If you are a GP or work at a GP…

[Merryoldgoat]

What is preventing you from offering the service you want to?

I’m curious because my GP is excellent but I don’t understand why the way they are isn’t standard. And whilst there are obvious geographical issues I know people in my road who use a different surgery and have a terrible time getting an appointment.

Monday I filled in a triage form online as I have a lump in my breast.

I had a call within an hour to make an appointment (was offered female doctor but wasn’t necessary for me), had an appointment yesterday morning. Called this morning to say my referral had been processed and if I’ve not heard in a week to call them.

This seems unusual given what’s in the news.

Is this unusual? Are my doctors especially good? I was able to access face to face appointments throughout Covid if necessary, have never waited more than a day for an appointment if it’s non-routine.

If your surgery can’t do this what’s stopping you?

I’m just curious as it seems to be so different even with less than a mile between surgeries.

Thing is ours was like that
I remember when they apologised because they were offering a non-urgent routine appointment because it was 2days away.
When dd1 had pneumonia in 2009 they came round twice a day to check on her. When ds was seriously ill, they phoned to check I was okay. When my back went, they didn't have an appointment available, but said to come down and they'd see me anyway.
They were never running particularly late, and we're always cheerful.

This was true until they merged in about 2019, but since COVID it's impossible to see a doctor. You may, if you're lucky get a telephone call, but more likely a rather dismissive text.
In my family we've got issues that aren't being dealt with because it's far too much effort just to get onto the triage list-and most of the time even with something fairly urgent you tend to get a text which has only rarely been helpful-along the lines of "your prescription is at the pharmacy" is great. Anything else has at best been unhelpful.

That’s a fair point and not one I’d considered. To be honest, my concern didn’t need a GP - I’m struggling with my hearing after having flu and just needed someone to check my ears for signs of infection - a pharmacist probably could have done it if such a service was available (I think it is for children but not adults?). So on that basis I can see why an ANP would be a better use of resources than me taking up a GP’s time? Or do you think cost wise it works out about the same when you account for GP supervision?

I worked at a GP for a while (non medical staff). The problem we had is that there just weren’t enough appointments. The first few people would get through at bang on 08:00 and that would be it for the day. All telephone. Only the GP themselves could book an in-person follow-up if they felt it necessary. No advance or routine appointments. No e-consult. We would have people crying and shouting on the phone if they didn’t get through in time and there was nothing we could do. I don’t last long.

But why no econsult? Why no advance appointments?

Why is it working so badly when other places use these things effectively?

I've been trying to get an appointment for over a week. Breast issue similar to yours so I was hoping an online consultation would highlight the need for a speedy appointment - NHS have always been good like that in the past.

Anyway. I did online consultation, waited all day for them to call back, which they did at nearly 6pm when I popped to the loo (typical) so I missed it by seconds. Called them back immediately and was on hold for 15 mins, then was told the doctor had gone home, and to call back tomorrow. Called them the next day, but got no call back. Called reception towards the end of the day, and they just told me to wait for a call which didn't come.

Played this game for a couple more days, then decided to just ring up and ask reception for the next available appointment, whenever that might be. They told me they were emailing me a link and I would have to book through that. Guess where the link took me...? Back to the same online consultation form. Tried again. Two days now and no call back.

It seems you aren't allowed to just book an appointment without having a telephone conversation with a doctor first - why?!

I have been told the only way to reliably get an appointment is to phone them at 8am on the dot and tell them it's an emergency, even if it's not, to try and get seen on the day. The problem is this means I have to call in sick to work, as I have no prior booking to show my boss and I have no idea what time the appointment will actually be. There's no guarantee of getting an appointment at all - I might be stuck on hold for half the morning to no avail.

It's an absolute nightmare and I genuinely don't know what to do. I can't afford private. It sucks.

It's unsafe because you can have an unlimited number of patients waiting to see a limited number of staff, who get tired, who reach the end of their safe capacity to see people.

3 weeks for a phone apt, not seen a GP since before Covid, am not sure if they even doing face to face anymore

My previous surgery was amazing, never a time when I couldn't get an appointment. Had doctor, nurse and physio appointments to book on the day or in advance every time I needed. Open 7am - 7pm too.

My current surgery nothing like as good, more of a rural village surgery, so fewer staff which I presume is the issue (although also fewer patients presumably?)

Mine was great before Covid - online appointments or phone at 0800 or 1300 for a same day or next day appointment
Now it is awful. We dont have e consult, you play fastest finger on the trigger to try and get through at 0800 - usually number 30 odd in the queue and then no appointments left when you do get through. They have also stopped people turning up at the surgery at 0800 who try to get an appointment that way.
I have some serious chronic conditions and need regular check ups but I havent had one for 18 months as I cant get an appointment.
Mine is a huge practice with GPs, PAs and ANPs but there are too many people on their books
It is also not helped that local schools are demanding children have proof they are ill when off school sick so parents try to get appointments for the proof

My GP surgery is fantastic. I’ve always been able to get a same day appointment even sometimes calling in the afternoon I’ve had a doctor call me to triage, often bringing me or my child into the surgery that afternoon. They do have practice nurses and a good relationship with the local pharmacy. The receptionists are good at directing people to the best resource but will book a GP call if you really don’t think another professional can help.

I know there are serious issues at another local surgery so it’s not all easy street but the way the surgery functions beyond mere patient numbers must have something to do with it.

Ours used to be like that. Then they merged.

Mine was great until they merged. Maybe that's the problem, like schools going down the pan as they merge into large academy trusts, the same is happening to GP surgeries.
Although the population increase doesn't help either. My local town has increased from 118k to 132k in just 10years (2011-2021 census results) and guess how many addition GP surgeries have been build to accommodate these extra people? Yep, none.

Where do you live?
Because here, in my LA where there has been 17,000 new houses in the local plan for a ten year period - with not a single additional doctor surgery, hospital expansion or even a school - I’d say that is what is having a massive impact on the existing GP surgeries and their ability to manage.

@Merryoldgoat I recently had to change surgeries due to a move. In my experience, the new one, which everyone raved about to me, is nowhere near as well-run as the previous one unfortunately. GPs are private businesses that have a contract with the NHS. Being a good GP doesn’t necessarily mean they have project management skills or business acumen. Both had GPs and Practice Nurses; in fact both use some of the same ‘part time’ GPs (which seems quite common - to be clear, this new surgery is not oart of the same practice group - it is completely separate). The previous GP surgery I could always get a same day appointment in an emergency but it’s only very recently that the current one has changed its processes to offer something similar. It still hasn’t switched on on-line appointment booking which the previous surgery offered and it infuriates me (I can at least still order prescriptions online, freeing up the phones).

I'm a practice nurse. I work pt. Two others work pt and two of us have less than two years to go. We don't want more hours. I want less. Our clinics are full for over a month. Yesterday I squeezed in four extra patients in the morning alone. These were urgents with chest pain for example who should have gone to A&E but came to us instead as they didn't want to go. They had to go anyway in the end.
Everyone's default is 'see your GP' or 'see the practice nurse'. Day after day we are full. GP clinics are full. Predominantly of elderly people regularly attending with several complex co-morbidities and often in poor health.

I don’t know why the partner GPs and practice manager don’t want those things, but they don’t, or at least didn’t when I worked there. They were trying to recruit another doctor to increase appointments but money was very tight.

My own surgery also runs mostly on same-day telephone appointments but if the doctor says to book a routine follow-up they will do it.

The number of GP partners at my practice has halved over the years. If I want an urgent appointment for my child it’s a nurse on the day. Last time I did that she referred for urgent blood tests and told me the I should book a gp appointment to review them at reception. Because the nurse had said the child needed one, I thought id get an appointment quickly - it was three weeks away.

Another child had a growth that needed looking at - referred to an out of hours practice covering my area, who gave an urgent referral for an x ray. It then took two months to book a follow up appointment - you need to ring at 10am to have a chance of an appointment in two weeks time (but I rang countless times over that two months and I got the first appointment I could).

it is exhausting and frustrating. As an adult I can raise an e-consult but it doesn’t work for a child.

Are you thinking of physicians associates? Advanced clinical practitioners / nurse practitioners have been around for over 30 years. And shouldn’t be blamed for the nhs’s / primary cares current state.

In ours you can get an appointment relatively quickly. I'm sure cold and clear things are sorted quickly. But anything that is not fixable with medicine or cast or require futher invetigation it all goes wrong. They're very reluctant to do referrals. And when they agree to do one then it takes several weeks and it is done wrong (has to be sent back and to get the jnfor necessary), rejected or to a differnet thing that was discussed. And then in the end it had taken months and nothing is sorted and you have to pay private anyway.

They still need some supervision - I get a query from ours most days. Yes, not as much as PAs who are dangerous in primary care.

That's remarkable. My DS is about to turn 5 and is yet to see an NHS GP in person for his reasonably severe eczema. We had to go private to sort a proper treatment plan.

Advanced Nurse Practitioners are autonomous practitioners, qualified at masters level who can prescribe and refer, they do not need supervision from a GP. They are registered and regulated by NMC Often if they have specialist qualifications (eg diabetes, family planning, respiratory) ANPs can advise GPs.
Are you thinking of Physicians Assistants, with just two years training? All the titles and acronyms are confusing.

Generally GP surgeries in affluent areas are able to provide a good service as; they're well staffed as people want to work there, a higher percentage of patients will have health insurance reducing demand and there is a link between socioeconomic class and chronic health issues.

GP surgeries in more deprived areas may struggle to recruit and will have a higher patient demand to deal with.

It does mean there is quite inequality with the level of service people receive from GPs.

I'm a patient not someone who works in a GP surgery, but I can tell you with mine, the issue is staff turnover and money.

Everyone has less time allocated for what they need to do and people keep quitting as a result. I really like a lot of staff and it's very obvious how much pressure they are under. There's not enough money to hire enough people so existing resources are stretched.

I'm also sympathetic because you cannot work like that forever and not make a mistake. Depending on the mistake, that could cost them their career.

I would say our GP is very similar to yours. We submit an online form and always hear back same day, usually within 15 minutes to 2 hours via text. Urgent appointments are always in the afternoon or next day or so. Even I submitted a form last week because I have what might be a piece of glass in my foot that needs removing. My ‘non-urgent routine appointment’ was booked for 5 days later. They are really good and keep you on top of everything they’re doing behind the scenes. I also have cancer at the moment, which is being handled by multiple hospital teams, but GP has been great about doing their bit.

It’s a surgery in a rural but fairly upmarket market town though. I suspect we maybe don’t have the pressures that more resource poor practices do.

So far our gp practice has been outstanding..I always try to thank staff as they can feel,undervalued.