What are GPs actually doing during all this time ?

[VivaMiltonKeynes]

We were discussing this . In our surgery they have e consult online and you get a call back . On the couple of times this has occurred it's not even a doctor at our practice - it sounds like a service they use and it is really appalling . They don't even seem to have read your notes . The nurses are run off their feet doing the usual blood tests, flu shots etc but what are all the GPs doing ?

@Nanniss the difficulty is pinpointing a single point to complain about.

• a lost/misfiled consultant letter - can happen anywhere
• a lost prescription - can happen anywhere
• an incorrect dosage on a repeat prescription - can happen anywhere
• test results not being followed up on - can happen anywhere

Each thing is minor but all of the above have happened to me and as a rule I go to the doctor very infrequently. Roughly a third of my interactions with the surgery have contained an element of admin error.

@GnomeDePlume - if you’ve experienced problems with delivery of your care the Practice Manager is a very good place to start because, apart from anything else they will have access to audit trails within the GP clinical system. This, means it is possible to find out who misfiled the letter, who viewed and filed test results. Problems can at least then be corrected and/or staff given further training.

@GnomeDePlume

The people who get let down the most are the ones who cant advocate for themselves. They will have tests done and assume that 'no news is good news'. That will be a good assumption in a well run surgery. In a badly run surgery 'no news' can mean anything at all.

How do you tell that a surgery is well run or not and do you really have much of a choice anyway? A badly run surgery is unlikely to have a sign up to tell you.

I can advocate for myself. I also know which are the most likely things they will trip over: test results, prescriptions, follow up appointments, so I chase things up, I do my research. If I wasnt able to advocate for myself I would be in trouble.

This sums it up . You have to be your own cheerleader with the NHS . I would love to know from practice managers, GPs etc - how do you view patients who do make complaints ? Are they marked as troublesome or do you ensure that their treatment is second to none going forward ? Be honest I am sure this makes many people reluctant to voice their views. I was many years ago involved in a complaint regarding my Mother's treatment - my own GP said to me " don't bother /it really isn't worth the stress ". I didn't listen and she was right - it was long and drawn-out . Did it achieve anything for other patients ? I would hope so but from what I saw written down I very much doubt it .

My baby ended up with the wrong medicine because the GP refused to see us face to face. It’s unforgivable and I’m so so upset about it.

The reason for limited face to face appointments is to reduce the risk of people catching CoVid at the GP surgery. More people coming in = more risk. Also if one staff member catches CoVid, they and one/more of their colleagues have to isolate, meaning the practice can't operate as usual.

@cherrycola742

The reason for limited face to face appointments is to reduce the risk of people catching CoVid at the GP surgery. More people coming in = more risk. Also if one staff member catches CoVid, they and one/more of their colleagues have to isolate, meaning the practice can't operate as usual.

That makes sense to a certain point.

But when the GPs reaction is “yes he needs to be seen but we aren’t seeing anyone so you will have to go to A and E” about a CEV child who is nowhere near ill enough for A and E but does need his chest listening to then it has gone too far.

Or when the GP admits someone needs to be seen by a Dr but instead arranged for the already over stretched district nurses to come out (for a patient who could have happily made it to the surgery) and act as a a go between. Then things go too far.

We had a fantastic virtual OT appointment yesterday. We have had lots of fantastic health care treatment both in person and virtually over the past year but locally GPs have become the “weak link” who are actually adding to the work of other departments. Locally they don’t seem to have really thought through to “we are seeing no patients in person” policy because some patients need seeing. Not all or even the majority but sometimes face to face is the only way to properly examine something.

Just in case it got lost I'll repeat that our GP surgery has been a zillion times better since March. In March they have done what they couldn't before and have gone on-line. I had terrible back/hip pain (have badly wedged a vertebrae in the past). It was wonderful to complete an on-line form noting onset, nature if pain, concerns. GP was on the phone before 9.30am, good discussion in about 4 mins, prescription for neuropathic pain at pharmacy by 11.30. Both DC have had very good on-line experiences too.

I'd also shout out for pharmacists ours has been fantastic.

In the case of our surgery I hope nothing changes post covid. I really don't want to go back to the endless unanswered phones, rude receptionists, no appointments after 6pm for a month and sitting in a grotty waiting room whilst others cough and splutter. I may be influenced by the fact that I work full-time and this system works far better for us.

@Nanniss I would be very interested (and I mean that genuinely) in your view on this quote from OP:

how do you view patients who do make complaints ? Are they marked as troublesome or do you ensure that their treatment is second to none going forward ? Be honest I am sure this makes many people reluctant to voice their views.

Most of us arent very good at effective complaining. We tend to put up with things and if we havent too much experience of well run surgeries we assume our own badly run one is the norm.

@Sirzy that sounds quite poor. It seems like the services aren't quite uniform. My daughter & I have been called in for face to face once each over the past 6 months, even though I thought one of us could be managed by video.
Not having to take half a day off work for a video appointment is an absolute dream for me personally.

We have had lots of fantastic health care treatment both in person and virtually over the past year but locally GPs have become the “weak link” who are actually adding to the work of other departments.

I can second that. I spent Sunday with a family member in A&E, where they went over and above to make sure necessary but not strictly urgent investigations were done before we left because, in their words, 'Normally we'd tell you to go to your GP, but you'll wait forever at the moment.'

@GnomeDePlume @VivaMiltonKeynes

I actually agree with you that you need to be your own cheerleader to get the best from the NHS - or you need someone to advocate for you.

As far as complaints are concerned, in my experience, most are due to poor communication or system errors rather than actual medical errors. We have a large elderly population at the surgery where I work and most complaints are from patient's family members rather than the patient themselves . I genuinely have no problem with this and am happy (once appropriate consents are in place) to investigate and explain what and why things have happened in the way they have. Complaints are often about perception of events rather than fact. It might surprise you that it's a part of my job that I actually quite enjoy and when it's done sensitively it can really help to strengthen the relationship between us and our patients.

The patients who take the time to complain formally and directly to us deserve a proper investigation and well thought out response. The ones I have a problem with are those who write anonymous reviews online or facebook posts.

DH mentioned that their surgery have received positive feedback as to the new systems. Pre Covid the average wait for a non urgent appointment was three weeks (large patient list and shortage of GP’s at the practice). Now phone consultations are same day and f2f within a week.

My go is doing phone appointments had deciding if you need to be seen it can diagnose over the phone. It was my gp who called me.

My pet hate at the surgery is having to phone again the following morning at 8 a.m., when of course every other patient is trying to get through before all the
appointment times are full for the day - havent they heard that people are frequently in pain and sometimes have difficulty in actually dialling the number? Why not accept bookings when patients phone the first time; is it really so difficult? And am I the only person unable to sleep at 3a.m.,for the pain and therefore dozey when the alarm goes? (I
slept through it this Monday after a sleep-deprived
weekend, to be told that all the appointments were taken, and I should phone again tomorrow)......
Next time, I plan to increase all painkillers and take
my chances staying in bed until I feel better.

By the way, I find it's more convenient to call in at the pharmacy for the flu jab, plenty of parking and straight into their little office, rather than the usual queue outside the surgery on Saturday morning.

That is a bloody good question OP.

having to phone again the following morning at 8 a.m., when of course every other patient is trying to get through before all the appointment times are full for the day - havent they heard that people are frequently in pain and sometimes have difficulty in actually dialling the number?

Or on their way to work, or at work, or getting kids ready for school etc etc. And then when you get offered some ridiculous appointment (usually 3.15, perfectly timed for when you're picking kids up again) being told, 'well, if you need it as much as you say you do, you'd find a way to get here'. Because real life is like that, yes.

I think it very much depends on where and who your gp is. I'm a healthcare worker and it's been difficult staffing our service because our team like any other team are humans. It would be really easy to look at our team and ask where half of us have gone.

We have significant numbers staff who met the shielding criteria, the usual winter sickness rates, then we obviously have staff who need time off to look after kids who are isolating from schools or are isolating themselves. Local teams similar to mine have been massively hit by an a staff member testing positive then causing big chunks of the team to isolate so we dread that, some us got redeployed to other teams to cover that.

So whilst my team isnt in a face to face covid role it's still a logistical nightmare.

Unfortunately things like Gps and consultants are ageing and prone to being vulnerable. Something like 25% of gps are over 55, but make up 50% of the permanent gps and there are 40,000 practicing doctors over 60 in this country.

GP’s don’t offer inconvenient appointments - they offer a time when there is a free slot. There are more patients wanting appointments than there is availability. DH’s practice are now doing telephone appointments from 8am - 8pm, five days a week on top of f2f where required.

@Parker231

GP’s don’t offer inconvenient appointments - they offer a time when there is a free slot. There are more patients wanting appointments than there is availability. DH’s practice are now doing telephone appointments from 8am - 8pm, five days a week on top of f2f where required.

They do try to fill the unpopular slots first. The amount of times I had to explain that I was commuting back from london to get to the appointment and so no, the 11am appointment is no good. It was generally met with a sigh and a "well that's all we have" before magically finding a post 5pm appointment for me. Almost without fail. During covid I'd accept any appointment if I could get one

My go is doing phone appointments had deciding if you need to be seen it can diagnose over the phone. It was my gp who called me.

Mine is doing the same, I've seen her twice since March and I can't knock the service, she's been brilliant.

Ours has been absolutely useless. You're not even allowed to ring. All communication has to be done via online forms. Which are triaged within 5 working days. It's farcical.

The reason for limited face to face appointments is to reduce the risk of people catching CoVid at the GP surgery. More people coming in = more risk.

The question is though, how many excess deaths like cancer, will there be, because of telephone appointments, rather than face to face? I imagine for the individual, who has cancer undetected, the chance of dying from that, is greater than from Covid 19?

On the whole my surgery has improved, it’s a part time rural practice and has introduced a digital booking system which is so much better than calling them, they were a bit hopeless administratively, but now I get texts to confirm/ remind me of repeat prescriptions/ appointments. I’ve had a smear test with the practice nurse, and a phone consultation with a doctor and they arranged flu jabs for me and my DH. So overall it’s much better.

My GP practice have been great. You phone to arrange for the GP to call you back; they spend the morning doing phone calls. For something like an ongoing rash they sometimes ask for a photo to be emailed through; if they feel they need to see you face-to-face they arrange that.

I reckon one GP is working from home (doing phone calls), and one from the practice building.

@Parker231

GP’s don’t offer inconvenient appointments - they offer a time when there is a free slot. There are more patients wanting appointments than there is availability. DH’s practice are now doing telephone appointments from 8am - 8pm, five days a week on top of f2f where required.

I wasn't suggesting they choose to offer inconvenient appointments, I'm saying that when an appointment turns out to be inconvenient, even when the reason for that is pretty obvious and commonplace, the attitude is one of incomprehension, usually accompanied by rudeness. It suggests a strange lack of ability to grasp the basic realities of normal life. I'm not talking particularly about my surgery, but about pretty much everywhere I've ever been registered. And I'm not talking about now, because obviously things are different at the moment. As a pp said, you would take anything now, just as I spent three hours of my day telephone queuing last week. But that's not sustainable and if I didn't wfh I couldn't do it. My point, made several times now but obtusely misunderstood by those working (or married to those working) in medicine, is that the longstanding failure of GP surgeries to get their heads round the way normal people live and work has put them in a poor position to come up with solutions for the Covid era.