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.

It absolutely cannot be true that there is no OOH GP provision in your area if you live in England - there has to be cover. Unless you mean that your OOH GP service is physically located in A&E and then it’s proper route of access is via 111 during OOH, rather than self presenting to A&E.

Our OOH service is physically based in A&E but runs as a separate service, by a different organisation. Patients call 111 - their details are sent through to an electronic queue where you’re called back by an OOH GP or ANP and given a booked appointment. Our service also sees patients sent over by A&E triage who shouldn’t have gone to A&E in the first place.

Patients often think it’s the same whether you self present to A&E and get streamed to OOH as it is if you ring and get a booked appt. But it’s not, we prioritise the booked appts, they’re seen within 30 mins of arrival, whereas the self presenters are subject to whatever the ED wait time is - contractually and ideally within 4 hours, but in reality we’ve seen waits of nearly 8 hours recently - and that’s just on our OOH/Urgent Care queue - never mind the A&E main department.

@ZealAndArdour our local one is also based next to A&E but is definitely not the same service and is appointments based.

One of the issues is people sometimes think their problem must be very serious as "they've sent me to the hospital"!!

@KassandraOfSparta

Expecting a cottage hospital to have a pharmacy open at 11 on a sat seems ridiculous to me. Folks expectations in general seem ridiculous to me

🤷‍♀️

To be competent to prescribe (and do a prescribing qualification) you also need to be competent in top to toe physical examination (and have done a Top to Toe Physical Examination module), have a good understanding of the differential diagnoses, and a space in which to do all of this examination and consultation. Not all community pharmacists want that level of responsibility - nor will their employers support the costs/time needed to undertake training in advanced practice.

Lots of the pharmacist dispensed antibiotics are based on PGD’s - which means they have a very strict set of criteria which than can check against the patients given history of their illness and dispense only if they fit that specific criteria. The few medications they can give on PGD are assessed as having benefits which outweigh the potential risks of not examining the patient, and are for low acuity conditions. PGD’s have specific inclusion and excision criteria - in the case of blood in the urine that will be excluded as the local meds management committee who write and sign off the PGD for general use will want these patients to be examined to check for sepsis/renal angle tenderness and for other differentials to be considered such as Pylonephritis or Renal Colic or even cancers.

None of the suggestions are simple solutions that can be implemented rapidly. Patient safety and clinical governance are paramount in our increasingly litigious society.

It's not that difficult to understand... .

Why put the out of hours there in the first place? It's just making it inconvenient for the patients? It's like someone at the healthboard thought "oh, there are empty rooms in X hospital, let's stick it there, terrific idea" without actually thinking whether it's appropriate and accessible.

I really don't like this attitude that nothing the NHS does should be criticised, ever. Out of hours provision in my large city is awful.

I havent saidnothing should be criticised.

There's lots worth criticising. Health boards make the most ludicrous decisions.

But the bottom line is they have extremely limited resources with which to serve an ever increasing amount of demand.

You dont want ooh in the cottage hospital. Someone else will.

Can't please all of the people all of the time.

So when we come in on a Monday morning to find 250 eConsults sent over the weekend - many for trivia - which would take up more than a day of the time of all the GPs in the surgery - what should we do? Close the doors all day Monday to answer eConsults?

Retired doctor, now works only privately, knows sod-all about the current pressures facing UK general practice. Honestly, I can't respect anyone who links to trash in the Mail.

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.

If we stopped this stuff we would lose funding and have to make some doctors redundant, so that wouldn't help. Plus in many areas there aren't the community health centres to get this stuff done. Mum's post natal check is vital for spotting PND among other things.

You can have any two of :

• quick
• cheap
• good

You can't have all 3. So two weeks for a good quality routine appointment, for free, isn't bad.

@passport123

No one seems to want to acknowledge this

I'd also add that if you want cheap you cant have good.

lots of NHS care is good, and cheap. It just isn't quick.

It’s a good point generally although it must be by area as we’ve had quick and good service

But yes when people say more funding for the above it’s our funding they mean. Increases aren’t always welcomed, across parties

@passport123

I disagree

If we want good the salary of the people providing it has to reflect that.

Healthcare isn't cheap.

Cost effective is not the same as cheap

So when we come in on a Monday morning to find 250 eConsults sent over the weekend - many for trivia - which would take up more than a day of the time of all the GPs in the surgery - what should we do?

My student DD's practice only has e-consult available during surgery opening hours. Can't access it at other times.
Presumably to stop a load of drunk students sending them in on a Saturday night!

Our old one turned it off altogether but from what I can tell, they would rather patients don’t contact them at all. Avoid any Modality partnership practice!
Our new one has it switched on only in working hours which seems reasonable to me.

We don't do econsults at all. There are only so many consultations we can do a day by any method.

In England, pharmacists to save the day and enable greater availability of same day appointments?

The problem with targets like these are everyone gets lumped in together, 2 weeks for a chronic mild condition is fine, but 2 weeks when unable to work, is quite another, so people clog up AE.

We've come a long way since Labours 2005 target of 2 days :(

But it doesn't solve the problem as everyone just goes on the phone. For minor issues myself and DD's have all now gone to on-line GP's. Most of the youngsters I know, now no longer bother with GP's. GP's have to get on board with the modern world, and adapt accordingly.

Actually most healthcare systems do have GPs/Family Medicine doctors. The split of responsibilities might be different (ie Americans seeing a consultant gynaecologist for a smear instead of a practice nurse), but the overall concept is the same. And yes in systems where you do have completely unfettered direct access to specialists, you do hear often patients complaining that nobody has an overview of their health/they are passed from pillar to post.

The NHS didn’t invent GPs, and it would be utter madness to get rid of them.

I had an utterly wasted appointment with a GP from my surgery recently. Didn’t even know it had been arranged until I logged into the NHS app to order a repeat prescription and saw an HRT review had been booked in.

I rearranged my day to accommodate the time given but didn’t get a call. I did however get one the day after from a GP who was unable to answer a fairly basic question, couldn’t do simple arithmetic to understand why I would need more gel after increasing my dose and gave me utterly incorrect advice. Completely pointless and she was doing these reviews all morning apparently. Why couldn’t their GP who specialises in menopause do them.

A waste of time from a surgery who is so busy you can ring in excess of 200 times when attempting to get an appointment.

Coffeys ABCD announcement today show very clearly nothing will change, just more unmanaged decline.

If your GP cannot met the 2 week appointments plan, the sanction is that the patient should leave and go to another practice...

Nothing for carers or NHS staff.

unmanaged decline seems charitable. deliberate, planned decline progressing as intended in line with key stakeholders' interests.