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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

That GPs do not have endless capacity

474 replies

memorial · 04/12/2022 20:44

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?

OP posts:
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FurryDandelionSeekingMissile · 04/12/2022 22:08

Going only by my own experience as someone with several chronic health conditions, I think there must be an awful lot of extra admin and extra time spent on things GPs do because they're required to, or they need to show they've been done to get their QOF payments or whatever it is at the moment, which supposedly increase patient safety or quality of care, but take up time and with little tangible benefit for a lot of the patients.

Like 28-day prescriptions. I know it probably reduces wastage (though there's plenty of people just blindly reorder every month regardless of need), but every four weeks they're checking through another batch of my prescriptions that I get every month and will probably continue to get for years to come.

Or the telephone asthma reviews. I have a peak flow meter, which is more than the nurse expected me to have, but the rest was pretty pointless when I know my condition and how well it's responding to treatment, and she can't do anything over the phone (tests, demonstrations, etc.) that I can't do myself. Just a waste of her time. I know for some patients it won't be a waste of her time because they may not know what things need actioning, but I've been asthmatic for thirty years and will call if anything changes.

Or e-consult forms where they all seem to be set up for people asking about a new lump or recent cough or bad shoulder or new low mood, but I actually need to address an ongoing thing or a referral or something and there's no way to get a generic/blank one. I arranged an entire referral for an assessment via e-consults and the GP texting back. Each time I do one, I have to pick from a list of predefined conditions (almost none of which are the actual conditions I have) and go through masses of questionnaires and fill in free text boxes, which presumably the GP needs to look over in case there's anything important there, but which are largely irrelevant (or I have to lie so the e-consult doesn't kick me out and tell me to call an ambulance or something, then write on there that I've had to lie in the questionnaire, which is something else the doctor has to notice and manage).

If I need a prescription medication for one of my chronic conditions that I don't have on repeat — because they remove things from repeat sharpish if you use them infrequently and you don't order them for a while — it all has to go through as a new condition, with a long econsult and questionnaires and text boxes which is all extra, when I could just put in a repeat request for the triptan or whatever and it would be there as a previous prescription for my diagnosed longstanding migraines.

This is the tip of the iceberg because I don't want to go into the details of the admin for some of my other conditions, but if it's relentless and tedious and mostly unnecessary for me, it must be horrendous to deal with on a massive scale. I understand that some of it helps avoid people slipping through the net and there will be good reasons behind all the things that cause extra admin, but there has to be a less laborious way?

Luckydip1 · 04/12/2022 22:08

@memorial the difference between GPs and normal jobs is you get this massive pension contribution, you would never get that in the private sector, 10% at best, I can't believe the taxpayer has to fund this and we still get such a lousy service,

ReallyTiredAndHungry · 04/12/2022 22:09

Luckydip1 · 04/12/2022 22:08

@memorial the difference between GPs and normal jobs is you get this massive pension contribution, you would never get that in the private sector, 10% at best, I can't believe the taxpayer has to fund this and we still get such a lousy service,

I work in the private sector and get a 20% non contributory pension. It’s not rare in the sector either

memorial · 04/12/2022 22:11

Luckydip1 · 04/12/2022 22:08

@memorial the difference between GPs and normal jobs is you get this massive pension contribution, you would never get that in the private sector, 10% at best, I can't believe the taxpayer has to fund this and we still get such a lousy service,

I've said this twice now. You are incorrect. GP partners pay both employer and employee contributions themselves. Your chip must be every so heavy now.

OP posts:
DorsetDandelion · 04/12/2022 22:11

Ravageur · 04/12/2022 21:03

My job is in a gp surgery. Times are tough I know. But 200 scripts? That takes 20 mins max assuming 50 x 4 per shift. No gp I ever worked with looked at them either. That's someone else's job (prescription clerk etc)

plus all my gps work part time all earning 100k approx. So i am sorry. But also not sorry. Sorry.

A lot of GPs are part time in the sense they don't work 5 days a week, but add up their hours and they are very much full time. 6 sessions will mean 3 x 14 hour days so 42 hours a week... I hate all this "GPs are part time" shit.
I'm very much not a GP by the way, just grateful to those that are

cezannesapple · 04/12/2022 22:12

memorial · 04/12/2022 22:01

With absolute pleasure. Everyone who insists on an orthopaedic referral for their sore knee (but doesn't want to lose weight or do physio) can self refer with absolute pleasure. Of course the waits might go from I dunno 2 years to 10 but I would be super happy with this model of care. Likewise just about every speciality I can think off. I would be more than happy to just see the strep kids

I'm really glad you aren't my GP.

EmmaAgain22 · 04/12/2022 22:14

HappyHolidai · 04/12/2022 21:05

Why would it take 5/8 years to have more GPs? Loads of doctors in other countries (India most obvious example) could come and work in the UK in the next 6 months!

There is a lot of non-EU immigration into the NHS. I don't understand why that's not increasing the number of GPS too.

Is it Government not funding the GP demand? Is it practices not wanting to recruit from abroad? Is there a visa/immigration issue? Some sort of regulatory barrier?

And do you think all these people are really keen to leave their home and come and work for the NHS?

HappyHolidai · 04/12/2022 22:16

memorial · 04/12/2022 21:12

Doctors? Are you joking? Government!
And FWIW I have been working on the inside for over 20 years both inside health boards and GP unions. As have many of my colleagues.
I'm sure it won't surprise you that government policy wins every time.

Sorry, I thought the GMC was a doctors body not an arm of government.

Or is the government stopping the GMC from registering incoming doctors who want to be GPs? We hear a lot from GPS about their woes but nothing about the solution of immigration to fix it, so more could surely be done on this? Especially with the PM the son of an immigrant GP!

As regards India specifically (don't know about other countries), they have a national strategy to train extra doctors to go and work in other countries so those of you feeling all imperialist or moral about it can relax. This article has some information.
https://www.orfonline.org/expert-speak/exporting-indian-healthcare-workers-world/?amp

MrsRinaDecker · 04/12/2022 22:16

My surgery needs to move into the 21st century! There is no need for the only way to access care to be an 8am phone call. It’s ridiculous that there is no E-consult option when practices in other areas can offer them. The GP’s themselves aren’t terrible, but the gatekeeping means it’s virtually impossible to see one. And that leads to people getting sicker, mental health wobbles becoming crises, cancer being caught later, chronic conditions being mismanaged, people showing up at A&E…
We need more doctors, and we need a functioning appointments system.

Vallmo47 · 04/12/2022 22:17

This thread is infuriating!!… Maybe if we all behave disrespectfully we will be honoured with a response. Everyone who has a negative experience is either lying or being entitled. Maybe you actually need to get on that golf course Op. I started off feeling really sorry for you but now I just feel done. There’s absolutely no point being kind when aggression and rudeness warrants the response. I can see why the service is fucked. The only way forward is to be rude, otherwise you are ignored. I, like many others, are just as much at the end of their tether as yourself. There are people worse off than you, there really are. You’re sick of rude people but when I approached you with kindness and understanding I got nothing back. So why bother??
I can 100% see who gets the care and it’s not the thankful ones who don’t visit the doctor until after 6 weeks when their oxygen levels are shit and your pulse through the roof. And even then it’s viral right?

Don’t waste your time answering this, ignore me like the other times. I tried, but now I’m out.

Rainbow1901 · 04/12/2022 22:17

After seeing an article about local GPs and how many appointments and so on were F2F, seeing other healthcare professionals etc. I was at long last able to workout for myself the percentages when people don't turn up to their appointments. On average as many as 15% do not attend - that is lot of appointments that could have been accessed by others who need was obviously greater than the non-attendees. What a waste of resources!! As a regular attendee of hospital appointments we are regularly told that non-attendees cost the NHS £xxx for each failed appointment - no wonder we have waiting lists that are years long and that's without getting in to see the GP first. I have no issue with e consults and have happily gone to a pharmacist for advice and have also received first class care from my GP when it's been needed but I wouldn't dream of not cancelling an appointment if I couldn't make it - this is an issue that businesses face too when people don't show up for things like hairdressers appointment - someone loses out somewhere usually in a monetary fashion.

HappyHolidai · 04/12/2022 22:17

I imagine some are and some aren't. Just posted a link immediately above about India's strategy on exporting doctors, so presumably the 300,000 they mention are happy to do so.

Tessabelle74 · 04/12/2022 22:18

@memorial as I know a partner in the surgery, and it was her who told me, I'm afraid I'm not talking rubbish at all. At the time it was sonething like £130 a year to have a patient in the books yet they charged the NHS £55 to see a patient in the urgent care centre ergo it worked out better for the partners to not have appointments available to patients as they got paid more to see them at the urgent care centre. It's surely a monopoly issue to have a GO surgery running and UCC? Especially as this one is in the same building!

Astrabees · 04/12/2022 22:19

On Wednesday I’m going to see a private GP for £120. Our local NHS surgery used to be great. Two lovely female GP’s and one male (he was married to one of the female doctors ) They all retired about 3 years ago and have been replaced by some part time doctors. They are all so very rude, never a “sorry to keep you waiting” a smile or anything pleasant. If you have a telephone appointment they won’t give any indication of time beyond am or pm. After being refused information about potentially serious side effects for some drugs I was about to be prescribed at my last appointment and arriving home in tears I’m going to dip into my modest savings for half an hour of proper attention.
Yes GPs work hard but when I think of the hours that social care managers put in, and constantly being on call coupled with solicitors who spend most of the night at the police station and still have to be in court the next morning I don’t think it is exceptional. They are also exceptionally well paid. They should be getting some up to date IT too, vets seem to be better equipped in that respect.

Twillow · 04/12/2022 22:21

PeppermintChoc · 04/12/2022 20:54

I don’t agree - I think the NHS is like a big colander and needs a big overhaul. I’m not sure that throwing money at it would help. It needs a serious re-structure. IMO it could do with a business mind going in, not just medical
staff. From what I have witnessed you have some depts working well over capacity whilst others under utilised.

In answer to OP’s question I’d like to see some more privatisation of healthcare, or better, more accessible private provision.

This is the government that reversed the national insurance health and social care levy that was predicted to raise £13 million. When we have huge issues with social care, bed-blocking, mental health provision etc this was an utterly short-sighted move. I don't earn enough to pay much tax but I was more than happy to pay this. What you say may have some truth, management of a huge organisation is always going to have efficiency issues, but in the OP's example a business manager is not going to help one doctor see any more patients when staff are off sick/annual leave. The stories you read on here of people waiting for ambulances are terrifying tbf. Privatisation is about profit not ethics, and more accessible private provision is not going to help those who cannot afford it nor should it mean provision for the needy is of a lesser standard.

memorial · 04/12/2022 22:22

Flamingogirl08 · 04/12/2022 21:30

You're not being unreasonable really but the fact is that it is near impossible to see a GP face to face nowadays and I'm sorry you can't blame people for being angry about that. All the same GPs are still at my practice that were there before Covid and yet you cannot see them face to face at all. That is hard to understand

I've answered this a number of times now. Unless you see their appt system you absolutely cannot say they are not seeing patients FTF because all are as national stats show. We are trying to see those that need to be seen not those that want to.

OP posts:
SoShallINever · 04/12/2022 22:22

I am a HCP and have several friends/relatives, who are GP's. One has recently quit to run exercise classes and makes a very decent living at that.

We have advised our DC not to do medicine because of the unbelievable stress and the poor (yes poor) pay. These are our brightest people who know they could earn far more in other industries. I think a lot of the general public don't realise just how much financiers, business analysts and top software engineers earn.

I know my DH (who quit medicine and now works in education) says that few of the brightest students choose medical careers now. My GP sister has been physically attacked twice by drug addicts and is verbally abused daily because she can't source certain medications, that just aren't available from the manufacturers, or because someone is unhappy with a wait time.

We all expect the best medical care, we just don't realise that the doctors and nurses left in the system now are the ones who are truly dedicated. The rest have already quit.

My heart goes out to you OP. Thank you for all you do.

HerMajestysRoyalCoven · 04/12/2022 22:23

What are you hoping to achieve that your August thread didn’t, OP?

Adviceneeded200 · 04/12/2022 22:23

Since my Mum died I've helped my Dad with his prescriptions. The medication side of it has been fine. The catheter bits have been a nightmare. Monthly prescriptions sent with brand names which are out of stock and the order gets lost in a black hole. No one seems to have time to call and amend for what brand is in stock. I've spent hours on the phone, and in phone queues, trying to sort it. This is a long term condition and Dad can't overdose on night bags! Some things really ought to be quarterly or six monthly prescription. Save some time.

Allsnotwell · 04/12/2022 22:24

I would make some medication available over the counter or via pharmacies- I’m in long term medication and there’s no reason not to sell it in boots - happy to pay for it but trying to get a prescription signed is almost impossible:
Same for say diabetics - let the pharmacies deal with it. Once diagnosed they tend to see specialist so not new for GP to be in that loop.

I would then look at ‘agencies’ that insist on a doctors referral or letter - things like housing - CAMHS - type stuff that takes a lot of doctors time - even people who rock up for their passports to be signed - ridiculous!!!

Take away the bits others can do and free up the doctors for those that can’t.

FuckMyLife2022 · 04/12/2022 22:24

I don’t want exhausted healthcare staff any more than I want a taxi driver who’s necked a bottle of whiskey that day.

The time wasters, the people demanding an appointment and antibiotics because they sneezed once yesterday, the people who are there several times a week for fuck all reason, the people demanding appointments and prescriptions for shit they can buy over the counter - to name just a few things.

EwwSprouts · 04/12/2022 22:24

All GPs should be 'proper' NHS employees. A salaried contract where expectations on both sides are clear. They would have less administrative burden and no buying into a partnership due to property. Complaints could be hived off to PALS.

marvellousmaple · 04/12/2022 22:26

Not in UK - but our system here in Australia seems to work pretty well. We have bulk billing ( free) appointments for low income people and under 18's ( at most surgery's) and everyone else pays a "gap". That is the difference between what the govt pays the GP and what they charge. Can vary but roughly $20-$30.
Where did all your GP's go btw? How strange.
We also have lots of Indian GP's , bulk billing clinics - they are free for everyone - are mostly Indian doctors.
I honestly have never heard of someone not being able to see a GP on the same day they needed them. May not be the GP of your choice and you may have to sit in the waiting room for an hour but you will definitely see someone that day.
Everybody ringing at 8 am seems ridiculous.

NoNotHimTheOtherOne · 04/12/2022 22:27

Making medical training more accessible wouldn't go amiss either. When the medical schools are saying you need to demonstrate extra curricular activity, DoE etc it's hardly inclusive of people who come from working class background and may not have the time or money to be able to facilitate the extra activities that make a 'good' application.

While this may be a valid criticism regarding who gets selected for medical school (although few medical schools pay attention to things like DoE any more), it doesn't have anything to do with the number of people training to be doctors. The number of medical student places is restricted by the government, not by universities. There aren't any unfilled places, so medical schools are taking as many students as we're allowed to.

karmalama · 04/12/2022 22:33

Slightly off the point but do you have to sign off every repeat script? That seems crazy
I'm a vet and we put repeat meds at top of screen and a date of six months that vet updates, if nothing has changed then a nurse can authorise the repeat.
Waste of time if you have to do otherwise .

And yes I think people are pissed because so
Much has changed since covid, pre covid we had a system that was a bit creaky but on the whole worked, all f 2 f, emergency appointments same day otherwise booked ahead, now it's phone calls, no
Prebooking shambles.
Dp had blood test mid morning at our surgery, he was the only patient in the building which previously would have seen a busy waiting room. Reception answering every call saying they were completely full up.
It's a village, same number of gps and population can't have gone up that much in last few years, so it's hard to understand why it's all so rubbish !

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