GP's please why are you not back to seeing us face to face

[whenwillthemadnessend]

Just that really ?

Please can any GP's explain the reasoning

If dentists physios and accident and emergency doctors can see people why can't GP doctors?

@MissLucyEyelesbarrow we have to complete the same PPE and cleaning for these checks. We don’t have the extra staff or hours to do this on top of our normal workload. It feels like GPs palming off their work to us - especially during the height of lockdown when we were swamped and they had little to do, apparently. I work in a variety of pharmacies and none of them are supportive of this. Their reasoning most of the time is that it’s too risky for them to do a BP check - send them to see the COVID-immune pharmacy staff instead. Funnily enough, we don’t get to reciprocate the pleasure. Some surgeries I work with will even refuse to take prescription requests over the phone and instead encourage patients to visit us in the pharmacy to request meds! The mind boggles.

My DD has begged to see her gp face to face. They have refused. She's had chronic back pain since November. Doc decided it must be sciatica. None of the pain meds work, doc just kept changing her meds. She's now on morphine tablets plus oramorph & still in agony.
She eventually got a phone call from a consultant this week who told her she must be improving by now & can't possibly be in so much pain. She is on the urgant waiting list for an MRI, he told her she will still be waiting about 6 weeks.
No-one has examined her back at all.

[quote tankflyboss]@Darkbrownistheriver

I volunteered at a vaccination centre. Couldn't get a shift for love nor money. They had so many people volunteer. There are threads of other people in the same situation on the coronavirus topic. It may not be true all over the country or in your area but please don't make out they are all staffed by exhausted GP surgery admin staff because no one else stepped up to offer. [/quote]
Volunteers are great and generously giving their time. However they are extremely limited in what they can do. Who do you think is identifying patients and ringing them multiple times to get them booked in, sending text messages, setting up clinics and staffing, chasing the non attenders and answering all the queries? Some people are keen and turn up when booked but certainly not everyone there is process is very resource heavy.
GP surgeries are following guidance given by the government. People seem to think they’re just making their own rules up and it’s not the case. If you’re not happy complain to the powers that be

@whenwillthemadnessend
I volunteer at the mass vaccine centre in Stevenage and welwyn garden city. Thank you. It is great to be doing something positive isn’t it?

I think things are gradually returning to ‘normal’ as regards general practice, but it will be a new normal. The phone triage will stay with us, as it seems to work well and as I said, most (but not all) prefer it. Covid has been pretty all-consuming for the past year, but we’re pretty much doing everything we used to do now. I can’t speak for other surgeries.

There is, though, the ongoing problem of GP recruitment, which seems unlikely to go away.

My gp surgery has been great. They've been doing mainly phone consultations but have been very flexible about timings of calls. However, face to face consultations are still available if the gp decides it's needed.
I can't praise them highly enough - I've been really quite ill and my gp has been incredibly supportive.
I hate to say it but it's actually an improvement from the way things were before.

Just look at the number of posts saying "Talk to your GP" on MN on a single day. There must be hundreds. The demand is staggering. GPs alone provide over 300 million appointments per year, and primary care nurses at least half that number again.

There are no enough GPs to go round and areas of highest need have the least funding and the fewest GPs.

Reading some of these I feel very fortunate indeed.
When I had my regular smear, I asked the nurse to have a look at a lump on my upper inner thigh. She insisted that all lumps are seen by a GP (I thought she'd be able to reassure me it was what I presumed was a lipoma) and within the next week I had a face to fanny face appt.

I felt kind of bad because I know face to face appt are so limited, but they took it very seriously.

The truth is that Covid has massively exacerbated the disparities between well and badly run practices. We all know of practices whose guiding principle is to keep as many patients away from the doctor as possible and that appear to have no understanding of normal people's daily lives, commitments and experiences, with an appointment system that reflects that ethos. Such a practice is likely to have responded badly to the challenges the pandemic poses to their infrastructure and working processes. This is the problem and is at the heart of the wide range of experiences reported on the thread. It's a shame that the GPs on the thread are so determined to puff their doctorly chests up that they can contribute no insight as to solutions to this largely administrative problem.

Private doctors are seeing patients face to face. I've seen one recently for a blood test as I got tired of being told to go away by the NHS one.

At my surgery it's a combination of f2f and tel.
You get a tel.consult first and then a F2F uf needed.
After every f2f appt we have to clean the room. Chairs and anything the patient touched. This time also has to be accounted for.
This means if every patient was a F2F our capacity would be halved due to the cleaning. Instead of 15-16 tel appt. It would be 7-8 f2f spots. Due to the cleaning times. So waiting times will double and we the HP would only be doing half the work they normally do.
Half the time would be spent cleaning. And putting on and taking off PPE.
If all the clinicians and nurses were having F2F appt. We would have no where to seat the patients. GP surgeries are not that big.
There would be no social distancing while you are waiting for your appt due to the sheer number of patients attending.
So there would be a very high chance of covid transmission. Due to these reasons until covid is controlled a lot more we are unlikely to go back to F2f apps for all consults.

Covid has brought out the best and the worst in everyone, GP surgeries included. I am very lucky that my GP surgery has been excellent. They have offered timed telephone appointments, responded promptly to emails, offered FtF if required following the telephone consult.
The Econsult service has been a bit iffy, but the receptionist told me that they were having technical issues with it. However, the telephone service is so good it doesn't matter.
The 2 GP surgeries a couple of miles either direction from mine have been absolutely dreadful. I am not sure why there has been such a big difference.

Routine medical care taking place in person around here, probably because of the lower vaccination pressure this month.

NHS dentist here. All Covid has done is worsen an already overloaded system.
There has been a issue in GP recruitment for years, so there are many areas with insufficient GPs. It has highlighted those practices that are agile and able to adapt but those are likely to be those who were fully staffed in the first place.
I'm currently waiting for a GP phone consultation about a DC. I quite like the lack of F2F unless needed but my GP practice was always good and have adapted pretty well.
NHS Dentistry has been hit hard because it was already an underfunded service; only available to 50% of the population, as that is what was commissioned. Add in new required operating conditions; room ventilation, full PPE, social distancing and we're able to see far less people. If they change our guidelines we can increase our numbers seen.
I've gone privately for 2 operations in the last 12 months as although they could have been treated under the NHS, the waiting times were horrendous. I'm fortunate to have savings to do this.

I tell patients in the first instance it will be a telephone call but if the GP feels it needs a face to face consultation then they make that decision and they make the appointment.

To be honest, the appointment system has been useless for years regardless of whether it's on the phone or in person. At my GP practice, if you need an urgent appointment you have to phone at 8.30. If it's non-urgent and you work in an inflexible job, you have to wait weeks for an appointment at a suitable time. Eg I'm a teacher so I can only go to non-urgent appointments after 4pm. That also means that I can't easily phone up for appointments as you are usually put on hold at 8.30, or recently they've just started putting on a recorded message saying the lines are too busy and you have to call back later, before they cut you off! I have a KS1 class to be in front of - I can't just leave them by themselves. It's even worse if they give you a phone appointment at a set time then don't call at that time.

One of my DC gets recurrent UTIs. She's usually well enough to go to school so long as they know to let her go to the toilet regularly, but needs to be seen by a GP each time. It's so hard to be able to phone up and get an appointment for her.

I really don't see why in 2021, GP surgeries can't have figured out a decent online booking system.

@ConquestEmpireHungerPlague

The truth is that Covid has massively exacerbated the disparities between well and badly run practices. We all know of practices whose guiding principle is to keep as many patients away from the doctor as possible and that appear to have no understanding of normal people's daily lives, commitments and experiences, with an appointment system that reflects that ethos. Such a practice is likely to have responded badly to the challenges the pandemic poses to their infrastructure and working processes. This is the problem and is at the heart of the wide range of experiences reported on the thread. It's a shame that the GPs on the thread are so determined to puff their doctorly chests up that they can contribute no insight as to solutions to this largely administrative problem.

No-one is determined to 'puff up their doctorly chests'. We are explaining why the pandemic has been shit for the NHS and we are slowly burning out providing so many more appointments than ever before, 70% of the vaccine programme and listening to people complain on here and in the media. I don't know any GPs who are not making a plan B at the moment.

I come on this forum to find out what is happening with the vaccine programme because people here seem to know before we get told anything. A couple of weeks ago on one thread, people were saying GPs were crap for not advertising the national vaccine booking site (which is absolutely nothing to do with us). A few days later someone posted that their GP had abandoned them because they sent a text saying that the national booking site is available. I mean FFS dammed if you do and damned if you don't.

Do any NHS dentists foresee when service should return to normal? My youngest DC has been waiting to have a suspected tumour removed from her gum since 2019. We've had appointments cancelled by her dentist and the city dental hospital, and nothing rescheduled. They think it's "likely benign" but "can't be sure until a biopsy is done"

Meanwhile, my eldest is under the care of a different dentist and has had routine appointments and work carried out throughout.

@lavenderlou

To be honest, the appointment system has been useless for years regardless of whether it's on the phone or in person. At my GP practice, if you need an urgent appointment you have to phone at 8.30. If it's non-urgent and you work in an inflexible job, you have to wait weeks for an appointment at a suitable time. Eg I'm a teacher so I can only go to non-urgent appointments after 4pm. That also means that I can't easily phone up for appointments as you are usually put on hold at 8.30, or recently they've just started putting on a recorded message saying the lines are too busy and you have to call back later, before they cut you off! I have a KS1 class to be in front of - I can't just leave them by themselves. It's even worse if they give you a phone appointment at a set time then don't call at that time.

One of my DC gets recurrent UTIs. She's usually well enough to go to school so long as they know to let her go to the toilet regularly, but needs to be seen by a GP each time. It's so hard to be able to phone up and get an appointment for her.

I really don't see why in 2021, GP surgeries can't have figured out a decent online booking system.

If someone says they are a teacher or they have a meeting or they will be with customers, we do try and accommodate them.

In the first lockdown I wasn't allowed to contact my child's teacher directly, the headteacher said we weren't allowed to. He was being set work daily that was taking him 5 minutes a day and I was hoping to discuss strategies with the teacher, nope not allowed. But I'm not blaming the teacher for this, I'm blaming the system. The pandemic has been rubbish for a lot of reasons.

I've had 2 telephone consultations during the pandemic. As my Dr's are offering a telephone 'triage' but if you need to see a Dr, they will make an appointment. First experience not so good as really needed to see a Dr, but got a referral I didn't need and coyld have been sorted with a gp appointment. Second eperience miles better. Appointment the same day and (sort of) fixed. I work in the NHS so I understand why gp's have put in telephone/video apts but some things really need to be seen by a Dr as some things cannot be diagnosed over the phone. Practice Nurses have been seeing people face to face throughout after the initial lockdown.

I sincerely hope the triage system in it's current form doesn't stay @Darkbrownistheriver! If it does it has to be working alongside receptionist discretion for face to face appointments and not just a 'one size fits all' solution.

I'll give you some good and not so good examples of what it's like for a patient at the moment.

Good - my DH suspected a prostate problem last month so called the GP. He had a telephone call back almost immediately and the GP arranged for a blood test next day, with a scan at the surgery three days later. In the past those would have happened on the same day rather than be spread out but we understand the issues with Covid and keeping socially distanced. The results for both were back within two weeks - both fine thankfully. Fantastic work all round and we're very grateful. There was really very little difference between the telephone call and a face to face appointment in getting to the next, testing, stage. So that worked really well.

Not so good. My sister discovered a lump in her breast a couple of weeks ago. She called the surgery (same one as my family attend) and asked for an appointment, explaining it was a lump. She has had a breast cancer scare in the past and explained that to the receptionist. 'The GP has to talk to you before we can arrange any appointments, I'm so sorry' was the reply, the receptionist was really sympathetic but she has no discretion to override the system now.

The GP has a time slot for calling back of 8am - 1pm if you've called in the morning, 1pm to 6pm if you've called in the afternoon. You can't ask for a call to suit you - like after school pick up or after your shift ends. It's a 5 hour time slot and you wait for that call.

So the GP called mid morning, had a chat and said 'right, as it's a lump I need to see you to exam you'. She felt like shouting 'I know and your receptionist knew but you won't allow her to book a bloody appointment without overseeing it all!' but obviously didn't because she's a nice person. Now that's frustrating and a waste of her and the GP's time as the receptionist could have just booked the face to face appointment as it was a lump in the breast of a person who has a history of lumps in the breast! Common sense should prevail. And it was fine for my sister, an anxious wait for the telephone call but she could at least take it at work. I work in a school (not a teacher but I do cover SEN classes as back up help). I can't have my phone on anything but vibrate. If the teacher is busy I can't just walk out of a class to take a call because a GP deems it's the time to ring. I need to be able to say 'can I ask for a call after 3pm' but the receptionist can't book that. I either need that or I need a proper face to face appointment so my work knows cover is needed at a specific time.

The triage bit works well for rashes, advice, first stage consultation alongside videos or photos. Before Covid we used to call for a GP call back if DS had a rash in case it was contagious - we didn't want to sit in a surgery and it worked well.

But, going forward, if you say you have a lump or something similar that will need to be examined the receptionists should have authority to book you in face to face immediately, not waste a phone call from a doctor.

And triage, if it is going to be used after Covid, has to be bookable to some extent if it is going to be needed. Not everyone is at home waiting for a call. My sister just need to have the lump checked, she wasn't in her sick bed. What about bus drivers, police or other emergency services, teachers, those in supermarkets - they can't just drop everything because a GP decides to call about their lump at that moment. Imagine your bus driver saying 'sorry, you're going to be 10 minutes late, I need to speak to my GP about my prostate gland!'

If telephone triage is going to be used in future it has to be used alongside traditional appointments and the patient needs to be able to say 'is it possible to schedule a call after x time as I'm driving a bus before that!'

So I hope telephone triage, certainly as it's currently used in our practice, is dropped or adapted as soon as possible post Covid. It works to keep people Covid safe but it's causing anxiety and frustration to some patients who are not time wasters but know they just need to be examined.

@tankflyboss
Thanks for volunteering and sorry (or glad?) they don’t need you. My experience is of the small GP vaccination hub we run. I wasn’t suggesting the admin staff were exhausted, just that they are giving up their time. My point really is that often the people who complain about things mostly (and I’m not referring to you) are the people who never do anything to help the situation - not just in terms of GPs, but also schools. These people never seem join the the parent teacher groups or volunteer to become governors, they never help out at the toddler and baby groups, or join the patient participation groups. They just moan. I realise that many people work and have families and not everyone has the time to do these things, and you’re still perfectly entitled to complain, but don’t just do it on Mumsnet. if you have a problem with how your surgery works, write to the practice manager and express your concerns. Make suggestions about how it might improve.

All that said, I think one of the major problems is that for people who interact very closely with individuals, GPs are rubbish at communicating with their patients as a group. They change how the appointment systems work at the drop of a hat (with the best intentions of improving things), but never tell the patients what they’re doing and why! I can quite understand why, if you don’t go to the doctor regularly and you’ve always rung up to book an appointment for next week, it’s bloody annoying to be told your only option is a phone call today. That’s nothing to do with Covid by the way - it’s always been that way.

I also get pissed off with with the way people speak about my reception colleagues on here. Yes, as in any organisation there can be bad eggs, but they are rare. The vast majority are trying to do their best for the patients. They’re not asking what the problem is because they want to embarrass you or tell their friends (they’d be fired). They’re asking because the docs have told them to. The receptionist has no interest at all in your piles or personal life. It’s to flag up for the doctors if someone has symptoms that might need priority over the itchy rash another patient has had for two weeks. In practice meetings it is always the receptionists that suggest things that might work better for the patients and complain about things that may make it difficult for them.

Not related to this at all, but a GP once told me that it is a very lonely job. She said that she was stuck alone in a small room all day, often with no time for a coffee or lunch with her colleagues, seeing strangers who she had no time to build any relationship with. I’d never thought about it like that before.

Just to add. Our receptionists earn less per hour than staff in all the major supermarkets. Not to say that supermarket staff don’t earn what they’re paid - they do.

Who sets the pay scale for the receptionists?