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?

I have been known to be a 'worried well', which dates back to having undiagnosed glandular fever as a teen and feeling like I was going mad.

This has recently been re-triggered by deaths of several people close to me who did 'just' have backache, or a cough, or a sore throat. I have told my doctor that I have health anxiety, for full disclosure, however the few referrals I have had have been suggested by them, not me.

Recently I went to a GP having had backache for six months. I was referred to a physio who was very dismissive but the exercise he gave me got rid of it. Should I not have bothered? Was this just me being a burden?

I questioned being sent to a&e by 111 when I had a baby with a high temperature; I had rung over a bank holiday to ask if it was OK for a baby to still have one three days on. New parents don't have mums and grandparents living near by anymore to ask these things to. I was just worried - not intentionally being a time-waster.

My very young DS was also referred by an ex-paediatrician GP for several things which turned out to be nothing. None of these things were pushed in a particular direction by me. I wouldn't have been a good parent if I hadn't had these things checked out. He wouldn't have been a good GP if he hadn't referred us. I have seen social care notes - 'why didn't the parent take them to a doctor?' is something often questioned.

The people I feel really take up GP and a&e time are people with severe mental health disorders. A&E staff are known to be very dismissive of people with borderline personality disorders. Social care doesn't have the capacity to properly help them. Mental health situations can become critical on days or at times when there are no GP appointments.

I know a mum whose child is constantly in a&e, who always turns out to be fine, and yet this has not been picked up by professionals as in my unprofessional opinion a potential case of Munchausens by proxy.

On the other hand I know someone else who was told her fainting episodes were 'due to her age' and it turned out to be pancreatic cancer.

I personally feel it's wrong for anyone professional to be dismissive of the 'worried well' (who are probably so worried they don't want to go to a doctor at the moment!) or for non-professionals to heavily criticise a system which can and does prevent things which are often symptomless until it's too late.

And let's not forgot the systematic underfunding of healthcare by the Tories since 2010. People shouldn't feel guilty for needing a GP appointment. People should be angry it's often so difficult (present situation excluding).

That said, I am sure that telephone and email GP appointments can only be a good thing for the future.

It is very difficult to determine that the worried well are time wasting - they are not. You have an emotional perspective on this and there are other perspectives including clinical, statistical, financial etc

The worried well are concerned and trying to prevent or early detect something that may be wrong. We also have routine screenings so going to the GP in between means that the GP may be obliged to trigger a referral or diagnostic pathway given the symptoms, costing more time money and anxiety for the patient.

It’s not wrong or dismissive to acknowledge that this is one part of the system and the users reasons for attending could be addressed in another way perhaps, it’s the best time to look at it now. Ultimately the main problem is not who or why is using the NHS but the lack of underfunding.

Yes everyone should be able to get themselves screened if they wish to, but unfortunately this means that all patients are trapped in a clogged blocked system where on one side, people are well but worried and the other side they are unwell and worried

I read a book written by a GP (I forget what it was, one of the many I read on child rearing!) who said if Mum's worried there's cause for concern, if Grandma's worried too then I'm worried. It is true it's hard when parents don't have "Grandma".

My gp has done decent phone triage for years, they always want to see me in person for oral steroids but they can do a same day nurse drop in for that so I ve only seen a GP to get a specialist referral once.

That’s really interesting about grandma’s, I must admit when my children are ill or have hurt themselves I often will call my nan before I have ever called someone medical because with years of experience with children and working in a doctors, she is able to give me advice on how to treat at home or she will tell me to talk to a doctor. My sil also swears by a home remedy to get rid of bumps to foreheads that she got from her 90 year old nan.

I do think it would be helpful to teach basic first aid in schools as well.

I wouldn’t mind if they keep the telephone triage if they could guarantee that a doctor will phone you that day and if you need to see them can get an appointment promptly. The current system just does not work.

It probably depends on how often you see your GP as well if this will work? I very rarely go to the GP for anything, and in my experience every time I've been, they do a full assessment (weight, BP, talk about lifestyle, contraception etc.).

For more regular/routine appointments phone/video should work very well, though.

My old gp said she would see some elderly patients three times a week, they would be on the phone at 8am every bloody day, she said they were lonely and in pain, which to be honest she could do nothing about, arthritis etc.

My GP is now doing an online system, put in symptoms, will get back to you in 24 hours. Well the elderly will still be on the phone. Not being savvy with this system.

With this virus a receptionist friend said they had 8 phone calls one afternoon, people really are staying away. Whereas pharmacy attached is snowed under with repeat prescriptions.

Will these elderly die because they are not seeing gp every week, probably not, but the worry is the potentially seriously ill are not being seen.

@cologne4711
Because I get such awful hayfever over the counter meds do absolutely nothing. If I am to function for six months of the year I need a combination of drugs only available with a prescription. However, they're all on repeat and accessed through a repeat prescription request. Not everyone asking for antihistamines is time wasting.

Our GP surgery is really good with telephone triage. You get a call back from a doctor or nurse, whichever is more appropriate, and 9 times out of 10 things are dealt with during the call. I get recurring UTIs, I get the antibiotics that work for me over the phone. Even if you call in the middle of the day, someone usually gets back to you that afternoon to discuss - a child falling ill, for example, can happen at any time not just conveniently before 8am. They saw my son after a nasty accident to see if he needed stitches to save us an hour journey to A&E. If they decide you need seen, then you're seen that day. One of my DC has recurring ear infections so the moment they show signs we get them in ASAP to try and prevent (further) damage to their eardrums. It's a really good system and works well.

Our old surgery had a list of things the receptionist thought warranted an on the day appointment, getting through her was impossible. You couldn't even get a call back from a nurse. I blame her for my child's damaged ears as she repeatedly refused us appointments.

I tend to think GPs have seen, in person, too many people and many could have been talked to over the phone to look for further symptoms or even given a prescription. Unfortunately people who won’t accept this and turn up at A&E when they should not. Out of hours services can be very patchy too.

I see a GP in person around every 3/4 years. It’s rare and I actually cannot remember when I last saw one. I had to contact the out of hours service last September just 3 days before a long haul holiday. I had vertigo and was physically sick. I was very concerned because the last time I had it, it took 1 week to go! My GP didn’t offer any help on that occasion at all. However the out of hours service from the local hospital (that surprised me) came out and injected me. I had more advice and help from that service than my GP offered. Being dizzy and sick isn’t conducive to seeing anyone at a surgery but as a very infrequent user of health services I was grateful for the service I did receive.,

In general though, we need to ensure appointments are available for people who need them, when they need them. I remember a few years ago I was asked to wait 3 weeks to see my GP. Routine repeat appointments take precedence it appears.

The system of appointments is also crazy at my DDs London surgery. Ring at 8 am if you want to see a Dr. Be 28th in the queue. When you get through the appointments are gone. If you ring at 8.30 (because you are ill!) - tough - the appointments are also gone! What sort of service is this? No offer to ring back. Just advice to ring again tomorrow. My DD wrote to her GP in the end.if wax quicker. She rang back. It’s truly awful in some surgeries but they need to look at how they work. This should mean ringing back and ensuring services actually work for ill people.

Our GP has used telephone consultations as a main way of consultations for some years now. Some appointments can be prebooked, but for most 'this has come up can I be seen today/soon' sort of stuff, you'll be given a time window during which GP will ring, and times between which that day's F2F appointments (if needed after phone call) are being held.

It works really well.

It wouldn't surprise me if more practices did more of it in future

The receptionists really need a big red sign alarm system on the screen for the worried well, saying phone appointment first of all back of queue then. Perhaps gps could see the really sick folk then.

We have private healthcare and can have a video call appointment with a doctor if it’s appropriate. It saves time and unnecessary trips to a surgery. I hope the NHS start using tech to make appointments more efficient.

I very rarely go to the GP, and I can see the advantages of a telepathic service, but, having once attended an appointment due to mastitis and ultimately having a breast examination, a tiny lump being found and then having to have a breast screening, I can absolutely see the benefits of actual face to face (in my case, if I’d just called re mastitis they’d just have given me the antibiotics and that be it).

I also know a man who went to the GP about something random, they pointed out an unusual lump on his neck and it turned out to be a very aggressive cancer, again, wouldn’t have been diagnosed without the face to face.

Ultimately I suspect it will come down the what the indemnity providers are prepared to underwrite. Pre Covid telemedicine was deemed too risky to be cost effective as a teleconsultation all in takes as long or slightly longer than face to face, but a significant proportion would then have to be seen face to face anyway increasing total work load.

If post Covid the legal position changes to tolerate greater risk we could see a big change, but it will take months to years to see how the inevitable claims relating to things that would have been picked up face to face but were missed on the phone/webcam are handled.

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

Fully agree. There's far too much of the "we've always done it this way" mentality. Hopefully, next will be the NHS stopping the use of faxes - they must be one of the last organisations to still use them - crazy stuff!

There is the other problem to consider of improving access to GPs by removing the burden of a face to face visit increasing demand.

I also know a man who went to the GP about something random, they pointed out an unusual lump on his neck and it turned out to be a very aggressive cancer, again, wouldn’t have been diagnosed without the face to face.

You can't routinely waste GP time "just in case" they notice something else whilst you're there can you? That man was just lucky - nothing more, nothing less.

There is the other problem to consider of improving access to GPs by removing the burden of a face to face visit increasing demand.

But massive saving of wasted time of the GP just sat there twiddling his thumbs if a patient fails to attend whilst waiting for the next patient to arrive. With telephone consultations, the GP could just carry on phoning to make best use of the valuable time available. Swings and roundabouts.

He wasn’t wasting anyone’s time, he was there legitimately about something else.

What I’m saying is that face to face meetings allow for GPs to access the whole person, not just a list of symptoms.

Luckystar1: you are lucky to see anyone. I never ever contact a GP unless I’m ill. I know the difference between needing help and seeing something through with home remedies. My surgery also gave up the Dr/patient link years ago. I believe I am allocated a GP but I’ve never seen him or her. As I said above, the last time I did ask to
See my GP, I was told 3 weeks. There is no continuity of care. Repeat patients do seem to get this but no one else. The Dr who rings you is the duty Dr, not your GP.

I don’t mean to imply people should not see GPs. I do think use of the phone back system should be more widespread but it has limitations.

Being suspected of being a 40 something 'worried well' was what caused a 42 year old female relative to die of bowel cancer, and a similar aged friend to almost die of sepsis. I do not think receptionists should be screening calls for this!

However I do acknowledge the point above that there could be other ways to deal with the problem, and accept that my viewpoint comes from an emotional angle.

When my kids were babies, I would have loved a paediatric nurse equivalent of the 24 hour midwife helpline (which I actually never rang) when I was pregnant. The no-nonsense of a "grandma" on call, who used common sense not a diagnostic pathway. Instead I got 111 with a computer system and got sent unnecessarily to a&e. I didn't want to wait there for 4 hours any more than the NHS needed the extra burden.

Blaming timewasters lets the Tories off the underfunding issue, and causes people like my Dad (not wanting to be a burden!) to die in his sleep ten years too soon. He couldn't get past the receptionist either. I really hope this was noted when the GP practice reviewed his unnecessary death.

My GP seems hopeful that face to face appointments may return in 6-8 weeks (I have an issue that should be examined in person)

Before covid, I would always call my practice for a phone appointment if it doesn’t warrant an in person appointment. It’s more convenient for everyone surely. So I’m fine if that becomes standard practice.

I think a lot of people might now think the NHS funding needs to be used sensibly. It needs to re-evaluate how it’s used and we need to re-evaluate how we use precious recourses. We also need a different system of funding health and end of life care. The constant refusal to make hard decisions and change what we do leads to under funding. Germany has a partial insurance system. We must move to this and not demonise private services. We need smarter working not more funds going into a black hole.