To be concerned about GPs new online booking services

[autienotnaughty]

So my GP and others that I’m aware of have adopted an online booking system instead of ringing at 8am.
So I have a chronic pain condition, I went online to book an appointment to discuss an element of it except you can’t actually book an appointment. You send a message and the GP gets back to you within 3 days.
I got a reply 2 days later ignoring my request for a face to face appointment it said “you have a telephone appointment with the NP for a medicine review discuss this issue then”
Now fine I can do that, except my doctors have a one issue at a time rule so there’s every chsnce she will refuse to discuss it. It’s also a telephone appointment and I wanted to be examined and I asked for doctor not NP.
This feels like an easier way of fobbing people off and making it harder to get an appointment.
Aibu to be concerned at this change of direction for GPs. It’s also happening at my dad’s doctors and he’s not online which means I need to request his appointments for him. I

I hear you, but in a situation where most GP services are massively overstretched they have to do something to try and cope with the madness of it all.

It is random at my surgery if you manage to get an appointment by calling at 8am - how is that any more fair than an online booking service?

People who are using a lot of gp resources and want to discuss multiple issues cause delays which impact other patients. Everyone can benefit from being triaged first by a NP in marginal cases, who can “gatekeep” access to the GP and often very knowledgeable.

If there’s not the money to give every patient a premium service, do you think it’s fair for people to have to phone up and just hope they get to the front of the queue? I’d rather that the practice can see online all the requests for appointments and give the most urgent-seeming cases the access to the gp.

It’s imperfect of course but unless we all want to spend a lot more on tax we had better put up with it.

My experience of e-consults and follow up has been very good over the last few years. Any system is only as good as the practice providing it and I am lucky that my GP practice is excellent.
I accept that some elderly people might find it challenging, but, we have had 20 years to get to grips with basic use of the internet.
I have a friend who is a complete technophobe and I have spent years trying to help her and show her very simple basic skills. TBH I have lost patience with her.
I and my friends are all around 70 years of age and we are all perfectly competent with basic IT skills. We had to get on and learn because our employment depended on it.
There needs to be some back up for people who cannot/ will not use technology, but generally I think used correctly, it makes everything more efficient.

It's difficult - I have had nothing but good experiences of our doctors online system since it came in, and have always gotten a call back and appropriate input.

I will caveat that with the fact that I've not had to discuss anything particularly complex, it's just been a case of getting appointments booked or anti-biotic prescriptions etc and it is great that they will accept photos for some things now and prescribe from those if they can.

Often with the old call system, if you didn't call until after 9, you were just told to call back the next day.

There have been a couple of MH related issues for various family members and they have been dealt with quickly with return phone calls and same day appointments.

I also like the fact that we seem to get referred to an appropriate professional which is not always the GP. I often think the nurse practitioners are much better as a first point of call for a lot of things than a GP and I often prefer to see an NP even if they then have to consult with the GP for prescriptions or meds.

Pharmacy First service is great as well and I wish they would expand it further - since it has been introduced, I've found the pharmacists a lot more helpful than GPs have been previously for similar conditions.

I can understand that for more complex issues it might not be right - however, our GP is constantly refining the online system, so I think they will keep iterating it based on feedback so that it gets better.

Have a copy of the message from the GP with you when you have your appointment with the nurse practitioner. If she objects when you bring up your issue, point out it is a direct instruction from the GP, her boss.

I've experienced the online triage system once. I got a f2f quickly but couldn't get a word in edgeways with a DR I've never seen before who ignored me, constantly interrupted me and handed me a fit note for 3 months despite not asking for one.

Not the best experience, hard enough dealing with a chronic illness and something new happening he assumed it was chronic illness related it isn't so now stuck as put off going back to GP.

I can see how it works in practise but like everything it won't be suitable for everyone

Our small town has had a 50% increase in population over the last 15 years, with no obvious increase in GP services, so clearly something has o give and the service we get now has to look different. I've found it helps to understand how the system works from the GP's perspective and to try to support them with that.

I recently had an ear problem identified by my audiologist. I normally use the online system and answer the interminable questions patiently, but this time I spoke to the receptionist and said 'I don't think the online system is suitable because I can't take a photo of the inside of my ear'. I got a call back within half an hour, a face to face GP appointment within another hour, I was listened to when I explained why I thought the standard first line treatment might not be the best option and I picked up the appropriate medication on the way home.

I've had several online or telephone appointments in the past, all of which have been dealt with swiftly. So I think that if patients have to accept non face to face consultations to free up capacity for the people who do need to be seen in person, that's an appropriate way to manage the resources problem.

You can thank your government for this - it's been mandated hat we HAVE to switch to online triage/appointment management.

We do have the option of telephone calls for those that can't or won't use online services, but it has massively reduced the demand on the phones so it actually benefits those groups as the phone lines are free for the care navigators to assist them.

I think online booking services can work really well - a lot of requests that come through don't need a GP, can be dealt with by nurses, paramedic practitioners, pharmacists, the Pharmacy First scheme, physios, admin team or social prescribers. Clinical triage via online services can effectively and quickly assess the requests and divert to the most appropriate service.

Just as an aside, I hate the use of the phrase 'fobbed off' as it usually translates into "I didn't get what I wanted" - usually because what you wanted was inappropriate... 😉

I'm not a fan of the e-consults purely because every time I've filled them in, I've got to the end and it's told me to phone the practice. I duly phone and have to spend a few minutes explaining that ... yes, I did try and do an e-consult.

My theory is if you mention a temperature when completing for a child, it won't let you submit it but nowhere does it say that up front and it waits til you've finished before saying "nope" so a total waste of time.

YANBU. I plan to move practices shortly because of the introduction (I know others will use it...I will make enquiries as to whether they actually read it first). Been with the same practice for about 13 years but this is the thing that's made the decision.

Tried to get a GP appointment due to having finished antibiotics following a tube being implanted between a failing kidney and bladder about 8 days before. The antibiotics are often used for UTIs. In the free text boxes I had given full info as well as readings from urine tests which showed some concerns.

A text came back no more than 5 minutes afterwards with a note that my info had been passed to the pharmacy, 'who can prescribe antibiotics if necessary'.
Rang the pharmacy, no notes had been added to the record. When I spoke to them, I said (I quote) "This is way too complex for us" and "Do you have an infection?" (Well, it's what I'm trying to find out...)
I am convinced that only the intro 111-style questions had been read, if at all, and no further part where I had described the actual situation.

It’s a better use of their time to have telephone appointments as nothing would be gained by them actually seeing you they don’t need to check your heart or anything. Just write down everything you want to say so you don’t forget.

I love online booking. It means GPs can prioritise correctly and see the sickest people on the day and push other appointments down the list and signpost pharmacists etc for people with colds. I’ve always been seen the day I’ve requested an appointment for me or my kids and if I need something else like a medication review they book me a phone appointment at an appropriate time and day. They seem far less stressed now and it cuts out the receptionist as doctor screening

No you don’t at our practice.

I've found that it's just meant me ringing 111 more often as so often they are taking no more requests.

Sounds much better than the mad scramble to phone at 8am, especially as for years I couldn’t call at that time due to being at work then. I should imagine that for many people 8am is a terrible time to be trying to call the doctors - commuting, getting kids to school etc. I much prefer the online system which I can complete at a time convenient to me and I’ve nearly always had a response the same day, if not the next.

My surgery moved to a triage system about 18 months ago. Apart from the fact that the form only opens at certain times (why?), it’s great. They saw us same day when we had been in an accident on the motorway and DD complained of a sore neck the next day.

Recently, I had a skin “lesion” I wanted checked. Filled out the form, they asked me for a picture within 10 mins and 10 mins later, they rang me to say they were referring me to a local skin hub. I had the appointment made within an hour of me filling out the form for the next day, and the outcome sent me within 2 hours of attending the appointment. Under the old system, I’d have waited up to a week to get an appointment if I’m lucky, then maybe they’d faff around with a referral (admittedly the skin hub scheme is relatively new) and I’d get to see someone a few weeks later. It was all completely harmless but had it been of concern, it would have been actioned so much quicker.

I used to hate the 8am rush so I am a fan. I can see it could be problematic if you have complex multiple issues to discuss.

Our GP practice uses the AccuRX booking system, which most of them use. I find it excellent. Most day to day things such as a meds review can be dealt with over phone - and if you talk to the Nurse Practitioner or the Clinical Pharmacologist and she/he feels you ned to be seen, you will actually get seen quicker. Same for people who get given an appointment with the MSK practitioners who are now running clinics in all our local GP surgeries - if they can't help, they'll often literally get a GP in the room in 5 minutes.

I actually worked as a GP Receptionist for 10 months. I had to leave due to the astonishing levels of abuse we were subjected to whilst each answering up to 110 calls a day - my worst day ever!, so I've seen it from both sides.

The online system really helped channel patients into the right direction, and definitely made things better for almost all the patients in the practice - the very few patients who could not use the online system were, of course, able to call in or telephone us and we would get them sorted. We also ran lessons for a year to help patients learn how to do it.

Go back to the forms and see if you can explain in a bit more detail why you want a F2F appt, or dscuss it in your call with the NP. Don't worry about the one issue thing - if it's part of something you're already going through, that's fine.

I'm perfectly happy with a telephone consultation, except that they are offered in three hour slots. I have a full-time, complex professional job with a diary like jenga. I cannot accommodate a three hour slot any more than my GP would accommodate me telling them, I'll turn up at the surgery at 2pm and hang about until 5pm and whizz into your office when I see a gap.

The on-line booking is fab, the belief that patients have bugger all else to do than wait for a call is abysmal.

The calling nonsense doesn't work for: court staff, teachers, nurses, retail staff, etc. If GP's can provide a 10 minute slot for a F2F, why can't they provide a 10 minute slot for a a phone call? It's about managing their time isn't it? Just like their patients have to manage their time. Oh' but patient time isn't important, is it?

Great as long as its an option and not the only way to book an appointment. My concern with online booking is what happens to people who don't have access, or for those in no fit state to concentrate on a form because of pain or distress.

Secondly, its awful not to be able in some way choose a convenient day and time for non urgent appointment. Patients have lives outside their illness and may have to book time off work and other commitments. I'd prefer to be somewhere private and not on the bus or at the school gate when I receive a call from the GP but its not possible to wait about between 8am and 6pm for three days.

I will try and help a little. Quite often, conditions are discussed on the ‘phone. Blood tests can be arranged etc. Once the results are back (usually the next day), the doctor will have more of an idea what they are looking for and should offer you a F2F appt. If you aren’t happy, you are well within your rights to ask to see them

At our GP's we're increasingly sent to a different practice in the next town.
Which is fine for a lot of people but if you don't drive its a nightmare. How someone who is ill can do a journey by public transport is beyond me.

@findingmeno I have some sympathy, but many GP appointments are not when debilitating sickness prevails. More ofo a problem is that faced by mother and step, 89 and 83 and no longer driving. Their GP practice is about 0.6 miles away and they can't do that journey on foot any more. The half hourly bus has been moved to hourly in the last year and the first bus starts at 8am. It is therefore difficult for them to get to an on the day appointment prior to 9.30.

Their solution is to have a taxi account with a local firm. Regrettably, that firm will not accept a pre booking for a journey of less than two miles and the local council has blocked Uber because it might put taxi firms out of business.

The local GP staff know this because they are affected. Their mantra of "well you've been offered an appointment and refused it" prevails.

The world has gone bats and customer service or patient care has been flung out of the window. But there is 1.7 billion to waste on Prumary Care Network Initiatives and hordes of operational backroom staff munching data.

Just as an aside, I hate the use of the phrase 'fobbed off' as it usually translates into "I didn't get what I wanted" - usually because what you wanted was inappropriate…

What sanctimonious claptrap. I “wanted” a colonoscopy because I had most of the symptoms of bowel cancer. My all-knowing, eye-of-Sauron GP and her partners required no such trifles to diagnose me with IBS and decide I was unhinged when I politely challenged their diagnosis. When my cancer was diagnosed (late and metastatic), I must confess that I DID feel a little fobbed off. 🙄 Patients are not all supplicants and halfwits - many of us are also well-paid professionals, the main difference apparently being that some have learnt empathy and humility.

@Vinvertebrate I’m sorry you were treated like that and got the diagnosis you did.

That’s why I was careful to say “usually”. I find it’s a comment usually made in response to wanting inappropriate antibiotics or medication, a procedure or referral that wouldn’t be accepted by secondary care, or an appointment with an alternative HCP contrary to the patients expectations.

I had to discuss my dad's DNR, with a duty GP that didn't know him, while on a packed train. It was very difficult.

Exactly , which is why I always insist on f2f , I have no intention of discussing my medical issues whilst I’m out in public or driving up the motorway .