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?

OP I do feel for you but also agree with a pp that you are only engaging with the posts slagging off GPs.

Anyway. I too would like to see the NHS stop being free at the point of use. I would like to see a European style insurance model. I would like to see people taking a bit of responsibility for their own health (not sure how you achieve that though!)
It’s absolutely bonkers that we are the only country in the world to provide this model, that it’s completely falling apart, and yet there’s a sentimental desperation from so many to hang onto it because a lot of people seem to think the only alternative is complete privatisation a la the US.

Just wanted to say thank you to the OP for everything we do. I am in awe of the GPs at my surgery - smart, kind and efficient. Personally I find telephone appts brilliant as I don't have to take half a day off work every time I need to see a doctor. I know now everyone likes them but my hunch is the silent majority are fine with them.

👏👏👏👏👏👏

@memorial what do you think are the reasons for increased patient demand? Because based on posts and articles such as yours, it’s definitely not just a case of population growth.

What do you hope to achieve from this post? Should we all bow down to you because you work hard? Should we all keep our mouths shut and accept a piss poor health care system because your tax returns haven't shown an increase in the past 3 years? Weird thread to be honest.

Thank you for being open about your pay OP. We need more openness like this and yes why not get £100k for such critical work?

presumably if your working conditions were excellent instead of dire you’d feel pretty blessed? I think doctors just to say that, be open and kill off the pay thing.

so what should we do about the conditions? I know all surgeries should have great telephone queuing software but that’s where my ideas end.

• Mental Health crisis. We as a society are being actively encouraged to seek out help when suffering poor mental health. First point of call is to see our GPs?
• Patients who qualify for free prescriptions are seeing GPs in order to be prescribed paracetamol/ibuprofen other medicine that they could buy cheaply from supermarkets?
• Ageing population. More alcohol/drugs issues. More obesity?
• GPs leaving the service due to being understaffed and underfunded so the GPs left are taking on dangerously higher caseloads?
• Low incentives to become a GP and poor treatment of junior doctors?
• GPs leaving the NHS to work for private care?

The system needs a massive overhaul. I can understand your frustrations Op at being treated rudely but I can also really understand the frustrations of the public at not being able to access a GP. And I'm sorry but your not the only ones overworked lots us are.

I am a carer and the current situation with the local GP services is impossible. It took me 16 weeks to get a GP to take me seriously about a clients worsening skin on her legs. Only once it became full blown cellulitis and I demanded a GP or nurse actually look at her leg did she get any treatment. She was in agony at 96. Photos just don't cut it.
I often spend more time on the phone to doctors trying to get through or sort incorrect prescriptions out than I do with my clients. Because every single time something has been done wrong. It's not my job to be pointing out mistakes to GPs. Nor my role to chase prescriptions which were ordered 3 weeks ago.

Tomorrow is my one day off this week. I work 6 days a week. But I will spend most of it trying to sort out medical care for my clients. I've just done two 16 hour days back to back and 12hr days the rest of the past week.
Your not the only ones overworked

Can I just say that my surgery is fabulous. I can always get a phone appointment the same day as calling (London). I did have to go private a few years back to see a neurologist, but GP's have been wonderful.

@CottageEmo

sorry your having a hard time. It should be better than this. I’m a trainee GP but spent several years as a junior doctor in mental health and I’m on shared care mental health meds myself so I’ve seen all three sides!

Key to understanding where it’s going wrong is knowing that if the GP signs the prescription for the meds the cmht have asked for the GP takes responsibility for that prescription legally even if it’s specialist recommended and even if it’s shared care. So if it’s outside the GPs competence (and lots of these specialist medicines are because they’re specialist) then the GP will feel really uneasy about prescribing. The GP practice will want to do the face to face checks themselves even if the cmht have because the cmht having done them and being happy about the prescription legally means noting for the GP whoes name is going on the script and so takes full legal responsibility.

your now getting the prescription straight from the cmht which is good. This is actually how it’s supposed to work for specialist meds especially if the dose is changing (being titrated) with shared care only when things are stable. The nhs budget for the prescribing and cost of these meds is allocated to the cmht not the GP. Secondary care trusts often have historically tried to get the GPs to prescribe saying it’s easier for patients but are keeping the funding.

You seem upset that the prescripton is going by post. three years ago pre covid I worked in a surgery that didn’t have electronic prescribe and all our repay prescriptions went by post or hand delivered to the local pharmacy. It’s only since covid that all England nhs GPs are electronic and it’s not in the devolved nations so the posting of the prescription isn’t an additional barrier for the CMHT doctor - having been one myself, this is definitely part of my role. Yes it’s stupid it’s handwritten as that leads to more errors but that’s the secondary care trust not bothering to set up a computer system that prints on FP10s (the green paper prescriptions) infact there is is nothing at all stopping the cmht or any secondary care system paying for electronic prescribing like GPs use negating the need for any paper at all. Some hospitals do have it and the secondary care teams can send the prescription to the pharmacy of your choice. It’s money saving by the secondary care and anger needs to be directed at them for not living up to their contract not at the GP

tldr: secondary care should be issuing the prescription. It’s a ball ache because they haven’t got a decent system to do so and so for years have bullied GPs to do it for them. GPs are too overstretched to do others work for them and take all the risk so have told them to sort it themselves. The can just as easily (if they invested in the correct systems) send an electronic prescription to a pharmacy (and arrange repeats) as a GP

You're forgetting that we don't have the capacity for self referral to specialists to be safe. Currently waiting times for specialities can be over a year. At least those people have been referred by a GP, where anything really worrying would have been referred under a 2 week wait, so it would happen quickly. If you self refer and the capacity isn't there to at least triage then it would really dangerous.
I do think it would be a good idea to have that in any new system though. I also think there should be more mental health provision in primary care, have a separate service for people to self refer for mental health problems and staff it with specialists and mental health nurses. It would save money and appointments in the long run and be better for patients.

Badly understaffed, loads of vacancies, people leaving burnt out creating more vacancies causing more burnout, and yet none of us can bloody train into the nhs either. It’s too expensive and competitive too. If there was a deliberate plot to destroy the country, it’s turning out to be quite successful.

I think people are just confused as what health care professionals say and what patients see and experience are very different such as saying you work 15 hr days and your seeing all these patients yet anytime iv asked for an appointment or to speak to a gp past 6 their not there. Since covid anytime iv been in my gp surgery there is maybe 1 or 2 people in the waiting room. Pre covid waiting rooms were full. Hospitals are just as bad saying we don't get breaks or we have to hold our pee for 13 hrs yet everytime iv been in a hospital there is often groups of nurses stood around having a chat or outsidehaving a fag. All these things are fine people should get breaks and have a chat with colleagues ect but it's the lies and the constant whinging which makes patients annoyed and a have a lack of sympathy for health care professionals. I guarantee everyone here pre covid had a gp appointment at 9am and see the dr walking past with a coffee chatting and giggling with a colleague about ten past 9. Again fine but it shows us you do have time so why act like you don't.

We need to throw open doors to foreign doctors.

And start a nationwide initiative to get people to exercise, eat well, not smoke. A huge amount of strain could be taken off the system if people just took basic steps to safeguard their own health. I know there are barriers, but it should be culturally unacceptable to be deliberately unhealthy.

We have an excellent primary care mental health worker. She is fabulous. She has appts within days and some FTF capacity. Patients can book directly with her and are offered her as an option when they ring for an appt. 99% refuse and insist on speaking to a GP. She can't prescribe or do sick notes which is what a lot want/need. Same for physio. Pharmacy.

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.

How common is this though? Who wants to spend 40 mins on hold to get free paracetamol?

On average as many as 15% do not attend

I had a f2f appointment last month, got a text to say do not come to surgery it would be telephone appointment. After not receiving a call I phoned back the surgery the next morning to be told I missed my appointment. The text was sent in error & I should have ignored it apparently! There is a lot of inefficiency.

@Qazwsxefv I’ve been on the same doses for 3 years.

My previous GP surgery - I saw/spoke to on the phone the same GP every time. Next appointment was booked prior to the current one ending, because they had prebookable appointments. It was never an issue for that surgery. So her needing to see/speak to me before issuing was not a problem.

I know whoever signs the script is legally responsible, I understand that. But if the patient cannot make a prebookable F2F/phone appointment, and you know that your phone on the day system is a shit show, and that sudden withdrawal from these meds is dangerous - then you have to make a compromise somewhere.

Crisis Team sent me to A&E so they could deal with my withdrawal symptoms/monitor me. I sat there for 36 hours, on a chair. My children had to go and stay with my friend for 4 days because I was in no fit state to look after them.

It was completely avoidable.

My issue with written scripts is two fold - I live at the edge of the catchment for that CMHT branch, I don’t drive. It would take 3 hours on 4 buses because it’s a rural area. So I can’t collect them. Royal Mail are constantly striking/a shit show, so they’re not reliable either.

My final issue is that the CMHT medical secretaries are angry as fuck at me for it, to the extent that my CPN had to step in and tell them to back off and stay out of it.

A huge amount of strain could be taken off the system if people just took basic steps to safeguard their own health. I know there are barriers, but it should be culturally unacceptable to be deliberately unhealthy

I think that's quite dangerous; physical health is often tied up with mental health & socio economic factors are very much a barrier to good health.

I can sense your frustration but that is only what patients are feeling too. The NHS has broken down which has been in the Tory pipeline for quite a long time. I don't work for the NHS, but my daughter does (nurse) and she too is subjected to abuse. She can understand why patients are getting frustrated, stressed, worried and upset. There is not a lot she can do to rectify the many problems the NHS has got.

It is hard on both sides, the staff and the patients. I don't blame the patients for venting how they feel as they all deserve better than what we are getting. There is nowhere else for us to turn and unfortunately (rightly or wrongly) in your position (and my daughters) this is now part and parcel of the role you are in.

I cant be arsed engaging with GPs the ones near us are shut, no waiting rooms, stupid e-consult and a standard receptionist with a shit attitude.

I'm not sure why you don't leave? Or retrain and do something else that earns you more and you actually enjoy?

I wouldn't like a GP like you to treat me, you're clearly really angry with they system and your finances are out of whack.

Why not join the others on the great escape to Australia? Or consider something you can cope with.

I'm sure when you trained for the job you knew the hours, the income and what was expected, like the rest of us with careers.

Yes, this. Surgery hours are 8am - 6pm at most, yes there may be some extended evening opening but not every night. I appreciate Partners may have some additional admin, but normal GPs shouldn't be working those hours and if they are, what are they doing?
Many can't understand what has changed so much, and so suddenly, during and after covid? It does feel like the GPs are blaming the government, it would help if they gave some concrete reasons.
My doctors have been seeing people in person, but generally it is one GP on duty to see a handful of chosen ones (generally one person in a large empty waiting room) and three nurse practitioners dealing with a tiny waiting room upstairs full of people. I assume the other GPs are working from home.
The only explanations I have are that many more GPs are going part time because of issues with their pensions if they earn too much, and many are doing private practice on the side. This still doesn't explain why the sudden change though.

A good starting point to rebuild the relationship between GPs and patients is to
work full time. It’s really hard to sympathise with GPs who complain about a heavy workload when they work only 3 days a week. So we don’t see the effort put in by GPs.

My ex was a GP. For 3.5 days a week he worked like a dog. For the other 1.5 days he would just chill. Never had any interest in working 5 days as said it was too draining. Well, so are many other jobs where 5 days are the norm.

Yes my experience too.
What I don't understand is why the wait for phone appointments of not seeing many F2F saves GPs time? If they are more efficient doing phone appointments then there should be ore appointments available?

My GP made an error of judgement in the pandemic (when it was all telephone appointments), and his decision not to refer me for urgent care nearly cost me my life as I ended up with severe health complications. He said my neck problems sounded like a secondary symptom of my Ehlers Danlos syndrome (I am diagnosed). It was arterial thoracic outlet syndrome with complications (severely twisted jugular and subclavian vein). I had the training and confidence to seek a second opinion, which led to surgery. I don't blame the GP. Overworked, under-resourced...human to make mistakes. There is no immediate solution to the current crisis. However, some strategies will alleviate the waiting lists. Text message reminders of appointments, fines or sanctions for non-attendance (not cancelled) brought in by UK law, and a State subsidised private health care system which offers affordable private care for those who need it alongside the NHS. I am paying for private care now because my urgent issues will take 18 months to be seen on the NHS. A few years ago I would have been seen in 14 days under the cancer rules. I appreciate not everyone can afford to pay for that sort of care. So, there needs to be a middle-ground where GP's can offer alternatives. This is somewhere between the NHS and full blown private care fees. A middle ground of initial screening of patients that need specialist attention. They get tests, scans etc and once the consultant decides if it is serious or not, they can refer for onward NHS care as required. Evidence-based gatekeeping that directs the patient according to need. No wild goose chasing around various departments as they all push from pillar to post wondering what is wrong with someone. Ultimately, it saves lives and saves the NHS money. Those who can afford to pay some fees will do so, and chronic disease is caught earlier. Then the NHS care and prescription burden is less in the long run.

The issue though is the system so many GPs have put in place where you can only get an appointment (F2F or phone) if you call the surgery that morning. There are endless threads on here of people saying that they try for days in a row and after multiple calls where they are cut off they eventually get through and are told there are no appointments left, call back again tomorrow... Those who do get through are told the GP will call but usually no time slot, if the call is missed then its try again tomorrow as the GP won't try to call back. It's all very well the GP then saying they are too busy to make multiple calls but if you are a teacher how is that supposed to work when you aren't allowed your phone out in class?

There was a thread the other day from someone in despair who had not managed to make an appointment for something serious - she told the receptionist that she'd have to phone 111 then and the receptionist told her not to as then the practice would have to see her!!