GP surgery sent letter to deter us book appointment for toddler

[Watapain]

Today we received letter from Surgery saying that we have booked several appointments in the last month for our toddler who has been sick often and has got a recurring issue needing doctors attention. We should consider other alternatives and not see the GP.
This has really concerned us as me and DH never see the GP. I am fuming as they have sent a form asking us to sign an undertaking that we acknowledge the letter. We are not happy about it and to sign the letter.
Have you been through anything similar and how do we approach about complaining about it as the tone on it seems threatening that they are looking to remove people from their list.

I have had periods with both my children when they have been at the gp extremely often and then months with nothing. It’s entirely possible that people are very frequent users during periods of acute illness because they then end up going down with something else.

example 1: child saw gp day 1, admitted to hospital with an infection, saw gp a few days after she was home as still poorly and again a few days later when she was dehydrated after vomiting for 10 days straight on the antibiotics. Same child then got bronchiolitis 2 weeks later plus a secondary lung infection. A few more gp visits and another admission to hospital. We were probably at 5/6 gp visits within 6 weeks.

example 2 - child v bad vomiting bug and dehydrated. Gp saw and then asked to see them again that afternoon and the morning after as child was borderline for admission. 2 weeks later, very similar thing happened again with another 2 visits and borderline admission. So 5 in a month. Both times she’d have most likely been admitted if we’d just gone to a&e and weren’t under the supervision of a Dr in primary care doing fluid diaries.

Both of those periods were hideous to be frank but our frequent gp use was entirely appropriate. Thankfully neither have needed to be seen for at least 18 months and hoping that continues!

I mean eg if a patient has a pattern of symptoms that put together might indicate a specific problem or source of help that the patient is unaware of. For example if you keep getting chest pains and asthma attacks, a referral for pulmonary rehab can be a good call (took an asthma nurse to suggest it for me, but it helped).

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(If you're waiting to see consultants and need a GP appt in the meantime, that can't be avoided).

@ToHellBackAndBeyondBeyond inappropriate. If a child or even adult needs medical attention, they need to see a medically trained professional. I would ask for a referral to whichever specialist is required and make a complaint.

Sorry @ToHellBackAndBeyond , unsure why it tagged you and I can't figure out how to remove it

Hi OP,

Before you go to the CQC and HealthWatch, it would be a good idea to contact the practice manager and talk it though with him/her first. It's almost certainly a computer error. If you ask about it they can just bin it and let you get on with your life.

I would do this and also forward to my MP, CQC and Healthwatch. Disgraceful.

Your GP practice are actually allowed to remove you from their list without giving a reason, the same way you can go and register elsewhere without giving reason or notice. Your health authority has an obligation to provide you with a GP, which they will do.

I've been to the GP 4 times in a month and needed seeing and there were no other options

1 - UTI, given antibiotics
2 - UTI, not resolved, antibiotics extended
3 - UTI still there, given different antibiotics
4 - allergic reaction to the second lot of antibiotics

It’s rather condescending when practice managers or the nhs like to inform you about the different services one can try before hearing off to the GP as if we haven’t already tried everything alread…and the fact that they think that we ALL LOVE the hassle of waiting on the phone at 8am to beg for an appointment so we can hang out at the doctor’s surgery for half a day.…or the fact that we ALL love hanging out at A&E for 6+ hours with a poorly loved one that’s not been seen by a doc because they can’t give us an appointment. sigh…

Complain OP!

I have been told (by people who work as GPs at different practices) that a high percentage of the patients they see every day are the worried well.

So there definitely are people out there who happily use resources they don't need and thereby make it harder for those who do need them to access them.

Am not saying at all that OP falls into this category.

Sending a letter like they did may not have been pleasant to receive, but it is doubtful that a complaint would very far. It would not be considered serious professional misconduct. At the very best, the health authority may ask the practice to review sending out this type of letter, but they have sent it within medical practice guidelines. You would be best to go to another GP to register.

Multiple appointments for same thing.
Diabetes review
This is what would have happened 20 yrs ago :

One appointment with diabetes nurse or practice nurse
They would do bloods
Blood pressure
Foot check
Dietary advice
Weight check etc
Medication
Appointments 2 ( one to get blood results and medication review )

Diabetes review in 2023
Support worker
Takes blood pressure
Foot check
Bloods
Phone appointment for blood results with support worker
Support worker refers to gp to check results
Pharmacist calls to check medication
Phone appointment with Diabetes nurse
Diabetes nurse doesn't give diet advice referes to a Support group run by another provider or a virtual support group
Appointments 5
Several more if you count the sessions of the support group!

Far more appointments needed now for one annual checkup than 20 years ago

Im not sure where you live?
midwives discharge babies after 28 days post birth, they certainly do not work with preschoolers.
we don’t have any “community nurses” either (im in London)

Mind you I didn't quiz them about their failure to diagnose rate. Maybe they only thought their patients were the worried well because they failed to actually diagnose what was wrong with them!

That also seems to happen a lot with GPs if anecdotal evidence is to be believed.

Hi, I work for the NHS. Completely understand how worrying this must be for you.

You could try your MP, CQC, Healthwatch - but as others have said, perhaps the best start would be letter to Practice Manager setting out your concerns and requesting a response. I’d suggest copying it to your local Integrated Care Board (ICB, they replaced Clinical Commissioning Groups).

PALS (patient advice and liaison service) is an health trust (hospital etc) thing. Your practice may have a PPG (patient participation group), but I’d still suggest first approach as above.

Disclaimer: acronyms and organisations correct at time of writing. Give the NHS six months and it’ll probably have changed. Again. And this is part of the problem!

Hope it gets sorted for you.

I think it’s reasonable to ask someone who is a multiple attendee at a gp practice to consider alternatives. Health care professionals should actually screen who is receiving the letters though -four visits in a month will be justified in some cases but not in others. An ‘automated’ service doesn’t distinguish between the two so should not be used. Babies and children are different than adults, they can’t really tell you what is wrong for a start. Sometimes parents need the reassurance of a gp assessing their little one.

I think is more reasonable for the GP to find out at an appointment why they are attending so often if it is a problem, not send a letter. A f2f chat to find out if someone has health anxiety would bemore beneficial to both parties. I go a lot to the GP as I have multiple conditions, including immunosuppression which means I get a lot of infections. I’d be appalled and very upset if the computer picked this up and sent me a letter asking me to consider alternatives. I can’t imagine pitching up at A&E every time I needed antibiotics is a reasonable use of the NHS. It would cost them far more for a start but also I’d have no continuity of care.

Dont let it upset you - they can’t remove you for going - there may be a scheme going on locally to contact x number of appointments in a month to keep people know alternatives. I am gp and we have some amazing pharmacy services.

people have clusters of when they see GPs more especially if very unwell. Don’t worry and hope your little one is better soon.

someone said contact cqc - it could be seen as positive they are contacting those using the service - don’t waste time on it, try and have good weekend x

MP? CQC? Blimey do people really have such an appetite for conflict and hassle that they’d do this?
Just send the letter back with a note saying you’re a bit confused by it, and would welcome to opportunity to discuss it with the practice manager.

This is a bit much I think.
Just ignore it and seek help if you feel you need it. I don’t think they can remove you/ your toddler.

My Mum had a text to say something similar. But she has long term health issues which require attendance to Nurses and Doctors every month. So she just ignored it.

I would call and ask to speak to the Practice Manager or email them and explain your childs needs. Do they expect you to go to A&E???

Not only would I not sign the letter, I’d be forwarding the letter to the practice manager and asking them to explain which of the appointments were unnecessary and what were you meant to do instead, and if your child is one with chronic conditions, I’d be asking exactly which specialists they’d like to refer you to as apparently the gp isn’t appropriate. If I didn’t get a decent response from that, I’d be going to the NMC and PALS.

Completely understandable that people need to go to the gp more frequently as you're only allowed to talk about 1 problem per appointment. They can't have it both ways!

Regarding op, I would personally go into the surgery and ask to speak to someone about it. I'm assuming you don't take your toddler there frequently in normal circumstances so they need to realise its inappropriate to basically threaten you when your child has been ill over a month.

I’ve been a GP for over 25 years.
In that time, I’ve seen it become much harder to get appointments. One reason for this is the expanding (particularly elderly) population.
Another reason is the vast increase in bureaucracy. Most GPs will now have at least one admin session per week, simply to deal with bureaucracy, such as audits, complaints, CQC, various NHS-mandated schemes etc. The list is endless.
So people should think very carefully before they involve MP, CQC, NHSE etc. Because in the time it takes for a GP to deal with just one such complaint, they could see 20-50 patients.

Something like OP’s issue could be resolved by a quick chat with the practice manager.

Make a complaint OP. that’s appalling.

OMG i have seen it all now, that’s disgraceful!!!!!!