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.

@SleeplessInEngland and yet the NHS in Wales (under Labour) is completely fucked and in much worse shape than England? We live hours from the Welsh border and yet DH’s hospital constantly asks for volunteers to go and help sort out the mess with extra clinics.

Brown pissed money at the NHS with zero increase in productivity. Mercedes and BMW did pretty well out of it though, judging by the consultants’ car park at the time.

That's a lazy and overly simplistic view. Yes, politics contributes but it is abundantly clear that some gp practices are considerably better than others. If some can perform well, why can't others? We need to stop deflecting the attention away from local health teams. They could and should be doing better and need challenging

You are assuming that all practices get the same resources, so that any disparity in quality is due to poor practice management. That is not true. Practices in more deprived areas receive less income and find it harder to recruit. Practices in deprived areas average half the number of GPs (per 1000 population) of richer areas, yet patient demand in those areas is highest.

Take 2 practices with 8,000 patients.

Practice A in a wealthy area would typically have 4.5 whole time equivalent GPs.

Practice B in a poorer area would typically have around 2.25 whole time equivalent GPs.

The average demand for GP appointments per year is 5.5 per patient, so 44,000 appointments per year, if you have 8,000 patients.

In Practice A, each GP needs to provide 9,778 appointments a year, or about 217 per week, allowing for annual leave.

In Practice B, each GP needs to provide 19,556 appointments a year, or 435 per week. Even if each appointment lasts only 10 minutes and they never have any breaks, that's 72 hours' worth of appointments every week per GP, without even factoring in home visits, prescriptions, blood results, phone calls, referrals, paperwork and meetings - all those other things take at least 3 hours per day.

Can you see the problem?

In fact, the situation is actually worse than that because Practice B probably actually has a higher than average patient demand.

So challenge away, my friend. Come to my practice and explain how each of my GPs can do 84 hours' worth of work per week. We're all ears.

The receptionist warned me about this - they call from a withheld number for privacy reasons but that puts people off answering.

It's not that patients aren't bothering, it's more that you book it 2 weeks in advance and say that yes, afternoon of 5th Oct sounds fine, and then something happens and you forget or get caught up in something. If you were going to the physical doctors you'd probably set a reminder, but not for a phone call.

@KassandraOfSparta

Ah c'mon

That's a complete cop out.

So entitled. Up there with claiming you're far too busy and important at work

🙄

This is so depressing.

I haven’t been able to get a face to face appointment at all for a number of issues, but it’s not just the telephone consultations that are sub standard, it’s the whole nature of the service.

I can only ever get an ‘appointment’ during the day. They never have anything after 4pm. Then they don’t call when they say they will. So I’m carrying my phone around work expecting a call at, say, 10am and finally getting (or sometimes missing) a call that finally comes at 11.30am.

I had to have an ‘appointment’ about menopause symptoms in the toilet at work the other day as they didn’t call when I had somewhere private to talk arranged.

A couple of years ago I could call up, get a non-urgent appointment booked in within 2 weeks and they could offer me a few different times. I don’t understand what has changed so drastically.

I went to pick something up from the chemist within my surgery on my day off last week and it was empty. Not a single soul in the waiting room, when it used tp be full all the time. There were still a number of staff in the office on computers.

What’s actually going on?

12 years and it's still Brown's fault. Does whatboutery have a statute of limitations?

But no, you're right. After this many years of degredation we should continue to hope tories magically decide to give a shit. I'll be holding my breath and keeping my fingers crossed.

But if every GP worked full time the number of patients that they needed to see each day would fall accordingly. If your GP practice had 5 GPs working 3 x 12 hour days a week each and each saw 200 in their three days, if they all worked a full week, they would still see not much more than 200 patients a week, but they would be spread over a full week not three days and so the GPs wouldn’t have such a hectic time of it and wouldn’t have to do such long days.

That’s the logic of a management accountant for you. Why doesn’t it work in practice? Where is the flaw in this argument?

No.

The phone call thing is a real bone of contention of mine. I was desperately waiting for a call in the morning. Lunch came, no call, called the surgery “oh they tried to call you” I genuinely had no record of the call and had been sat by my phone. I suspect my signal dropped out (but even then I usually get a text). When I finally did speak to a GP they were v concerned and invited me in. It took a whole day. I cancelled my plans with my kids so I could be sat by my phone. Luckily it wasn’t a working day. Just ludicrous to expect people to clear their diary for a fleeting call and drop them off the list if they don’t pick up in that, what, 4-10 second window.

A GP practice in a wealthy leafy suburb/area is bound to be able to offer a better service and attract more GPs and have less long term poverty related illness.

An inner city practice will find it far more difficult.

The bottom line is the Tories do not care about health services, be it GP's or Adult social care, they see tax cuts and banker bonuses as more important.

They have been in for 12 years, plenty of time to have made a start on dental & gp's etc etc.

I’ve had the opposite experience. When I lived inner city I was at a fantastic practice. Was able to get an appt when I rang at anytime of day - even for the FOLLOWING DAY. Which just isnt possible at my current, leafy suburban practice.

@Topgub nothing to do with being busy and important. How are teachers supposed to see a GP these days?

What about bus drivers?

A four hour window is not workable. The GP’s need to do better or we need to be able to bypass the bottleneck they create. (And yes I know secondary care is fucked as well).

@SleeplessInEngland you suggested a change of government would help. There is recent evidence to suggest it didn’t.

Its not a Labour/Tory issue. My preference would be for a cross party committee to set up the best available alternative. I would happily co-pay for a French/German service, but not for more mediocrity from the NHS.

I agree, I don't think the model works.

We need access to specialisms more easily. For example, if you were the lady who's had a never-ending period for 4 months (on another thread today), do you really need a GP? No, you need gynaecologist or a para professional in that specialism to assess you.

Many people don't know what's wrong with them - they need to see a GP (and maybe pay a small amount). Others do, and should be able to access care direct.

And I think we need to pay insurance and the NHS needs to be for A&E, maternity and life-threatening conditions. If you want a knee replacement so you can keep on running, you claim on your insurance. If you need a cataract operation, you claim on your insurance. If you have a heart attack or cancer, the NHS treats you.

@Deguster
Are you implying teachers and bus drivers aren't busy or important?

How did they manage to get a gp appt when its f2f?

Tbh a lot of these attitudes is why we're in the mess we're in.

Everyone wants to snap their fingers and for everything to be done to suit them. Now. Immediately.

And then completely ignore all the valid reasons why that's not possible.

Are you sure you'd pay more for a fench/German service? They have about double the number of staff and hospital beds we do.

They're struggling now too. And have no plan of how to pay for elderly care either.

@HotDogKetchup When? not all inner cities are not poor struggling places & its not born out by the data.

Brexit caused many EU professionals Dentists, Vets and GPs to leave the UK.

Its funny that so many of these issues have really come to the fore in the last few years.

If people want better access to health care they're going to have to pay for it.

All this, oh let's have a European system is all well and good until you actually cost how much

As it is, of you want private, now, in the uk, you can!

Literally nothing stopping you

Except....

You dont want to pay

🤣

@gatehouseoffleet What happens if you need a knee op to keep you at work? have you any idea how much private med insurance is???

& ALL areas of the NHS have shortages of staff across all specialisms, including gynae

Well as others have said there are real barriers to that. I need to speak to my GP about having my HRT meds changed. But as others have said, private GPs are more set up for the "one-off" problems rather than something which is going to need an appointment or new script every 3 months. And you can't see a GP privately and then be referred into the private sector - although the NHS has referred me privately no questions asked in the past.

And yes, I pay so much into the tax pot, I resent paying twice over. Once for a non-functioning NHS, once privately.

I was inner city until 2018.

@KassandraOfSparta

Your tax isn't paying just for the nhs.

Very few people are net contributors.

Most people take out far more from the nhs (and the state) than they ever put in.

Especially in old age.

So I doubt you'd be paying twice.

the impact that patients not attending appointments has on the NHS must be catastrophic

But people can't get through when they try to cancel. I am sure there are some lazy idiots who don't bother to turn up, and you always have the elderly who forget, but nobody ever answers the phone. So you either have to turn up despite eg feeling under the weather, or just not go. The quickest and easiest way to improve this would be to allow people to cancel online and allow people to make short notice appointments if a cancellation appears. And of course employ enough admin staff to answer the phone!

You can throw all the money you want at it but the fact is that there is a massive shortage of GP’s and a large population that they have to look after. Tbh I wouldn’t want to be a GP. They are constantly savaged by the public who seem slightly clueless to the pressures and expectations on them. There are of course some appalling GP’s but largely they hard working and are looking after more patients than they can deal with.

There are so many things we could do to improve the nhs that wouldn't involve a 2/3/4 tier system (european)

Unfortunately successive govts see it as a drain rather than an investment.

They dont fund it properly or actually even understand how to make it work.

No one seems to be moaning too much about being burdened with 150 billion of borrowing for a short term fix which will have no long term benefit to the UK, its literally pouring money down the drain as in 2 years time, we'll be back to square one.
Gas will still be super expensive.

To have EU standards of healthcare wouldn't cost much more more but it would take a very long time to achieve as staff take a longing time to train, atm we have the worst of both worlds - an expensive NHS but v poor care.