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?

I think there are several things that can be done if the Government would support them:

Train more doctors and give them bursaries to cover fees on the basis that they take up UK positions for 5 years. No restrictions on training numbers either!

Nurses should also get free training in return for working in UK.

Complete overhaul of the prescription system. It is crazy that doctors have to sign repeats every month. Roll out a patient app that allows repeat requests online instead of the ridiculous paper system now in place. Pharmacies often do meds reviews - this could be more extensive to relieve doctors.

Walk-in clinics so no appointment necessary. Nurses (not admin staff) to triage and help those that don't actually need a doctor. This could also take a lot of non-urgent care away from A&E. Charge a small fee to be seen to deter time-wasters.

More specialists working within walk-in clinics - eg. mental health, dermatology, diabetes care, menopause, gynaecology, etc. E.g. come on a Monday afternoon if you want to see a dermatologist (again no appointment required).

Bring back medical secretaries to do all the paperwork during/following a consult. My private specialist always has his assistant in the consult and she takes notes and does the follow-up letters etc. Old-fashioned but reduces the admin burden for the doctor. Speeds up the consult too.

If there are not enough GPs, we need to do everything we can to reduce their admin load to free up time for them to see the patients that need them.

I was agreeing with you, up until you said "Secondary care is almost at a standstill". As a secondary care dr, you have fallen into the same trap as those who criticise GPs have. Just as I know that GPs are all working their socks off, you should know that secondary care is not at a standstill - we are still running clinics, performing operations/procedures lists, and manning the acute take specialities. My hospital was running at 300% of usual attendances at ED yesterday.

We shouldn't be dividing - I wouldn't say that GPs are being lazy, please don't imply that secondary care docs are not doing their best.

Gosh all GPs from one incident. Fabulous. Let's get rid of us all then eh

I understand sec care is working flat out. But there is no doubt that waiting lists of years long have pushed a lot of this work into primary care? Would you disagree with this?

Can't tell your point? Would you rather we didn't tell you? Or that this is incorrect?

@Unicorn1919 most prescriptions are electronic these days.

I definitely think some GPs would be happy only doing telephone appointments.
I only got a few face to face appointments because I was worried about something else. Otherwise would have just been staggered telephone appointments for months no doubt.
Sometimes in person discussions are much much clearer.
Even if you still get thr right answers!

Still don't get the right answers or medication you asked for. I also think you have to keep asking for any progress.

I wish they were around here. We still have to tick the boxes and return the slips to the surgery every month. I am in the South East, so not a remote part of the country!

That’s bizarre. I’m in the North East and ours have been mostly electronic at mine and other practices for years 😲

@memorial
Can you explain how a two to three week wait for a phone appointment with a GP is the norm now whereas pre-Covid it was 5-7 days for a face to face?
Isn't the telephone appointment system freeing up GPs' time? And so why are things getting worse in terms of GPs' availability?

Massive increase in demand, continued reduction GP numbers...I've said it so many times. Just because you haven't had a FTF appt doesn't mean your GP isn't doing a significant number it just means they are seeing those that need to be seen not those that want to. It's going to continue to get worse.

I had to drive around to 8 pharmacies today to obtain antibiotics for my toddler's ongoing severe chest infection, and none had any so we were going to go without until her dad found the only pharmacy here who had them. They all said it was a manufacturer issue.

Face to face shouldn't just be for urgent or people really worrying about something.
You weren't supposed to be really anxious and nervous before a GP appointment.

To the point your blood pressure will be sky high. .
Well yeh it's only high as this is such an unknown thing going in face to face for a start!!

Thanks for the explaination memorial. I get that GPs are still busy when they don't do F2F but my question remains. Isn't working more efficiently by doing phone appointments saving time? Of course any time efficiencies can be offset by increased number of patients and fewer number of doctors. But I struggle to understand what has pushed the demand up by so much in such a short space of time.

I agree with you about F2F. Patients have to push for it more. Telephone app are fine esp when you don't even want them
.eg about repeat meds are being asked to have a blood test for routine check.
Every time I've gone for F2F I was either the only one in waiting room or 2 other people. But it was 4/ 5pm.
I feel like I'm their only patient, dead atmosphere lol and I was embarrassed going in. Just gives me the chills.

I'm speaking from experience working in a customer facing role which has changed from F2F to phone/remote working during Covid.

I can fit about 40% more in, maybe more. The time saved travelling to clinics and doing home visits, waiting for no shows, is huge. Now if someone is not available on the phone, I just move to the next person. While I'm on hold, I multitask by writing notes and doing my admin. There's no time wasted chatting to colleagues or refueling my car.

I just find it hard to believe that GPs are not saving all this time too.

We don't have enough room so we stagger FTF appts. So I might do 10 tel calls then see 2 FTF and rpt throughout the day. So it may seem quiet to you but at 5pm I still usually have 10 tel calls to do plus loads of admin. 10 tel calls can be 2 hrs work for complex chronic disease, mental health or med reviews.

We are but we are doing 20% more work. We are managing patients on sec care waiting lists and a huge increase in demand.

Even 10 years ago I had time to pop home for lunch for half an hour. Now I often don't pee or eat at my desk till 3pm!

Online consultation and phone call may be quicker if only the patients who you would previously would have seen are accessing them. However, I think it’s so easy to type out an online consultation day or night and get a reply that it probably increases demand quite significantly.

Why do you need to stagger F2F appointments?
Surely not cos of covid..

Would you rather work 8 30 till 5pm Monday to Friday?

I'm confused? Our phones are open 8 to 6:30 most of us are there from before 8 till after 8?? I'd love to work 9 to 5 sure don't know any GPs that do , do you???