition (like asthma) and if that’s exacerbated then really someone should have an asthma action plan to manage it

To be blunt sorry, I am not trying to be rude, your interpretation of ‘deteriorating’ and an emergency may be very different to a clinicians concept of deterioration

sitting an exam isn’t a life threatening infection or event, although it’s important to you and your child. You are one of many people sitting an exam or going on their holiday and finding it hard to manage hayfever symptoms (many of whom do not even try OTC meds) and panicking and wanting an appointment. Similar goes for HRT, women start treatment and still have symptoms, so they keep returning. Not all medicine is a cure I suppose and there are different interpretations of importance

You could ask for it to be put on repeat as there is no such thing as a yearly hayfever review

Call for her tomorrow and ask to get a call back from the duty doctor. Often older people will actually downplay things if they feel it’s going to be difficult and not want to bother people.
can anyone drop her a thermometer? Is she eating and drinking?

They really did do this. Most practices had hot clinics in their area. Consultants (apart from in A&E and on wards) were also doing most of their outpatient reviews by phone.

I still don’t understand what you mean now about pre-covid? I will answer anything but I don’t know how to answer this

The issues were there before COVID, there has been no increase in GP’s since 2015. COVID has made an already unsteady situation a lot worse. We have the bottom to last number of Gp’s per 1000 patients in Europe, and we have a nursing crisis

Thank you Menora, I will try tomorrow.
She is eating and drinking but she eats very little now which may be part of the problem as she is gradually getting weaker.
One of my neighbours who is a retired nurse is going to visit tomorrow so I can give her a thermometer and bp monitor to take. Her cleaner helped her do a covid test Monday which was negative .

Thanks for your reply @Menora

I understand what you’re saying - if he was septic, had chest pain etc it would have been an A&E job. I’m not being goady but what is an urgent situation that a GP is first line to help with?

I checked their social media accounts yesterday and today and they’re still saying the same thing, ‘We are receiving significant high call volumes today due to the extended bank holiday period. Please be aware that there will be a wait to get through to us and if you have requested a call-back it will take some time for us to get back to you. We also have NO routine telephone appointments left. Therefore, if your call is not of an urgent nature, or you are just seeking general advice please call NHS 111, pop into your local community pharmacy, visit our website @…., or use our App which can also be downloaded from the website. Thank you.’

I had tried all of those things and if I’d not got things sorted on Monday he would have been left deteriorating for 3 more days which is not acceptable in my opinion.

He does have asthma but this medication hasn’t been mentioned at his annual review - I will request that montelukast is added to his repeat medication and ensure that it’s discussed at his next review in the autumn.

I really feel for everyone in primary care at the moment. It must be relentless but I do feel that unless we stick up for ourselves and our family, being assertive when needed it will be at our detriment.

I think it is the differing ways surgeries are working that is confusing. Yes they all are having a horrendous time but some are managing much better than others and maintaining good standards. Why is best practice not being followed. Why are many receptionists controlling access, making medical decisions, being unpleasant and incompetent and getting away with it. Why is this phoning in first thing the only way to be seen. Why don't they understand most people can't take a phone call whenever they choose. So many faults that make a patient feel infuriated, worried and at risk. The surgery is there to serve the community; it is their only job and some are failing us very badly indeed

Sorry, I don't mean seen in the actual sense of the word I mean allowed to join a list for a call, video or just some acknowledgement that you need help.

In Ireland it costs you about 60 Euros each time you see a GP. Even if it's not America, there are expenses with the European approach to healthcare.

You know exactly what I mean.

Doctors are still stuck in the 1970s with 9-5 monday to friday working hours and similar attitudes to work. We live in a 24/7 society. GPs should be available 24/7, certainly in major cities and towns and even in smaller towns they should be available so that people can pop in early in the morning or in the evening. Society and businesses have moved with the times, doctors have not, and they think they are safe in their own little cossetted world, but they are not.

They are. It’s called Out of Hours.

We’re open 0830-1830 5 days a week. We offer extended hours 2 evenings a week and one Saturday a month (that was suspended until recently as we’ve been doing the Covid vaccination programmes on a Saturday and some Sundays).

Most practices are contracted to offer extended hours if they can do so. It’s not easy to provide though with so few staff. If you offer extended opening you also need to provide ancillary staff such as receptionists, phlebotomy, nurses.

The surgery doors might close at 1900 but my GPS are often there calling patients and doing paperwork until 2100 at night.

Very fortunate here, not a bad word to say about the GPs here. The cover a very large area with too few staff but have always been seen in person same day when needed, as has DS. If they can manage it not sure why some places it's absolutely broken. Lack of GPs is a huge issue that isn't easily resolved though and likely causes the biggest impact- what to do about it is another question though. Ideas on a postcard.