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.

No, I'm not, but every ANP I've worked with has needed to run things by a GP as well.

Yes and geographical location is also a factor. I live in an area that is not deprived but it is rural, with poor transport links and no airport for 100+ miles. Drs do not want to work here, recruitment has been a problem for 20+ years. We had the targeted enhanced recruitment scheme to attract gp trainees and even then it was difficult. On a positive note trainees don’t struggle to gain employment once qualified. But the area is still short anyway.

There are factors such as patients per GP and the demographics of the population e.g. older population require more appointments on average per patient than younger population but I think often it has to do quite simply with the competence of the GP. My practice has a few GPs one is very good (and difficult to get appointments with because of that), you see her once and you get what you need from the appointment. Another is not as good and it requires multiple visits to get appropriate care, if people aren't getting appropriate diagnoses/ treatment/ referrals on the first appointment they are going to use up more GP time to get the same level of care as they'd get in less time from a more competent GP - and the condition may deteriorate in the meantime requiring extra appointments again, thus greater pressure on the practice.

Isn't that sort of 'wait your turn' service now mainly provided by drop-in centres and/or Urgent TReatment Centres ?

The practice I used to go to closed down and I was transferred to another practice within the same health centre. Demographics or area plays no part in this.

The difference between the two is like night and day. I’d got so used to bad ‘service’ and thought all GP practices were run like mine.

My new GP is amazing. I can now actually get a same day appointment and I’m regularly contacted to make appointments for check ups. Who knew GP’s could offer physio, nurses, blood tests etc. all on site? Not me.

I think my old practice was manned by locums who never had a clue how the computer worked never mind the referral process or how book me in for a X-ray or scan. One time I was told to turn up at A&E for an X-ray on an old injury that had been playing up. A&E, quite rightly sent me packing right back to the GP.

It is no surprise they had to shut down. Clearly some practices are better run than others.

Our practise is an absolute disgrace. Impossible to get an appointment and rude receptionists. I asked for clarity about the new booking system from a receptionist. There are never appointments on line so I asked if it was possible to make appointments by phone. She simple repeated the online procedure so I said that I know that but is it possible to make an appointment on line. She again repeated the online procedure and I again asked if there was an alternative. It was clear that she wasn't going to give me a straight answer and when I persevered she became very abrupt so I gave up. I then rang the other surgery in the group and asked the same question and wea given the answer straight away. Yes can phone. I did wonder if the receptionist's had been told not to give this info out ...but why I was ringing on behalf of my 93 year old mother. ..which she knew. When I finally got an appointment for myself it took a month and I was rushed in and out ..even though I hadn't seen a doctor in 5 years so hardly a 'nuisance' patient. The practise was shown as 'requiring improvement' in a recent inspection.
My husband has Glaucoma and his prescription had been changed by the hospital consultant. When the new prescription wasn't available we called into the surgery as quickest way to hurry it up. The receptionist said there was 'no record' of this new prescription. She was adamant that they hadn't received notification from the specialist ....until I produced a copy of the letter which id had for 3 weeks and which noted that as well as sending a letter to the surgery the consultant had emailed the prescription to them the day of my dh's appointment ..because it was important he started the new medication straight away. So ...they hadn't picked up the email and had filed the letter without reading it properly so it was never put before a doctor to authorize. 😱
If there was anywhere close enough I would change doctored even though I've been with the practice 35 years as it's deteriorated so much.
The think that is really irritating though is the endless message on the phone before you get to a receptionist telling us they are running on a skeleton staff and should use 111 pharmacist or anybody else before bothering them ...yet their website advertised that they can take more patients. This when they require improvement, run on a skeleton staff and can't provide a service for the patients they've got 😱
And breathe 😂😂😂 Well done if you got this far. 😁

@Tubetrain that makes sense.

Our GP practice used to run this system but you had to be there by 10.30am and occasionally they would turn ppl away if they had too many waiting. Personally I thought it was a great system, though I imagine it caused aggro for reception staff if they had to manage patients demanding to be seen quicker or whatever.

I'm very lucky that I don't need mine very often but when I do, its for an infection that needs certain antibiotics as quickly as possible that I've had rather a lot over the past few years. So I phone up straight away, sometimes 8am, sometimes later in the day. get the usual "I'm sorry there aren't any appointments " preamble after which I explain that I don't need an appointment, I just need these specific antibiotics and explain why. Sometimes I get an appointment at a Walk In Centre later that day/evening, sometimes a telephone appointment but last time (december) I got a nurse practitioner at one of the surgeries within a couple of hours which i was very surprised about!!.

You seem to be getting the same service as we provide our patients. No idea why all practices can't offer the same.

Ours isn't that good, but it's not bad, easy enough to get a phone triage where they then decide if you need to be seen and if so that tends to be pretty quick. My youngest was throwing a temp and very much not himself on the 23rd decembwr and after the triage phone appointment they had him in for a face to face within the hour.

Only annoying bit is the phone triage as you're not given a time for that call, but it's much less of an issue now our phones use WiFi for the phone signal

My very local GP was awful, so I moved me and the dc to one a little further away and it's brilliant. Filled in an online form yesterday 11am. Got a call back within a few hours, and was asked to go in and collect a prescription for short term relief, a sample pot and to book blood test. Bloods now booked for next Weds, will take sample in on Friday and follow up next week. I would say that this could be due to symptoms of bowel cancer necessitating urgency, but my experience has always been the same since moving GPs whether it's for the dc's ear infections or my own minor ailments like chest infections or muscular skeletal issues.

We used to run it. At the end of my morning surgery of 15 patients, there would be maybe 25 people in the waiting room for the 3 doctors to see as extras. What quality of care do you think they got? how focused was the doctor?

No it’s not standard . I waited 3 weeks for a female GP to check a breat lump . Once the referral was done on the 2 week pathway I got an appointment quickly . Unfortunately after having X-rays and biopsy I wasn’t contacted over the Christmas period as promised and had to chase up results 3 weeks later . Even then my GP had to chase results up months later to get the results written down.

Well this is my simplistic view but not working in the sector I wanted to understand why such a disparity.

It does seem like it’s essentially down to the GPs who run the practice being willing to innovate and investigate better ways of operating.

I cannot believe that there are people still having to do that as rush for a phone all at 8am.

Our econsult opens at 8:00 and is open all day until 18:00

There are 5/6 GPs at my surgery - mixture of FT and PT and I’d be happy to see any of them. All extremely competent, kind, knowledgeable and patient.

I think it helps if the practice doesn’t have a load of mediocre doctors and one good one.

I’m very grateful to my surgery for their care. Luckily the doctors are quite young so hopefully they won’t be moving on anytime soon!

That doesn't happen at our surgery.
I don't work there, so I don't know why, or how it works, but it does.
Potentially it might be because there is open surgery every day?
Perhaps it is because the GPs are there to see the people who turn up at open surgery. They don't complete a list of appointments, then, as they are finishing have to start seeing extra patients - that's not how it works. I don't know if people are turned away once it gets to a certain number. I've never seen that happen, but obviously I'm not sitting there day after day observing.

Isn't that sort of 'wait your turn' service now mainly provided by drop-in centres and/or Urgent TReatment Centres ?

I think the availability of drop in centres and Urgent Treatment centres varies across the country. I often see things mentioned on here that don't exist (as far as I know) where I live.

@Merryoldgoat sounds like my GP, are you London/SE

TBF DH had pneumonia and had to ring 111 for treatment in boxing day morning and by 8-30am (within half an hour) he'd got through, been triaged, spoken toDr and had script sent to pharmacy for me to collect when it opened

When it works it really works

Would be totally normal for me at my doctors. Any serious issue like a lump, suspected infection they see you the same day and refer. Breast clinic sees everyone within 2 weeks.

the surgery i work in its patient choice if face to face or telephone

Mine are good too. Phoned up for a non urgent appointment, told the GP would phone me back that morning. And they did. Job done!

Yes - SW London.

Our out of hours works far better than the GP.

The out of hours isn't at all to do with our surgery.

Those statements may be connected.

My GP surgery has changed from an arrangement where you had to phone at 8am for an appointment that day . Sometimes when you got through all the appointments had gone and you couldn't ask for the following day or make an appointment-you had to try again the following morning..
They have changed to e-consult, which I thought would be a good thing but it's a tick box form and not at all flexible. There is a rude receptionist and if you phone she just barks "E-consult!" At least you could speak to someone before. I had side effects from a medication and it just didn't fit the box.
The effect of this is that people with uncomfortable or immediately concerning issues are going straight to A&E.
I do understand that they're under pressure but the receptionist really is very difficult. I witnessed her being very uncaring towards a young woman who walked in clearly very ill.

I’ve worked in primary care for 25 years now. It’s generally shit as its overworked and underfunded.

I believe GP services carry out 95% of all NHS contacts with approx 9% of the NHS budget.

Short staffed, increasing expectations from patients, the government and secondary care. Too much work being pushed onto us from hospitals - they’re busy but we have to look after the patients waiting months and years to be seen by them, as well as doing a lot of their work for them.

We’re not an emergency service, we’re not a drop in centre, we have limited capacity for appointments but unlimited demand.

Management makes a difference, a good manager who proactively manages demand and capacity can make all the difference.

I work in a really good practice but am a patient at a less good one, probably because in my home town house building has increased the population by thousands with no extra capacity in health care.

As a HCP I’m tired, disillusioned, broke and starting to get compassion fatigue 🙁

They have changed to e-consult, which I thought would be a good thing but it's a tick box form and not at all flexible.

Oh yes e-consult. What a wonderful idea.

I was having pain in the chest. I was pretty certain what it was, but thought it ought to be checked out. So I thought I'd go through e-consult, which said if I needed an appointment, they'd give me one.
As soon as I put "chest pain" on the tick box it said "make an appointment urgently with your GP".
Guess what happened when I phoned the GP? Apparently I didn't qualify for an appointment (even phone one), and should use e-consult. They kindly told me this by text so I couldn't respond.
Result it, I haven't been seen. Great result isn't it?

But this is your surgery at fault - not the software.

If I called in those circumstances they’d have seen me immediately. I know this because I had (likely non-serious) chest pain and was in the surgery within 2 hours.