Why do so many people have issue with crap GPs in the UK?

[AgapanthusLove]

I know the NHS is much revered but as a non UK person I am baffled by the very regular threads about poor service from GPs.
Why are so many of them seemingly so bad at their jobs?
Why is it so difficult to access them if an appointment is needed?
It seems very weird to me. I think I would rather pay for a service that worked & I felt attended to than a 'free' service that didn't give a shit about me or anyone else
Are there not enough GPS? Are they not trained highly enough? Why does there not seem to be enough to go around?
Genuinely interested as I've never experienced anything like what I read about here

Yes, we have weekly texts not to contact the surgery 🙄

My new GP is pretty decent. The front desk ppl are fairly friendly etc.

OK. So how is an average, medically untrained person to know whether they need treatment or not, if they can't see a doctor within a reasonable time window?

Let's revert back to the symptoms stage. You felt gradually more and more unwell over a couple of days, and today you woke up at 5 am with a stabbing, throbbing pain in your ear, fever of 39C, your lymph nodes on that side of the face are swollen. You take a paracetamol, wait for 8am to call your NHS GP, and the best they can do is offer you a mid-July appointment. Or try to call tomorrow, maybe there will be a cancellation. Or the day after tomorrow. You decide to go to a pharmacy, they can't prescribe anything and suggest you see a GP. What does a sensible person do next? It is a genuine question, maybe I indeed misunderstand how things work.

Its due to lack of competition/choice because the NHS stifles it. The NHS and therefore NHS GPs are further stifled by often putting budgetary demands set by managers before patient welfare, so its all about cost savings, as well as pointless red tape to justify management practices. Its management and system led, rather than patient and demand led.

Its also not free - when you have to pay twice, once through taxation and once privately, for essential treatment, it must surely be the most expensive healthcare system in the world.

I've lived in 2 other European countries and although one is somewhat known for being reluctant to prescribe antibiotics or other medicines, it was still far easier to get them for serious problems that would have gone untreated in the NHS unless you were very very lucky here (I got Lyme Disease which cleared up because my Dutch GP immediately recognised the symptoms and prescribed me the correct and lengthy course of antibiotics).

In the UK, I present, first of all as a woman and secondly with glowing cheeks and looking in full health, and am generally dismissed as having nothing wrong with me. It took 3 visits to my GP, 2 to A&E, 1 ambulance trip and 1 hospital stay for me to be prescribed the correct antibiotics for A-typical "walking" pneumonia,. The GP wrongly diagnosed me with a kidney infection and then told me twice more there was nothing seriously wrong. The same happened with a stress fracture, although that was more NHS orthopeadics fault. The NHS point blank twice refused to prescribe me antibiotics for a serious cat bite and a massively swollen finger seeping pus and I had to pay to see a private GP and get a private prescription. Apparently I should just have suffered longer than a month for it to clear up on its own? I really don't trust the NHS as a healthcare provider at all. Apparently, they are quite good for "lifestyle" related diseases but for everything else, they are brutalist. The state provision element also seems to encourage rather a lot of arrogance and "doctor knows best" attitude where they simply fail to listen to the patient or observe properly.

Hmm, I'm Polish, so I have a bit of comparison between NHS and health services in Poland. I'd say NHS quality downgraded, but it's still there if you need chemo or some surgery etc. and if it's urgent, they really put an effort to prioritise you. I recently wasn't feeling well and I got the appointment and blood test, so I can't say anything bad about my GP. The only thing I don't get is how extremely hard it is to book the appointment with i.e. gynaecologist or when you're 30 the only breast cancer screening services you get is when you feel lump in your breast etc. I pay privately for these services in Poland. Breast scan, gynaecologist visits etc.

Oh and the obsession within the NHS with geographical boundaries. You move 4 miles along the road and are expected to change your GP (and all the hassle of providing ID and utility bills that entails) because you are no longer in "their area". I'm still on my Dutch GP's books, because they don't kick you off like that. In the UK if you go on holiday and become ill, you have to persuade a local GP to see you or return home. Its hard enough to see your own GP, never mind trying to get a different GP with little financial interest in you to take you on. And even if you do see them, invariably they won't diagnose or treat anything, but will tell you to see your own GP when you get home.

I agree. If I have a sore throat I pop.into see an ENT, my favourite is in a mall.above the supermarket so I just add.it on to the list of things to do. Turn up, see him have a camera check, go to pharmacy and collect mess, 15 minutes and £50 although insurance pays but I would.pay triple not to have to use the NHS. We have put aside a hundred grand rather than buying another property just in case we end up in the UK for some reason and need medical treatment.

I don't think they are bad at their job. I've always found them to be helpful and professional with a wide knowledge. However getting to actually see a GP is another matter altogether. I've entirely given up phoning and prefer to go to the surgery to make an appointment as it actually takes substantially less time than trying to get through on the phones. Even then it could be two or three weeks before an appointment is available if you need face to face. Appointments are usually offered by phone with a 3-4 hour slot given meaning an entire morning / afternoon off work with the risk of missing a call if you got the loo though to be fair our lovely doctors do try at least 3 times which I think is very good.

I honestly do not understand it. We get told to use Livi but last time we tried that it kept us hanging on for SIX hours before finally saying no appointment available. It gave an appointment time and kept moving it back and back.

We get asked to email for repeat prescriptions which often works well except they never acknowledge the email so you've no idea until you get to the chemist whether or not the request was received and acted upon - another lottery.

I think the GPs themselves offer a good service but something seems to have gone very wrong with the admin and availability which was fine before covid struck. I know GPs who are working constantly which is presumably why it's so hard to get an appointment but when the waiting rooms seem to be empty if I go to the surgery, the phone calls are timed over a 4 hour slot and it's a lottery to get through on the phone or the phone app and emails are not replied to, confidence is lost

Actually, it was the BMA (doctor's union) that for many years wanted to restrict the number of medical school places and medical schools.

www.bmj.com/content/337/bmj.a748

They wanted to avoid “overproduction of doctors with limited career opportunities.” which basically meant they wanted to keep numbers low so that high demand led to higher wages etc.

@forinborin

I would have asked to see the practice nurse or kept trying daily for an appt with the hope the symptoms would have resolved in a few days as they most likely would.

That is so true, @AchatAVendre
I once had to travel the length of the country to get an inhaler because I was not at home.

That's much better than it used to be now though. I've had phone consultations while I've been away in holiday and the GP has sent the prescription to the pharmacy next to my hotel in Cornwall or wherever. The only problem I've had is when I've been in Wales/Scotland.

I think there is a fundamental problem in the way patients are dealt with by GPs in this country; I only realised it once I had experienced being a patient in other countries. And it is amplified if you are a woman, or poor/vulnerable in some way, or don't have someone with you to back you up.

The default approach seems oten to be to send people away or dismiss them unless they keep coming back, which will prove that something is "really the matter".
I suppose a contributing factor is that appointments are limited in time and the GP doesn't have adequate time to go into details, which comes down to funding/money.

In other countries you are listened to and taken seriously by doctors, it's a totally different attitude in my experience. It's good for people to feel grateful for the NHS, but that should not mean that we have to be grateful for any scrap of attention or care, no matter how inadequate.

Similarly, there are problems from the patient side with people booking endless GP appointments (my friend is one of them), or not keeping appointments, not looking after their health etc. And I believe this is also caused by the fact that the service is felt to be "free" (though it's not), it is valued less than a service we pay for at the point of use.

Topgub, if a pharmacist told me I should see a doctor, I would think that I should given they almost certainly know more than me about health matters.

You don't need to see a doctor for a sore throat. You also very probably don't need medication. Gargle some salt water, take a strepsil, wait for it to get better.

At least you're not going to the GP. Because it's people who demand to see a GP for a sore throat who are clogging up the NHS.

I once took my baby to kids A&E to be checked over after another car ploughed into ours and he couldn't move his neck properly. He was 2 months old. A woman came in with her teenage son demanding he be seen as he had a cough. People are pathetic and entitled.

I don't know why this is such a surprise.

I have a very bad history with GP's, years ago horrific episode, which even my mum was very unhappy about. and even recently problems re red tape and referrals for shoulder op, that surgeon said I should've been sent to him years ago. And 10 years of being fobbed off re HRT and then me telling a GP the NICE 2015 guidelines, ie me telling her what her job is, and a more recent dosage error by another GP. When you post it all, it's a shambles.

Others have had it much worse than me. This is rarely acknowledged.

A lot of MDs aren't that competent, GPs just seem more incompetent because they do most of the detective work which is hard but they are well compensated for it. Problem with medical stuff is the people who work in it are typically very privileged so they often have an excess of confidence they're doing a good job when a lot of the time they not. A sort of overestimation of themselves.

I see. And what happens in the scenario where the symptoms don't resolve after a few days?

I don't know, I prefer to treat myself better than that. And for the life of me I cannot understand why it is considered to be something shameful in the UK.

It seems to vary widely from surgery to surgery.

Ours suddenly took in a load of patients from surrounding towns and villages around 5 or so years ago. It went from a busy practice where you might have to wait a week or so for an appointment, to a practice that literally has no appointments to offer. As in their system will only book 4 weeks ahead and there are no available appointments in that time frame.

I started trying to access help with chronic migraine via our surgery in 2019 but ended up having to go private. I was being prescribed 3-month trials of various drug combos and asked to make follow up appointments with the same GP towards the end of that period. I rarely saw the same GP more than once and it was normal to have 3-6 week gaps without any migraine meds at all because of no appointments available and not having repeat prescriptions set up (as drugs were on trial).

After they abolished the online appointment request form 2 years ago due to "a higher than normal volume of requests" it was a case of 10-30 minutes waiting on hold every single morning to be told no appointments, try again tomorrow. Eventually, after almost 5 months with no meds at all I went private.

It's a shame because they used to be an excellent practice, and were really thorough when I went to them with some pretty vague symptoms back in 2015 expecting not to be taken seriously. I was referred on for all sorts of scans etc and was asked to return for 2 follow up appointments (turned out to be POI).

Meanwhile, friends in neighbouring villages have a great GP service. It's a lottery.

@forinborin

I dont think its shameful.

As I said, you paid for a service that got the outcome you wanted. All good.

But there's no denying that leads to other problems (see post about camera for a sore throat) as well as the NHS being free at point of use causes problems.

There has to be a balance between expectations and what its possible to provide from a very poorly funded public service.

We dont have that balance.

I don't know what's wrong with the GP system. I have used the NHS more than most and I have encountered the entire spectrum of GPs—from great ones to completely negligent ones.

However, I have also had hospital treatment many times and the consultants I have encountered have been, without exception, brilliant. The surgeries I have had would have cost hundreds of thousands of pounds if I was a private patient (far more in the US) and in most cases I would have had exactly the same consultants treating me.

So if you ever have anything seriously wrong with you, you will be very grateful for our brilliant NHS. If not, count yourself lucky and don't begrudge the money you paid in taxes to support it. I would happily trade places with you any day.

The one huge service the NHS lacks is medically assisted dying for people whose lives have become intolerable because of illness or infirmity. Please sign the petition on Parliament UK (just search for "Legalise assisted dying for terminally ill, mentally competent adults") and you'll find it, and please email your MP to ask them to attend the important debate that is taking place on 4th of July!

@WotTheDickens I agree with almost all of what you said, but I don't count myself lucky because when I had something seriously wrong with me two GPs misdiagnosed me, then the third one made a correct diagnosis but didn't make an urgent referral for treatment and so I was left with a permanent problem that I have to live with every day. I don't think we should be grovelling for substandard care. I do find this line of "our heroes" and lionising the NHS pushes out legitimate criticism. Maybe that's even the point of it.

You don't have to wait 4 weeks for an appointment for an ear infection. You would have an emergency appointment and thats the sort of thing where they might even be able to deal with you over the phone especially if you have had ear infections before.

In the UK if you go on holiday and become ill, you have to persuade a local GP to see you or return home.

@AchatAVendre There is no "persuading" necessary, you just go in to the surgery and fill out a visitors' form and then wait your turn like everyone else. It's a very simple process. Or as others have said, you just book a telephone appointment with your own GP.

@tulips27 I'm sorry to hear what happened to you. I had a similar experience with two negligent GPs that refused to refer me upward. I certainly don't consider them heroes and in fact I thought they should be struck off!

I was unlucky to encounter them though, and in hindsight I should have changed GPs long before my serious problem reared its head as I had always found them to be uncaring and dismissive. My life might have been very different if I had done that.