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?

This is similar to my/my family's experience too, except we are triaged by telephone rather than email. If necessary, appointment provided for that day when it takes a few minutes for physical examination and prescription and/or onward referral.

My partner called his GP this morning 8:30am. Appointment made for 10:30am. He had his antibiotics in his hands by 11:00am.

Previously he'd have waited days for an appointment due to people having booked weeks in advance to discuss 'minor issues'.

I think this system is much more effective in ensuring those who need to be seen are being seen.

I take your point that urgent things should have priority, but it can be frustrating when you have a comparatively minor and non-urgent issue that nevertheless can't be treated with home care or OTC or off-the-shelf remedies (or should only be treated with OTC remedies for the short term as advised on the packet), and your only option is to join the scrum for same-day appointments and compete for them with people who need to be seen straight away. You seem to be contrasting the people with minor issues with people who need to be seen, but whether the minor issue is something that may develop into something worse if left untreated, or just something that has an ongoing impact on quality of life, the fact that someone doesn't need to be seen now doesn't mean they don't need to be seen at all.

Unless you put quotation marks around "minor issues" because you were thinking of people who don't really need to see a GP at all, I guess? But then it can be difficult to know sometimes whether or not something is a GP matter.

@FurryDandelionSeekingMissile

Yeah, I mean minor issues/ailments i.e. something on which a Pharmacist can advise / provide medication or confirm to patient the issue does not meet 'minor ailment' status and a GP consultation is required.

I would imagine GPs appreciate patients who come to them via this route, rather their first course of action being demanding a f2f for a stye, cold or similar etc.

That's fair enough.

I think it's very difficult for one service to provide

• same-day urgent (but not emergency) healthcare
• treatment of minor to moderate illnesses
• assessment and referral of serious health problems
• follow-up of people seen in secondary care
• chronic disease management, monitoring, and medication management
• case management where a patient has input from multiple specialties
• preventative medicine and screening
• all the various form-filling for government or other official requirements, and requests for arse-covering approval of people for various activities, and stuff about "check with your doctor before your start a new exercise routine"
• online services, phone services, f2f services, home visits, care home visits

and so on — probably a million other things I haven't thought of — for everyone from babies to people who are dying. It's so many different kinds of things that need different kinds of service. Ideally you need to be immediately available, but also able to give people an appointment in a few days that they can book time off work for in advance, or to give people an appointment far in advance if the doctor says "come back in six weeks and we'll see if it's helping". I dunno how you'd do it in a satisfactory way without having to build a lot of expensive slack into the service.

Receptionists aren't meant to triage but they need to take enough information for the doctor to be able to triage you appropriately.

So why then, if your Doctor has specifically told you that if X happens you should call and ask to be added to their same-day call list, and you inform the receptionist of this, do they refuse to do it when the doctor has already made that judgement and doesn't require any further information?

Some receptionists might do their jobs properly but many do not, and waste time needlessly interrogating patients about things that they know nothing about whatsoever.

I think you need to ask your surgeries manager that question because that's not how mine works

I find it strange that people constantly abuse and blame GP's when the problem lies with the government.

I suggest that we demand the government to improve and properly fund the current health system.

20 minutes? That is 6seconds per prescription and doesn't sound safe as OP highlighted. The GP's at your practice must be superhuman.

I think you need to ask your surgeries manager that question because that's not how mine works

They're awful. I won't soeak to them anymore. I email my GP directly instead.

@FurryDandelionSeekingMissile

Fair point regarding all the different aspects which we've become used to being provided by GPs.

I think you've hit on something regarding the inbuilt 'expensive slack'. That was probably there prior to Brexit/Covid. Since 2016 there appears to have been a mass outflux of GPs. Decisions to leave General Practice whether due to personal decisions to retire, emigrate, return home, move to the private sector etc. etc. etc. were compounded by the lack of new recruits (from an already reduced pool of graduates) choosing General Practice.

To some degree the NHS has been attempting to prepare us for this, well they have where I am, in Scotland. There has been a substantial public info campaign to remind patients to use Pharmacists, Dentists and Opticians prior to seeking GP assistance. Info campaigns on 111 are regular too, presumably to prevent people rocking up to A&E with issues that meet neither criteria. Screening programmes for bowel, breast and cervical cancers are regulary given screen-time too.

I know my own GP practice has a multitude of clinics to support people with long-term conditions e.g. asthma, diabetes, cardiac etc. They have other clinics too e.g. pre- and ante-natal along with clinics for carers. Within the practice there is a non-medical support officer to liaise with other agencies on practical matters such as benefits, housing, domiciliary support etc.

Screening/smears/bloods/removal of stitches/re-dressing of wounds etc. are undertaken by practice nurses. District nurses are very active with the >80s and care/nursing homes where, I suspect, they are offering a triage-type of service to our elderly citizens.

The receptionists are well-trained in customer service. My experience of them, both on the phone and in person, is they are professional, efficient, patient and empathetic.

I'm struggling to see what more can be devolved from GPs to other HCPs but I'm sure experts will be working on that.

Although I don't hear complaints locally (not even on social media) about being unable to secure a GP appointment, I'm well aware from the media we've got lengthy waiting times at A&E. I'm not sure if that's lack of staff at A&E, people presenting inappropriately, bed-blocking or a combination of all three.

Again, I expect experts will be analysing the data and will be looking at practical solutions particularly for the bed-blocking issue. Personally, I'm hoping for a return of many more local authority owned/managed care homes with a move away from our older people being considered cash-cows for the private sector as opposed to being cherished members of society.

A girl can dream, eh? 😊

I’ve had terrific service from my GP over the past two years including being called in for a face to face appointment a couple of days ago as well as in more straitened times.
I appreciate that this is due to a combination of factors including very hard work, good organisation, well planned resources and perhaps some luck, and I’m so appreciative.

What kind of entitlement is this ...

Sometimes you need an appointment to discuss non-urgent concerns. Eg, the school and I have concerns about one of my DC's possibly being in the autistic spectrum. I need to see a GP to discuss whether to start the referral process. It is ridiculous that I have to phone up at 8.30 and then have to keep ringing back for up to 2 hours before I can get through to make an appointment like this (I'm a teacher and can't do this anyway). My other DC has hypermobility and it is potentially causing her some other issues.

These are not things that a pharmacist can help with. It would be much better if I could phone the GP at 4pm and make an appointment for 2-3 weeks in the future. If this were possible, there would be fewer people clogging up the phone lines at 8am. Not possible at my GP practice though.

I would write to the practice manager explaining this issue.

It's the kind that causes much relief within the reception staff group and is only indulged by the GP for the protection of said staff group.

Oh, and the poster is the office joke who is recognised by everyone, including the poor GP, as a 'stupid, arrogant bitch' .... 😂

Gosh ... In any other profession this wouldn't be allowed. There is a system for everyone to follow so that it's a fair system. You wouldn't speak to a CEO because you didn't like customer services.

I can absolutely guarantee that we will have numerous complaints and abusive behaviour tomorrow. What do you suggest we do?

Having listened to the GP in the family this week, on this subject, we need to go to a European style with insurance and co payments, for those above the welfare state safety net (pensioners, the disabled, the unemployed, etc). If people had to co pay, I suspect they wouldn’t be so keen to waste their own money and GPs’ time on viral coughs, colds, minor ailments, etc? I do not understand why people are still going to GPs and A & E with colds? Surely any adult had the average 6 colds a year, as a child and should know by now, that they get better by themselves? Ditto coughs following an infection, etc.

I also think the UK should get rid of the “gig economy” and anyone who works effectively as an employee, should have a proper contract of employment with rights to mutually agreed set hours, holiday entitlement and sick pay. The UK government should give people fully funded sick pay for a reasonable period. I do wonder, if the reason people go to the NHS wanting a magic pill, that cures them instantly, is that they can’t afford to take time off and live on statutory sick pay?

Except I am unable to get an appointment for DS who needs to be seen but doesn’t need to be seen today. My only option is to call in every morning after he should have already left for school, for an unspecified number of days to get an appointment possibly taking an appointment from someone who needs to be seen today because of the first come first served system they are operating.
I’m at the point of deregistering and paying for a private GP.

You say your son needs to be seen. Perhaps he doesn't need to be seen and a telephone consultation would suffice?

I and others I know have had telephone consultations where, previously, we'd have expected to be seen because the telephone option was not a 'thing'. The outcomes are the same - prescription issued, appointment to see GP, advice provided or onward referral.

Very few people, it turns out, actually need to be seen - as evidenced by many previous posters referring to 'empty' waiting rooms when they've been invited to attend a f2f appointment.

A lot of people can't seem to accept GPs are smart enough to diagnose over the phone when they have a patient's record in front of them, are listening to what the patient is telling them in the here and now, and asking them the same questions that would be asked f2f.

I truly also don't understand from where people have conjured up the idea the GP telephone triage system is about preventing treatment? To me, at least, it's perfectly straightforward. It's about prioritising those who need f2f and providing advice/guidance/support via telephone consultation if that makes more sense.

In your particular case regarding your son, the GP would listen to what you say and react accordingly. If a f2f is required, I'm confident they could accommodate an after school appointment.

The telephone consultation seems to be a false time economy for GPs. Once you have taken into account the time to set up a telephone consultation, prepped beforehand and set aside the time for it, they may as well offer people F2F as an alternative. No doubt a lot of people will be happy with the phone call and others will prefer F2F, at least you're giving people a choice.

I’m pretty certain that telephone consultations save time for both patients and GPs, in general.

On the question of telephone consultations, we have a choice of 2 specialist units, for DD to be referred to. One, near to us (consultant admits is the top unit in the country) and the other, near to her consultant (but a 7 hour drive for us) Her consultant wants her to be under the one near to him, because he says he sees the professor once or twice a week. In this day and age, he could communicate with the one near us, by phone and email.

Why is it, patients are told telephone calls are just as good f2f, but a consultant wants f2f and expects us to drive anywhere from 7 - 12 hours return journey?

I'm not an expert but I don't believe the Hippocratic Oath mentions anything about office hours.

Having listened to the GP in the family this week, on this subject, we need to go to a European style with insurance and co payments, for those above the welfare state safety net (pensioners, the disabled, the unemployed, etc)

Half the population are struggling to pay their essential bills as it is so how do you propose they'd afford this too?

Ultimately the people who just above the limits for financial support are going to be the ones who end up sick or dead if we go down this route - and they tend to be the ones we need the most.

What kind of entitlement is this ...

It's not entitled. It's much more efficient for her and me. She suggested it jn fact following problems with the receptionists trying to gatekeep when it was not appropriate. I never waste her time or contact her except when it's necessary (e.g. meds reviews or issuing blood test forms paediatricians have for) then she gets it done without the receptionists causing a drama/ losing the message/ giving her the wrong message etc.