To think that people have become completely incapable....

[memorial]

Ok so I'm a GP (yes yes I know I could be anybody) and have been for over 20 years.
But bloody hell our society have become completely and utter incapable of any kind of self care or self responsibility. I have never known anything like the kind of demand we are facing. And I'm sorry most of it is just complete and utter nonsense. Over and over again.
Genuinely ill and needy people are being lost in the deluge. It's absolutely impossible to offer any kind of decent care. And we are losing doctors, nurses and staff rapidly. And we cannot recruit. It's not about pay It's about absolutely ridiculous workload and risk.
Yes the system is broken yes we need more of everything.
But every single thing does not need GP hand holding. It doesn't need 2 page complaints because you didn't get what you wanted when you wanted it.
Some days I just think people won't be happy until I go and wipe their arses for them.
I'm done. And it's not just me.

I'm not in favour of charging for an appointment, but I am in favour of surgeries/hospitals taking people's bank card details and then charging them if they don't show to their appointment without getting in touch to cancel it.

Another good point.

We're being utterly bombarded with constantly catastrophic information. No wonder unease and anxiety is increasing. It seems the media gets off on it - it's revolting really.

My dd did work experience at a GP surgery recently, as she is planning to go into medicine. It was a real eye opener for her. IT didn't put her off, but it certainly highlighted the fact that you have to really want to do the job in order to put up with the incredibly pressured working conditions. She was really struck by how incredibly hard they were working in order to meet the almost impossible levels of demand, and by how much abuse they got when they were trying their very best to help.

Our own GP surgery has always been lovely but dd's experience made me appreciate them all the more for the incredible job that they're doing in almost impossible circumstances. Yes, it is hard to get an appointment sometimes because there isn't enough resource in the system - and yes, because some people don't help themselves as much as they could - but none of that is the fault of the GPs or the receptionists etc.

OP, I would just like to say a huge thank you for all that you do, and to say that many of your patients do really appreciate it, even if they don't always think to tell you this. I am sorry that you have to work in such challenging conditions. Our society needs more people like you.

Schools ask you for GP letters to support any claims towards SN/extra time/anxiety, so what are parents supposed to do? We need medical proof.

GPs are at the nexus of multiple social problems (e.g. housing, poor diet) and institutional problems (e.g. SEN budgets cut, no dyslexia diagnoses etc).

To get ADHD diagnoses you have to be referred by GP to psych, unless you can pay to go private.

GPs are used as gatekeepers by government for so many purposes. In some countries they simply don't have GPs and patients book directly onto the speciality they need. There is a lot of pharmacy/herbal use (e.g. Germany).

Perhaps the GP system itself is the problem?

I'm sorry, I know this must be very frustrating and I can understand the burnout.

I wonder if many people presenting with these minor complaints also have some low-level MH difficulties (especially given the crap time the world is having lately), perhaps compounded by social isolation, and going to the GP with these minor physical ailments is a means of reaching out for help, even if it's not the most effective way to reach out or best use of the GP's time?

I think it's also important to remember that it's easy to expect people to look for information for minor ailments and injuries first, but the sheer wealth of information (and misinformation) out there, much of it contradictory, can make this very overwhelming ... hence the desire to get it straight from the GP's mouth.

And of course some people are just irritating timewasters, but they're probably always going to exist!

the real problem is the system being so underresourced :-(

Aha! But it would be impossible to cancel it. The phone line would ring out. There would be no email address or it would go unanswered.

And that's if they'd actually told the patient when the appointment was...

The NHS's own studies on DNA admit the above are issues.

I had a health problem recently which started off very much in the range of the "normal" sort of thing you wouldn't see a doctor for. When it took a turn for the (much) worse, I called the doc and she called me back then had me in that day. Gave me a proper once over and prescribed medications - when that didn't work I was back in the following week again within 24 hours of calling. And so on. Under her care I eventually got better, and avoided having to go to hospital which would have been the next stage. So I do think good surgeries can triage who needs help, and get them urgent medical care.

The triage system is arguably what needs to change for OP? I move around a lot and the last few practices have all had a system where you speak to a receptionist, they line up a call with the doctor if they think you need one, and all that before you see anyone. Surely that helps? And the people with the sniffles/sore foot since yesterday get told to call back in a couple of days if it hasn't cleared up?

Also, when GP's refer on , often appropriately for things like mental health services, the services themselves are terrible. CAHMS has massive waiting lists, so with suicidal teen or self-harmer, people return to GPs as at a loss of what to do.

Got a child with an eye infection- go to the pharmacist, have to see the GP. Can't just get the blinking product over the counter.

I also think a lot of people don't understand the system as it's really complicated and different in different places. I use Minor Injuries for grazes etc. I know to do that. I also drive to A & E if I need to (we have a GP on site for 24/7 minor stuff),, would never call ambulance, but my dad does as he doesn't know how to access care.

I use pharmacies, Minor Injuries etc, as well as GPs, many don't as they don't know how to get care. Cue very harassed GPs...

The thing is these days is that hardly anyone wants to take full responsibility for themselves, you see it first hand all around and on this forum. They want a quick fix rather than a long term cure, because a long term cure takes effort and excuses are easier. People scoff at self help books and the self care attitude, then fall apart when life doesn't go their percieved way because they haven't done the work to become resilient.
l think you deserve a medal OP and how many are interested or empathic towards yourself ? l would imagine its all take take take with very little in the way of give and for all the ninety nine percent of things that go right it will be that one percent that is flagged up. My job involves working with customers and it can be utterly draining, l get the blame personally if an item has gone up in price, or been moved, or worse still discontinued, anything that goes wrong with their shopping experiance its all my fault, same complaint over and over again, l am praying to God our store goes solely online asap, it will be such a relief.
Good luck to you.

Our GP triage system is actually very good and I've seen a GP in person when needed, or phone call with a prescription arranged all on the same day as they weed out the rest. They seem to have a way of cutting through the unnecessary appointments. They are totally harassed though by the sheer workload but they wouldn't be seeing half the type of patients this GP sees, not in person anyway.

@memorial I hear you 💐. I was where you are 4 years ago. Last GP standing in a struggling practice, after the Lead GP walked out of the door one morning and never came back 😢. We were APMS rather than a partnership, so I was less financially entangled than you as a partner, but otherwise this is all very familiar. I was working 12-14 hour days, seeing my own full clinics, doing all the Duty Dr work and the vast bulk of results/letters etc, supporting the rest of the staff. The work was never finished, I would just stay until I was too exhausted to carry on and then try not to crash the car on the way home.

I finally reached crisis point after 2 years of this. I took a week of annual leave, with Locums covering, and just couldn't unwind at all, felt anxious all the time, couldn't sleep, worrying about what was going on at the practice. On my first morning back, 8 out of my 12 most complex patients were on the duty list before I even started, and in every case they'd been seen by a locum the previous week who had completely ignored the detailed management plan I'd written in their notes to cover my absence, and had done whatever was expedient to get the patient out of the room. Months of careful management undone in a week.
I was found sobbing 30 minutes later when the ANP came to see why I hadn't started my clinic yet, and I had to go home.

I was off work for 4 months, had some therapy from the Practitioner Health Service, and was formally diagnosed with severe Occupational Burnout. I went back (too soon in hindsight) with many promises from management about how things were going to improve, but nothing changed and 11 months later I burned out again and left the practice. The practice closed 2 weeks later. I still feel a lot of guilt that my patients were abandoned.

I have since tried two different salaried jobs, reduced my clinical hours, taken on an academic post which I enjoy very much. Earlier this year I realised that there is no practice that is not struggling, and I just can't do this any more. I have PTSD-like symptoms triggered by being in a practice environment. I worked my last GP session at the end of June, and I'm only just starting to feel my energy levels and mental equilibrium returning.

I have 20 years of experience as a Dr, 15 years as a GP. I'm too young to retire, but I won't be going back into practice again. It's been such a part of my identity that my feelings about it are a lot like grief, but I'm gradually coming to terms with the fact that no career is worth my mental health. I will continue to Locum in A&E (which is busy but nothing like as stressful, as no appointments and much less paperwork!), and do my bit to train more doctors through my academic role.

You sound very burned out already. Please don't wait until you hit crisis point like I did, it was incredibly damaging and I'm not sure my ability to tolerate stress will ever recover. We cannot keep general practice afloat through sheer force of will. If you haven't already, I would recommend doing a Maslach Burnout Inventory (I found it startling just how high my score was, when I thought I was 'on the verge of burnout' and was in fact already deep into it) and refer yourself to the Practitioner Health Service, they were so helpful in giving me space to process and reflect, and permission to feel how I felt (as you can see from this thread, understanding is difficult to come by outside of the profession).

You have done so much, stuck with it so long, please look after yourself now.

OP, I suspect a lot of the people making sarky comments are exactly the same people who think they need to see a GP if they cough once.

The NHS isn't fit for purpose, but that's not the fault of GPs.

OP, I think you sound like a fantastic GP, and we need people like you not to resign (though I can see why you might: I left a job in academia for similar reasons).

if people took some responsibility for their own health then the NHS would be fit for purpose.

It was not intended for a society full of long term, lifestyle related (in many many cases) conditions. These conditions require a massive amount of input and resources.

Our current eating/drinking habits and sedentary lifestyles will be the death of the NHS, before they kill us.

memorial thank you so much for starting and for continuing to post on this thread.
You give us a rare and, for many complainers, a much needed insight into what our GPs have to deal with, in dealing with both the NHS and its patients.
Thank you for your informative opinions, comments and statements, they are most welcome.

The comments about menopausal women are appalling.

We need more information and education about the menopause not less.

Just because many women suffered in silence in the past doesn't mean they should now.

I can imagine it's very hard.
In all fairness i have never had any GP related issues. I only really see them when DC have illnesses that aren't shifting, i get a triage call and the GP then usually asks to see them straight away. Interestingly when DS needed antibiotics recently i found it much quicker to see an nhs GP than a private one (im in SW london) as hardly any saw kids

It's different with little ones, they can't express or explain how they feel. They can go downhill so fast if they get certain conditions. Anytime you speak to pharmacists, 111 or Dr reception they will tell you to take them to a Dr.
Minor issues like dehydration can make small children very poorly so Drs would much rather see them and take preventative steps.

Thanks all for an interesting thread. Emotive on various fronts, there are some very informative and enlightening posts from pov of patients and HCPs.

And another thing to keep in mind ... many minor ailments would be fixed by people having time to take time off work (or caring duties) to take care of themselves by resting (or whatever it is they need, e.g. exercise).

But many of us don't feel we have the luxury of taking time off from work for a mere moderate illness or injury, and of course someone with caring duties may have no one else to step in. So we're desperate to get some medication or advice that will help us get through the day, rather than just letting nature take its course--or to have our GP confirm that we're really "bad enough" to deserve time off work.

And/or we have to pester the GP for a fit note to explain why we're not going right back to work. Which may also be a waste of your time, but is required by our employer.

Mine can be crap sometimes but what service isnt ,but by god when it’s serious they get you in like me no period for 3 years then bang a period and I was seen the next day at 8am as she came in early for me and referred 6 weeks later for investigation thankfully nothing sinister and same with my bowel habits so glad I didn’t need the camera up there.

I’m also diabetic and have good control but my GP still phones after hours to check on me occasionally she’s done this since 2015 by the way.

not all GPs are bad

I have a friend that goes for everything and I mean everything instead of starting at home oh no it’s I pay my taxes so I’m using my GP or worse A&E for minor things.

sorry your at your limit @memorial

Well I suppose there's a remote possibility that he's holding secret face to face surgeries in the middle of the night while telling his receptionist to lie to patients that he only does telephone consultations; playing a littke joke on the hospital consultant who wrote asking for a patient to be monitored weekly, to whom he replied by letter that he couldn't do so as he was not carrying out in person appointments; putting false information on his online booking system which gives no option to book face to face appointments...but, you know, Occam's Razor?

This is an interesting thread. I agree with the poster upthread - there’s a limit to how much you can care. A few people have said that the OP lacks empathy - it sounds as though her empathy has been a bit used up by people who want to be magically fixed.

I think part of the problem is that people expect those in “caring roles” - doctors, teachers and to some extent the police - to specifically care about them. They feel entitled to it.

When I see my doctor, I am his job for those ten minutes. He wants to do his job well but he isn’t going to give me much thought once I’m gone, unless I am extremely interesting in one way or another (which I am not).

I would agree it’s a mess. I have a relative who is a GP nurse and she has talked a lot about leaving. I think one of the biggest side effects of the current system is people dying from entirely treatable conditions because they haven’t kicked up enough fuss in comparison to others, and that is absolutely not how it should work, you shouldn’t have to hassle the system to be seen or get treatment, and people who consider themselves self sufficient are falling through the net.

I have lost 3 family members in the last year due to this specific reason, and I find it terrifying that if that’s just my experience, how big a problem is this.

The thing is, while there will no doubt be people who will want to go to the GP with any little thing, without waiting a while to see if symptoms disappear or seeing a pharmacist (still don’t understand how they’re getting so many GP appointments though) I do not this is very many people at all.

Most people seem to underplay their symptoms, bury their head in the sand, put up with pain, convince thdmselves it’s nothing and would rather be smacked round the face than have to see a doctor. It’s a last resort for most people that I know. And that’s due to a combination of not wanting to admit they’re ill, knowing it’ll be really hard to get an appointment, not wanting to have to get past the doctors receptionist, having to deal with an often miserable GP and sometimes not having money to pay for prescription costs. I can’t believe there’s many people that really want to constantly be at the doctors!

@memorial I completely agree with you. I have MS and I’m currently experiencing the delights of Tamoxifen induced menopause (no hrt for me). The truth is the biggest improvements for both those issues come from the things I can do for myself. So while Tamoxifen has blown my IBS up (previously managed by FODMAP), the hot flushes and IBS are much improved by not drinking wine and reducing carbs in my diet. Sometimes I choose to live with the consequences of a nice glass of red and some lovely bread, but it’s not a matter for my GP.

With MS, I’m always hearing from acquaintances that I “must have a mild version”. I don’t, I exercise, I chase up the support available through OT and neurophysio because no drug treatment can do what those things can.

I’ve even had an MS Nurse specialist disbelieve my symptoms and blame them on exercise as she appears to unable to comprehend anyone exercising through pain or discomfort, therefore there is nothing wrong with me. Fortunately my GP appreciates my efforts and was invaluable in getting me on the right pathway to the support I need. When my back hurts (and it’s had me unable to stand at times) , I get the physio gear out.
I think many people expect magic bullets in the form of prescriptions, and it’s an unreasonable belief. The idea that they might change their lifestyle is out of the question.

I’m sorry you’re in this position - my personal experience and that of friends and family in healthcare is that it’s the most competent who are worst hit by the stress of the current problems. I’m afraid of how the system will worsen as the best leave. But when people close to me were in a similar position as you I urged them to get out, take care of their own wellbeing, no one else will.