That GPs do not have endless capacity

[memorial]

The number of threads slating GPs for not seeing or doing this or that is saddening.
They may say they don't blame "GPs" but that's very much how it feels.
There are less GPs doing far more work day on day. Secondary care is almost at a standstill and we are picking up a lot of that slack. Add the can't be too careful/rather safe than sorry, the aging multimorbid population and the deluge of mental health problems....
GPs are retiring and leaving in their droves, it is near impossible to recruit and locums are expensive and do much less.
Other HCP can help but a recent study has shown they don't actually reduce workload or pressure.
We are seeing many FTF but in order to manage the demand we do have to do some kind of triage.
Those of us left are working 14/15 hr days and yes I know other professionals do as well. But do you want to be the 50th contact of the day, the 200th prescription, the 100th blood result of a tired stressed doctor. Would you be happy their decision making is on point. Pilots who make safety critical decisions have enforced time and rest periods. GP are expected to provide immediate access for everyone but also not allowed to miss anything/make a mistake/be short....
I ask those who are demanding to be seen what they think the solution is? What is the priority?
I am ill after a week of seeing numerous ill kids strep or otherwise. I probably shouldn't be working tomorrow but we have one GP on well earned leave and one who has a family emergency. I can absolutely guarantee that we will have numerous complaints and abusive behaviour tomorrow. What do you suggest we do?

You are not being unreasonable but not talking about it doesn't help.

Talking about how medical staff are angels and refusing to criticise a service on its knees helps no one. It absolutely needs to be talked about and criticised, people need to come forward with stories about how it's failing because unless they do people who are lucky enough not to need it urgently right now will continue to be able to stick their head in the sand and convince themselves that if they truly needed help then it would be there.

You can't see everyone. That doesn't mean that someone didn't need to be seen, or that they were unreasonable asking to be seen. It just means that the service is going badly wrong and that needs to be acknowledged.

We are on the same side, even if you are too tired to feel it.

This would disproportionately affected young people who would be expected to pay as they r turn 18 and people who are having to watch every penny. It would make both of the most vulnerable groups less likely to seek help.

What are your phone lines like? Are people able to get through to cancel easily?
What about those who are worried that if they cancel they'll be "told off"? A lot of people just freeze rather than make that call. Do you make it clear that a cancellation is helping you to redistribute the appointment and will be dealt with in a none judgemental way?

Totally agree

@Buzzinwithbez

I can only speak for the French system - most HP's use Doctolib, an app/online platform that bypasses the need to contact surgeries for routine or non same day appts - although same day appts are often available. Cancellation is quick and the cancellation is immediately offered to someone else. Am attaching photo of routine check up for next year. Options to change or cancel appointments. Reminders are sent to patients several days before the appt and the night before. Works a treat. Can also book Covid tests etc

Yep - out of pocket payments are an incredibly inefficient way of doing things

I can only speak for the French system - most HP's use Doctolib, an app/online platform that bypasses the need to contact surgeries for routine or non same day appts - although same day appts are often available.

So can people (mostly elderly) without smartphones or other internet access not have routine appointments?

I will mention that the issue would be less if it had not been for Brexit. Not no issue, but I am confident there would be more GPs had it not happened.

And also what are your notifications of appointments like. Do you have reminders or with current waiting lists are you sending an appointment six months to a year in the future and then never reminding and expecting them to remember? Bearing in mind as well that a lot of conditions cause executive function issues that make it easy to forget things, or mix up days, particularly if someone isn't working. Are you using text messages as well as mail - with current mail issues I've luckily had text reminders of appointments I never got the letter for. Are your systems joined up in a way that checks if the person who is meant to be seeing a consultant in hospital A tomorrow didn't get hospitalised a week ago in hospital B and is too jacked up on morphine to know what day it is? Are they joined up in a way that ensures that the person in hospital B anxiously telling staff that their oncology appointment is in hospital A tomorrow actually has a way to get there? Do you have a way to rearrange appointment times that just outright don't suit or is someone trying to drive two hours through rush hour traffic to get to a 9AM appointment at a regional centre because they're scared of losing the appointment if they don't?

Yep. And people with conditions which take a while to diagnose, meaning repeated visits whilst the GPs diagnosis turns from "eh maybe post viral fatigue" to "actually your bloods are starting to go deranged this might be serious" whilst they're on sick leave from work so getting low pay are completely screwed.

*I ask those who are demanding to be seen what they think the solution is? What is the priority?
I am ill after a week of seeing numerous ill kids strep or otherwise. *

I don’t see how the solution is to not see people?

Yes, I have recently had to ‘demand’ my child was seen. GP refused to see her in the first place, OOHs GP only offered a phone appointment so she ended up in A&E and being admitted. After this the GP sent me back to A&E with her due to a suspected infection - can’t a GP diagnose and give treatment for a chest infection?? Was told no, had to go to A&E. Spent 10 hours there, A&E were equally confused about why GP seemed to fob off responsibility.

DD only got worse over the next week, tried the GP again and at first they didn’t want to give me an appointment and tried to brush me off because I was worried over nothing and they wouldn’t book an appointment for a fever. I had to ‘demand’ and push because I knew this was all the same illness and she was getting worse.

I pay tax for NHS services, I don’t have a say in how it is run, I dont have a say in how many GPs are trained, but I am certainly not going to sit back and let my DD be failed because the GP practice is over worked.

Out of all the doctors, consultants and nurses treating DD over the past month only 2 a
had a decent bedside manner!
GPs are just like any other person in society, some do a great job, some work to the best of their ability with their hands tied due to demands and some are actually just woefully inadequate.

My GP has saved my life. I’m very lucky to have been treated as a person and not a condition, in a very caring way. My GP is always booked up, I don’t mind waiting but on the other hand if it’s something urgent then I’m very happy to go through triage. This has resulted in same day care when needed. I also understand that something I may deem as urgent actually isn’t. I also understand if my GP is running late, I trust that they use their judgement as to who needs more time. I also know that when I desperately needed help it was given.

I know not all GPS are the same but they do an incredibly difficult job and deserved to be paid more than they are. They also deserve to be treated with respect and empathy. If someone was rude to other people they can refuse to help, a GP has taken an oath to help.

It’s not a job I could personally do and I’m extremely grateful to my GP and others as the majority do an amazing job.

Also they are people too, they may have bad days and even get something wrong - they are after all human. I know I’ve made mistakes before.

Presumably most people using online scheduling systems means the phone lines are freed up for those who can’t.

@Killeditwithkisses patients are not the cause of your problems

This is the number one thing, and doctors like OP seem to completely misunderstand this.

Frankly if you get to the point where you resent patients, are bitter etc you should probably just move jobs because you are definitely not offering good care with that attitude.

Absolutely.

Put pressure on medical schools to accept people wanting to retrain in their 30s (and beyond?) - without automatically barring them because they made twattish decisions as teens.

in my 30s I’d have made a superb and dedicated GP. I wasn’t going to take maternity and I wasn’t going to fuck off to NZ.

So you're visiting the GP weekly to discuss your vertigothat happened in 2017 ?

About 5 years ago i had a lovely GP who you could normally get a f2f appointment with on the day. They also ran kids clinics for 2 hours twice a week, first come first served, no appointment necessary.

He was the only GP at the practice.

His practice got marked as failing, no idea why as we always got great care off of him, and he then retired.

We are now in a group of surgeries which was tricky getting appointments but after covid it is nearly impossible.

In the past month i have requested appointments for suspected conjunctivitis for a baby, suspected ring worm for a primary school aged child and tonsillitis for myself. All have been phone appointments where they either agree very quickly with my diagnosis or tell me it's viral and will clear by itself!

The one f2f appointment i got the GP barely looked at the problem area before dismissing it as temporary and it would go away. When i say my appointment was all of 3 minutes long, i am not exaggerating. It didn't go away and after requesting i be referred for an urgent appointment and having some tests, turns out i was right, it is a problem and i now need lots of treatment for it. This is 8 months on now!! If I'd been seen and properly listened to then this could potentially have been cured months ago rather than leaving me in pain for all that time.

My old GP does locum work sometimes at my new practice and I'm always so happy to speak to him if he is the one treating me. He knows the history of the kids and I and it's the continuity of care and the willingness to actually listen that makes the massive difference.

I am now sorting private medical insurance and will pay privately to see a GP going forwards for the baby as we had a horrible time with them being very unwell and getting any kind of help was a real battle.

In Australia, most GP practices have similar online booking systems and most of those seem to be HotDoc.

It is great because I can see which doctors are working on which days and what appointments are available. I can book double appointments if necessary and I can tick a box to let the doctor know if it is a standard consultation, skin check or a bunch of other things that I can’t remember off the top of my head.

I can also telephone and speak to a receptionist (I’ve never been more than 3rd in the queue) to book directly with them. I had to do this for DC recently as she didn’t meet the standard tick boxes (vaccinations) and I wanted to coordinate nurse and doctor appointments.

It is a good system, and yes, I do pay for it. First, through taxes and secondly, with a private top up.

I have Medicare, like most citizens and permanent residents and refugees and some temporary residents etc. This means if I can find a doctor who ‘bulk bills’, then I don’t have to pay anything extra. There are fewer bulk billing doctors in my city than private but I have still been able to get a same day appointment with one.

My usual GP is at a private practice. She doesn’t ‘bulk bill’. So when I go there, at the end of the appointment, I pay $100. Then I get an immediate rebate (same day, even shows up in my account before the $100 comes out) of $40-80 depending on why I saw the doctor and how much I have already spent on healthcare that year (Medicare has a ‘safety net’ - if you/your family spends more that x amount, you get a much bigger rebate).

So, for $20-60, that is £11-33, I can get a same day appointment with the doctor of my choice. It is absolutely worth it. And if I couldn’t afford it, then I could see another doctor at another practice for free. Again, on the same day.

I don’t think Australia is really all that special. If they can run this system, so could the NHS in the UK.

And just to make things more complex - I also have private health insurance. Many (most?) people do. It doesn’t cover GP appointments (I don’t think any insurance here covers GP appointments). Because I am paying for private health insurance, I do not have to pay the ‘Medicare levy” which is an additional tax paid by anyone over 31, earning over a certain amount who doesn’t have private health insurance. If I go to hospital, I can go private (and choose the hospital and my doctors) or through Medicare (insurance would pay me).

The system in Australia is not perfect. However, I would take it over the NHS anyway.

While it’s true that some patients don’t help themselves by neglecting their health there are plenty if conditions that people have no control over.

I get migraines and the triggers are hormones, bright lights, certain alcoholic drinks and weather. The drinking is the only trigger I gave any control over and getting my triptan medication is the difference between leaving work and spending the rest of the day in bed and staying at work and being productive.

Tge reasons for people neglecting their health are also not always straight forward.

I think the problem here is the vast numbers of people wanting immediate access for every thing. A lot is reassurance and health anxiety.
Demand hugely outstrips capacity. Australia doesn't have this issue which is why many NHS GPs go to Aus or Canada.

"A lot is reassurance and health anxiety."

Why do we have so much health anxiety? What is undermining our confidence in our bodies and in our judgment? What can be done about it?

I think the problem here is the vast numbers of people wanting immediate access for every thing. A lot is reassurance and health anxiety.Demand hugely outstrips capacity. Australia doesn't have this issue

Do you have evidence of this or is it just your opinion? How do you know why patients in Australia (or the UK for that matter) visit their GP?

I honestly do not know what the answer is, but what I feel with my GP surgery is that the number of patients that they have on their books exceeds the number of patients that they have the capacity to offer a service to. There is not really enough choice so it’s not like you can leave and find a different surgery. When I have managed to see or talk to a GP they have been amazing and so helpful however the difficulty I have found in accessing GP services when my children are poorly, has made me not access the GP surgery for more routine stuff. I try my hardest to avoid the Drs.

Where did I say that?

I am pretty much there weekly now. Mostly because I used to have a GP who decided to ignore the consultants suggestions and someone's inability to read notes from previous appointments