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?

@failedmydog I was just thinking the same. Hope this is not my GP!

I do think the NHS is broken & many HCPs are understandably burned out. GPs salaries do confuse me though because the ones I know in London do tend to be earning 6 figs. I think that salary is deserved but perhaps the job isn't seen as attractive to younger entrants because they think the salary is lower?

I don't disagree.

however, when we (DH and I) went for our 4th covid over 50 jab, there were 3 gp's waiting to give it. Despite a specified time slot, no queue, nobody else there, . No nurses. Seemed a waste of precious resource, unless they are paid better to deliver it? Should mention you can't even get a gp phone back around here for a few days. This isn't a small country practice it's a large town.

Absolutely this 👏👏👏

@karmalama yup Each repeat needs checking and signing (electronic or digital). As far as the GMC are concerned I of course put as much effort into checking each repeat prescription as I do into originally completing the prescription. I think there is something called repeat dispensing coming that may make this easier….

And on a few other points…
GPs get only one hour on….x condition…I just don’t know how this can be worked out. Each medical school teaches a different curriculum and we had one term on mental health at mine and then teaching and simulation in the foundation program on psychiatry. In GP training I spend 4 months as a junior doctor in an inpatient psychiatric hospital (most but not all Gp trainees will get a psych job) and have had lecture and it’s tested in the postgrad exams and you have to write 1/8 of your portfolio entries on mental health. I mean it’s possible that some student just had a bad run of luck and missed the meds school lectures as was sick and then the was working and missed the foundation training and didn’t get a psych job in Gp training but they wouldn’t then pass the exam or portfolio requirements without proving they have learnt a lot of mental health stuff!

GPs from India/elsewhere. The Uk recognises foreign medical degrees if you pass the PLAB exam, but it doesn’t recognise foreign GP training. So we are importing doctors at the GP trainee stage and then putting them through the UK “training” which is a minimum of three years (and then not actually issuing them visas due to the passport delays this summer so they don’t get to start the programme and then all get kicked off the training for not having visas - joined up thinking yay)

Since the uk GP training is set up for UK grads who have completed the foundation program many overseas doctors find it very very hard to go straight in as most of GP training is being a SHO in hospitals (the doctor you see at 2am on the ward or in A and E) with little formal teaching and Indian and similar hospitals really don’t work like ours. Studying for the exit exams and portfolio is done in your own time and at your own expense with very little actual mentorship. Sadly the GP exam is racist and so is the regulator and the NHS is a toxic place to work so many struggle a lot (despite being great clinical doctors). And then if they do qualify as a GP they then have only like six weeks to find a job and a sponsor before they get kicked out the country which makes so much sense since we’ve just trained them to be GPs (has happened to a few friends of mine who despite qualifying as desperately needed GPs and having jobs to go to got threaded with being deported due to not getting the paperwork in place - and as being an overstayer would be a crime and so they would loose their GMC reg - they chose to leave rather than risk never working in the Uk again.

the whole systems a mess and id rip it down and start again but goodness knows how to do that and have healthcare in the years it will take us

Why would you get rid of OOH OP? I’ve just been to OOH and been given steroids and an inhaler. The GP there was wonderful. We called 111 originally at 1pm this afternoon, so it took 9 hours to see someone but I am so grateful that they saw me as my chest and cough was just getting worse.

Literally so grateful. I don’t the GP I saw was well either to be honest. Same cough.

Im so sorry you are also unwell. I forced myself to work on Thursday and Friday because I am also self employed and didn’t want to let anyone down. I think that’s in part why I am so bad now. If there’s any way of you not going in and recuperating then you probably should. 💐

YANBU, it sounds bloody awful being a GP. But equally, I'm not sure it's fair to blame patients. While I'm sure there are many who seek GP appointments unnecessarily, it's really hard to get an appointment when you need one and that is quite frightening.

My surgery didn't have any appointments to get my son's vaccinations done for ages, I've had multiple bouts of bacterial tonsillitis where I couldn't get an appointment and have ended up in hospital on IV antibiotics a couple of times, which would have been avoidable if I could have seen a GP earlier. I'm not blaming my GP specifically as I know it's the system, but what are you supposed to do in a situation when you are pretty sure you have something that needs urgent treatment other than try to insist on being seen?

Massive immigration from poor countries - these people use the NHS disproportionately more than native people with very little put in the pot

is this true? I don't think the NHS could survive without mass immigration since it employs so many

I worry about the move away from universal access.

I worry that those who don't have to pay e.g. those demanding immediate f2f appointments for paracetamol or a sneeze will continue to do so because there is no financial impact on them. The well-off will continue to be (ridiculously pushy/demanding) parents screeching and demanding instant attention for their Tarquin and/or Pandora's snuffly nose because they pay.

And, somewhere in the middle, will be people who genuinely need attention who will be unable to justify £15/20 when that money is needed to feed or heat them/their kids for a couple of days.

At least, at the moment those in the middle are actually in the lottery and just may be seen. If they can't afford to be seen then they definitely won't be seen.

@Lou670 it's quite worrying right.OP please take a break.

Why can't the surgeries block the worried well or self inflicted symptoms. We know one who's in there regularly. There's no magic fix for a pensioner who's grossly overweight, type 2 diabetes who scoffs chocolate bars, has heart problems he says. I get so cross when he brags about all his appointments.

Reversing Brexit would help.

oh, hang on, the doctors aren’t responsible for Brexit….

also - do you want doctors to not be registered with a professional body and not have a code of conduct, ethics, etc, they need to abide by?

I think it depends on the GP practice itself, I know there are some really good ones so don’t want to tar everyone with the same brush …

However the ones in the town I live in are not the best. Since covid lockdown GPs are very reluctant to see their patients (despite everywhere else mostly getting back to normal) … I work in a care home and it’s rare a GP will actually see an elderly patient now. Even when the patient has symptoms that could maybe be cancer (so very serious), it was just an over the phone job. Surely a GP cannot do a good job of accessing a patient over the phone, don’t some things need a physical examination to diagnose and treat. Even when the patient is elderly with dementia, (so probably not priority 🙄), they still deserve good healthcare. We had one GP who didn’t even want to come out to verify a death, (she wanted to do it over the phone with senior taking pulse) the senior had to argue with her that we couldn’t do that as we were not trained to, when the GP turned up she had a face like thunder and clearly was not in a good mood at having to come out, very unprofessional especially in such sad circumstances…

It almost feels to me that GPs have used covid as an excuse not to see their patients face to face.

Things like chest infections are treated blindly and not followed up on, we have had residents admitted to hospital with sepsis and the GP hasn’t been out to see them once before their admission… I feel like since covid GP services have really gone down the pan.

Except that in 2008 the doctors all voted not to increase the number of medical school places

www.bmj.com/content/337/bmj.a748

"Delegates at the annual BMA conference voted by a narrow majority to restrict the number of places at medical schools to avoid “overproduction of doctors with limited career opportunities.” They also agreed on a complete ban on opening new medical schools.

David Sochart, from Manchester and Salford, warned that in the current job climate allowing too many new doctors into the market would risk devaluing the profession"

So they got what they wished for....

Hi just want to say thanks for the amazing work that you do! Being a gp is not as easy as people think it is the amount of knowledge and skill you need is unimaginable. You get faced with a multitude of different issues each day and realistically deal with conception to death and there is no one else medical or otherwise that could say they need with such a wide scope knowledge. I am not a dr but have family who are and I work in the NHS myself and know it needs an overhaul but people get angry with the wrong people! I am very fortunate that I only have good things to say about my gp any time I have had issues they have called me back and if it’s necessary seen me or my DS in person. I think people need to realise that if a GP can sort your issue over the phone there is no need to get you into the practice because they can continue to review other patients.

@catsonahottinroof

What are they doing working those hours ….admin admin and more admin

each repeat prescription is supposed to be checked just as well as if it’s the original one - done properly that’s 2 mins per script at least. As a trainee I’d do 20-30 a day so an hour on that… and GPs do more (total 1hr)

checking blood and other test results….depending on the result that can take 2-5min (or more if it’s a bad day and you’ve picked up a cancer) As a trainee I’d get 10-20 a day so that’s around an hour as well (total 2 hrs)

reading and responding and coding to hospital doctors letters and similar (so hospital dr writes to say Mrs blogs had her appendix out - you enter this into the computer system so your electronic health record (which GPs manage) knows that is what has happens to you-) around 2-5mins again per letter and again as a trainee 10 a day, GPs get many more so maybe half an hour on that (total 2.5hrs)

home visits 1-2 a day to housebound patients- depending on how rural the practice is can take 30min-1hr per visit with travel time included (total 3.5 hrs)

answering electronic messages and phone calls from district nurses (Mrs blogs needs a different sort of catheter bag please change the prescription)/pharmacy (the hrt you prescribed is out of stock please change)/ambulance crews (Mrs Bloggs called 999 but she’s not wanting to go to hospital please can we talk about her)/social workers/mental health workers etc etc …about an hour on this (total 4.5 hrs)

care home ward round - where you go and see all the patients that need seeing in a particular care home that week - one half day a week - call this 30 min a day averaged out (total 4.5hrs)

writing letters (actually sent as emails)to refer patients to hospitals or ask advice from specialists (say 15 min as most are templates) (total 4.45hrs)

death certificate for expected deaths- say one a week. Need to see the deceased and maybe discuss with coroner - say averages at 15 min a day (total 5 hours)

filling in stupid stupid forms for the DVLA/council housing/ safeguarding (not a stupid cause but the form is)/social care/district nursing/wheelchair services/blue badge etx who all require something that can’t be auto populate on a different computer system and requires you to copy paste in different formats - 30mins (total 5.5hrs)

the bit where I’m actually interacting with patients face to face in the surgery or on the phone is only about half of my workday

This is what I do not get . Why when we are short of GPs do my prescriptions that are the same month after month not just get signed off by a pharmacy?

I know of a GP that gave up about 6 years ago because he was sick of all the paperwork.

Of course you are not being unreasonable OP. DH and I with various health conditions are so grateful for the care we have received from our GPs over this and previous years. It hasn’t always been possible to have an appointment as soon as we wanted (non-emergency), once or twice there have been small errors (e.g. one test needed being left off a blood test list and followed up later), but given the unreasonable and enormous pressures on GP and how tired, both physically and mentally we know they will often be, we appreciate the really very good/excellent service we receive. Maybe it helps that I was an NHS Clinician until I retired in 2014, so we have an appreciation for the pressures, you and your colleagues are under. Many people will just not get what is involved in the job.

As for training more GPs, it takes a long time to do that and produce a fully trained doctor. This government has chosen to train too few because it’s cheaper to bring trained doctors from abroad. However, since losing many due to Brexit, and with policies against immigration, there incompetent, contradictory policy has led to the situation we find ourselves in. They have broken the NHS.

@londonmummy1966

its 2022. GPs who have been working for the last 4 years won’t have even been in med school then!

I wasn’t a doctor in 2008 so know the eact motion delayed but I’ve been to a few conferences since then and when the topic comes up it’s always to limit med school places to foundation places - as you can’t practice without full GMC reg which you can’t get without foundation - the nhs is the absolute monopoly employer at this point (in much of Europe our “pre reg foundation year” is actually part of their undergraduate time). No one I know has any issues with increasing meds school places if foundation’s places also increased.

it would be best seen as part of the med school course imo - like a final placement. You can’t let kids into medical school and then only give them half a degree (which is what a medical degree without a GMC reg is really)

Have a nurse working on the reception desk as the first port of call. She can then triage patients
Some could automatically be signposted to a pharmacy, and others given advice or made an appointment
I think in larger workplaces above a certain turnover, should have to provide private healthcare. That would ease a burden.

@Ravageur
you think the GPs weren’t looking at the prescriptions? Who was signing them then (electronic or pen)? A predictions clerk signing scrips would be major fraud and illegal. What you are implying is negligence or fraud. I am assuming you raised this massive issue with the regulators?

why are GPs signing prescriptions- because it’s the law - yes pharmacists and some nurse practitioners can also sign some things but they often don’t want to because it’s a lot of work and you take on all the legal responsibility when you do.

(In reality a prescriptions clerk will check the scripts for ones there not happy with and then pile them up for a more detailed look, you go through the no-worries ones quickly and then spend time on the “concerns” ones. I’d expect 10-20 concerns a day as a trainee£

@Qazwsxefv thank you for this. So many people come up with brilliant ideas (just hire some Indian doctors!) as if no one else has thought about it and it’s that simple. Another thing that is not considered is the brain drain in other countries and the impact this has on those societies.

OP can you say the 3 things you would do to improve the system - right now, in a year and in 5 years

And why do you think other HCPs don’t reduce GPS workload - and what needs to happen so they do

The surgery gets paid per jab - and people think they were giving their informed consent!!