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

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.

I don’t know where you live but this sounds so American to me, the idea that you need to see specialists and get meds for everything. I don’t know anyone in the UK who would think they needed to see an ENT specialist and get medication for a sore throat, unless it went on a really, really long time or was unbelievably severe. You’d take paracetamol and suck Strepsils and drink fluids until it passed.

I was looking after some American visitors at work once and they turned up a bit croaky after their flight and were adamant they all needed to see a doctor and get prescriptions for antibiotics immediately for their sore throats. I was baffled. Over here we constantly have it hammered into us that antibiotics should only be used very sparingly and when they’re really needed, not for every little twinge.

Not saying the UK way is the only way or even the right way but I do think this shows that in some countries healthcare is seen as an opportunity to flog as much as possible to patients/customers rather than treating people based on actual need.

@tulips27 p.s. I hope you made a complaint to the GMC, and if it happened in the past three years you might be able to sue them for negligence. I engaged a firm of solicitors for this purpose on a no-win-no-fee basis and their upfront costs were covered by my home contents insurance policy.

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

Totally unnecessary, and if they are prescribing antibiotics, irresponsible.

Abundant healthcare paid for by insurance comes with its own problems, as beautifully illustrated above.

What do you think the NHS should provide then? OK, so minor ailments with low chances of complications are abusing the service, got that. When should the health service actually step in then?

I am also from the tradition where you go and get checked sore throats, suspicious moles, persistent thrush infections immediately with a specialist. Probably just cultural difference.

My experiences over the years with GP has been pretty good on the whole for a ‘free’ service. One or two duff experiences but over all always got the help/referrals I’ve needed.

I must be lying then. No, it was the first (and hopefully last) ear infection in my life. And one of only two times I tried to use the NHS in my 15+ years of life here, and the other one was similarly amazing.

What do you think the NHS should provide then?

Access would be a good start. Confidence that you will get through and sent somewhere more appropriate if necessary. Not having to clog up urgent care /A and E because you can't access medical care.

Basic, universal protocols for one thing. When I was repeatedly refused an MRI scan for months for what turned out to be a stress fracture, only at my Stage 2 complaint did I find out that my Trust had absolutely no guidance or protocols in place for sending patients for MRIs. It is, apparently, up to the individual choice of the practitioner, who seemed woefully unaware that most stress fractures can only be diagnosed by MRI.

I am baffled as to why the GP holds the power of all referrals.

Especially when, as we have heard above, GP practices are private businesses (who provide services to the NHS).

If I could change any part of the GP operating model, it would be this.

The biggest problem with GPs is they are not statistically literate and can be marketed to and have the wool pulled over their eyes by pharmaceutical reps so they become complicit in drug-related deaths and never fully understand how or why. They aren't evil, they are just unwitting accomplices who are trained and tested to a high standard in recognising symptoms, just not in drug efficacy outside of 'it has 80% efficacy" -it's nice a shiny but it doesn't raise a 0.01% risk as much as they think it does.

@forinborin

At the moment, post 10 years of tory underfunding and the monumental covid fuck up?

I dont think the nhs can provide much unfortunately.

It certainly can't provide the level of service people expect. It also cant provide all the non medical elderly social care people expect.

Properly funded and run its one of the most cost efficient services. But thats not what we have

My GP is really good. But getting to see them is almost impossible.

You have to call at 8am and hold on for over an hour sometimes. I can't use my phone at work, so can't call.

I also use private service if I need it asap now.

The nurse at my GP is very good though and calls you back quickly.

Also they issue repeat medication quickly.

My GP surgery was always great with my kids when they were small, always got them in for an appointment. Now it's still like Fort Knox, no chance of an appointment.

My daughter had been suffering with pain in her knees and ankles, in Covid I got her a private GP appointment over video, she had an MRI within a week and then sent for physio, 20 sessions without having to be reassessed.

I've got an issue with my eye, booked an appointment this morning on doctor care anywhere at 10.50, appointment at 11.00 and going to get my prescription in a sec.

I appreciate we are lucky to have private healthcare, it does leave me uncomfortable that the consultant that saw my daughter works across both sectors as does the physio.

The NHS isn't fit for purpose, and I have no idea how you would repurpose it. People in general aren't prepared to pay more tax for it, social care or elderly care.

@Yodaisawally

aren't prepared to pay more tax for it, social care or elderly care.

No but they still expect the state to provide it and moan when it's not like a 5 star hotel.

Which is ok unless you're like me and need antibiotics ASAP
My GP surgery cuts you off if more than 20 in the queue. You can ring at 8am on the dot and get cut off as too many people, when you do get through there's no appointments
Luckily they are pretty good at trying to squeeze me in as I can't wait if I need antibiotics
It's just a nightmare getting through

@bustickets some people do need to see the GP for a sore throat
3 weeks ago I had a telephone call with the nurse practicing and she prescribed antibiotics. They didn't work so I ended up seeing the GP face to face who then gave me new antibiotics
I mean it was just a "sore throat" but it was raging tonsillitis with pus all over my tonsils and she had to get haematology on call because she was concerned I might need IV antibiotics

@AgapanthusLove because we have had succession of Conservative governments and Brexit.

It suits me not seeing a GP but just using the online ask my GP. I usually get an email back within 2 hours and don't have to take time off work.
I work in the NHS and it's hellish trying to get time off for medical apps.
They see you if it's essential or if you need bloods or whatever you can go in.

Far far fewer GPs than are needed, and GPs look after a wider range of illnesses than in other countries.

I used to work in Canada, and absolutely straightforward stuff, which GPs in the UK would manage without a second thought, was under secondary care follow up over there.

Anything child related was seen by a paediatrician (a paediatrician give DS his vaccinations whereas a practice nurse did the jabs in the UK). A gynaecologist did my smear test, not the practice nurse.

You see a similar picture in much of Europe - I work with a Spanish nephrologist currently (on an exchange here) who would see her dialysis patients in Spain at every dialysis session (3x week). I see mine 4x year. But then I have 120 of them, not 24, and I also have 800 Nephrology patients, 250 CKD5 patients, a weekly biopsy list, significant teaching and training commitments (I’m a training program director), management responsibilities, a research portfolio, and various other things my colleague doesn’t do in Spain. If I just had 24 dialysis patients to manage, I have no idea what I would do with all my spare time.

So obviously if your care is 100% consultant-delivered by a workforce which has no time-pressures, you are less likely to feel rushed or not listened to. Requires about a four-fold increase in doctor numbers though, which wouldn’t be possible without a huge expansion NHS funding, and an increase in medical school places.

People are unhappy with the NHS because it is massively understaffed and running on fumes. They aren’t wrong to be upset, but it isn’t down to the staff being shit.

GPs prescribe to CCG formulary standard these days. Drug reps can’t influence their prescribing (because they aren’t allowed to prescribe off-formulary).

If you have evidence that CCG prescribing committees (usually comprised of a combination of GPs, senior pharmacists, and secondary care specialists) “have the wool pulled over their eyes and don’t understand therapeutics”, I’ll be all ears. My experience is that they are very rigorous and it is very hard to get new drugs approved.

When you last sat in on one of their meetings, what aspects of the evidence being discussed did you think was statistically illiterate?

My GP service operates something like this. 1. Phone for an appointment. 2. An automated voice tells you that you are number 43 in the queue and you can press '1' for a call back when you are near the front of the queue. 3. The receptionist calls you (always when you are on the loo!). 4. The receptionist explains that you need to fill in an online form. 5. You explain that you cannot access the online system, despite trying to do so for weeks. 6. The receptionist fills in the online form whilst you dictate. 7. The form flags up as 'urgent' so a GP will call you. 8. The GP calls you to see if you need to be seen, need to go to A and E or need to hang up. 9. You make an appointment to visit the surgery.

Once you get through the 9 point screening system, the GP has five minutes to see you. They may refer you for tests. If so, you have no idea when or if these tests will take place. You may get the results from a test, but the GP will not discuss what the results mean.

I know GPS are under terrific pressure and I realise that the pandemic and Brexit have had something to do with the dip in services. However, as I also consider private consultation, (despite having paid for the NHS for more years than I care to mention), I cannot help wondering if a drift to the private sector is what the government really want.

Then perhaps we will have a two tier system: a rudimentary service for people who cannot afford private treatment, and a better and quicker service for those who can.

That's just not the same as what the poster I quoted was describing so it's pointless to equate it. For most people, a sore throat doesn't need any treatment. I assume you didn't call the GP the moment it started to feel a bit sore? Or after you cough or sneeze just the once?

Underfunding for a start.

Far too many patients

Ten minutes for an appointment.

I need between 5 and 7 insulin injections every day and sometimes more to stay alive.

The cost of insulin worldwide is soaring at an alarming rate so for myself and others, the NHS is essential to my survival.

You need an appointment to be allowed in to my GP Surgery. They have a buzzer entry system. 'Rock-ups' can't get in.