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?

There's so much more mental health now at my surgery .... takes up a lot of space

Yeh you just have to pick a day you can phone at 8am.

I think finding it hard to get an appointment can give you anxiety ..
My blood pressure was 180 / 111 at the surgery. Oops. Not sure how I can relax more.

I am ashamed at how some NHS professionals have come across on this thread. I wanted to say that there are many of us who share patients’ frustrations, can see why they are angry and not take it personally. We are fed up of the system too and the factors that have led us here to the crisis. We don’t all call patients horrid names.

Surely a decent NHS should listen to the concerns of patients. Even if it turns out to be ‘nothing’. Or should we only cater to cancer and emergencies?

It is ok to expect better from our health service. Even if we are far from where we should be. Why should patients accept shit service. We are all going to be patients at some point and deserve high quality care and kindness.

I was sent an email by the GP practice asking me to make an appointment regarding recent test results. The next day I call at 8am, half an hour in the queue, only to be told by the receptionist that I didn't need an appointment.

A week later I go in for a flu jab. Whilst there, I asked receptionist if I needed an appointment to get my meds changed as specialist has said he wanted to try something new and had sent a letter to GP and copied me in. Receptionist again said no appointment required.

A week later I call to find out if my prescription is ready. Pharmacy (at GPs) tell me I can't have my prescription until I have had an appointment. I start again and next day I call for an appointment at 8am. This time receptionist has to agree and I get a call back from a doctor later that afternoon. Doctor asks me why I haven't seen him about my test results a few weeks back! Tells me to make a face to face appointment! I asked him to pre-warn the receptionist so I don't get fobbed off again! So from abnormal test results to seeing the GP was over a month!

Anyway, as if that wasn't bad enough, I have just had an email from a consultant giving a time and date for an appointment for my late DH who died two years ago! If I didn't have mail forwarding on his email address I would never have known and that would be another missed appointment. I wonder how many other dead people are still getting consultant appointments. Not surprising there are so many no shows! Honestly the health system in this country is completely broken!

The NHS is only going to get worse. Yes it needs changing and does social care - but upcoming changes to the latter have been further delayed.

My family and I, well I can't remember when we last needed to see the GP and hope it stays that way, but if we unfortunately do need help, I should be able to feel confident that I will get it. But I guess it is 80% of the services are used most by the same 20% kind of thing.

The former senior partners of my surgery, husband and wife - left there a few years ago, to open an aesthetics clinic.

So, my latest:

• Called for an appointment last Friday (2nd) with GP for a mole that showed some worrying changes
• Waited 10 min to speak to receptionist
• Was given an appointment that day
• Referred by GP to Dermatology clinic
• Got text Thursday for appointment today
• Attended appointment this afternoon (yes, Saturday)

Good news, unlikely to be a problem but I will hear from them within a week.

This is how the NHS can work at its best despite understaffing and other cuts. I understand that in other cases people are let down and disappointed. But the service is by no means entirely a failure.

I haven't read all the thread - but whilst money is needed, what is ultimately needed is much deeper than that.

There aren't enough GPs and the pipeline is not adequate. Successive governments have failed to address the problem. We patched it together for a while using foreign doctors--now we don't have that. More GPs wish to work "part time" (which, remember, is really just "slightly less than full time in other jobs" instead of 60+hrs a week).

Meanwhile, British GPs are expected to do more than their counterparts in some other countries. More is expected to be handled at primary care level and GPs are expected to restrict access to specialty care. But apparently only 10% of health spending is on primary care.

The structure of GP practice may not be helping. A lot of GPs don't want to be partners, despite the extra money. They just want to be salaried and do their jobs.

What's needed is a proper plan for investment in primary care and into encouraging GP training. But that will take years to bear fruit. The UK will suffer from poor primary care for a long time, I'm afraid. There's simply no way to magically create doctors.

Phoned up GP surgery last Monday at some point between 10 and 11 in the morning due to increasing mental health struggles and wanting to go back on medication. Was in position 2 of the phone queue. Had to wait for maybe ten minutes. Told the receptionist I was struggling mentally. Appointment with the mental health nurse given face to face at 2pm that day. Had a 20 minute appointment. Left with prescription and follow up appointment in two weeks time. I didn't even know the surgery had mental health nurses now. Didn't expect the turnaround.

GP of 17 years here. There's been a lot of good points made on this thread. Op I hear your frustrations. I'm a bit worried about you though as I'm just back to work after some time off sick and I see a lot of my thought patterns in yourself from before I went off. The practitioner health services were honestly amazing in my area and it might be worth contacting them for a chat? I don't want to be patronising but honestly I feel so much better after their support and a bit of time to recharge and reset.
I've rediscovered my love and passion for the job and a lot of it is to do with the fact I'm now insisting on 15 minute appointments and also face to face if possible. I will do phone calls if the patient requests it but my default is face to face.
I'd be here all night writing about the issues facing General Practice at the moment and there are definitely no quick fixes. The one thing I will say is that the whole pay debate is a massive red herring. We do get paid well for what we do. Maybe not amazingly when you consider the amount of training we do and obviously there is massive variation as GP's are self employed and there are huge differences between locum/portfolio/private/salaried and all the combinations in between. Generally though it's a very good salary. The thing is though you could throw as much money as you want at me but it isn't going to increase the amount of hours in the day where I am safe to work. It doesn't matter if I'm on minimum wage or 80 quid an hour, after 12 hours of intensive work my judgement when looking at blood results or clinical rationale isn't going to be as good as it was at the start of the shift. It's the age old comparison of air traffic controllers aren't allowed to work for more than a certain amount of hours so why is it different for doctors? And obviously in immediate risk medical jobs such as surgery the mistake is immediately obvious and catastrophic but if I'm processing blood results at 10pm on Monday evening after being at work since 8 the chances are I may mark something as normal which is actually a red flag for impending kidney or liver failure or a PSA which seems normal but which has risen by 20% from the last reading and needs urgent referral.

It just feels so unsafe at the moment and you feel like no matter how much of yourself you give to the job it will never be enough as the demand far outstrips your own personal capacity. I often feel like I'm dancing on a cliff edge with the GMC and they and the press would be more than happy to hang me out to dry if I did make a mistake. That then leads to ever more defensive practice which further exacerbates demand on the system and also GP's reducing their face to face sessions so they can actually spend more time catching up on the admin side of things (unpaid) This is one of the main reasons that GP's are working less contracted sessions than before.

Anyway I'm really not sure what the answers are. I'm currently managing ok but I know I have to be careful not to let things build again to the point it did earlier this year when I truly believed that suicide was a viable option as I felt I was failing my patients so badly.

FYI I do not work, and have never worked, in the NHS.

Nor do/did I work in a receptionist capacity.

You are correct about one thing, though.

Making assumptions is truly awful/appalling.

How long were your face to face appointments supposed to be previously?
15 sounds good esp when that means some of them will end up being 20 mins.

My appointments have always been 10 minutes since I qualified as a GP. 10 minutes was manageable back in the day before advanced nurse practitioners as you’d have a variety of appointments. Quick contraceptive/snotty kids/titration up a blood pressure med interspersed with longer complex mental or physical health stuff. It usually balanced out so you could run somewhat to time. When the advanced nurse practitioners came into our surgery I started to run noticeably very late with my appointments. It’s no surprise really as it was only the more complex cases that were being seen by me.
Using ANP’s has long been the plan to try and manage the demand for primary care by the NHS but unfortunately the consequences haven’t been thought through. In a lot of ways it deskills GP’s in the day to day bread and butter stuff of sick kids and chronic disease management. It also means that every appointment with a GP is generally a complex one that takes far longer than 10-15 minutes to sort out.
I became a GP as I wanted to be a generalist and get to know my patients and their families. But at the moment even General practice is being siphoned off into “specialties” as there’s not enough GP’s to do the old fashioned all round “family doctor” job.
My practice is fully multidisciplinary and we have 3 partners. Me (GP) advanced nurse practitioner and business manager. I believe that General practice needs to have equity between all the primary care specialists including the doctors/nurses and business partners.

Making assumptions is truly awful/appalling.

Nowhere near as appalling as the things you said though, is it? You sound like a deeply unpleasant person.

You sound like a deeply unpleasant person.

What I said was realistic i.e. it's what happens when customers make an arse of themselves, come over all drama-queenesque, clamber on their high-horses and bleat at the 'CEO' or equivalent.

You sound like a deeply arrogant and entitled person.

Those character traits sit rather well with your admitted trait: making assumptions.

Just another thought. A lot of posters have mentioned how the GP they have contact with doesn’t seem to give a shit. I’m afraid that is going to become more common as the GP’s who do give a shit are leaving because they feel they can’t do the job properly due to the current mess. Out of 7 friends who qualified alongside me as GP’s only 2 of us are still working as NHS GP’s. The others have either retrained in other specialties such as palliative care and diabetes, one now works as a private GP in the EU and one doesn’t work at all after suffering quite a severe mental health episode. These were all deeply committed, passionate and competent GP’s but all of them felt we had been sold a lie when becoming GP’s in terms of being able treat and care for patients without the appropriate resources. It stands to reason that if the job is impossible to do you are left with people doing it that don’t give a shit about the standard of care.

@Olijuniper I agree with absolutely everything you’ve said - GP for 13 years here. Especially the recommendation for practitioner health for any doctors reading this who are struggling, I’ve used them and they are truly fantastic.

Oh the irony, another post full of assumptions. I'm not sure what's arrogant or entitled about simply doing as my GP requested. But ok, write whatever nonsense you like and continue insulting people you know nothing about for no reason if that's what cheers you up.

@snowbellsxox what’s your point? You seem to be implying there that it’s somehow less/not worthy of medical attention.

Not at all, I think it needs to be looked at. It's very serious and I don't think it's being taken seriously enough. The wait time that it's triaged for sometimes shocks me! All I meant was it's on the increase and should be looked at separately/ special department and help. I know that they have mental health services but sometimes either the wait is long or you have to be at your worst point!

All I know is that ten years ago if my 4yo had a cold that turned into a nasty chesty cough I could ring up, get an appointment and the GP would be happy to see them. Now if I do the same I have to call 300+ times until I get through, be triaged by a receptionist with no medical training, then be told there are no appointments or that I can go through 111 if I'm REALLY worried. So I wait a few days and in the meantime the 4yo goes really downhill, so I call again 300+ times to get through and end up in some out of hours centre miles away and am told off for not using GP service.

It's not the GPs fault. I know this. But really, Wwyd? I'm not a doctor, I can't diagnose and treat much more than a mild virus.

I've taken up loads of GP time this week because my entire family has been sick. I have put in a call to the practice manager to thank them for how wonderful they are.
Some things that have taken the doctors' time could perhaps be dealt with by a pharmacist, if the system was changed to allow it. For example, when the doctor prescribes sugar free antibiotics but they only have the sugar ones, or prescribes 125mg but they only have 250mg then the pharmacist should be able to use their professional knowledge to consult with the patient if necessary and change the dose, or swap between liquid and tablets - I have had literally all these three scenarios in the last week just in my family which the receptionist is very helpful with, but has to refer back to the GP every single time. This must be very time consuming for them multiplied across their entire practice and perhaps the pharmacist would be able to help a bit.

Obviously that's barely the tip of the iceberg and there needs to be something done to address training places, migration opportunities for those that want to come, tax relief on pensions (so that older doctors aren't just retiring to avoid lifetime cap on pension if they would otherwise be happy to continue working), oh and making training family friendly so that parents can more easily remain in the workforce.

Either remove the lifetime pension allowance cap for everyone or no one at all. It would be unfair to only do this for GPs.

@Olijuniper I’m sorry to hear it got that bad and really glad you had help and seems to have recovered and come back from that point.