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'.

"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"

Yes reception staff have access to our records. But they are in effect, triaging patients who call for an appointment.
This should not be their job no matter how many training days they have completed.

As per my previous post, whose job should it be? You cannot possibly think it reasonable that a GP or other health professional sits answering the phone? Please suggest a workable alternative?

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"As per my previous post, whose job should it be? You cannot possibly think it reasonable that a GP or other health professional sits answering the phone? Please suggest a workable alternative?"

Pre covid it was the patient themselves who decided if they needed to see a doctor.
They called up and asked for either a face to face or a telephone appt.
If the patient felt it was urgent they would be seen on the day ,if not then they would be given a routine appt for a few days later.
The waiting room was full of people ,with 2/3 Dictors working their way through them.
Back then the reception team didn't want to know why you were needing to see the GP .they did not want the responsibility of deciding whether it was urgent or not.
It was nowhere near as stressful as the current system.
The waiting room is now redundant as there is never more than one patient in there .in a room that seats 20/25 people.
There's no shortage of people behind the reception desk though ,usually at least 4 there.
Nothing beats a face to face appt, a lot of "information" about a patient can give a lot of clues as to how that person is doing.
things that a telephone call can't see.
Simple things like how a person is dressed,do they look like they are taking care of themselves,have they lost weight ,can they walk easily,do they look confused .are there bruises,
I could list 100 things that give helpful clues.
I have no idea how my 84 year old father copes with trying to get an appt.
The phone calls ,
being held in a queue.
making sure he chooses the right option on the phone.
Being questioned by a receptionist about why he needs to see a doctor.
I think it's probably at that final stage he would give up.he would be stressed and too embarrassed talking to the receptionist about the catheter that was needing to be inserted.
I miss the good old days, all we moaned about then was the doctor running a bit late, but at least we were seen.

Tell me you know nothing about the way primary care works, without telling me 🤦🏼‍♀️.

For a start, people have been complaining about disclosing their health issue to the receptionist for as long as I can remember so it's complete nonsense to say that's a hangover from the pandemic. And there isn't an alternative workable solution for the urgent appointments of the day and deflecting with a load of waffle about the good old days doesn't change that. Routine appointments would spiral to many months away if everyone who fancied one was booked in (not to mention the large number whose health issue will have resolved by the time and will cancel or even miss that appointment as well as those who just forget or don't turn up).

And do you have any idea how many patients might be registered to a particular practice? Of course not. It can be around 20,000 in a large practice and increasing all the time with new housing being built and growing population. This is at a time of workforce crisis in primary care, many thousands of vacancies and GPs and other staff leaving in record numbers, retiring years early and in some cases taking their own lives because of the extreme unrelenting pressure and stress they are under.

So do you seriously think that 20,000 people can be accommodated on skeleton staff when making their own demand of an appointment? How are those who need to be seen that day identified in that system exactly? Because they say so? So when the elderly man with a chest infection can't be seen because someone has come in to have their verruca looked at (true story) because they've told the staff it's urgent, how do you deal with that in this 'patient knows best' approach of yours?

There may only be one duty doctor seeing the urgent cases (see aforementioned workforce crisis) and their time is extremely limited, so must be prioritised. Many others who demand to see a doctor, could be just as well served by a Nurse Practitioner, Paramedic or other health professional but how to identify if everything is big secret? A multidisciplinary approach means the best use of everyone's time and the right people seem by the right professional... not that hard to understand. There are many pulls on GP's time other than actually seeing patients in clinic that the general public have no idea about but are important parts of their wider work and there are less and less GPs all the time so that workload increases.

This conversation is taking the thread off topic so I'm leaving it there, knowing that people like you are so invested in their own narrative, no matter how false, that you can't be told. But I've said my piece at least.

Just to add to the general theme, like GP's you also get terrible Hospital Trusts and good ones. The ones that run smoothly, have good IT systems in place, have integrated care and solutions between Acute and Social Care, do exist. You just never hear about them. They would be the ones that also coped with Covid slightly better, had hot and cold units, bought their own PPE etc etc. Local management whether acute or GP have a lot to answer for.

The government does not "run" GP's nor CCG's, nor Hospital Trusts. They are given a framework for care, given money, and then those local areas choose what they treat and how they are run. This is what everyone wanted. Local decisions, taken at local levels, run locally. You then get what we have now, which is postcode care, and often because bad managers get removed from one area, and then pop up in another, I could give you a list, but I can't!

I’ve always assumed that receptionists are covered by the same confidentiality rules as all other NHS staff

They are - but as with all others you'd better just hope that they regard confidentiality as more important that tasty gossip

Every time I hear stories like this I thank my stars for how lucky I am.
My GP surgery are amazing.
They are in an area of economic deprivation and serve a huge chunk of a city Centre community.
I ring them if I need them during prescribed hours in the morning, there an afternoon call in also. There is no time limit on your calls if it's for a child.
The practice staff triage you on the phone then the GP calls you back, is usually within 90 mins. It's only ever longer if it's a really minor ailment like a skin irritation. Often the call comes within 30 mins!
When they call they ask all the relevant questions and if appropriate, will leave a prescription out for you to collect within a few hours. If your condition is bad, they'll see you in the afternoon. They are so kind and compassionate. One of them quickly flagged me to cardiology following an incidental find he made during a routine check.
Once I even dropped in with my 2 year old who'd cut his hand on the off chance the nurse was free. I waited about 20 mins and he was seen and treated.
I realise this is unusual from what I hear but there are so many great GPs out there. If they were all like mine I think we'd be in a better position!

Every time I hear stories like this I thank my stars for how lucky I am.
My GP surgery are amazing

You and me both, mydogsteppedonabee, but I had to change practices to get it

So while few can know all the insider details, we've got two surgeries in the same area - same demographic, same number of GPs in place, same number of support staff, and one's hopeless and the other excellent

Go figure ...

Go figure what? You wouldn't be surprised if it was two hairdressers or two coffee shops. GPs are independent businesses and always have been (for those who think they have been "privatised").

GPs are quitting because the public hate them. Or they move abroad where weather hours and pay are better. We need more GPs and not to bash the ones who actually stay around.
a practice that had 4 GPs and 3 leave and they leave 1 behind. No one is going to take a job in that practice as they know it’ll be too much work and it spirals. The one remaining GP tried to do their best and the patients spend all day complaining that there is no one else. And the one remaining GP thinks fuck sake, I’m the one that actually stayed and I’m being blamed.

Also they are paid day for 40 hours a week. The general public are now saying they need to work 7 days a week and 80 hours for the same pay. If I worked in Tesco M/f say and I was told I had to work weekends as well for the same pay MN wokld telll me to tell them to do one.

GPs are independent businesses and always have been

I'm well aware of that, sorrynotathome, but was simply intrigued that two practices sharing the similarities mentioned are so very different

If I worked in Tesco M/f say and I was told I had to work weekends as well for the same pay MN wokld telll me to tell them to do one.

There is a difference between working in Tescos for the NMW, and earning £90,000 pa in the professions - in the professions, working 70 - 90 hours a week for 35 hours pay is the norm!

How many professions cause death or serious injury quickly if they don't do their job properly?

That's why there are limits to the hours pilots, train drivers and others who steer large passenger vehicles/heavy goods can work.

Would you want an airline pilot to fly 90 hours a week?

Doctors, nurses, teachers. . . they don't have to do these jobs. There is no societal obligation to continue to do so when the pay is (comparatively) shit, the conditions are shit, they are treated with anger and contempt. They are also not required to work however many hours required because others are no longer doing these jobs because they've voted with their feet for the aforementioned reasons.

@gloriawasright Our surgery has always had the system of the receptionist asking a series of questions set by the GPs to prioritise the calls. Urgent ones, according to those answers, are then triaged by GPs or nurse practitioners but the others were booked for a routine non-urgent appointment, maximum up to 3 weeks ahead, if the patient wanted one.

From the pandemic onwards the demand has spiraled and it became unmanageable as the wait would have been far too long. We now have to have the clinicians triaging all the requests that have not been redirected to pharmacists, physios, psychologist, etc as well but, while that deals with the simple queries and those needing quick reassurance, it takes GPs time away from delivering routine appointments so we can't win.

Unfortunately we cannot rely solely on a patients' judgement on when an appointment is needed

My husband is currently sat in Barnet A&E. Two weeks ago had red patch develop on leg -keen runner/cyclist/swimmer so assumed insect bite. Swelling became worse each day -every time phoned GP no available appointments-despite being messaged a review would be required before further repeats of blood pressure meds would be issued. Leg worse today -no appointments again so went to local pharmacy as recommended by NHS when need advice.Pharmacist said needed to see doctor asap and sent back to our doctor - still nothing available so told him to go to minor injuries unit a mile and half away. By now it is 1.30pm. Goes to said place and when seen after 2.5 hours immediately sent to Barnet A&E as too serious for them to deal with. Arrives at Barnet and completely overwhelmed with patients *has referral letter, seen after a couple of hours and sent to UTC which is in same building. Seen bu UCT and then sent back to Barnet A&E as needs a blood test -11pm still not sorted-just so annoying as know A&E is busy but kept being sent back there!

All too late

I will say that sometimes GPs do get off their bottoms. My mum had an operation three weeks ago and appears to have a urine infection. She had gone in to talk to reception but they told her she had to use the e-consult.

I did it for her and she had a phone call asking her to go in to see the GP in person.

But if I had not been able to do it for her, what would have happened. The receptionist should have used their common sense with an elderly lady who's recently had an op.