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.

@Topgub that is literally the opposite of what I’m saying. F2F means you have an appointment at (say) 9am so you arrange 30 minutes cover.

As I’m sure you can work out for yourself, that can’t happen if you only have a vague 4 hour window within which you might receive a call.

That makes it virtually impossible to see a GP if you have a certain type of job. That’s the bit I’m not okay with. And it’s the GP as the service provider who is responsible for accommodating these patients.

Peoole do say they want higher funding like Europe - but that funding comes from us

You are right though there is a way to get that by paying. So if you think I want to put more in to get more out you can

As for op we’ve had a completely fine service, we do have private but haven’t had to use it and just use NHS GP

So the effects of Brexit and then CV had not yet really sunk in.

I dont agree all care is poor.

Most isn't.

And this huge element of entitlement is a massive part of the problem.

People want the nhs to fix all their problems for free (at point of use) right now.

Its not possible.

My experience in this particular practice was vastly different from my experience of outer city practices both before and after. Maybe it was just an exceptional practice.

Going back to the OP - if you can access private healthcare. Personally I do, because I’m in the fortunate position where I can afford to.

I haven’t tried a private GP appt but definitely would in the future.

@Deguster

Because f2f appt never run over or late either

4 hour time slot isn't ideal but its not impossible

Once your in the system, care is often excellent but around 7million people are waiting at least many months and in many cases 1 or 2 years to get that care.

Ambulance and social care is not of developed country standards.

Charge for AE, GP & Consultant appointments, most countries in EU do, with exceptions for the elderly poor etc would be one way to get money into the system BUT as with eye or dentistry, it doesn't guarantee affordable care.

Funny you should say that, I saw an advert on NHS jobs the other day for a surgery wanting an ACP to work in a Community Matron type role. On the person spec they wanted the full Advanced Clinical Practice MSc qualification but only wanted to pay Band 6 - and that was dependent on experience and qualifications.

Fully qualified ACP’s on Agenda for Change get paid band 8a with opportunities to get 8b, 8c or 8d if taking lead ACP roles, etc. But in acute hospitals the ACP’s work on the Registrar rota and should be competent to manage the full complement of scenarios arising in their speciality, especially if they’ve been through a credentialling process with one of the Royal Colleges.

How on earth can surgeries expect to attract competent ACP’s on a band 6?

Is there a misunderstanding in Primary Care of the scope and competencies of ACP’s? Or the differences between a fully qualified ACP and what would be referred to as an ANP? Do GP’s and practice managers assume that an ACP is just a nurse or paramedic with a minor illness + prescribing module under their belt?

What a terrifying concept you describe. Good healthcare is holistic. What if the raging osteoarthritis in your knee renders you sedentary and obese, thus increasing your risk of a heart attack? What if you have COPD and can't afford regular private healthcare for this chronic condition so end up frequently presenting to A+E with exacerbations? What if you have lived an exceptionally healthy lifestyle and have never needed A+E care, but develop cataracts and can't afford to pay for surgery? What if you become suicidal due to your preventable blindness - is the treatment emergency mental health treatment or is the treatment cataract surgery? Many, many things that we do are life-improving rather than life-saving. Why on earth should people be willing to accept seriously limited mobility or preventable blindness? We can and should be able to fund a decent healthcare service.

@Topgub youre just being obtuse. Ofc F2F overrun but you can mitigate that by getting the first appointment of the day or scheduling them for a time that works. (Even the most inefficient GP’s struggle to run massively late at their first appointment).

Teachers cannot simply leave their class to take a call. Bus drivers can’t park up to answer the phone. This is not unreasonable entitlement - this is pointing out that our GP service is the primary care equivalent of a fucking Trebant.

FAOD I’m neither a teacher or a doctor, and I have private healthcare and unlimited private GP appointments through my employer. I am not brave enough to live without either in the UK because I have seen the NHS in action and it’s fucking terrifying. I have no skin in the game, but you’d still have to lobotomise me if you seriously expect me to agree that entitled NHS patients are the problem in this scenario.

We just need to start saying that to get on to a medicine course you have to agree to work as a Dr (GP or other) for the NHS for at least 20 years at at least 4 days a week.

Medical school places are 10 x over subscribed, training a GP costs the UK taxpayer £250k each (and I’d imagine other disciplines it’s similar) and the majority of Gp students say they aim to work part time. That’s one of the main problems causes of the lack of GPs in a nutshell.

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.

Before I start on the above - which I do think is interesting and possibly how things will move forwards, I wanted to share my experience. I am a high traffic patient at the GP (I am on immune suppressants and have multiple conditions.) Part of the issue for me is that you cannot get hold of a specialist when needed - e.g. I have called rheumatology 9 times, sent them several emails etc over a month and nothing. That department in my large local teaching hospital is falling apart and so I have to place even more strain on the GP for things rheumatology should be dealing with. Likewise neurology.

I had some tests done and need to see a GP urgently - according to the message I received. Next appointment - 3 weeks. Next door's baby had stopped feeding for 48 hours, high fever, screaming etc - next emergency appointment 2 weeks (they called 111). We compared notes and for urgent antibiotic prescriptions - there is a 5 day wait. Being rural, the practice dispenses for us and won't give us a prescription to take to the chemist who would have the antibiotics in stock - pencillin and amoxicillan. Friend's daughter ended up in hospital on IV Abs whilst waiting for dispensing.
However, at other times the surgery has been fantastic. I know they have closed 3 times recently due to covid outbreaks - patients had attended whilst knowingly having covid.

Insurance - this is rather like a US based system. However, I am aware from my sister who lived and worked there - the cost of insurance is astronomical and normally provided by employers. There are different tiers, providing different levels of treatment and vastly differing excess amounts for treatments. (Not to mention I am sure a lot of expensive and possibly bells and whistles treatments and tests are recommended as someone is ultimately making good profit out of it!)

Let's say we introduce an insurance system in the UK. I can't see any providers willing to take on those with pre-existing conditions without hefty and unavoidably high premiums. A number of conditions - diabetes, cancer, rheumatological etc can cost enormous amounts in ongoing treatment. One of my prescriptions costs about £15k a year. I would have to do without and end up losing my job and on benefits needing care if self-funding.

What I suppose I am trying to say is that whilst an insurance based system might ultimately work, I can't visualise the transition to one for patients with ongoing conditions.

This also brings me onto the point that I can't see a private GP for most things - unless it's a simple infection. A couple of them won't see me anyway as I have autoimmune disease and they worry about not having the full background.

Oh do shut up, GP criticisers. These threads are so very political. Even a cursory glance at current politics shows that GPs are stretched to breaking point. Why demoralise them further? Either you are Tories who want the NHS to collapse and this is an underhand way of feeding the narrative via social media, or you are a patient who is going to get a big shock down the line, even you're paying out for health.

Being rural, the practice dispenses for us and won't give us a prescription to take to the chemist

They can't do that, if they ARE doing that, they are in breach of god knows what. You, the patient, dictate how and where your prescriptions are dispensed. We are rural too and have a GP dispensary. I don't use it because they are effing useless. My prescription is sent to the local chemist instead.

Medical education and the foundation programs all need an overhaul. Junior doctors are treated absolutely terribly, paid so poorly and are subject to some really arduous and arbitrary policies and rules around taking leave, deanery allocation, etc. Not to mention all the issues of working in a broken system, with patients who treat them like dirt on their shoe and consultants who behave similarly.

I don’t know why anyone would want to dedicate their life to medicine, it is all so onerous.

I see lots of my nurse colleagues who have done their best to provide circumstances for their kids that enable social mobility and education that they didn’t have access to themselves, lots of their children have gone into medicine and are at uni or in the foundation program - every single one of those women says they wish they’d been able to steer them away from it, that they knew it wouldn’t make for a happy balanced life to become a doctor.

Yep! Some people should be very careful what they wish for!

It is not part time to work a 40 hour week
most GP’s are female and many have families. It should not be restricted that being a GP means you have no choice but to be forced to work ‘full time’ when full time means 70+ hours a week. Women campaign for flexible working rights day and night - apart from if you are a doctor it seems…

@Deguster

I said part of. You'd have to be lobotomised not to agree its part of the problem. Or completely ignorant of the nhs.

Interesting that you have faith in private health care but think nhs doctors are over paid and couldn't get a job in the private sector

I wonder where you think private hcp come from?

Also a but worrying you're ok with your oH working in and providing such a terrifying service

Charge everyone? Of every age? Or would children, those on benefits and pensioners (many of whom could well afford) all be exempt leaving the fines to the poor sods in the middle. Again.
I've just run a clinic this morning and my non attender was 86.
If you fine one you fine them all IMO.

I really don't understand why some GP practices cannot give an allotted time-slot for telephone appointments!

Mine has offered the option of telephone appointments for years, it was handy if just for something like a review of new medication.

But it was bookable just like a f2f appointment, and yes the GP could be running a bit late but never more than 20 minutes or so. So it's not discriminatory against people in jobs who can't just leave their post when the phone rings such as bus drivers and teachers as they are able to book the appointment for a time they are available to speak to the Dr

my whole point is that if every GP in the land worked at least 4 days a week, the hourrs worked per day would drop considerably as there would be more full time equivalent GP’s and therefore less strain on each individual GP. Full time 70 hours a week would be consigned to the past.

I think we can all agree 70 hours a week is unsustainable, but also unsustainable is someone taking a place on a medicine course, the UK taxpayer ploughing in £250k to train them and then them only working one day a week.

and yes I agree that we need to bring back bursaries for nurses and midwives.

@Topgub ignoring the insults, are you ever going to tell me how a bus driver or teacher can access primary care via telephone consultation?

@Deguster

How have I insulted you?

Bus drivers work shifts as far as I know?

And I'm sure if it was really important a teacher could make arrangements to have their phone on them and step out of the class for 5 min.

Also, not every gp has this system. Mine doesn't. So I'm also sure the gp surgery could make other arrangements (f2f, phone at a specific time etc) if the situation was explained.

Can you answer why you have faith in private health care given your views on nhs doctors?

Er, no. If you read my post more carefully, you will see I have referred throughout to whole-time equivalent GP, i.e. GPs who are working full time (40 hours per week on paper, though more in reality), not to head count. Whether a WTE GP works their 40 hours over 5 days or 3 days, they will still only have the same total number of hours available.

And you have not addressed at all the issue of a poorer practice having half the number of GPs. Or the fact that, when there is an unprecedented shortage of GPs, and when every GP has the option of moving to Australia or becoming a locum, you are hardly going to improve staff retention by forcing people to work full-time, if they don't want to.

As with most things, it's easy solving a problem on paper, if you ignore all the difficult bits. The reality is somewhat harder.