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

My GP is wonderful. I have no trouble getting appointments and I talk to her on the phone about once a month (I have a chronic illness).

I’ve been a practice nurse for many years and my opinions based on my experience are:

There are some crap (uncaring) GPs.

There are more good GPs.

GPs are (in my opinion) well paid for what they do.

Some of our practice staff do a mix of private and NHS work, that’s allowed but it is causing a two tier system.

Admin for each appointment takes longer than the actual appointment, which is a big reason it’s so hard to get an appointment.

There are still a lot of people who abuse GP services. Some of the people we see don’t need to be seen (for physical ailments anyway, loneliness and health anxiety are rife in our population).

Some of the people we see should have seen us much much earlier and end up with serious issues/dead because of it

There is no way of us differentiating between those who waste time and those who need us unless we try and screen via receptionists, telephone appts etc and people don’t like that.

The dialogue of not using the NHS unless you really need to us is lost on those who need to hear it and having a negative affect on some people who really need us.

We waste a shit tonne of money on stuff we don’t need due to inefficient systems.

There are some bad GP’s. All we hear is how awful they are because as a nation we love to complain about the bad and ignore the vast amounts of good.

a) there are fewer GP’s
b) We have an aging population with multiple health issues that take far more time than a 5 minute appointment.
c) many people seem to believe that they should be cured, totally ignorant of the fact that we all react differently to medications and treatments. There is an expectation that we should be cured - my mum was like this - she told me the doctor was useless because she wasn’t better. When I asked they had actually referred her and tried multiple tablets - my mum struggled with the side effects and therefore labelled the GP useless.
d) self care is poor in a growing number of people. They prefer to just get it checked instead of dealing it with it themselves.
e) community care is increasingly difficult as is hospital care which puts an additional strain on the service.

unless we get more staff (easier said than done, I wouldn’t do the job under the intense pressure and scrutiny) then it’s not going to get better.

A lot of this is a factor of where you live. I think if you are outside the big cities is probably ok.

I see these posts from people in “market towns” claiming to have excellent service from their GP’s surgeries and I don’t recognise this at all.

In South East London where I live the NHS provides Third World levels of service.

It’s impossible for me to get an appointment at my surgery without queuing for at least 45 minutes very early in the morning and even then not guaranteed. It’s absolutely awful.

And I speak as someone who is a huge supporter of the NHS. I have huge sympathy for the people who work for the NHS and I still think the acute care they provide is fantastic but the day to day community levels of service that people need for preventive medicine are just not functioning in London.

I saw my GP on the 13th June, suspecting a recurrence of breast cancer. Appointment letter for specialist arrived next day. Saw specialist yesterday, examination, mammogram, ultrasound. All appear clear. Further referral for nuclear bone scan on 5 July. This is NHS treatment and is how our NHS should work. I've been treated speedily and with respect. I have no complaints at all. I don't understand why it varies so much in different areas. I live in a prosperous small city in the South.

Itsjustnotok There are some bad GP’s. All we hear is how awful they are because as a nation we love to complain about the bad and ignore the vast amounts of good.

I'm a professional, and if I made the mistakes that seem to be reported here, I would have been barred from practising long ago. Generally, as a professional, you don't expect to be lauded simply for carrying out your role.

Under funding, not enough GPs and too many people making appointments that aren't really needed or that they don't bother to attend.

I do like the NHS, but I think the 'free' nature of it means that people don't really value their appointments as much as they should. I would support a European style system where you pay a nominal fee of around £15 for an appointments (with exemptions for children and those on certain benefits), with a ceiling amount for the maximum you need to pay per year.

Appointments with a public health benefit (contraception, vaccinations) could remain free.

I'd also love the idea of drop in nurse clinics for a reduced fee to check minor ailments (listen to chests, look in ears for infections, check manky toenails etc). I had a child with recurrent ear infections and burst ear drums and it seemed crazy to take up an appointment each time I just needed someone to look in his ear and see if he needed treatment or if we could leave it. Plus sometimes you need recurrent logged if you want further treatment (with DS he needed grommets but we wouldn't have qualified under the NHS as we only went to the GP about three of the seven burst ear drums in a year).

I agree OP, in that I am baffled by the reverence that people have towards the NHS.

I am in the US (waiting for the comments about people dying in the street, how awful it is to pay for care, the NHS is shit but at least we're not America!) though British born and raised. The difference in care, both in quality, efficiency and speed, between the US and UK is night and day. That's not to say there aren't drawbacks to the US system (I'm a big proponent of single payer care and would prefer a European-style public-private partnership system) but the care delivery is superb.

As an example, at my daughter's annual physical scoliosis was identified. Within days - literally, I think it was 4 - we were being seen by a pediatric orthopedist and on a treatment plan. Groundbreaking surgery at the Mayo Clinic scheduled shortly after. I went to my doctor with slight swelling in my throat and had an MRI the next day. Called with results at 8pm that night - further treatment scheduled.

Within the last week I've had a screening mammogram and colonoscopy (I've reached the grand old age of 45, when screening begins.) In contrast, my 68 and 70 year old parents in the UK have NEVER had colonoscopies, even though one has frequent symptoms. I had the preliminary results of the mammogram and colonoscopy the same day, through an online portal. The same portal in which you can message your provider, see test results and make appointments. My Dad, who has a chronic illness, receives his appointment times by letter 🙄 and in fact has occasionally received the letter after the date of the appointment 🤯

There's a line in a James song:

"If I hadn't seen such riches, I could live with being poor."

That sums up the general British attitude to the NHS - you don't know how shit it is because you haven't had anything better.

I know this was about GPs but I needed to have a vent. My Dad - yet again - has been let down by the NHS and it's a disgrace.

I'm also a big believer that people don't value what they don't pay for. People should have some skin in the game - pardon the pun - and care should not be entirely free at the point of delivery.

@alanabennett

How much do you pay for that service?

I don’t agree with this at all.

People do pay for the NHS. It’s simply that we all pay National Insurance Contributions instead of us all paying private insurance premiums - which incidentally also come out of your pay cheque in the US.

I can't think I've ever had a problem with a gp either. I've seen various ones for me and my kids. Some tricky wishy washy things too but have always had great service.
One GP really went out their way for an issue to do with my daughter. They were amazing. They were genuinely very concerned about my daughter and I can't thank them enough for it.
My dad died of cancer and also always had amazing and personal care from his GP. It was a great comfort for us that we believe that the NHS and his GP did everything for him. He was first diagnosed at the tail end of the pandemic but we didn't see any effect on his treatment.
The palliative care he received was just incredible.
The NHS is not perfect by a million miles but to suggest lots of GPS are uncaring or incompetent is crazy.

Just over $200 a month, from my paycheck, and this covers me and my three children. Were I childless it would be about $120 a month.

I am baffled as to why the GP holds the power of all referrals. In my country you pick up the phone and call whichever specialist you need to see. You can use the gp to diagnose but other than that you can go directly to whoever you need

Absolutely this. I’ve experienced 4 healthcare systems as an expat, from fully private to social insurance, as in most of Europe. I would happily swap the NHS for any of them. I find the NHS worship terribly embarrassing because it makes us look parochial and thick - it’s a terrible example of British exceptionalism. Our healthcare is crap, we are treated like supplicants and NHS policy is to be parsimonious about everything except employee pay. It’s an Orwellian comedy.

I’ve lived in 3 different parts of the UK and have had to complain about shit service from the NHS in all of them.

And we have the highest paid GP’s in Europe!

It's yet another postcode lottery. I've had decent GPS but they are not the standard. We are southeast but my surgery is in an extremely poor area. Appointment making is a joke - tried this morning, playing phone roulette for the standard 45 minutes at silly o'clock, only to be told that 2 (non consecutive) days of the week the phone lines open 30 minutes earlier, so there was nothing left. You can book nothing ahead, ever, are triaged first by a receptionist and then with a second call from the GP before they will consider seeing you. They close for 2 hours at lunch, don't answer the phone after 9am and won't give results except between 2 and 3 which was a mission in the days I worked. You cannot get in the door without an appointment and there are signs up everywhere to let you know you'll be chucked off their books should you disagree. They never read the notes, often google symptoms and in my experience don't actually listen.

Meanwhile, because I've not guessed the right time on the right day I've got two sick tinies, a school run, a child with pus running down his face from a perforated eardrum and the receptionist says well go to A&E or try again tomorrow. Their phone line reads a 9 minutes recorded message about covid precautions out every single time you ring before you get the option to go to reception.

111 had me booked into a local paeds clinic with proper parking) for 9.30 after a 7 minute assessment call. We were called in at 9.31, in the pharmacist by 10. The paeds clinic examined both children properly, despite only having an appointment for 1, took 20 minutes to go through everything, chatted to the kids and made it all extremely pleasant. I know where I'd rather go, and it's not the GP.

@alanabennett
That sums up the general British attitude to the NHS - you don't know how shit it is because you haven't had anything better.

Thats really patronising and not true at all. I lived in the US for fifteen years. I noted you did not mention how much $$$$ all this “great” care cost you? When I left it was a minimum of $400 to call an ambulance and the dispatch decides whether to allocate you one or if you have to somehow make your own way to a hospital. I’d also gone to ER with a suspected heart attack and even though the ER doctor told the nurses to give me blood thinners…I was never given them. He also said I needed an EKG immediately…which I got after 6 hrs of waiting in bed in a bay and it showed episodes of unexplained tachycardia. Eventually whatever had happened sort of petered out and I was discharged late at night with no diagnosis, no medication and no follow up. Never admitted to the hospital. And because I’d gone to an ER and was not admitted my $250 ER Co pay was raised to $3500. And I supposedly had “gold” health insurance…..certainly cost the Earth as it was a premium of $1400/mo for self and family coverage.

Getting an annual squash your tits to paste mammogram for only $20 when you’re paying all the rest hardly seems to show that the NHS is “shit.”

Oh, and I had a US doctor treat a knee injury this doctor supposedly was #1 in the field as he did all the Olympic athletes for the US team. He fucked up my knee such that I was on constant steroid injections, several (botched) surgeries and had to wear a knee brace. It wasn’t until I’d got back to the U.K. and seen a proper NHS orthopaedic surgeon that my knee was properly treated and I could walk and exercise again with no brace and no pain.

The same with my DHs frozen shoulders. One was corrected by a US surgeon and still gives him problems. One by an NHS surgeon and that shoulder is fantastic.

This is true about payment being made from taxes/paychecks, but I still think a nominal charge would do much to dissuade time wasters (of which they are many).

The irony is that people often talk about the cost of US healthcare, but as I mentioned, I pay around $200 a month for 4 people. If I lived in the UK and earned the same salary, I'd be paying NI contributions of £473 a month - around 2.5 times more than I pay in the US. For far inferior service.

Oh, and my BIL in the US has just been diagnosed with stage III lung cancer. He hit his lifetime cap on his health insurance a few years ago when he had open heart surgery so they’re not covering shit. So he’s pulled $10k from his 401(k) (a type of defined contribution pension pot you get through your employer) and his plan to pay for his chemo is to gamble the $10k and win enough money to pay for his medical bills. I’m 100% serious. Whether or not he has a chance to survive lung cancer hinges on his luck in a casino.

But the NHS is “shit” apparently.

The irony is that people often talk about the cost of US healthcare, but as I mentioned, I pay around $200 a month for 4 people.

That cannot be all you pay for healthcare. $200/mo would be a HDHP where you’d have a ton of out of pocket costs if you didn’t have good luck with your health.

I am baffled as to why the GP holds the power of all referrals. In my country you pick up the phone and call whichever specialist you need to see. You can use the gp to diagnose but other than that you can go directly to whoever you need

Because as I discussed upthread, the model in this country is that GPs manage a lot of stuff that is managed by specialists in other countries.

I’m a nephrologist. Current wait to see me in a new patient appointment is 4 months. My clinics are normally overbooked by 4-5 patients (ie an extra 25% of patients squeezed into each clinic, due to lack of consultant capacity). There is no give in the system whatsoever. If I saw every patient with CKD currently managed in primary care, you’d be waiting a good decade.

We have national guidelines on who needs to be seen in secondary care and who doesn’t - if a GP refers me somebody who falls outside of those guidelines, I usually reject the referral (unless there is a very good reason to reject the referral). Or I’d be swamped, and have no space for actual emergencies to be seen urgently.

On the plus side, if I get an actual emergency referral, I will stay late and see them same week as another overbook. Or pick up the phone and see them same day in A&E.

It will be her contribution, not the entire cost. The company she works for will be kicking in the other, usually significant, percentage.

If she leaves her job she will become liable for the whole cost under COBRA, which usually is immediately unaffordable. Her costs would go from the $200 per cheque to several thousand per month for the same coverage - coverage she is only entitled to keep if she can afford it, and until COBRA runs out, which is a maximum of 18 months.

There will also be an excess, deductibles to meet, and of course co-pays.

I’ve done the US health insurance thing. It isn’t pleasant.

Yes, you're correct. The point I was making (perhaps not very well) was that the base level contribution I make is less than I would as a UK taxpayer on the same salary.

my insurance covers 80% of all healthcare charges, with an annual out-of-pocket maximum of $7,000 I believe. So I won't pay more than $7,000 each year regardless of what health issues befall us. My daughter's spinal surgery, plus a 4-day stay at the Mayo Clinic, cost us about $5,000 after insurance. Which, had we needed to, we could have paid in installments. It's not an ideal system at all - but if we'd been in the NHS I'm sure she wouldn't even have been referred for surgery.

Underfunded, people vent. There's also A LOT of threads started by the propaganda machine to pave the way for ditching the nhs.

My family has had generally good experiences of the NHS, but found it to be behind the times in terms of the care available to us in the EU or during significant stints of employment in America.

I don’t recognise these Americans who hop off the plane demanding antibiotics, etc. But then DH and I each always had free membership in what is called an HMO, a kind of mini NHS. Each of ours was centred around a superb university medical centre (that would refer out any rare things they could not treat) with a network of GPs and community paediatricians throughout the area as well as community dermatologists, psychologists, etc. Standard of care was high. A current example is that Americans over 50 are now getting their second free COVID booster whereas we are just gearing up to offer it only to those over 65. (Clinically vulnerable are eligible in both countries.)

Each of us has a serious but easily managed condition. We got the original referrals and treatment plans in America and both had to deteriorate upon returning here and then endure a long wait time before we could restart. It was as if we weren’t believed because we were doing so well with treatment. Isn’t that the point?

They probably don't do NHS work