Any GPs about? Can you help me understand please?

[ChittyChittyBoomBoom]

This is NOT a GP bashing thread. I just want to understand.

My GP practice are still not seeing patients for face to face appointments. Why is this?

@MinesAPintOfTea

I'm in a difficult home situation with mental health problems. I've had one conversation with my GP since lockdown because I cannot talk openly if I am at home with anyone else. The closed door is actually an important part of the consultation.

I'm desperately trying to figure out how to keep me and DS safe and manage on light medication. It has been grim.

MinesAPintOfTea I’m so sorry, that sounds incredibly difficult. Have you been able to ask for a face to face appointment?

I've found it easier to get an appointment. All triaged by telephone and seen face to face twice when needed. Monthly blood tests carried on as usual.

Overall, it seems better for a professional who could potentially see a lot of clinically vulnerable people every day to minimise contact as much as possible. An asymptomatic GP could inadvertently inect a lot of people.

Having said that, there clearly needs to be some decent national guidance as others have not all had the same good service. A bit like schools in lockdown, many went above and beyond, others did very little.

I saw my GP the other day parking his car on a busy street in London with the sunroof down. I've never seen him look so happy. Then he put his NHS badge up and wandered into the bookshop.

I had spent the previous weekend in A&E because he wouldn't see me, and hadn't been able to organise a scan.

He wasn't great before the pandemic. He called me up once last year to say that my in-person appointment was cancelled because he wanted to go to his son's school play. But a phone conversation isn't much use when you want to ask about dodgy moles. Now he does it all by phone. I suppose he feels all buoyed up with the clapping and the badge.

There are really two NHSs here, one is splendid, full of brave, incredibly hard-working doctors and nurses, and the other just seems like a kind of sinecure for people with little real interest in medicine or the point of care to doss off and play the system. I think all GPs who haven't been at work for the last few months ought to be sent to do a rotation in A&E to sharpen them up a bit.

You can make complaints against GPs, and in your case you should. Here is where to do so: www.england.nhs.uk/contact-us/complaint/complaining-to-nhse/.

The GP practice we use does a phone consult and then if needed people get booked to go in. We actually find it more convenient, but I think they should update the online booking to offer video calling and also messages where this is possible. Those are all available services, it's just that our practice aren't set up to use them.

Thank you MRex.

I certainly don’t want to go in all guns blazing, but feel that should know that in some circumstances, their system just isn’t working.

I believe they speak to you on the phone first . If they need to see you they will book an appt. At my gp surgery, you’re only allowed to attend if you have an appt. I had to speak to the doctor the other day. I tried to phone the surgery and no one picked up and then got cut off. So then I looked on the online website where you fill in a form about your symptoms and a doctor will get back to you. Luckily the doctor called me in the morning the next day and said I needed a blood test. I had to go to the surgery to collect the form but wasn’t allowed inside. My sibling also had an ear infection at the start of lockdown and no one would see him to look on his ear. They prescribed antibiotics over the phone which didn’t work. It went on for a couple of months, discharge and loss of hearing. Eventually, he managed to get a face to face appt and do a swab. They were able to treat him with the right medication based on the bacteria found. But Why did it have to take so long, it could’ve gotten significantly worse!

GP here - We never stopped seeing people but at the beginning of lockdown we were really trying to minimise the numbers. In our area, our peak was in March, not April. At that stage we didn't have PPE and the local rates were really high. One of our neighbouring practices unfortunately lost a practice nurse and a member of reception staff to Covid with most other staff being unwell and everyone obviously having to isolate, if that happens to us that's 10,000 patients without a GP.

We kept childhood vaccinations, 6 week checks and postnatal checks going throughout lockdown but paused smears. This was because the hospital labs stopped processing smears. They restarted processing in May so we restarted doing them at that time. The labs also asked us to slow down with our blood tests during lockdown and it was difficult to get x-rays. This has now all normalised. At the beginning of lockdown we were asked not to make routine referrals to hospital. We are allowed to make the referrals now but the waiting times are massive for some specialties. Patients call us regularly about this, there really is nothing we can do about what is going on in hospitals.

The situation is very different now from March/April and we're seeing quite a few (with PPE) but doing telephone triage first. Quite a lot can be sorted over the phone or by video but those that can't be sorted this way are invited in. I'm particularly bringing in the elderly plus anyone who needs an examination. We try to spread out their appointment slots so that they aren't crowded in the waiting room at the same time. If they are relatively young and fit we try and ask them to wait outside if the weather is ok.

Our practice usually has 3 GPs, 1 practice nurse, 1 health care assistant and 1 phlebotomist working at one time. On a normal Monday morning pre-Covid for example we would see 18 patients each. That's 108 patients going through our waiting room on a typical morning. Our waiting room is usually rammed. If you try to space them out 2m we can safely get maybe 6 or 8 patients in at a time. If we go back to pre-Covid everyone face to face, that's a lot of vulnerable people crowded into a small space with no ventilation catching Covid from each other like they did in March (we had some deaths of patients who could possibly have caught it from the waiting room).

@Livy178 I've had patients walk in to A&E and tell them that we refused to see them when we've offered them an appointment on another day or asked them to try a treatment first and get back to us if it doesn't help. On the other hand quite often I offer the slot in half an hour or an hour's time and they are too busy to come. People have always abused A&E, it's not different now. If you would like to come and shadow me for a session in GP to see what we're actually doing please feel free to pm me I think there's a lot of lack of understanding from A&E. All of us on the other hand had to do A&E jobs as part of our training.

@ChittyChittyBoomBoomChitty, when were the two occasions that you needed your GP? Were they near the beginning of lockdown or more recently? I ask because as I said above, we are seeing face to face now and both cases you mentioned above, if you called me with those tomorrow I'd bring you and your son in immediately but if it was March I probably wouldn't have. Some GPs may still be refusing face to face completely but they are not meant to and are in the minority.

@MinesAPintOfTea

I'm in a difficult home situation with mental health problems. I've had one conversation with my GP since lockdown because I cannot talk openly if I am at home with anyone else. The closed door is actually an important part of the consultation.

I'm desperately trying to figure out how to keep me and DS safe and manage on light medication. It has been grim.

@MinesAPintOfTea that sounds really difficult. Most practices are offering a way of contacting them online, does your GP do this? If I got a message from a patient indicating that they were unable to speak freely on the phone like this I would bring in. Some practices call it 'AskMyGP', some use 'Doctorlink'. Alternatively, could you text a friend and ask them to pass the message on to your GP?

Our GP saved my DH's life last year when a simple appointment turned into a immediate referral straight to coronary care same day appointment. That would just not happen now. We both know how lucky he was and thank God that this happened last year and not this.

I had a face 2 face last week after a few weeks of telephone appointments due to a on going medical condition and they were great. Have to go back in 4 weeks time. I prefer it this way. GPS seem calmer and even had a junior doctor sit in with my gp and let him record my appointment

@Livy178 Not all practices are the same. Ours is triaging patients, dealing with some complaints by phone (the team includes GPs, nurse practitioners, pharmacists and a paramedic who cover most eventualities between them). Patients who need to be examined are given a time to come in - some do, some don't as @Sweetnhappy1 said.

I have found it all fine so far. I've preferred telephone appointments and I can deal with things over the phone and send photos.

My Mum can't manage that and has had 2 appointments.

My son needs his ear actually looked at and I'm wondering how long the wait will be for that, but that's the same as before, long waits.

In other words, people who can use phones, email, send photos are asked to and it appears that the non tech using oldies are being seen. That's fine.

A friend's mum had a fall, hurt her back and became very depressed (almost immediate personality change). Despite weekly pleading phonecalls, the GP would not see her in person for 8 weeks. She was then referred for an X-ray and has been found to have a wedge fracture of the spine.

Another friend's father, aged 85, had trouble with his 'nether regions' (his words). After antibiotics, prescribed over the phone, failed to work, the doctor asked him to take a photo of his backside and email it over. The man does not have a smartphone or digital camera, nor the ability to photograph his own bottom. He refused. A month into the problem, and now really unwell, he has now finally got an appointment.

Those two people live elsewhere in England, but I know of only one surgery in our town where GPs are seeing any patientsF2F, although as a PP said, several have nurses beavering away doing blood tests and dressing wounds.

@Scarby9

A friend's mum had a fall, hurt her back and became very depressed (almost immediate personality change). Despite weekly pleading phonecalls, the GP would not see her in person for 8 weeks. She was then referred for an X-ray and has been found to have a wedge fracture of the spine.

Another friend's father, aged 85, had trouble with his 'nether regions' (his words). After antibiotics, prescribed over the phone, failed to work, the doctor asked him to take a photo of his backside and email it over. The man does not have a smartphone or digital camera, nor the ability to photograph his own bottom. He refused. A month into the problem, and now really unwell, he has now finally got an appointment.

Those two people live elsewhere in England, but I know of only one surgery in our town where GPs are seeing any patientsF2F, although as a PP said, several have nurses beavering away doing blood tests and dressing wounds.

Your friend's mum really did fulfil the 'Accident' part of 'Accident and Emergency' and if she had rung me with this at the time I would have told her to go to A&E where her fracture would have been picked up.

The 85 year old man really should have been seen by the GP, that's not good care. I don't know any 85 year olds who would be able to send a photo plus no-one should be sending photos of intimate regions.

www.google.co.uk/amp/s/amp.theguardian.com/society/2020/sep/14/nhs-reminder-about-face-to-face-appointments-angers-gps

GPs are being contacted by NHS England today to ensure they are offering face to face appointments.

The reason is that GP surgeries are private businesses and can do what they like.

My Gp won’t see anyone face to face, except for vaccination and newborn check for baby. The six week postnatal check was over the phone.

Dm Gp has been wonderful and saw her where she had a very persistent uti. Then again for a skin infection she had. Her doctor prefers to see patients before prescribing antibiotics. If I could change my Gp’s to her one I would.

There's an article about this in the Guardian, the unions are annoyed at the tone. I'm very happy to see a GP virtually for 99% of things and hope the practice continues. However it isn't acceptable to be offering no face to face at all as some pps have said.

Pre-Covid there are two types of appointments at my GP.
If it's an emergency, you can phone for an appointment on the day - you will be triaged over the phone by a nurse practitioner then you can see a GP ASAP.
If you want to book an appointment for another day, you call and book - choosing whether you want it over the phone or face to face.
Now in Covid times, you can call or fill in a form online.
I filled in a form on Friday on the surgery website explaining why I wanted to talk to a GP. I got a text from the nurse practitioner later that day telling me I had a phone appointment with my GP this morning at 8.30. After the call, if the GP wants to see me, I can go in later today.
Obviously it would be more time efficient if I just went into the surgery this morning for a face to face appointment but at least it's contact.
I've also had blood tests - had to wait around the usual time from being told I needed it to actually having the tests.
Am pleased they've come up with a system but as I said, doing a face to face GP appointment straight away instead of going through a GP phone appointment first would be far more time efficient & less work for the GPs!

Dd has seen GP face to face. She had an ear infection last week and had to go. Gp looked in her ear and prescribed abx.

I am sorry everyone has had such difficult experiences.

We are operating a total triage system, that means we get approx 200-300 calls a day for appointments ( that is up by a third) and we are only a 7000 patient practice and we will sort on the phone what we can and bring you in if we cannot.

Behind the scenes what you are not seeing is that when the hospitals closed their doors all the patients who were waiting for specialist appointments came back to us, all the patients waiting for surgery came back to us needing extra meds to manage their conditions.
All the elderly relatives that lost their family and friends support during lockdown and due to shielding came through to us for help.

I have had 2 weeks annual leave this year, I'm unlikely to get anymore for the next 6 months, my workload has gone up 200 percent, I don't get lunch breaks, I go in early, leave late and work into the night on paperwork at home, I have never been busier.

So yes we are working and we are working harder than ever, we might not being seeing every person face to face but we simply would not have he time to help everyone if we did .
And if we get covid and that service shuts then there will be 7000 patients without a GP service while we all recover so no, we cannot afford to throw open our doors to everyone.

Looks like the govt has had enough of this too

www.bbc.co.uk/news/health-54138915

Behind the scenes what you are not seeing is that when the hospitals closed their doors all the patients who were waiting for specialist appointments came back to us, all the patients waiting for surgery came back to us needing extra meds to manage their conditions.

Are any hospitals still refusing to see patients?

all the patients waiting for surgery came back to us needing extra meds to manage their conditions
Oh give over! Ticking through the approvals takes no time at all. My consultant managed to put through blood test and an extra meds request from the hospital while looking after covid patients, I think the GP can manage to tick the bloody approval box for renewals without wearing themselves out.

Dsis severe learning difficulties was asked to take a photo of her vulva as she’d come out in a rash - receptionist said could her carers try and photograph it and give it to pharmacist or email to surgery .

Thankfully all involved refused to take photographs - her learning disability nurse was astonished that the receptionist had ever thought that appropriate ! In the end she was prescribed stuff based on verbal description thankfully .