State of the NHS & GPs

[ChocMarshmallows]

AIBU to worry about the state of the NHS and accessing GPs

It used to be hard to get through to the surgery, with long cues on the phone to get an appointment.

But now .... What kind of new hell is this?

We are no longer allowed to phone the surgery and have to book appointments online. The online portal opens at 8am and shuts within a couple of minutes until the next day.

If u r lucky enough to get a GP appointment after the triage, they r no help, won't prescribe anything because it's all too costly, and won't do any tests for the same reason

My son (age 11) hasn't been to the GP since he was about 5. Finally got him an appointment as he's really ill and we've had various probs over the year which are concerning me. Asked for a blood test because of these problems, and told 'we don't do them anymore unless X, y, z' and although he's really poorly and hasn't had antibiotics for years, he can't have them now because 'we don't give them anymore'.

What is the point of GPs now if you can't access them and they do nothing.

Don't get me started on A&E - a friends waited 18 HOURS to be seen last week

My mum died 2 years ago in an NHS hospital, pretty sure lack of staff, no consistent care, a too long wait time for operation (too late she died before it could happen) contributed.

It's scary and I want this government out NOW before it becomes a case of 'only those rich enough can access health care and expect to live a long healthy life'.

So how did the consultation go - usually I like to offer next steps, whether that be medication or advice/things to try at home?

Fever can be tricky in children, it is very common, particularly right now when there are loads of germs circulating.

But agree that speaking to another GP would be a good idea.

It was once a month, has been once a week since Decemebr.

I phoned last summer when he seemed frequently ill (at least once a month) for some over the phone advice (pre this online system), I didn't ask for an appointment as I know children do sometimes get ill alot. I spoke to the practice nurse who said he sounds fine and not to worry.

I am concerned now because the frequency of illness has increased and we've been having absence letters from school about his attendance and I don't think this frequency of fever is normal.

Yes exactly - given he's not a frequent attender and I've not bothered them this far, I thought they'd take us more seriously - as u seem to be as worried as me.

What were your expectations? What are you hoping for? Is he well between episodes? If so this would seem entirely normal.

So just a GP bashing thread because you're an anxious parent then? Sigh.

OP, who said to you that that the GP "wont prescribe anything or do any tests because it's too costly"? Was it the GP themself who said this? A receptionist? What tests did you request or prescriptions did you request which you were told are "too costly?" for the GP to administer. Generally interested OP as this doesn't line up with how the NHS should operate.

My expectations were to be taken seriously. For the go to understand my concerns. For some blood tests to be ordered to rule out any nasties.

The GP also said it's normal.

I have another son who has been off school once since December and once last term. That's it. Why is DS1 now off for one or two days each week, or more sometimes? I don't agree it's normal. Maybe it was normal when it was a few days off each month, or even when it reached each 2 or 3 weeks, but IMO (and I know I don't have 5 years medical school training so maybe I'm wrong, but I do have my parental intuition) fever once a week since December requiring missing at least 2 days school each week, is not normal. His brother and his friends are not ill this much.

I am not GP bashing. I am maybe government bashing. I work in the NHS myself and have seen its decline over the last 10 years. I feel sorry for GPs, but I need help for my child.

Hardly an anxious parent. Have you read my updates? This DS hasn't seen a GP in 6 years. I would imagine an anxious parent would take their child to the GP a little more often??

I agree OP

I'm fiercely supportive of the NHS and have family who work within it. But GPs are the worst and are fuelling the crisis in A+E because they will use any excuse to not see you.

Today, I had an appointment. I had been phoning for 3 weeks, every morning, and got nowhere. Every time I got through I was told no phone calls phone tomorrow. You can't book non-urgent appointments and you must get a phone call from a HCA before they may offer a GP call. It's incredibly rare to get an actual appointment.

Before Lockdown 1, I had had an accident and made an existing injury to my neck and shoulders worse. I was told I would need to see a physio and potentially have a scan. All that went out the window due to lockdown. Instead, when I called I was sent a prescription for codeine and naproxen and told just take these.

I've had worsening issues since, to the point where for the last 3 weeks I couldn't move my neck at all. If I wanted to look to the side I have to move my entire body.

I called 111 during this who told me that it's not a hospital situation and to keep trying GP. No minors or walk in here.

In desperation, I sent a prescription request for codeine, and naproxen which I've had regularly since the first time. I put on the bottom that I'm not happy to keep taking these but I cannot get so much as a triage call and 111 told me it was a GP only issue.

I got an email telling me I couldn't possibly have called every morning for 3 weeks or they would have let me be phoned. I don't know what desk dragons they think they have but the women on their phone line you'd think they were paid a bonus for everyone they refuse a call to. They really are vile and everything is "go to the pharmacy" or "call 111".

I was told they have a physio in on Friday and I could make an appointment. Why I wasn't told that weeks ago but I got an appointment.

I was then told by the "physio" she's not actually a physio, she's a HCA. She said she didn't have much she could do and to keep using a heat pad.

It was a total waste of time. No referral no nothing. Oh and now, because I've seen a "physio" the surgery won't let me have painkillers as I'm under her care. What care? She did fuck all. She felt my shoulders, said "oh yeah, they are stiff, try rolling them in the morning" and that was that.

I am baffled as to why they've not come under greater scrutiny. Even hospital staff say they are partly responsible for how many people end up in A+E or how many are being diagnosed too late because they get fobbed off

It's a disgrace but then no doubt part of the concerted effort to break the NHS down and prove it's not fit for purpose.

At our GP only 1 GP is in per day. And the phone line is for 2 different surgeries.

No.one told her. She's decided because it fits her narrative.
Tests and prescriptions DO NOT cost the GP or the practice anything. Never have. It bollocks.

Has his fever been accompanied with other symptoms? Also, do you have a sense of what you think might be wrong? It can be helpful to tell the GP this, as can help rule out if possible.

I'm confused. So you wanted abiotics. But you also want tests to rules out "nasties". You think he has cancer? Did you say that? Seems very unlikely that but if you really think so go back and say that.
I have to say almost all GPs I know (including me) are so burnt out and worn out and over worked and sick and tired of people demanding things and thinking they know better than 20+years of training and experience that sometimes empathy burnout gets the better of us.
I actually feel sorry for patients but it has become unmanageable and unsafe and the solution is not to keep whipping the GPs .

You sound lovely and very understanding memorial. I bet you are a delight in real life, and a great friend to off load to.

Ok, I apologise I didn't realise GPs were not accountable for the cost of blood tests and prescriptions. I held this view because I was once told (albeit some years ago), by a GP/commissioner friend that blood tests were costly for the practice and they had to limit them and be careful who they referred for what. I also thought (but I don't know why) there was some link between commissioning gp surgeries and costs of prescriptions and medicines they were prescribing, but I stand corrected. Apologies.

@memorial completely agree about the burnout. I had a patient come to an appointment this week just to yell at me about how difficult it was to get the appointment. Their symptoms had resolved, but still wanted to come and tell me 'what a terrible job I was doing'. This is not the first time this has happened either.

Your last line answers all your issues then
. How much work do you think one GP.can do then? Safely? You do know they are dealing with many thousands of patients. It's people like you that means I am plotting to escape as soon as I can despite being an excellent dedicated GP desperately trying to keep my practice afloat. But I am well and truly tired of being kicked in the head repeatedly. Like any abusive relationship the only thing to do is run away. The government plan is to run primary care with non doctors.

I wasn't worried at all, just thought it was odd you were really anxious about it but had let it go on for 2 years.

How are you measuring these fevers? Does he have other symptoms?

Lots of thermometers are inaccurate and kids like time off school so will commonly fake.

I assume you've googled and have concerns about leukaemia or something.

Sorry OP this sounds like a nightmare! Absolute running into the ground by the government.

I book my GP appointments (in person and telephone) via the NHS app. Really easy and no need to call! Is this not available?

What your friend meant is that they order clinically necessary blood. They don't think "oh we've done a few FBCs this week on sick children so to save money we won't perform a necessary test on the next one".

In that case YANBU monthly fevers aren’t normal for an 11 year (that’s not to say there is something wrong but they should be checking that!)

The GP will have refused your requested tests and antibiotics because you've read something online and those tests and antibiotics aren't actually indicated. Not because they are too expensive

This isn't true - some GPs do ration care and medication because they think it's too expensive. I am not quite sure how it all works with the commissioning budgets but some definitely want to spend as little as possible on patient care and won't refer either unless they absolutely have to.

However, it's true that they won't prescribe antibiotics unless there is a good clinical reason to. Although it's probably a drop in the ocean compared with the misuse of antibiotics in agriculture.

OP is there a drop in centre anywhere near you? You'd have to hang around but they are much better than GPs, you will be seen face to face. We have to drive about 12 miles to get to one from where I live, but if I were in your position I would do it.

This was the conclusion I was tentatively trying to reach, that it was an assumption rather than something OP had actually been told.

OP, now we have established that GP practice do not have to pay for tests/prescriptions, you must surely understand that for obvious reasons they can't hand them out like sweeties to anyone/everyone that asks for one and only request them when they're actually needed to rule out something the GP thinks might be the case.

If every GP did a blood test and gave antibiotics every time they saw a patient as a precaution or every time a patient asked for one, the backlog and wait-times for test results would be insane. GPs have a form to fill out requesting certain results from bloods, "ruling out any nasties" isn't something they can tick, they can only specify something if they have a genuine suspicion or belief that there is a cause of a symptom which can be identified in a blood test. They can ask for certain levels of cells etc to be measured for example, but if they have no real reason to do a blood test they can't just do one for the sake of it.

And "people like you" are no loss to the service

Our surgery advertises having 8 GPs. 4 nurses. And 3 HCAs. They have two prescriptions nurses too.

So why is only 1 GP working per day? What are the rest doing?

It wasn't like this prior to lockdown. It's just GPs realised they could do phone calls and not much else.

Our GP surgery was recently voted one of the worst in the county. They are letting people down from the admin staff who couldn't be more dismissive and who ask all the juicy details to the point where even saying "it's a personal matter" isn't good enough.

I'm sure with the number of staff they have they could do more.

And I said, I am pro-NHS and the strikes. But as someone with family in the NHs who all say GPs are not helping matters with their part time work strategy and their refusal to accept that every other service in the country has gone back to non-lockdown working.

You're right that you don't understand how it works.

The NHS can only do so much. Therefore medications and referrals are carried out using guidelines based on evidence-based medicine.

Under the private model you could pay for panels of pointless blood tests, get full body radiation and scopes in every orifice for no good reason, because they can profit from that.

The medication that is rationed is £1mil per course novel chemotherapy drugs and brand name meds that cost 50x the generic with no difference in active ingredient.

As with all these threads, it is so dependent on how your own GP sets up their services. Some are terrible, some are good

Absolutely - and IMO this is what blows a hole in "It's all the government's fault", especially when there are huge discrepancies among surgeries even in the same area

Though it's water under the bridge now, it's also worth remembering that GPs' mouths had to be stuffed with gold to get them to join the NHS in the first place, and it appears some still resent this - like my last GP, who used phone appointments to tout for private work on his NHS time

Most of all though, OP, I'm sorry your lad's unwell and hope he'll be seen and much better very soon

Tests and prescriptions DO NOT cost the GP or the practice anything. Never have. It bollocks(

My mother's experience says that it is not bollocks. It probably depends on the area, and on the GP concerned, but there's no doubt that they ration access.

FWIW, my practice and many others have kept telephone consultations because it actually means we can get through more patients, not less. We always offer face to face if the patient wants/needs this.

And I'm not sure about our part time working strategy, never heard of this. I'm full time and clocked over 60 working hours this week. There are GPs in my practice who are part time, many of which end up doing full time hours for part time pay. We are on our knees, under-resourced, and overworked.