to really have it in for GP's surgeries...

[mersmam]

Had an appointment with my community midwife today (I'm 30 weeks pregnant and haven't seen her since I was 16 weeks, which was when she made the appointment.)
Got to the drs surgery to find it locked and a notice up saying that the surgery is closed this afternoon for staff training! As far as I'm aware there has been no attempt to contact me about this! I rang the midwife's office straight away but could only leave a message and have so far had no response.
Am really annoyed as have arranged my whole day around the appointment (and DH had arranged to work from home so he could come too).
Generally I am just sick of the whole GP system - I can never get an appointment at a convenient time - when I do I always have to wait at least half an hour (no joke with three DCs under 5) and the staff on reception are rude.
I asked for a home visit once as I was ill along with all the DCs and you'd think I'd asked for the moon...

The thing with the midwife today feels like the final straw...

Should I change surgeries to somewhere further away (which would be less convenient?) or are they all like this?

I agree with everything you are saying fivecandles. And I don't think anyone here is saying the whole of the NHS is an uncaring, neglectful organisation, Northern.

Northern,

''Roughly half of all NHS patients' complaints are likely to receive an "inadequate response" from NHS trusts supposed to deal with them.'

Absolutely beyond me why you continue to defend this appalling record.

'The Healthcare Commission found roughly half of the 8,000 annual complaints required further work after the initial submission because the trust's response was not good enough.

As a result the biggest single cause of complaint was that a previously complaint had not been properly responded to. This rose as a proportion of the total, from 16 per cent last year to 19 per cent now.'

Jesus, even Anna Walker, the commission's chief executive, said "It is clear from our wider work on complaints that trusts are not always systematically learning from them and improving their services for the future as a result. They clearly need to do so," she said.'

And you obviously missed this data from my previous post,

'Of nearly 500 patients polled, 69 per cent said that they had wanted to complain about the healthcare they had received in the past five years.'

I seriously think you need to wake up and start respecting that patients know what they're talking about.

I don't have to 'imply' that this is negative. It is appalling that so few complaints are well handled. It is appalling that so many patients want to complain. It is appalling that so many patients feel unable to do so.

And even the Health Commission's chief exec recognizes this!

'I have continually said that patients should feel empowered enough to complain '

and yet you berate them for doing so! And tell them they've got it wrong.

Northern, I think you're missing the point here. Nobody expects you personally to 'fix' this situation it would just be nice if you acknowledged that there are real problems in the NHS in terms of many patients' experiences and the ways their concerns are or are not handled.

As I've said there is an irony in that very often this is all that patients are after when they do complain - an acknowlegement that their complaint is legitimate and an assurance that lessons will be learnt.

And people have been appreciative of the NHS on here. I double checked in case it was just my perception and cut and pasted a few quotes ...

Our surgery has lovely reception staff who are always very helpful

Mine offer same day appointments and the two times they had to cancel appointments on me they did so with as much warning as possible and were most apologetic. (Not meant as a brag, more as an example of a great service you can get.)

My GP's surgery receptionists are lovely - kind and helpful

Our receptionists are lovely and helpful, also the nurses and the ladies in the pharmacy and so are the majority of the Dr's.

I amlucky enough to have had 2 out of 3 good surgeries, and the present one is fantastic, receptionists are young, helpful and cannot do enough for you; I can get an appointment at a time to suit me within the next 2 days.

I love my GP surgery. I love it so much that when I moved just outside of its area, I begged to be allowed to stay with them and not have to move to the considerably bigger surgery that was nearer

That's 8000 (well nearly 9000 actually) out of a total 135 000 - it DOES not represent widespread failings although it can and will be improved on. Nor is it the case that 50% of all complaints are badly dealt with - I make 94% that are actually.

Anna Walker says Trusts are not always learning from complaints - a position I do not and have not disagreed with - often they are learning from them.

19% of complaints that went to the HCC were about the handling of a complaint - what we don't know is how many of those were upheld or sent back to the Trust for more work?

I really have very little interest in spending my evening further dissecting figures because it's quite plain neither of us will be shifting from our positions.

I believe in the NHS as a valuable organisation - that is active in learning from it's mistakes and that provides an incomparable service to the people of this country. As an NHS employee I don't like to see that unfairly attacked and I will refute those attacks to the best of my knowledge. As a patient you obviously feel we aren't listening to yo - I'll bear that in mind the next time I deal with a complaint.

94% of complaints that are dealt with adequately that should read.

'what I resent is the failure to display any of that appreciation on threads such as this.'

I think this is odd considering the title of the OP and the experience which prompted it!

Actually, people on this thread have often given very balanced viewpoints. They have said repeatedly as I have that there is wonderful work done in the NHS but sadly that doesn't make their own distressing experience any less distressing. It IS possible to recognize the value of the NHS while also pointing out the weaknesses within it!

'Can you not appreciate that often patients who have had bad experiences just want somebody to listen to them, accept their point of view and provide some sort of assurance that lessons will be learnt as a result of their complaint (however this is made and whoever it is made to)?' Of course I appreciate this - I do this in my job every day.'

But, sadly, you really don't seem to be doing this here. Your position is automaticalyl to defend the NHS rather than to accept the experiences described here as genuine and as signs of problems within the NHS.

' Can you not see how your blanket defense of the NHS as a whole is adding to some people's feeling that their concerns are not being acknowleged or taken seriously? ' I think you mean your conerns - and if you persist in misreading my posts I'm afraid you will feel like that.'

No, this is how various posters evidently feel.

I honestly don't see why you can't acknowledge the very real problems and failings being described here as problems and failings which are systematic within the NHS.

It says HALF Northern

'''Roughly half of all NHS patients' complaints are likely to receive an "inadequate response" from NHS trusts supposed to deal with them.'

That's half of the 8000 - not half of the 135 000. The remark refers to the HCC complaints - not the 124 000 adequately dealt with and I really am going now!

From The Guardian

'The National Audit Office (NAO) found patients faced too many obstacles when trying to complain. Most trusts do not help them find a way through the complicated grievance procedures and too many cases take too long to complete.

The NAO said one in seven people using NHS services in the past three years were dissatisfied with their experience. But only 5% of them bothered to complain.

Karen Taylor, the NAO's head of health studies, said: "The main reason people don't complain, whether in NHS or social care, is that they don't think anything will be done as a result."'

Anna Walker also said "Complaints represent the raw feelings of patients and the NHS must listen and learn from them.

"At the centre of each one is an individual who has genuinely suffered.

"Too often, this was not just because of what went wrong but because of the way people were dealt with."

And this from The Telegraph

'The National Audit Office (NAO) found that while 14 per cent of patients were unhappy with their NHS service, less than one per cent made a formal complaint to their health trust.

There was also little evidence of services improving as a result of complaints made.

It also found that one in five health trusts took too long to respond to patient complaints.

Edward Leigh, Chairman of the Commons Public Accounts Committee, said that the reason so few patients make formal complaints is that they have "no confidence anything will be done as a result".

"Complainants are often confronted with a defensive and unhelpful response when sometimes all that is needed is a simple apology or a promise to improve services.

"There is also little evidence that complaints are leading to better services. This is no way to keep people's faith and trust in health and social care services."

The criticism comes after David Cameron, the Conservative leader, attacked Alan Johnson, the Health Secretary, for an allegedly cold and bureaucractic response to a complaint over the death one of his constituents, Elizabeth Woods, after she contracted the superbug MRSA.'

As someone who looks at polls etc an awful lot - would like to make a couple of points.

A poll of 500 would normally be considered too small a sample to be statistically significant. The magic number is usually 1000. I would also be interested to find out where those respondents came from. Mori etc usually use random responses. I would be concerned, for example, if this was an online poll from the Patients' Assoc website - as those visiting it would be more likely to have had a negative experience than other people.

There would also be a statistical bias towards complaining if you ask someone if they had something to complain about - and note how long back the time goes - five years. There doesn't seem to be any quantifying of how serious these complaints are, either. Are we talking negligence, or rudeness on reception? Or for these stats, are they all being lumped together?

I would hate to be a GP, or a doctor of any sort. I don't think I'd have the emotional strength to be able to deal with the sort of life-or-death calls they have to deal with, every day. We have to accept that we get the NHS we pay for, and vote for - and yet because we feel we own it - nothing less than perfection is demanded from them at all times.

I'm not necessarily defending rude receptionists. I'm prepared to accept there are some. There are rude people in every walk of life. But then, when I worked in a shop when I was younger, I do remember what it's like to have to smile and be nice to customer 2 when customer 1 has just been rude enough to leave you physically shaken.

I think there are a variety of issues muddled together here. the first issue is about receptionists. I have provided a number of training sessions for GP receptionists (yes they sometimes do get training!) and whilst some were indeed difficult individuals, others were clearly trying to do a good job, and cared very much. The best ones were well respected by the practice team, and I think this is key. It is the GPs who decide how much support they need and how to spend their money, so if a receptionist is poorly trained, has a bad attitude or is clearly snowed under then that is the GP team's choice (usually a partnership of GPs only, fairly rarely including a practice manager or nurse). In general receptionists are often paid very badly, sometimes work very part time, and often do not feel part of the wider team. I can understand why they are not the happiest group, as to be regularly abused by patients whilst being unappreciated by your employer is not a good combination. On the other hand the practices that employ a good manager, and provide enough money for sufficient admin generally had excellent happy teams who got very good feedback from patients (I have run large surveys with very high satisfaction rates, and lots of positive comments).

PCTs pay GP practices on a contractual basis. They are mostly small businesses and choose to spend their money however they like (a small number are run directly from PCTs). Some will employ other doctors, nurses, practice managers and administrators, and take a smaller income others will chose to have the minimal amount of staff and maximise the amount they keep themselves (or keep a personal touch if you like) some employ their wives as receptionists and work alone. There is a huge amount of variation, and whilst the government is keen on making practices larger and better supported not all GPs think that is the way to go. Some GPs run several practices as a larger business, and those are the ones that draw large salaries (not necessarily a wicked thing, some of these practices are the best run and most liked by patients).

The trouble with the new contract is that it was used politically, and the GP negotiators had too much power/got away with too much. I think it did GPs a real disservice. So when it was introduced although it was designed to drive up quality it was not allowed to be vigorously enforced or used as performance management in any way (we were told we weren't even allowed to mention the words). Which in my opinion did the really good practices (of which there are a great many) a serious disservice. Because there are some mediocre practices that could have done with a bit more of a push to improve, and I'm afraid also some really bad practices too. This is for all sorts of reasons -perhaps the GP is a poor businessman, maybe bad at choosing and managing staff, some fall out terribly with their partners and become dysfunctional, some should retire earlier or take time off for sickness or a holiday or too, some are unmotivated or should really have chosen another career, also some GPs were drawn here in the 50's/60's when we had a huge shortage of doctors, but instead of being welcomed they found that they couldn't work as consultants in hospitals or join the nice practices because there was an awful lot of selection by tea party. So they became GPs in very poor and deprived areas and some really resented it. Anyway the problem was that the contract which was intended to reward good practices for their excellent work, ended up being used to reward all practices, even the fairly shoddy ones. So it became meaningless. Which is a real pity because a lot of time was put in to drawing it up, and it could have been used much better. If I ran a good GP practice I would be very angry to see a colleague that couldn't be bothered getting the same reward that I had worked very hard for.

Another issue, which the OP has run into is that the NHS is very badly connected together at times, and communication often suffers as a result. There are projects to try and address this, but it is often where care and customer service fall down without being really noticed, and it is often community services (district nurses, HVs, children's community services etc) where this hits as they are unfortunately politically invisible (almost all initiatives are either about hospitals or GPs). So no one thought what would happen with the midwifery clinic when the practice was shut, because the midwife wasn't part of the practice team. She obviously realised this too late to let her patients know in a proper fashion -maybe the notice was put up when she realised that her clients weren't turning up (too late for the OP).

Re the Healthcare Commissions "findings" I think you should bear in mind that the reason that the complaints procedure is being changed is because the Healthcare Commission were basically incompetent in managing their part of the system. Some cases they took two years to even look at because they didn't employ enough staff, and then they outsourced a big chunk of the process to try and catch up (not an unreasonable thing to do, except that the people they got to do it were not competent). I have heard of complaints being returned to trusts with advice to do things that were not actually possible, not clinically advisable (they often do not have access to the highly specialist clinicians that are sometimes required for specialised complaints), or out with the complaints procedure. My own trust was censured for following the rules because they got them wrong (timelines for example) and told to make information available from counseling sessions that were confidential. Sometimes we got them back telling us to do things we had done already, or make very trivial changed in wording. Rarely did they raise any serious issues, even when they should have IMO. If you don't believe me, try reading the Ombudsman's report on the Healthcare Commission. Not edifying.

The NHS complaints system is difficult to use, and more support should be given to those that need it but some things about it are more to do with the way the NHS is structured. The biggest complaint we had as a PCT was that we couldn't do anything about complaints to independent practitioners (dentists and pharmacists as well as GPs). It was very frustrating for us too, because we could only do something when there was a real clinical risk, or the person in question was under investigation or close to it. That part of things was supposed to change as a result of Shipman, but when I left still nothing had come through (it required Parliamentary approval).

As with all things though there was a lot of variation. Some trusts took complaints very seriously, offered meetings with senior managers and clinicians, really put in changes etc, whilst others did things very badly (no monitoring, terrible response letters, complaints seen as a nuisance etc). Now I am out of the NHS I can understand some of this, as it is a very very high pressure environment, and with so many things clamouring for your attention no wonder something difficult like a complaint gets neglected, but I also think some of it is an attitude left over from the paternalistic days that patients should really go on knowing their place. It probably doesn't help that there always seemed to be an over representation of people who made very trivial complaints when those that really should have raised issues often don't (not a dig at those people, I understand why people mostly don't complain, but one of the reasons that complaints are often seen as a drag rather than a learning experience is that sometimes it is those you have bent over backwards to help that make a fuss, which upsets people, whilst those with genuine and important issues don't want to complain).

Re the Patients Association survey, 500 is a tiny amount, and I'd really wonder about it, because we surveyed about 10,000 patients annually and very few were negative. I would imagine some sort of self selection went on there - possibly it was a survey of people who came to them rather than the other way around.

woops! A bit long there! Perhaps I do miss working for the NHS

No Nooka - that was fascinating. I even turned the Today programme off so I could read it properly. Although I have to ask - what on earth were you doing up at 0510?

Lol I live in Canada now (it's midnight here). I miss out on all the really good debates and only get to chip in long after things have moved on

I have just managed to get through this thread because I have found it fascinating. There seem to be two sides here, but the thing is they aren't even in conflict, really. Yes, there are some absolutely awful receptionists out there (not going to go into the general NHS problems) but there are also some really good ones.

I've been fortunate, in that I've had a wonderful surgery which was just a few minutes walk away. If I rang up for an appointment, yes, I would be asked what the problem was. But at this surgery the GPs had areas in which the specialised in, so telling them I had a respitory problem enabled them to check whether the appropriate GP had vacancies. If it was urgent, they would just get me in to see anyone. I have seen the nurse as well, who would then get any required prescription checked and signed by a GP while I waited in reception after the appointment.

They were also very willing to ring if there were any late cancellations or late comers as I was so close to them - a win for each of us, they got to free up a later slot and I got in to see the GP earlier.

On a previous move I had a choice of two GP surgeries, I personally went in and visited both of them, to get a feel for them and see what sort of receptionists there were. I also asked them what sort of appointment system they ran. In the end, it was the appointment system that decided it for me. The one that had the 'ring at 9.00 am for an appointment that day but can't make one for later in the week' was just not an option for me, so I chose the other one. However I made a point of telling the other surgery that although they had lovely facilities and I thought the staff sounded nice, there was just no way I would put up with the awful appointment system they had - they need to know that patients are not willing to put up with that sort of rubbish.

With this last move, I had a choice between several surgeries, one offered Saturday appointments for those who worked and could not make it during the week - I chose that one.

I think the main problem for those who have awful receptionists at their GP surgeries, is that this is a never ending problem. You can choose not to go to a small shop if you get poor customer service, you can just take your business and money elsewhere, but you can't just up and leave a GP surgery easily when you are ill.

Poor service from reception staff is just not on - a large proportion of people seeing the GP are at their most vulnerable, a hormonal pregnant woman, a woman with PND, someone with depression who has just barely plucked up the courage to make an appointment are just some examples. It is awful, and they should never be rude.

But how many of the people here who have had poor service from the receptionists at your GP had the gumption to actually go and look for an alternative surgery? (Obviously bearing in mind that some people have no choice of surgeries in rural areas!)

Yes, complaints need to be made, but at the same time LOTS of people have a choice, they can choose to leave that surgery and go to another one - and writing to the practice manager to tell them WHY they have left, but for some reason people don't.

Nooka thankyou for your posts which I also found interesting.

One of the things that I think about complaints which tallies with what I've read is that very often all patients want is an acknowledgement that something has gone wrong, an apology and an assurance that lessons will be learnt.

Really, this would often be dealt with most effectively and efficiently at the time of the problem. A 2 year wait or even a wait of a few days or weeks after a cumbersome complaints process is likely to add to patients' feelings that the NHS doesn't care. And there is that sense that practitioners are unwilling to admit error and close ranks which has been highlighted in some of the research I've quoted from earlier.

I really think that patients would be a great deal more sympathetic and less likely to complain in the first place if communication was better and swifter.

About Receptionists, I've always acknowledged that the things that sometimes make dealing with them difficult are not always their fault. Nevertheless they are the first point of contact and sometimes the only contact that patients have with the NHS so it is crucial that communication at this early stage is smooth and problem free.

There are several things at my own practice which mean that dealing with Recpeitonsi is likely to be stressful for both patients and the Receptionists which in my view are resolvable. One is the requirement that patients phone at a given time (9am and only 9 am) to make an appt, secondly the requirement to discuss symptoms and thirdly the practice's opening hours. Now, I imagine none of these is the responsibility of the Receptionists but it means when a patient finally gets through to them they are likely already to be disgruntled. The Receptionist is then the only person that a patient can express these feelings to. All of these issues create what in my view is unncessary stress and potential for conflict in what should be a helpful and straightforward encounter.

But there are many other things. Why is it beyond the capability of a receptionist to explain what the waiting time is likely to be and apologise for the delay? This is standard practice in most other organisations. I would feel so much better if I KNEW that I was going to be waiting approx 20 minutes for example and that would help me decide for example whether I would be back at work in time to teach my next lesson etc, etc.

And also the fact that however bad a day the receptionist is having it is likely to be much easier if she makes an effort to be polite and respectful to the patients. They need to have proper training in patient care and conflict resolution. They need to learn to smile even if they don't feel like it.

Whatever sort of lesson I may have had first in the day if I go into my next lesson showing a lack of respect for my students and acting completely fed up then I'm asking for trouble.

Really informative posts Nooka - thanks for posting them!

I think this thread highlights the importance of filling in feedback forms when offered - whether good OR bad, because a balanced view is infinitely preferable - unless the feedback is given, or the complaints are made, there is no incentive to change.

A friend of mine did complain to the local NHS hospital for the atrocious treatment she got from the anaesthetist just prior to her knee replacement op - she got a full apology and assurance that said anaesthetist will be offered re-training. As someone said, sometimes that is all that is wanted by the "injured" party.

in defence of my lovely GP practice we have great GPs, nice nurses and goodish receptionists and appts when we need them

I would say that in 90% of complaints an apology an idea of what happened and why and some learning is what the complainant is after (and in truth is all they are likely to get, as if you want compensation at present that is not the route to go). Sometimes you get someone wanting blood, but that's often where communication has broken down, or the person is grieving or has other issues. It's very rare in my experience that the grievance is unfounded, although sometimes people complain about what appears to be a trivial aspect of their care, which when you look at the issue closely is clouding something more fundamental (ie x was rude to me is sometimes code for someone feeling a lack of respect in the system).

Many complaints are resolved immediately, on the ground by staff to hand, and the best services do this very well. The trouble is those encounters are not recorded (usually because of a lack of time and a dislike for paperwork) so you can't use them to balance the stories of long waits and poor handling (which unfortunately undoubtedly happens too). Good PALS teams also resolve many problems some of which might have become complaints - a much better route because most people want things fixed rather than a letter some weeks later.

Fundamentally the problem with the complaints services is a lack of resources, both for the services themselves, and also in the clinical teams. Managers rarely have spare time, and answering a complaint properly takes time and care, as you have to investigate what happened - the reason for complaints needing to be raised in good time is that the more time has passed the harder it is to know what actually happened, as most complaints are fundamentally about communication, and clinicians/admin who see many many patients every day will not remember the encounter (of whatever nature) nearly as well as the complainant. Trusts have traditionally been censured for having too many managers, and complaints are generally looked after by managers (they certainly should be as they require thought, sensitivity and experience to get right, and a certain amount of seniority to investigate as well as clout to get changes implemented).

Margo I would agree with you about people voting with their feet being the best way for GPs, as their income is still closely related to list size. The trouble is that when you sign up you don't know whether they are going to arrange things in a way that works for your circumstances.

The issues about the phone booking system is I am told by colleagues a problem with the way that many surgeries implemented their 24/48 hour response requirements. An incentive was introduced to try and make sure that people with urgent care needs could get a same day appointment. That drove the GP computer systems developers to enable a different way to book slots. It was quite an upheaval to the way that many practices were run, and many of them never signed up to the second part of the programme which was supposed to improve longer term booking. Plus there wasn't an incentive for that, so a sort of half changed system remains in many places.