To ask where have all the GPs gone?

[Lolacat1234]

Got sent to an "urgent care walk in centre" by 111 today because my 3 year old daughter has a high temp and was very unwell earlier today. Got there and very soon realised I had been sent to A&E, there is no such thing as an urgent care walk in centre, it's just another name for A&E. Sat there for 6 hours before deciding she needed sleep and her own bed and that I would try my GP surgery in the morning. Please no comments about I should have stayed, when I left there were 25 people ahead of my daughter and I had already been there 6 hours, she had lost it and was having a breakdown. My instinct said it was OK to leave, dose her up and reassess in the morning.

As I was leaving (I was the 3rd mum with a sick child to give up and go within half an hour) the receptionist just said they can't manage an out of hours service at all because there are no GPs. My friend I was chatting to told me her local surgery has no GPs at all just nurse practitioners and they bring them in from another local surgery if needed. It all seems very scary.

Where have they all gone?

And the reason I needed a referral from primary care to genetics is because I ended up going private for all my chemo because my NHS experiences triggered PTSD (yes, the proper diagnosed, horrific sort - not just the “ooh it makes me feel a bit sad” kind) caused in no small part by the actions of medics with attitudes like yours, ie it didn’t happen, but if it did happen, it was probably your fault anyway. Private can’t refer to genetics, GP could - but didn’t think it was necessary. Luckily my DH sorted it with a colleague - it’s the poor fuckers without doctors in the family that I pity.

But you can have a brownie point for knowing what Lynch is - that’s more than the GP registrar did. (“You were just really unlucky!”)

We've definitely discussed this before - I'm sure there is only one MN poster that is a lawyer (you said this last time) with a history of bowel cancer and successful negligence claim and a (CD) oncology husband. And you definitely had a different username.

Regardless, it's not about who agrees with me and who doesn't, and people are obviously free to do so. That's what discussion fora are for.

Luckily, I can hold more than one thought at once and so correcting you on your continual error regarding GPs vs GP's doesn't have any bearing on my views on the limited information regarding your case or which I deem more important - you're simply making stuff up (a bit like your bowel cancer claim above).

I was quite clear in my initial posting that your GP may have been negligent but there are certainly elements of your story that don't ring true. I don't and have never supported poor practice and your implication that I do doesn't have any basis.

Regardless of where you had your chemo, secondary care should have referred you to genetics. If the private provider couldn't refer you (possible) they would have written to your GP asking for a referral. So your GP's view on whether you needed to be referred wouldn't have come into it.

And let's not get into a comparison of whether GPs are held in higher esteem then lawyers - you wouldn't fare well there because as we both know incompetence in your profession is utterly commonplace (I have an LLM and unfortunately come across many in part of the work I do). But of course, all lawyers must be shit because there are so many unhappy clients and they can't be wrong, right?

Private secondary care referred me to genetic family counselling for genetic testing, and would have tested my family had I tested positive as it were. Referring for genetic counselling is a role for secondary care, and a referral from primary care would have likely been rejected. Private secondary can, and do, refer to an NHS service.

That being said. We all know that there are some truly shit doctors out there. Like there are some truly shit solicitors. And truly shit people in any profession. One reason that everyone needs to be in control of their own healthcare. Ask for second opinions. Take evidence. Insist on referrals.

Sorry to hear your daughter was unwell, and hope she is on the mend. There is such a thing as an urgent care walk in centre - two of my local hospitals have this, with separate entrances from A&E. Both are brilliant, in normal times, with 'normal' demand on services. They may be under pressure at the moment, though. Back in 2019 we were told that the government would ensure an extra 6k (or was it 5k?) GPs by the end of the parliament. As things stand, there are around 2k fewer than in 2019, and the DHSC admits that this 'promise' is not going to be kept. At the same time, demand has gone up. GPs are having 15-20% more consultations than before the pandemic. The only way to cope is to make maximum use of the healthcare professionals who can fill the gap - nurse practitioners, pharmacists, therapists of all kinds. Thank goodness for those people, otherwise it would be total meltdown. This is why seeing a GP is difficult, and why urgent and emergency care is so crazily busy. An undersourced health system, poorly (or not at all) planned, with no provision for expanding the workforce. All down to the Tories.

I do confess twice I have paid to use an online doctor ( around £35) in sheer frustration and it worked really well. I am loathe to support this kind of thing as I can see things heading in this general direction - which isn't good in many ways as not all can just 'pay'

There is no wonder A&E is so under pressure though when it's nigh on impossible in many cases to see a doctor within a week- even with quite serious issues- anyone remember the days of 'home calls' !! These worked very well when someone was very poorly and literally in bed all day. Does this still exist anywhere??

We still do 5 to 6 home visits per week (NHS) although pre-Covid it was probably around 15 or so per week.

In general they're reserved for palliative care and the truly housebound - previously, we were way too soft and ended up seeing lots of people who, miraculously, could make it to the hairdresser but not the GP surgery.

They're a very inefficient way of practicing medicine - I can normally see 5 or 6 patients in the same time as a visit with better lighting and better access to kit.

I'm going to defend my practice. I'm lucky enough to enjoy fairly good health so this is the first time I've had to make an appointment since before the pandemic. I go to a large practice where I don't think I've ever seen the same doctor twice, which is fine with me.

I filled out the online econsult form outlining my issue yesterday afternoon. I got an automated response saying I would hear back by 5pm today. I had a phone call an hour ago asking if I was willing to go to another practice (which is actually closer to my home) and if so I could have a face to face appointment tomorrow morning. Quite honestly I think that's excellent service, yet I see constant moans on Nextdoor saying how terrible my practice is.

@privateandnhsgp thanks for that info - and thanks for the work you do- I can see it must be a pretty thankless task some of the time . I've not seen a GP for 20 years and now have seen one 4 times in 8 weeks - -

you're simply making stuff up (a bit like your bowel cancer claim above)

Really poor form to write that on here - probably a breach of Talk guidelines, not that I would bother to report you because, in fact, that remark shows what kind of human you are far better than I can. I am not a troll, and I have no idea why anyone would lie about having bowel cancer (which I did), Lynch syndrome (which I do) and PTSD (which I have now thankfully largely recovered from, thanks to having enough money and insurance to mostly swerve the NHS). I hope you show more empathy to your patients (if indeed you are a partner in a GP's practice and not some kind of shill).

To clear up a few things:

• there was negligence on the part of my GP, as was proven in court (and partially settled with an admission).
• the reason the referral protocol was not followed in my case was because I was too young to have a malignancy. If you still think I am lying then I suggest you have a google of BCUK's "Never too Young" campaign and read those stories, or look at Deborah James' account of her abortive attempts to get referred by her NHS GP. Are they also lying? All of them?
• I have no idea why secondary care could not refer to genetics - possibly because it was out of area. All I can say is that no letter was sent or received, and that a young GP registrar had no idea what either Lynch or HNPCC was, but didn't let the small trifle of her ignorance stop her from attempting to dismiss me as merely "unlucky" rather than carrying the genetic equivalent of a loaded gun. Luckily I knew more about it than her - not many in that situation would, I suspect. Risky.
• Totally agree with your comments about lawyers. There is appalling practice in the legal profession for a myriad of reasons - the fact that the big money is in corporate law so few decent graduates go into private client (which is where most of us cross paths with legal practise); the fact that the pile-it-high-and-flog-it law schools are taking money for very little training, and it really bloody shows in today's new recruits. I am quite sure that plenty of the grumbling clients have a point, and amazingly I can feel extremely disappointed about that whilst also firmly believing that most lawyers are decent and that I can only do my job to the best of my ability and not extrapolate about others.

I saw today that a GP prescribed steroids to a child with symptoms of scarlet fever, instead of AB's, and the child died that night. I have no medical training and even I know that was a fuckwitted thing to do when the rate of scarlet fever is many times higher than usual. As I wrote upthread, it appears this type of 'wtf were you thinking' diagnosis is not uncommon, and my view (based on my own horrific experiences as a cancer patient and in seeking help for my autistic son) is that greater circumspection amongst GP's is needed and a review of their training and the way they interact with patients. It baffles me that NICE has supposedly protocol-ised so much and yet these "never" events seem to happen daily.

yes we visit when needed i.e. bedbound or terminally ill. But as has already been said, the concept of the GP popping round because you've got a cold and don't feel like getting out of bed isn't compatible with the volume of medicine we do these days.

the concept of the GP popping round because you've got a cold and don't feel like getting out of bed isn't compatible with the volume of medicine we do these days.

I haven't seen a single person here or irl asking for that either. Just wanting more than filling in an online form and waiting six weeks for a call which you miss because you're working. And then filling in an online form again and missing an unscheduled call again and then repeat until dead. People require and need a bit more than that from a health service they pay for.

I live in an area full of GPs - it’s close to 7 surgeries / various urgent care centres and so know many. All of them work 9-5. To the point where many local surgeries don’t have any in person GP appointments out of hours. It’s always nurse / ecp & in several cases straight to a specialist in urgent care / hospital (who incidentally do work out of hours / shifts). Forget home visits

Yet if you want to see a private GP these same GPs will fall arse over tit over themselves to see you & will even come home if you book via Bupa. Bupa even got two seperate GPs to come to my house at 8pm for £100 each when DS was sick.

So it is about greed and money for a lot of GPs. Ever since entry grades for medicine courses became inaccessible to working class / working medical professionals - medicine has become an alternative to investment banking for a certain type of person. And being a GP is seen as a mechanism to a lifestyle instead of a profession.

Hopefully as AI / RPA use in general practice and hospitals become more commonplace the need for this profession as a gatekeeping service for the NHS vanishes.

The gatekeeping aspect is the worst thing about GPs imo. If you need attention from a gynae/heart/whatever specialist you should just be able to book it. It's like you have to ask permission. From someone who is permanently unavailable.

Or who is only available if you go private and pay full fucking price. Worse even than the USA as there's no co pay or insurance or anything. Paying private in the UK means paying full whack plus paying all your taxes for your supposedly free at point of use healthcare that doesn't fucking exist. It's the worst of both worlds. Or, death. I guess. That's also increasingly an option.

It's not all bad. I sent an econsult on Thurs pm. I received a call on Friday pm offering me a face to face at 9.30am on Sat morning at a different GP practice. I spent 15 mins with a GP, he issued a prescription and by 10am I was walking out of Boots with the medication. I was really impressed.

Paying private in the UK means paying full whack plus paying all your taxes for your supposedly free at point of use healthcare that doesn't fucking exist

Exactly this. When I lived in the ME, my employer used to pay my insurance that meant I regularly had a family doctor visit my home to diagnose a migraine and deliver medication to my door. That is plainly not an efficient use of doctor time, but there is clear blue water between the NHS and what the private sector delivers, even in the UK. The UK population has been gaslit into believing the NHS is a good example of healthcare delivery when the patient experience is dire.

If and when NICE guidelines allow, there is an argument for just employing people (not a GP on a casino salary) to apply them and refer when appropriate, with fewer GP's to do whatever the fuck it is that GP's do these days. That's if we even need more than a "family doctor" service for sniffles and contraception, which also seemed to work quite well in the ME.

The trouble is that we don't have enough doctors to make meaningful changes - something that the BMA itself supported until quite recently.

Paying private in the UK means paying full whack plus paying all your taxes for your supposedly free at point of use healthcare that doesn't fucking exist

We have private and have used it once in about two decades. Because NHS has been easy to access and they’ve been good. If needed I would just use private. It’s good to have it but not that necessary so far (touch wood).

Yes, the service that people talk of is definitely available privately. The cost of a private prescription is quite something if you have got used to NHS charges. Likewise testing and diagnostics. Being in a hospital is thousands a week.

The NHS does everything at very low cost. You cannot expect the same level of service. You would, to make a difference to GP services,start rationing radically the treatment that people receive. People now live longer than ever thanks to the NHS - a victim of its own success in one way.

I think it would be helpful if private GPs could prescribe on the NHS. I have private GP appointments included in my private healthcare but I don't use them because if they issue a prescription it would cost a lot more than £9.60.

The cost of a private prescription is quite something if you have got used to NHS charges

Quite - my last private rx was for antibiotics and it cost pennies. Ditto with DS' generic Ritalin (which the NHS made him wait years for, during which time he was kicked out of school - of course, nobody in the NHS gave a flying toss about that).

It goes both ways. Most insurers pay prescription costs. That was certainly the case for me when I accessed expensive (at the time) platinum-based chemotherapy treatment for the cancer I apparently didn't have. 🙄

Yes, the service that people talk of is definitely available privately

It isn't though. No private maternity outside of the SE, no private paediatric service either. Private cancer services are scarce outside of major cities.

Private GP is now available nearly everywhere because the service is so piss poor that we don't mind paying. (See also: dentistry). But there simply are not enough doctors to deliver a full private secondary service which means we're all stuck with the dreadful NHS to a greater or lesser extent.

ah, I am SE but in general it used to be true in the event of actual emergency or complexity you were better off with the NHS. Even in its degraded state I suspect that is still true.

Private medicine is er, good for rich people issues. Unfortunately the list of what those are seems to be expanding.

The NHS is insanely cheap - base cost of seeing a highly qualified consultant is £160. He ran his own clinic and doubtless can name his price privately.

Anyway, I didn't want to suggest private prescriptions are cheap - they are, for recent drugs (not antibiotics as those are genetically produced) absolutely incredible. 9.60 is a bargain.

@LexMitior yes it is insanely expensive here because there's no integration with private providers like there is in every other country where they're part of the universal healthcare provision. That was my point. Elsewhere in the world if you access private healthcare it's cheaper due to the various integrative mechanisms. Here we pay loads and also pay taxes to fund a service that doesn't really work.