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'.

Thanks! Just googled and I think there's a benenden at Nuffield health near me, so I'll investigate. Thanks

I've recently used Benenden along with my usual GP and it has been really helpful. It is supposed to work with the NHS. Glad to help. It's worth the money, not all things are covered in terms of treatment so it is worth looking on the website.

Thanks oranges ...

And the other side of the coin. A couple of years ago DH went to see his GP because he was having pain in his shoulders and a few other symptoms. He was diagnosed with a trapped nerve, given painkillers and anti inflammatories and advised to rest. A friend had lost her mum to lung cancer a few months before and had had some similar symptoms so DH mentioned this and was told the symptoms didn’t fit lung cancer. Told that if symptoms didn’t clear up he would be referred for x rays and physio.

The pain got worse and when we couldn’t access a GP appointment for couple of weeks we went to the local walk in centre and explained what was happening. They examined him, said it was indeed a trapped nerve and advised we see our GP again if things were no better - they weren’t, and he was starting to have breathing difficulties. We went to see our GP together and I explained that I had done a bit of research on the internet and was worried it could be a lung tumour. GP examined him and listened to his chest - declared it clear, but after a fair bit of insistence the GP reluctantly agreed to refer him for a CT scan and blood tests.

We never got as far as that. He collapsed a few days later and was rushed to hospital where the attending doctor said he had one of the worst chest infections he had ever seen. He was quite angry because it was clear DH was very unwell and he asked why we had not sought help earlier. When I recounted how many times we had seen our GP, and the fact that a few days earlier they had declared his chest clear, he clammed up and never said any more. DH ended up on a ventilator in ITU as they couldn’t clear the infection and a CT scan later revealed a large inoperable tumour at the top of his lung, sitting on the nerve. He died two days after the diagnosis. We later found out that for this type of tumour, shoulder pain, together with the other symptoms he was having, is quite common.

So I disagree. Not saying all GP’s are the same, but given that the UK has one of the worst rates of early cancer diagnosis, something is amiss. And if I think something is wrong I now have no hesitation in insisting I am listened to properly, instead of being fobbed off with drugs. One problem is that GPs seem to be still sticking to the ‘one complaint, one appointment’ system - there is a notice up in our surgery to this effect. So a series of seemingly unrelated symptoms, which taken together can point to cancer, will continue to be missed.

"One problem is that GPs seem to be still sticking to the ‘one complaint, one appointment’ system - there is a notice up in our surgery to this effect. So a series of seemingly unrelated symptoms, which taken together can point to cancer, will continue to be missed"

The most relevant thing I have read on this thread.

Thanks for sharing that DotandCarryone2.

I'm so sorry to hear what happened to your DH.

Yes, I think sometimes we need to push for when what feel we need. And in this case, I want the GP to do more then just chat to my son. I want a thorough check over and some bloods. Just my mum intuition maybe, but intuition I am not prepared to ignore just in case there is something serious going on.

I completely agree about the 'one issue, one appointment' thing. I have long thought this will lead to things being missed due to people not reporting all symptoms assuming them to be unrelated. Or not reporting something more serious than the presenting problem, because the patient thinks they can't take up the appointment time and is going with what they feel is the more pressing issue. Eg. My mum had a bloated stomach, told the doctor, they went down rabbit holes looking into gastro problems. They didn't ask about her shortness of breath, heart palpitations, and other symptoms and she didn't raise them altogether in the same appointment. Thus v severe heart trouble was missed for ages. The bloating was fluid in her stomach as a result of heart failure.

Well I missed a heart failure because the patient literally crammed 20 various non related issues into knee apps so

I'll finish properly.....20 issues and symptoms into one apps. So much so that my brain was scrambled and entirely unable to diagnose or manage anything. Funnily enough there are good reasons for things but why actually listen to those that know what they're talking about.

Threads like that make me truly belive that NHS GP is over and should be. Let the government bring in the privatised hybrid salaried mostly non doctor service
Cheap fast or good. You can only have 2. We know whi h 2 the government want. So be it. We're tired of flogging a dead horse.

Worrying. What part of the country? There is a massive recruitment crisis but evidently felt in certain places more than others

@ChocMarshmallows I think you are getting a rough ride here. I would recommend keeping a diary of your sons temperature (even on days when he is well). Sometimes this sort of thing can highlight something eg an activity or food that might make him unwell. I would hope they would re consider bloods for anemia and many coeliac

My sister works in the health service. She advises ring 111. They have the ability to book appointments with your dr. Seems some appointment are kept for those phoning the surgery and some for 111

I work in a surgery (I'm not a GP) and agree with all that the GPs on here have pointed out. We are not rationed on tests or prescribing, other than they should be clinically appropriate.
I do feel sorry for GPs now, it is an ever-increasing workload and a more demanding public with a greater sense of entitlement alongside the media constantly drumming up negativity with the narrative that GPs are all skiving off somewhere.

Our surgery is swamped, we deal with hundreds of patients every day by phone and see considerable numbers face to face too. I worked last week with a task list of over 100 patients waiting for calls or prescriptions the whole time and as one was sorted another added on. The pressure is huge.

...and just to give the other side of the coin to @ReformedWaywardTeen that GPs are responsible for A&E numbers, can I tell you that a large amount of the GP workload is caused by hospital outpatient clinics still running by phone and telling patients to go to the GP for medication, tests and follow-ups. We have now started sending a letter to these consultants saying this is inappropriate and we do not have the capacity to do it but guess who will get the blame from the patients for any delay?

@memorial I agree things will have to change in the NHS and all we can do is try to tread water until things improve. Hope it doesn't grind you down too much.

"I'll finish properly.....20 issues and symptoms into one apps. So much so that my brain was scrambled and entirely unable to diagnose or manage anything. Funnily enough there are good reasons for things but why actually listen to those that know what they're talking about."

Things are very different post covid,some surgeries have not returned to normal .face to face and appointments are like gold dust ,patients can't really be blamed for trying to get as much seen to all in one go .
Trying to get through on the phone line which never seems to get picked up .
when it is we are told all the ( telephone) appts are gone .
try again tomorrow morning .
Or the next one .
When we do actually get to speak to the receptionist ( who has no more medical training than joe blogs ) we have to explain why we want to see a doctor .
And even then the face to face appointment will not be given until the doctor calls and decides whether we need to be seen .
The frustration and stress this all causes is sometimes why patients don't actually even bother trying trying to be seen .
It is a horrible situation for everyone ,and I get that it is not the way a face to face should go.
But some conditions do present with more than one issue .we as patients don't have the knowledge that you do therefore we don't know which problem to prioritise when we finally get the golden ticket giving entry to the surgery

This

You are demonstrating the worst kind of GP attitude.

The poster explained that due to a GP ignoring her DG several times, his cancer was missed and he passed away.

And all you can do is act all woe is me, hard done by?

I cannot imagine how you behave towards patients frankly, I've had ones who made me feel bad for mentioning symptoms which presented together and you sound exactly that type who rolls their eyes and makes me feel a burden for attending an appointment for the first time in years. Most of us have to beg and plead almost for even a phone call, then have to wait weeks (or they do in my surgery) only to see a GP who couldn't be less interested. Then the cycle begins again of self care, pain and illness, pharmacy saying you need a GP, constant 8am phone calls where you then get a rude and disinterested and deliberately obtuse and obstructive moron on the phone line try and fob you off or say nothing left.

Exactly this.

But no doubt you'll receive the same "I'm a GP so more superior than you" response as I did.

20 issues at one appointment doesn’t sound typical though. My DH had a handful of other symptoms, each treated as a separate issue, but if our GP and the walk in centre had listened to us when we tried to explain what else was going on alongside the shoulder pain, instead of dismissing us as ‘self diagnosing via the internet’ as the walk in centre nurse put it, things may have been different.

I can only speak from experience. My friends’ mother had the same type of cancer and was suffering with a swollen, weeping and red eye, which was pulled down at the lid. She was told this was nothing to do with the shoulder pain, which, like my DH, was diagnosed as a trapped nerve. She was actually sent away with anti depressants - because she had been to the surgery several times with the same issue, for some reason they thought she was depressed !! She was advised to see her optician about the eye issue, and on doing so was told to go straight to A&E - the optician rang ahead and it transpired that they had seen signs of a tumour during the exam, later confirmed as lung cancer. The eye problem was part and parcel of the same disease and the GP missed it because they treated it as a separate issue.

In both instances the patient knew better than ‘those who know what they’re talking about’ but the concerns were dismissed. OK, so I understand that multiple issues can confuse things, and I agree. But given that cancer can present with diverse symptoms which can seem unconnected, I don’t think ‘one issue, one appointment’ is the way to go. Don’t know what the answer is, but given that GPs are the gateway to the referral services something has to change.

I am a paediatrician in Australia and work publicly and privately. In our private clinic we are all pretty busy, months long waiting lists but over the clinic there’s some movement on a day to day basis with people rebooking, rescheduling.

For what it’s worth, we would triage a referral like that to be seen within a week or so. I agree it’s most likely going to be nothing serious but it’s somewhat unusual to be feverish that often, at that age:

People complaining about having to disclose their issue to the receptionists (who do usually have training in patient navigation, signposting and basic clinical triage despite what some ill-informed commenters might think), I'm genuinely interested in how else you think this could work?

If the surgery receive 200 calls+ for example between 8-9am, which is not at all impossible, with no one willing to briefly outline their issue and all asking for a GP appointment, how are the 'right' people seen? It's not possible for everyone to be seen just because they want to be. And it's not a good use of GP or other health professional time to be answering phones themselves. What workable alternatives are you proposing? What do you think the reception staff are going to do with your information? Your phone/device tracking and third party companies probably know far more about you than they will.

On your first point of what is clinically appropriate and what is not. I was diagnosed with rheumatoid arthritis a couple of years ago at the age of 60. The consultant wrote to my GP asking for the pneumonia and shingles vaccinations to be given before I started treatment. I was given the pneumonia vaccination but the shingles jab was refused as not clinically appropriate because I was under the age of 70. The consultant queried it and the GP refused to administer it, despite the fact that I have had chickenpox and am at increased risk due to immune system being compromised. They had no problem when I paid for it though. How is that not rationing ?

@DotAndCarryOne2 I can't answer that with any certainty I'm afraid as I'm not a GP and have no involvement with vaccines.
This might be totally wrong but my best guess would be that the NHS would only reimburse the GP the cost of the vaccine, which is around £100, if all the eligibility criteria were met so they would be considerably out of pocket if they did it. Remember GP surgeries are private businesses that contract their services to the NHS. How many businesses would we expect to give us a product worth over £100 at their own expense?
Even if the GP was moved to give it they would be administering it outside the terms of its licence which would mean their professional insurance would not cover them if you had any reaction or problems following the dose and they would be legally liable for that.
The other question would be, if the consultant wanted you to have it due to their treatment, could they not arrange it via the hospital?

@DotAndCarryOne2 my GP practice definitely doesn't do one complain one appointment.

However I've learnt to be quick and concise in describing what's wrong and ensuring I'm suitably dressed so I can reveal body parts/strip quickly.

Sounds about right when you reason it out like that - and it does fit with the fact that when I decided to pay privately there were no objections. The cost was £140 if I remember correctly. NHS insistence on all of the eligibility criteria being satisfied seems short sighted when you consider the cost if I had had to be hospitalised with Shingles, which was a distinct possibility had I not had the vaccine. I did query it with the Rheumatology clinic, but it’s a local cottage hospital and they had passed it back to the GP because they had no facility to administer it themselves.

When you call our surgery, there is a brief recorded message from the practice manager, explaining ‘care navigation’. I’ve always assumed that receptionists are covered by the same confidentiality rules as all other NHS staff, as they have access to patient records, so I don’t really see what the problem is in disclosing the reasons for calling.