Online GP systems do not stop the 8 am scramble, do not facilitate a GP call back or enable more serious patients to speak to a doctor

[H8484peful]

So we have had the new online system for some time and I’m amazed at what the government are promising with its rollout everywhere.

At our GP it opens when many are commuting and closes during the afternoon and also at any given time for the rest of the day when it’s “ overwhelmed”. It’s hugely difficult to get in the queue if you don’t have constant access to your phone during the day and hugely difficult to get appointments if you’re not in the queue early.

The receptionist now refuses to do anything as regards appointments other than talk you through the form( obviously only when it’s open which it often isn’t).

The triage system sends everybody with med queries to the pharmacy regardless of what the query is. They then decide if you can access a doctor for your query. I recently had to argue for a doctor to look at a medication suggested by the hospital for me to get from my GP that came with no details as to dosage or time frame. I was already on another medication. Said GP said I’d done the right thing to push for a GP to look at it. It took some time and a lot of calls discussing my personal details to get this with staff consistently saying computer says no, it’s not how the new system works.

Appointments are often weeks in advance for a GP and you’re triaged off to less qualified staff for most things.

You have zero say re appointments even if you put times on the form. They ignore it and you then get something unworkable and you have to submit another form if you want an alternative time.

Paperwork and referrals are often lost in the system.

You absolutely can’t ring and request a GP call back.

It’s a GP rated as Good.

The elderly, busy and vulnerable are going to put at huge risk and patients absolutely aren’t going to be getting what the government is promising. How on earth is the government not aware of this?

Our practice has been using e consult forms for ages, they’re fine to use but state that it’s likely to be 2-3 days before you get a response. We can’t book a GP appointment online, just things like asthma clinics or diabetes clinics, everything else seems to be that you have to fill in the e consult. The other issue with the e consult, if they’ve reached capacity, that’s it until 7.30 the next morning.

If you phone, you’re placed in a queue but they offer the option of pressing 0 to get a call back, which invariably doesn’t happen. All appointments are sent via text message with a date and time, which luckily for me, I can generally attend but then I’m retired so my time is usually my own.

I feel sorry for those who aren’t tech savvy, who don’t have a smart phone or very elderly as the practice seems to be more set up for those who have all the time in the world to attend appointments or those who know their way around a smart phone or pc. I don’t expect any of this to improve as we have a shortage of GP’s and yet more houses are being built without the resources to manage more patients.

We've had this system for a while and it boils down to whether common sense is applied.

We get a text or a call within 24 hours, more urgent stuff they call you on the day or send a link to book an appointment, if it's not urgent or you want to see someone specific it might be 2-3 weeks away (the only annoyance is if they offer a day you aren't free). I'm ok with that to be honest, it's not a perfect world and lots of things aren't that urgent.

As far as I'm aware, the receptionists will book an appointment for those who can't use the form, there is still a queue when I do call.

Before it was rubbish for anyone commuting or doing the school run, this should improve that. If they are closing it by 9am then that is a problem that should be raised.

This is my experience too - but I still find it much, much better than the previous system of having to ring up at 8am ON THE DOT, being held in a queue for 40 minutes and then being told that there are no appointments left today, ring back tomorrow.

I just find it bizarre that practices are opening the forms for a limited time only (surely it is helpful to the practice to have triage nurses working early evening, possibly even from home, to mop up afternoon messages? and then again early morning for overnight ones?) and are providing limited tick boxes to answer questions.

Ours is open 24h, and the questions are very general - there's no tick boxes, just a general set of questions that can apply to any situation. I did find it challenging to answer when I wanted guidance on reducing but not stopping immediately a medication - as I had to say if the condition was getting better, worse, or staying the same, with the implication that something getting better wouldn't need a call!
But I've had everything from "we'll see you in the next hour" to "appointment in 2 weeks with your DD" and in between calls from pharmacy team, phone appointment with GP, advice to visit pharmacy (though the NP was a bit patronising about them as they took my blood pressure and panicked as it was 1 point over normal, and then was fine with the NP).

Also appointments they make (medication review etc.) are relayed through the messaging system.

Yes one will be missing assuming for part of the day (if the booking system is closed at a certain time) but those who can be seen by other HCP will be filtered out and that in itself will free up more space for those that need a doctor

Our local GP surgery is like the OP describes.

As an example I received a letter through the mail to ask me to make an appointment to see my named GP.
(It's about a recent hospital appointment).

They could have phoned me direct or got their practise manager to call me to make an appointment. The reason they didn't is that they know there are no available appointments with them scheduled.

I can't do it online. The ability to make an appointment to see a named GP was abandoned pre-Covid plus the entire online system is suspended for any enquiries when they can't cope. This can be for part of most days in the week.

The online system is for triage only or prescription requests.

The telephone system can take a queue of 30 calls and then disconnects. The 30 person queue disconnected after 1 hour or without notice.

There is a facility to ask them to call back which can take 24-72 hours and they will only call once.

I did persevere and get through. My appointment request had to go to a 'group' who would phone me back.

It took a week. I am on a waiting list for an appointment.

My GP like all the partners there only works part time now. The practise manager stopped taking calls during covid.

This is spades. The “I’m poorly I need to be seen by a Dr” mentality is part of the issue as to why we find ourselves in this situation.

It’s as if people are ignorant to the fact that there are other healthcare professionals about. If you end up in hospital for whatever reason, it’s generally not a doctor doing all your checks hourly etc…. You’re much more likely to see the nurse then in the more severe cases where the nurses can’t help the doctor will be called.

We have online form for quite a while. It works 7am - 6 pm, not at the weekends. I have really mixed experience. I was never sent to a pharmacy but I never feel the form for things which could be resolved by pharmacy.
A few times for physio type issues I had a phone call which was absolutely useless. I had a next day an appointment for a skin issue. I had 6 weeks wait for a skin issue. Both skin issues were the same. So it’s practically hit and miss how your form is filled.
I’m in a family and older people oriented city area, not a young professionals type area. Our surgery was overwhelmed for quite a while. We absolutely need more GPs not a new system.

Its robbing Peter to pay Paul- there will be NO additional appointments slots - we cannot clone ourselves.
Plus... the system is open ALL day.- until 6.30pm.
Previously we could close it if were overwhelmed. Now we cannot.
Its not safe.

I don’t know. I was there a couple of week’s ago and enquired and they said they didn’t do online appts. 🤷‍♀️

I am lucky though that I have a very efficient surgery who can get you in same day sometimes or the next day.

I’ve used it once for mid back pain that I’d had about 5 days. I completed the triage form. Was contacted within 10 minutes and offered and appt that morning, not at my surgery but a a hub further away. I did say on the triage form that I didn’t need to see my own doctor. It was a short drive away, I drove myself and was seen on time and satisfied with the outcome

If you’re a GP surely it benefits you having other staff on hand that could take things away from you that they could easily deal with?

Surely if you have to see/speak to 40 patients a day, who aren’t triaged, a lot of those could be seen by other professionals?? No?? Is that not a waste of your time when you could be seeing cases where your colleagues has deemed more serious?

I agree @CandleMug it should definitely gate keep GP time clinically for clinically appropriate appointments. I believe GPs also spend a huge amount of time on prescription requests, checking appropriateness, interactions, red flags, signs of deterioration. A pharmacist could potentially do some of this work with a proper oversight and tight system of work in place. Triaging the e-consults initially could be done by a range of staff with training, oversight, audit and very clear remits. With them coming in over the day they are not concentrated so can be picked up differently.

No system is ever going to be perfect, it certainly isn’t perfect now.

I should’ve added to my post that our practice does have ACP’s and HCA’s who do stuff such as blood tests, steroid injections, asthma etc so an appointment with the GP is, I guess, more for referrals if necessary (at least that’s what I’ve seen a GP for most recently) and other medical stuff that isn’t covered by other medical professionals.
We’ve also found that it’s rare to see the same GP twice, we seem to have a lot of locums or temporary GP’s and that’s been since Covid. I assume this is similar to a lot of areas, not just ours and unfortunately our town is small so there is just the one medical practice.

All of that said, when I’ve needed a referral, our hospitals seem to be quite quick on the ball and my most recent procedure was done in a matter of weeks at a private hospital but as an NHS patient.

Ours works really well, Accurx I think is the system? I never have issues filling it in and I get a message back / call same day. Even with simple admin things like a fit note I get them same day.

But they need to be able to limit the number of requests a day to the number they can actually triage that day, as otherwise they will begin to run behind and you'll get to a stage where it takes a month for anyone to even see it. Obviously the ideal solution would be to take on extra triage staff, but if that isn't viable and so they have to work with the resource they have then of course they have to close the form once they've had all the requests they can get through before the next opening time (which I'm reasonably certain is what's happening - they're not setting it to be open 8-10, they're setting it to close when they have, say, 100 unactioned requests and that happens to occur around the same time each day).

Would this be the Patches system by any chance?

my GP surgery uses this and it is utter shite. They open it at 7am and it stays open for an unspecified amount of time until it is “full”.
It has box after box to fill in, mostly with the same information, if you make your condition sound too trivial it sends you to 111 or a pharmacy, if it sounds too urgent it directs you to A&E.
The surgery no longer allows phone calls or emails or walk-ins, the only way to contact them is via the stupid app.

Recently I wanted to discuss changing some meditation I am on, I got a telephone appointment with a pharmacist scheduled for 4 weeks after I had submitted the request. The first thing the pharmacist asked for were test results that I had included in the request but which were in the wrong format so they couldn’t use.
I was told to submit the data in the approved format and request another appointment.

Very much “the computer says no”!

I just hope that this isn’t the system rolling out to everyone.

@DecoratingDiva We have PATCHS and it never closes? I think it is excellent.

I'm guessing our practice have taken on extra triage nurses and extra pharmacy staff etc.
I've once had "see the local pharmacy" but other than that and one non urgent query that got lost and I resubmitted, everything has got a reply which was urgent or not as seemed appropriate.

No ours is Systmconnect. It truly is shite.Aside from the continual switching off it has a list of categories you have to pick which don’t cover everything and there’s no “other” mop up category. There is no alternative ways to book appointments .

Being able to pick your own time would be amazing but it has zero facility like that. It just plucks any old time out of thin air and ignores any details re preferred times.

Most appointments you get are 2 or 3 weeks later so not this mythical speaking to somebody on the same day.

Medication queries go straight to pharmacy dept and it will not tolerate a request for a GP having input. Yes, yes I know often you don’t always need GP input but often you will. I have autistic adults on heavy meds and this really worries me.

Anything to do with women’s health has its own extra hoop to jump through now with extra waiting time.

It’s dreadful, so many people in the community are fed up with it and reviews online for what was a good practice are now really poor.

It does sound as if the constant switching off is for safety reasons which the gov is now stopping. 😳And yes yes to basically needing more GPs but from reading on here many are struggling to get jobs and up hours. It’s basically hiding a badly resourced situation behind tech and shuffling patients around. One wonders if funding is going into IT as opposed to more GPs.

Why can’t all GP surgeries have the same in-house NHS IT system? Why is the tax payer funding crappy IT companies to run several packages that clearly don’t do what they’re supposed to?

I've only had good experiences with the triage system - occasionally I've had to wait a few days for a call from the GP but it does work as a system.

The issue has been that it started off being open all day, then until about 3pm and then 8.30. So you need to get in early.

That simply doesn't work for a lot of people and so I don't think it's remotely unreasonable for it to be on all day. And also it asks for so much information that it takes a while to input it all. I do wonder how you are meant to use it if you are not used to typing quickly/are not reasonably articulate and can't explain what you want.

Also, I am entirely happy not to see a GP if I don't need to. For example, if I had a dodgy looking mole, a nurse or a PA could refer me to dermatology. A GP doesn't need to do that. Ditto if I need a referral for private healthcare - in a lot of cases it probably wouldn't need a GP.

I've been referred for various tests without ever seeing my GP as well.

Yes I think one of my local health centres only uses it for the over 16s. Maybe they've changed that from today!

I've looked at mine and it says it's open 8-6 for routine queries (and admin questions). (For over 16s).

For complex queries you now have to book a telephone call but it doesn't tell you how to do that.

So that's their method of getting round the rule. Is a dodgy mole a complex query? Is needing a FIT test because you've got dodgy bowel movements complex? How are you meant to know?

I would want a GP for private healthcare referral. I have no wish to waste money. Also having had skin cancer myself a GP will very much be preferred sometimes and the option should be there. Even cancer research expects GP involvement.

www.cancerresearchuk.org/about-cancer/melanoma/getting-diagnosed/seeing-your-gp

Also the gov is proclaiming the IT system is giving you easier access to GPs not farming you off to lesser qualified staff. They are not being honest .