Are GPs ever going to get better?

[KassandraOfSparta]

Just phoned my GP to try to get an appointment as I need to see/speak to a doctor. First appointment was a telephone consult in a fortnight.

My issue is indeed something which probably can be dealt with over the phone but if it hadn't been, wait for 2 weeks to speak to someone and then wait again to be seen in person? Is it any wonder people are going to A&E and queuing there instead?

(And before anyone pipes up, yes it is something which needs a GP. I sat through several repeats of the "if you have an issue with your eyes, see the optician. Pharmacists can help with minot ailments" message. Also to preempt the other common question, no online anything, just a webform to fill in for a repeat prescription).

Out of interest, how much is a private consulation with one of those online GP things and a private script? Starting to think things are not evern going to improve.

I'm curious to know why they're gate keeping my access to a private specialist

As a pp said, that's the insurers' requirement. You can go direct if you are paying. But a lot of private healthcare insurance providers now provide access to a GP even if it's only via video call, so you can circumvent your own GP if you want a referral and can't get to speak to anyone. My DH managed to do it via e-consult though - he filled in the form, said he wanted a referral and the GP phoned him and then did it.

@Topgub I'm not being sexist - I am saying that none of the workforce plans take account that most GPs training these days are female and want time off to raise families and want flexible working.

So in the past my GPs surgery had 3 full time Drs (all male) plus one part-time female GP. Now there are 9 part-time female GPs. Surely you can see that more people therefore need to be trained, it will take longer for them to become trained if they have time out to have families, and that there should be more incentives to get people to train as GPs (at the moment medical students tend to go into other areas as they pay more).

If we don't acknowledge there has been a change to the workforce how can we ever address the issues.

I apologise as I'm not answering all of your points but not everything here is inefficiency. A lot of rashes can be diagnosed with a history and a photo and many patients prefer to have this done over the telephone (or even email with eConsult). If the rash turns out to be something less common and the patient has to come back, this doesn't necessarily mean it would have been diagnosed first time with a face to face consultation - rashes tend to evolve and time / lack of response to a certain treatment may be needed to confirm the diagnosis.

Re. recapping - it's good practice to hear things from the patient's own point of view and to check that the patient's understanding matches up with what has been documented. Anyway, if a GP has 10 minutes for a slot and needs to spend 5 minutes reading/recapping, this will all be done in the same time slot. Taking 5 minutes to read without the patient will just take 5 minutes off of the patient appointment so really it's just down to whether patients would rather have a shorter app where they talk less or a longer app where they get to recap - that's just down to patient choice rather than efficiency.

When do you propose smears should be done? It seems rather sexist to not offer appointments around school run time!

@GelatoQueen

It is sexist to presume that females want time out and males dont.

We should be encouraging male gps to take time out for their families too.

Not implying that female gps doing it is the problem.

Also, I'm sure 9 part time females are more than equivalent to 3 full time males

its a joke in our profession that when people retire an item on their bucket list is to start a boundary dispute….

I think most people using or working in the NHS would welcome a 'throw money at it' approach. I'l bet you go private anyway OP. You're doing the Tories' dirty work here, after all.

Does your surgery have the e-consult option via their website? I have been finding that very useful and it is my "go-to" now. I don't have to fight through the receptionists at all these days using that. The GP responds to my query and has been a face to face where it was needed.

You can’t use steroids long term so the stuff on script from a GP is very short term use

Still needs a GP though. As does having an operation to sort them out.

Some of these problems can be helped if not completely solved by better systems . Some practices have poor levels of technical support and , partly because of the time investment they are reluctant to try and change . One of my dc works with GPs in this field and he says a lot of the staff are very reluctant to make any changes at all. Many places still routinely repeat processes many times rather than use the technology available, they often have too few telephone lines and refuse to use databases preferring to re type stuff.

A classic example is telephone appointments, at my GP a telephone appointment is for a set time just like a f2f . Yes they occasionally run late , as do f2f but there’s none of this ‘it will be sometime in the next 7 days’ , which my mum was told at hers …. She missed it as was in loo on day 4 and was put to back of queue.. . My Practice also reminds you by text and provides a link to cancel and amend and also gives you a 20 minute warning before the call …, all of this is automated ( just like a hairdresser etc) . They also use social media to let you know if the surgery is closing, remind you to book for flu etc , and provide tips on Instagram reels, Facebook etc on managing common health issues .

Yes it does. My point was that even something 'minor' (sorry to those suffering from piles, I'm not minimising) like piles cannot always be dealt with over the counter.

Plus, some pharmacists are better than others and you can find some perplexed when they're asked for advice.

I agree @cyclamenqueen - the systems are often not fit for purpose but there is no appetite for change. My DF was referred under TWR to the breast clinic, waited patiently at home, nothing for 3 weeks, rang the breast clinic. No referral for you - go back to the GP. GP said they sent it. After some more blame tennis, it transpired that the GP “had sent the referral on the wrong system”.

TWR referrals are amongst the more time critical of GP work - and there should be zero margin for error. Nobody apologised and nobody gives a fuck, because NHS. DF is still awaiting her 2 week appointment 4 weeks later, having been very sternly told that a GP fuck up is no reason to be put to the top of the queue.

Yes! Our GP turned it off, as too many people were using it!! You couldn't make it up.

Some people in this thread have made very pertinent observations about inefficiencies in healthcare that they have experienced and have made very relevant observations. However, the difficulty comes in making a system that works for everyone. Some patients prefer telephone consultations as it is more efficient for them. Some would much rather be seen face to face. Many really like eConsults (which I think are great) but some do not have the technical skills to use them and some do have the technical skills but do not feel they should have to use them. Some people are perfectly happy to explain their symptoms to a receptionist so that they can be triaged, some are not. Some do not want appointments around work hours, some do not want appointments in the evening as they have children to look after or other things to do. I have known surgeries that have found that they have far more cancellations and no-shows if they hold surgeries outside of the standard times. Some patients feel confident navigating secondary care and feel that they don't need primary care at all. Many do not and appreciate having their care coordinated by a GP. How can a system be designed that suits everyone?

As an aside, I also do not think it is the role of GPs to compensate for inadequacies in people's employers. People should be given time off work for healthcare appointments. People should not need a GP appointment /doctor's note (if they are in the self-certify period) /a prescription for antibiotics to prove to their employer that they really are unwell. I was amazed when I was a junior doctor in GP how much poor mental health was really related to terrible bosses! A lot of conditions seen in GP are conditions that will naturally get better with some rest and time, but I'm not sure people are given the resources to do that. I'm not sure what the solution to that one is though...

www.dailymail.co.uk/debate/article-11233171/We-need-public-inquiry-Britains-broken-GP-writes-retired-doctor-MARTIN-SCURR.html

DM article for you, yes I know, but it is a good summary.

What do you expect the Practice to do, if they do not have enough GPs to deal with econsult, as well as everything else? It is impossible to recruit, or even to get locums, in many areas.

No doubt you would also complain if the Practice reduced appointments, to give time for econsult. Econsult does avoid the need for an appointment in a minority of cases but, most of the time, it is extra work. There is no one to do it.

Tackling a shortage of GPs is going to take a while. There is also an issue in Scotland that higher rate rax payers pay more tax than counterparts in other parts of the UK so there is no incentive to work in Scotland, you're better off in England or Wales, or N Ireland.

Short term what I would like to see my GP surgery do:

Drop the Covid messaging and open the surgery doors again.

Allow me to send an email rather than having to ring - or a webform where you can describe your issue and someone decides whether you need to be seen by a GP, or the nurse, or need a referral to hospital, or a specialist clinic or whatever.

Have an option of video conferencing for the "show and tell" style appointments to cut down on the doubling up of appointments, first by phone, then being asked to book a face to face.

Stop doing smears/contraception/baby immunisations/6 weeks checks and direct women to the local specialist health centres / HV hubs where they do nothing but these things. Doubling up of time/resources.

Think beyond the 9-5, Monday to Friday model. If you are ill where I live evenings or weekends, it's A&E or nothing. No such thing as a "walk in centre". Closing on a Wednesday for example and opening on a Saturday instead might be much more useful for a lot of people.

@KassandraOfSparta

No incentive to work? What a load of rubbish

For everyone of your suggestions there will be someone who doesn't want things done that way.

Especially the idea of gps not doing smears etc

It would also be extremely unusual for there to be no out of ours service.

Nhs 24 runs nationwide for a start

Also, make better use of pharmacists. Already in Scotland pharmacists can prescribe short 3 day courses of antibiotics for UTIs. This is not a well publicised system. Pharmacists should be given the ability to prescribe in more situations.

People don't like change full stop. But people aren't particularly ecstatic about having to wait 2 weeks to speak to a GP on the phone either.

If you are ill where I live evenings or weekends, it's A&E or nothing.

Are you rural @KassandraOfSparta
Does a toddler with an ear infection on a Saturday night have to go and wait in A&E???

I'm Lothian and at weekends we ring NHS24 and nurse rings you back (some time later). If they decide you need seen an appointment is made for you at the GP out of hours centre, which is at local hospital but definitely not A&E!

My practice is usually good, but I hate the reliance on phone appointments.
i can get a same-day appt if needs be, but it’s 2 weeks for a routine one.

No I'm not rural. Suburban.

Last time I called NHS 24 or 111 or whatever it's called I had a raging UTI, I knew I had a raging UTI, the pharmacist had refused to prescribe because I had blood in my urine, I was running a temperature and could barely move. You phone NHS111 and reassure them that you are still breathing, wait 8 hours for a call back, and are then asked to attend a health centre where nobody is expecting you and wait another 2 hours to be seen. Then schlepp half way round Glasgow looking for a pharmacy to dispense the prescription.

@KassandraOfSparta

So not A&E or nothing then?

What were you expecting? A gp to visit your house and bring the antibiotics with them?

Clearly not.

But asking someone to attend an out of hours in a "cottage hospital" style location and then prescribing something when there's not a pharmacy on-site (or even one within 5 miles open at 11pm on a Saturday night) seems a little lacking in joined-up thinking, no?