Do you think we'll ever go back to routinely seeing GP face to face?

[Makeitgoaway]

It's long seemed a terribley inefficient process to me, both for the GP and the patient. If it's something mild and routine, the prescription or advice can be given over the phone, as now. If it's something more complex the GP has refer us on anyway, usually without much of an examination.

An example, I was suffering with a very painful foot. I knew I needed physio but I couldn't access that without first waiting 3 weeks to see GP, taking up a valuable appointment and then waiting again for the appointment I really needed. GP didn't even ask me to take my shoe off so there was nothing that couldn't have been done by phone. A physio would have been far better placed to diagnose the issue anyway.

Another, I needed antibiotic cream for impetigo. Pharmacist had diagnosed it but couldn't give me anything that would help without a prescription, which I needed to see a GP to get.

If it was something GP did feel they needed to see the patient for, an appointment could be arranged at the initial telephone consultation and I'm sure in many cases that would be necessary but it must be possible to cut out a huge number of unnecessary face to face GP appointments?

Our GP surgery has used 100% telephone triage calls for a few years now.

We only go in if we need observations, blood pressure etc. As much as possible was being done by phone anyway.

It's a good working system so I think it's the best way forward.

Our appointments are same day, and I've called at 2pm and still got a telephone appointment.

I assume it saves a lot of time.

Possibly but I think telephone appts will become normal now

One thing I do expect is for my gp to never again say the words ‘it’s JUST a virus’ when my dc are ill
One of those ‘just a virus’ episodes triggered a lifelong serious condition so I hated the p
phrase anyway and they said it patronisingly so often. That plus always saying how over use of antibiotics would lead to the next huge health crisis due to bacteria resistance when I’ve had mastitis and been made to wait and then got more I’ll
Sorry......ranting
Hopefully this changes gp practices for the better

The lack of people in a and e I feel too is not just those drying away it’s also a direct result of gp not sending people there I necessarily or because it’s out of hours and they are shut in our area there are far more appts available via phone which seems to have helped hopefully they extend this to weekends too after this

Interesting Sunnie. In both the examples I gave, I asked if I could speak to someone in the phone to save us all the bother of a f2f appointment and my surgery insisted I needed to go in. So maybe your system will become more widespread. I wonder why it wasn't already?

My surgery does online appointments. You send your problem over and someone will either email you back or ring you back advising what to do next.
If they had the option to attach pictures I wouldn't of needed to go in at all. Great service.

My son had a consultant's appointment yesterday over video link and we agreed that the next appointment will be over video link so I'm guessing there will be a lot more use of technology. (He did say that he'd still like at least one face to face a year).

We've had telephone triage GP appts for about 18 months -you get summoned in on the same day if you need to be seen.

It's so much more efficient- and means you can call about DC's medication from work without having to haul them out of school for no reason too!

I have been doing gp at hand the last few years - video calls! So much easier and can always get an appointment quickly (usually same day) going into a surgery is a nightmare

GPs could have been routinely offering telephone consultation (triage is not the right term for this) provided by a clinician. The current crisis has meant they now all have to do this. But as a pp pointed out there are more advanced forms of digital consultations that can provide even more benefits for patients and the public.

Telephone consultation has improved practice efficiency significantly and digital consultation even more so. There will always be a need for face to face activity alongside this and other traditional pathways for vulnerable patients. But this was the vision for GP practice before Covid and has now been accelerated.

GP will be receiving funding to recruit their own physiotherapists soon (delayed by Covid) who can see a patient as a first contact.

A lot of general practice is way behind the curve on tele health/digital healthcare. This is speeding it up. We got training this week on a new online system which will make a massive difference and hopefully be rolled out everywhere - basically you can submit a short history and problem summary online, even add photos and the system either recommends self care, pharmacy, referral to physio (without having to see GP) or the GP can prescribe something or bring the patient in to be examined (I really want my own surgery to get this!). It's going to be huge for the GPs, not so much for me as a nurse as most of my work is hands on and the patient needs to be there.

We need to be embracing the change, it is brilliant for people of working age as they don't have to come in and take time off work. The elderly can still be seen and have home visits and time is freed up so everyone gets better care.

I think the gps will also get stricter about appointments. My Nan works in a gp surgery and the doctor recently commented about how many calls they have been getting and how it shows half the people that demanded doctor’s appointments did not really need them. It’s the same with A&E, now people are worried about Coronavirus they are abusing A&E less.

This has been a long time coming and it should not have taken a pandemic to get there!

EsmeeMerlin, I don't think all the reduction in hospital and GP visits is down to people previously wasting time.

No pubs, work, travel, schools or sport must rule out a very high proportion of accidents that previously led to A&E visits.

People have much reduced contact with others so won't be getting many of the infections that would have previously taken them to GP, or the minor injuries, as above. Also with so many people not at work or working less and from home, they won't need certificates in the same way for work absence.

It's a bit worrying tbh, to hear that people working in the practice are assuming all the previous patients were time wasters.

I work in primary care and it is known that a lot of people who are prone to wasting GP time have stopped. But it is true activity is down so people are not as at risk of injury or problems

I can’t tell you how many requests for hay fever meds we have had of late though.

and how it shows half the people that demanded doctor’s appointments did not really need them.

Not totally convinced that's true. I hate phonecalls, I need to be able to see the person's face when I'm talking to them. I know a few other people who feel the same. This just means we can't access healthcare, not that we don't necessarily have medical issues. I really need anti depressants right now. I'm really struggling with lockdown, it's undone two years of therapy and suicide is constantly at the back (front) of my mind. I tried to phone my GP...needless to say I won't be doing that again.

GP SiL is loving it though and absolutely would rather continue this way. Says it's got rid of a lot of usual "timewasters".

The sad thing is the "timewasters" probably do have un met medical needs, even if "only" MH. They've just given up trying to get help for now.

Yes. With the exception of the poor sods who have no jobs or the people who’ve lost family members, life will pretty much go back to how it was for the rest of the population.

The time wasters tend to be people who cannot be bothered to go to a pharmacy for their requirements. Usually under 50 years of age. Want creams, calpol and hay fever tablets or referrals and xrays for sore knees from too much cycling or being overweight

People who have MH issues, socially isolated etc are well known to most surgeries and not ignored or turned away. In fact a lot of surgeries are doing more than ever to help them - look up social prescribing initiatives

how it shows half the people that demanded doctor’s appointments did not really need them

What a horrible thing to say. Maybe they have just given up trying, and are now putting up with a chronic condition.

Or maybe they will end up like my Dad, who found it so difficult to get a GP appointment, that he died of bacterial pneumonia in his sleep.

Not unless they start charging.

I can’t tell you how many requests for hay fever meds we have had of late though

Why don't they just go to the pharmacists and buy anti-histamines?

Without offending people with anxiety and MH issues - I have anxiety myself and I understand how awful and consuming it can be. It should be addressed and not by GP’s who have 10 mins to see you

There is a cohort of patients called the ‘worried well’ (usually under 50/60) who have some degree of anxiety, but GP’s don’t have the time or resources to help the roots of the anxiety (home life, money, family problems etc) who swamp up the surgeries. They may have relatively mildly raised blood pressure and keep requesting blood tests. They fret a lot about the dose of their medications. They don’t go to pharmacists for hay fever as THEIR hay fever is much worse than that, and they think there may be an underlying cause to everything. Headaches and backaches could be signs of cancer etc. It’s really worrying. Most 2 week wait referrals are made based on a set of criteria but very little people of these are diagnosed with cancer. It is brilliant we have these pathways to diagnose people early on but early screening has led to early worrying and over worrying and can be a burden to the NHS people using GP’s ‘just in case something is wrong’ and not ‘when something is wrong’

We need better use of things like pharmacies and technology to guide and help the worried well away from over using GP time

I also used to work in an walk in service setting and most of the daily attenders were men who had overdone things or hurt themselves during sports activities, which often used to outweigh children and the elderly who had accidents.

I did not say all those who wanted a appointment were time wasters but it is well known some people have abused the nhs by going to the gp when they do not need to or by going to A&E when they could first go to other avenues first like pharmacies.

my doctors system is normally

emergency appointmemt, the doctor on call rings you and books an appointment if you need one.

Normal appointment the doctor rings you a couple of weeks later and books an appointment if you need to be seen.

Thats pretty much what they are doing now but you are less likely to get to see someone even dds asthma reveiw was done over the phone and by a doctor rather than her usual nurse, so I assume eventually it will just go back to the normal system but maybe with a higer threshold to be actually seen.