For thinking that it was actually less efficient and more expensive for the GP receptionist to offload me to other services today?

[Tryinghardtobefair]

I'm asthmatic and I developed bronchitis over the weekend after having a bad cold - it happens every year. Because I'm run down I've also developed a UTI (dipstick confirmed). Called the GP surgery and explained to the receptionist about both infections, thinking I would get an appointment to see if I could be prescribed a broad spectrum antibiotic to treat both issues at the same time.

The receptionist told me I can't see a GP because the surgeries new policy is to refer chest infections to be assessed by a doctor at the GP overflow clinic, and to send UTI patients to the pharmacy for antibiotics. So she's referred me for appointments at both. Which means two consultations and two antibiotic prescriptions.

If I had one of these issues I would completely get it. But on this occasion wouldn't it have been more efficient and less expensive for someone clinical to decide where I should be assessed and treated, rather than the receptionist just blindly following policy and potentially doubling both the time taken seeing me, and the cost of medications etc?

I don't work in the NHS so if I'm wrong, and this way is still more efficient please let me know 😊

Exactly this. She doesn't make the rules. She does as she's told.

Just to get on my soap box for a moment, I think this is one of the biggest problems with NHS GP practices - the actual operational process within each surgery is so inconsistent becuase they're all run as individual businesses. The NHS tries to improve this by providing clear pathways, processes that are supposed to be applied etc, but that simply doesn't account for the reality of individual practices and what skills they do/ dont have.

I'm not 100% sure of the answer, but I thin it's probably some combination of best practice (established by surgeries with high patient satisfaction, good percentage of resolved cases etc) being more proactively insisted on across all surgeries and more careful monitoring of these processes.

In our area, it is astonishing to see how the differences play out. There is one surgery that is NOTORIOUS for being bad and another that is well known for being excellent. I drove past the bad one the other day and wasn't exactly shocked to see that it has a sign up saying, "accepting new NHS patients". Considering that the area is expanding rapidly and most practices are overfull.... I think it's a pretty clear sign of their incompetence.

Similarly, 3 miiles down the road, my sister's GP surgery has yet to give her a same-day appointment, EVER, and don't even get her started on various other issues. She now routinely rings me to ask what would happen at MY surgery if she needs x or y just to double check. It's ridiculous.

Yes, and you haven’t understood my point. Looking at this from a practice perspective, most people won’t turn up with your mix of problems, they’ll have one or the other. So by dealing with the majority of people in a more streamlined fashion, even if there are outliers like you who have more appointments, it’s more efficient. It might cause you as an individual more inconvenience.

Believe it or not, these policies are not just made up on a whim.

Thank you.

I don't think she was fobbing me off, and I haven't said that. I also haven't guessed what antibiotics I need.

All I was questioning is the efficiency of making two referrals where I will be prescribed two different antibiotics in two different consultations in the name of policy
Rather than a clinician seeing if there is one medication that can treat both issues, and deciding where I should be seen based on that decision. It's not uncommon for one antibiotic to treat two infections.

The doctor at the respiratory hub won't do anything beyond prescribe for a chest infections. I've been before and it's very clear they only deal with that, so I'll have to go to the pharmacy as well. And the pharmacy won't prescribe for a chest infection.

My issue isn't that I can't be seen at my GP. Nor is it the receptionist following policy (she's just the person that offloaded me, I know it's not her decision). I'd have happily gone to a generic overflow GP if one existed. My issue is that The NHS higher ups constantly complain about a lack of funding, a lack of appointments and an increase in antibiotic resistance, yet would rather potentially block two appointments, pay for two lots of antibiotics and increase the risk of antibiotic resistance because policy says nobody is allowed to deviate from the pathway or use their common sense and assess if an appointment can be freed up and if two infections can be treated simultaneously.

It may only be one extra appointment or one extra course of antibiotics but when you times that by thousands. It adds up. And it may be relieving pressure on the GP, but I've now taken two appointments when it may not have been necessary

I do understand your point. But surely it would be more efficient to see the few outliers at the GP surgery if the majority fit into a clear pathway? I'm effectively just blocking two appointments now when both issues could have been sorted in a single GP appointment. All the streamlining is doing it moving the pressure to a different service.

Also when you put it into a countrywide perspective, it's not really more efficient at all because it's thousands of outliers being prescribed extra medication and being given extra appointments. It all adds up.

Are you a health economist?

Where is following the policy and procedure - the one she is instructed to follow - in any shape or form her making a clinical decision?

It's the pharmacy first. They won't assess or prescribe for chest infections. I asked last week when my daughter was showing symptoms.
The respiratory hub on the other hand won't deviate beyond chest infections. So there's no getting around it.

Before the streamlining came into place the GP would deal with two conditions if they were simple. I had a chest and an ear infection last year. There's a specific antibiotic that I respond well to with my chest so they prescribe that once they hear crackles. And then they gave me antibiotic ear drops for my ear. It was all done in my time slot.

I don't blame the receptionist, I just think that sometimes policy isn't always the best route.

Do you always become so snappy at people with a different point of view from you? Did you want discussion or simply for people to affirm your feelings?

Don’t post on AIBU if you don’t want to be told that yes you actually are being unreasonable.

Tbh, the level of overreaction you have shown here could be an indicator of your overreaction to the GP receptionist.

No. I just have common sense. If you spend a little bit of unnecessary money lots of times, you spend a lot of unnecessary money...
If you do that while you are already struggling for money, you will struggle even more for money.

If you avoid spending that money you eventually end up with more money...

Lol. I didn't overreact to the GP receptionist. I said "Please could you send me an appointment confirmation for the respiratory hub via text?" And then I asked which pharmacy offers UTI treatment

Believe it or not, regardless of what I think of the system, and regardless of whether I think a clinician should have the final say when someone doesn't fit cleanly onto a single pathway, I'm aware the receptionist is ultimately bound by the policy, so I'm not going to be a dick about it when she's making sure I can get seen.

And I wasn't getting snappy. I was pointing out that I specified my post was about this situation specifically so there's no need to pounce and call me ignorant to every other time policy has saved time. It's AIBU. We all know comments like that are people desperate to pounce.

surely the chest and urine infection can respond to amoxicillin? i.e just one antibiotic?

lets hope so!

This is a problem with protocol driven care. Most of the time having standardised pathways is a good thing that improves the quality of care for most people most of the time but there are occasions when it is sensible to deviate from protocol. The problem occurs when the first decision maker is not senior or experienced enough to be able to make that decision. It probably would have been better for the OP to see a GP and have a single appointment both in terms of her well being and the overall cost to the NHS but the receptionist won't have the authority to make that decision and there's a distinct lack of joined up thinking in the NHS these days with everyone only focused on the night own service/budget. I agree that appointment requests should be screened by a clinician, not a receptionist for several reasons.

My gp has a sign up which says appointments are 10 minutes long and only one condition/illness can be discussed,if more than one then you need 2 appointments.

Great! Let’s make all care decisions in the NHS based on one random person on the internet’s common sense. Who needs clinical experience and health economics, anyway?

A free at point of use healthcare system will be set up to maximise the total benefit across the system, taking in many factors. Your personal convenience is one of those but not the most important.

I hope you feel better soon.

I agree it’s a mess op. I have a problem with my shoulder. Tried to make a gp appointment to get a referral for physio. I wanted that because I have private health. If they refer me to physio my PH will cover it and they can in turn refer me for x ray/scans etc. Couldn’t get a drs appointment (literally never can) but saw the Advanced Medical Practitioner. Explained what I wanted and she refused. Instead she prescribed me Codeine (8 a day and gave me 100!) and sent me for an X Ray. Why? All that cost to the NHS could have been avoided? X ray was fine so I now need to go back to get referred for physio - like I originally asked. Such a waste of public money and time.

When are GP surgeries going to open 7 days a week.

the other side of "never in a million years"

that is such an unfair request.

Anything relating to do with health is a clinical decision. Just because GPs instruct admin staff who have no medical training to decide who should treat a patient doesn't make it the best thing for the patient or NHS time and costs. As OPs post indicates.

She’s not talking about all the other times, she’s talking about this time.

If I were you I would be ringing 111 or going to out of hours/A&E (it's not an accident but it is an emergency). Not treating a bad infection in your leg for another 5 weeks could cause all sorts of problems. Is it cellulitis? That is a medical emergency.

This is something that's been discussed time and time again. The last Tory government particularly liked shouting loudly that GP's were slackers and demanded weekend working. But it's never going to happen. We don't have enough GPs to cover the current 5 day service, never mind an extra two.

So much for patient centred care then. I think its harsh to be dismissive of the patients inconvenience especially when they may have conditions making attending separate appointments extremely difficult.

Having a double infection is a pretty big deal actually. The person may very well not be physically well enough to attend two separate appointments especially if travelling on public transport. Not everyone drives so the inconvenience for the patient who is unwell should be a big deal and of importance. Sad to see the dismissive attitude expressed here.