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?

They are seeing people face to face. I was there recently. I won’t go into details but it involved a pair of rubber gloves.

A practice near us is amazing. They had a seperate room from the start ofbthe pandemic where they would see people with auspected covid, (seperate enterance etc) they have kept this up. They offer face to face or phone consults, amazing, above and beyond. Our gp a few villages away, no appointments unless your consultant demands it, you may see the nurse if they think you are ill enough for hospital. They don't do half the phone consults, you have to phone at 8am all appointments for phone consult gone by 8.10am. Wouldn't give antibiotics to 8 year old with suspected urine infection without seeing them, (last one she ended up in hospital with excess blood which they couldn't find cause for so notes said she must be seen and bloods done), refused to see child and only accepted urine sample as mil stood outside surgery and demanded they test it. After many follow up phone calls and never seeing or speaking to gp finally got a prescription for antibiotics.
Poor service but as they work for themselves there is nothing you can do especially as too rural to be close to another practice. Very glad other essential workers don't function like our gps. Hopefully though we are in the minority.

[quote Bagamoyo1]@Kazzyhoward
You do know that GPs don’t do the diabetic eye checks don’t you? It’s done by the retinal screening service, sent from the hospital. They use the GP premises, but GPs don’t control whether it happens or not.[/quote]
Yes, I do, but the GP surgery aren't doing diabetic foot checks either, it seems the entire NHS has thrown in the towel on any that's not an emergency. How come eye tests/foot tests etc were essential before covid but now they're not? All the routine stuff seems to have been abandoned.

My GPS are not brilliant IMO. Lady CQC report inadequate but I have been in fir appointments throughout mainly with nurses for blood pressure check, smears but also seen GPS f2f if deemed necessary following phone consultation. My dentist on the other hand keeps cancelling. Appointments due last March and still no appointments.

Tbf Kazzy I'd just treat that as any normal appointment running late. The ones with the mental health team over the phone occasionally ran late and it isn't too much of an issue.

The problem with the GP is you ring at 8 and they ring anytime between 8.30 and the end of morning surgery. Which means I can't go to work, but I also can't also give work a time when I'll be in other than it'll be about an hr after the GP rings me back.

I’ve been a GP for over 20 years, and a 100-hour-a-week junior hospital doctor for 5 years before that. I can safely say that I have never worked as hard as I am working now.

We are doing telephone triage, followed by face-to-face appointments as needed. We have to be very careful about bringing patients to the surgery. We’ve been told that if a patient is seen in the surgery, and they subsequently test positive for Covid, then the room they were seen in can’t be used for 24 hours, despite being cleaned. Which of course would have a huge knock-on effect for other patients.

Regarding timing of phone calls - it’s difficult. Every morning I look down my list of patients and try to work out (from the 5 words by their name) whether or not they may need a face-to-face review. If I think they might, then I tend to call those patients first, so I can arrange to see them later that morning.
I’m probably seeing 6-10 patients per day, and telephoning 30-40.

We’re also vaccinating 100s of patients every week, with no additional staff. We are working overtime and weekends - the reception staff and nurses are getting overtime pay, but the doctors get nothing. Not a single penny. We get money from the government for delivering the vaccine programme, but after costs we will just about break even. And we are all exhausted, but we’re doing it because we know how important it is.

I know services vary in different areas, but wherever you live, I’m certain there’s a lot more going on behind the scenes than you are aware of.

@EachDubh I was told by a consultant at 111 that my GP really should see me in person and that he'll personally call them to make an appointment for me ASAP, "they'll call you to confirm", he said. Waited for the call for a few hours, when I called them they said "no need to see you, just pick up the prescription". I appreciate there are many amazing hard working GP surgeries, but ours is really poor, sadly we don't have much of a choice.

Quite shocked reading the majority of these responses that so many are in favour of GPs continuing fast remote telephone appointments in order to "see more patients'. Well not see obviously. But well it's cheaper and more efficient so....

[quote Frezia]@EachDubh I was told by a consultant at 111 that my GP really should see me in person and that he'll personally call them to make an appointment for me ASAP, "they'll call you to confirm", he said. Waited for the call for a few hours, when I called them they said "no need to see you, just pick up the prescription". I appreciate there are many amazing hard working GP surgeries, but ours is really poor, sadly we don't have much of a choice. [/quote]
111 don't have consultants. They have call handlers.

"I was told by a consultant at 111 that my GP really should see me in person "

You do realise that most 111 operators have NO medical training whatsoever, and actually very little clinical backup? They also have absolutely NO authority (on a contractual level) to make your GP surgery do anything and we always re-triage what it sent to us by 111 because about 80% of the time it is nonsense.

I'm so envious of people whose doctors are doing F2F again. My surgery's doing phone appointments but they never have any. You find that out after being on hold for an hour (no exaggeration). If it's routine they tell you to try again next week. If it's urgent they tell you to go to A&E. I'm self-employed and wfh. God knows what people with proper jobs do.

And podiatrists, the state of the toenails of the elderly is shockingly bad, their toenails are curled round their bloody toes. Getting beyond a joke now

@Bagamoyo1

I’ve been a GP for over 20 years, and a 100-hour-a-week junior hospital doctor for 5 years before that. I can safely say that I have never worked as hard as I am working now.

We are doing telephone triage, followed by face-to-face appointments as needed. We have to be very careful about bringing patients to the surgery. We’ve been told that if a patient is seen in the surgery, and they subsequently test positive for Covid, then the room they were seen in can’t be used for 24 hours, despite being cleaned. Which of course would have a huge knock-on effect for other patients.

Regarding timing of phone calls - it’s difficult. Every morning I look down my list of patients and try to work out (from the 5 words by their name) whether or not they may need a face-to-face review. If I think they might, then I tend to call those patients first, so I can arrange to see them later that morning.
I’m probably seeing 6-10 patients per day, and telephoning 30-40.

We’re also vaccinating 100s of patients every week, with no additional staff. We are working overtime and weekends - the reception staff and nurses are getting overtime pay, but the doctors get nothing. Not a single penny. We get money from the government for delivering the vaccine programme, but after costs we will just about break even. And we are all exhausted, but we’re doing it because we know how important it is.

I know services vary in different areas, but wherever you live, I’m certain there’s a lot more going on behind the scenes than you are aware of.

@Bagamoyo1 People have just come here to whinge and moan. They are ignoring the fact that we are having to vaccinate at the same time as routine GP work. Sometimes I think these threads are started by politicians or journalists. I pasted this earlier, no comments on it, I'll just put it here too www.pulsetoday.co.uk/news/workload/one-million-more-gp-appointments-taking-place-per-week-than-before-pandemic/

"My surgery's doing phone appointments but they never have any."

So in fact they probably have lots but they're all fully booked - ie demand >> supply.

Why do you think this wouldn't be the case if they restarted full F2F.

The bottom line is that there aren't enough GPs, because you (the general public) pay about £120 per year to your surgery in total regardless of how many times you are seen and this has to pay for reception, the nurses, the repeat prescriptions system, the doctors, the paper in the printers etc etc.

Fewer and fewer doctors are willing to put up with the hours and frankly having to deal with the small but vociferous group of arsehole patients that make it a misery. Expect more of the same.

I work as both an NHS and Private GP (and the Private GP Practice appointment cost is £125 per appointment - so more than a year's worth of NHS). And yet the private patients are more polite, more understanding, and more reasonable.

I honestly wouldn't shed a tear if NHS GP collapsed (even more than it is). The public will finally get what they're paying for!

@Kazzyhoward you can get your diabetic retinopathy test done at any of the large optician chains. Fortunately my local hospital has resumed diabetes eye tests but it’s rubbish that there’s so much inconsistency in medical care across the country. I’ve also had a routine dental checkup at Tesco dentist.

Oh God. 111 Call handlers. I'm sure it's not the fault of the handlers themselves, but it felt like a considerably better service when they had more medical expertise.

I think there are a lot of illness and conditions where a person might develop symptoms that could also be attributed to covid. I don’t think it’s really acceptable at this point in the pandemic to say we won’t see any patient with these symptoms, even if we actually suspect it is something else. I understand the argument about the room being out of action later if someone tests positive, but actually, other public services have had to totally rethink how their services are delivered, I think there would be a way around this problem.

My two year old was ill a few weeks ago. Seemed to have discomfort in her vulva and spiked a temperature. The GP would not even discuss other possibilities over the phone until she had had a covid test. Getting the antibiotics for her urine infection were delayed by at least 24 hours by having to get the covid test. She was never examined by anyone other than me and DH. I think this is too much of a cop out on a GPs job tbh.

My GP said they would see me in person soon. However I had a weird skin reaction that would be better assessed in person so I don’t know if they were just saying that to me, or if it’s the same for all patients

@kerankeedoc @ExpulsoCorona The 111 call handler took my call, did the evaluation and got the consultant (some sort of doctor or health worker? I'm sorry if I don't know the right term) to call me back. He did and did a phone triage. If you're saying I just got a call back from another operator with no medical credentials, next time I might as well just call my Mum.

@ExpulsoCorona

I did read that link. But it doesn't answer why so many people who need them have not been able to get appointments. It doesn't answer why paramedics, and A&E staff, are complaining that they are dealing with cases that should have been dealt with by patients' practices. It doesn't account for those with conditions that have gone undiagnosed, or parents' at their wits' end who haven't been able to get an appointment for their sick child. I think most people are aware that there are thousands of brilliant GPs and practices, but the system is currently failing many people. I expect you will come back with another cavalier and defensive comment along the lines of 'people are just whinging and moaning', which is beyond insulting to many who are having serious issues. I'm sure you are a fabulous GP, or whatever other medical professional you are. Massive respect for you on that score. But absolutely no respect for your pretty weird denial of an obvious issue, which you seem to be taking personally.

Well in fairness your mum is probably able to give the same kind of advice that 111 does and there's less danger of her calling an ambulance to your house for a bunion or something.

@therestissilence

It's pretty simple. People complained about getting an appointment BEFORE covid. And that's because there aren't enough GPs (getting smaller by the week) and fewer Doctors willing to do the job.

This has been couple with reduced footfall in GP surgeries because a F2F appointment is now so much slower (PPE, scheduling patients so they don't meet in the waiting room, extended clean down times) and different ways of working. Things are slower despite there now being a nett increase in activity (as per the NHS England links that have already been posted).

And that's even before the huge extended flu and covid-19 vaccination drives that have been delivery by the same primary care staff that are still doing their day jobs.

I could also match every ED staff member and paramedic story with two of my own. Hospital OP activity is still probably around 70% by phone in my local area and ED care has been shocking. I've personally lost count of how many buck pass phonecalls I've fielded from paramedics who won't take responsibility for something and want to put my name at the bottom of the sheet that falsely says the patient refused transport to hospital when they've been talked out of it by the paramedic (targets met, hey guys?).

The bottom line is that £120 / year for an average of 6 consultations (maybe it's 7) doesn't cut it, the workforce is getting tired and is refusing to patch over service delivery and I suspect after Covid is done they'll be a fresh round of retirements. The all you can eat buffet will have to stop. Sorry.

@kerankeedoc
Don’t be ridiculous. I am a 111 call handler. We asses the patients symptoms using the pathways system which is the same one 999 have. Its the people calling who trigger the unnecessary a&e and ambulances. People will say yes to anything.
Anyway we have clinicians so paramedics and nurses with us. During the out of hours we can send referrals to the out of hours doctor. During the day there is not much we can do as their gp has a duty of care. I have phoned people’s surgery’s and spoken to the receptionists. They will tell me there are no phone appts at all today. I explain that I’ve done an assessment and they need to be seen within a certain time frame. Sometimes they will say ok I will talk to the gp. They come back and miraculously will get a gp to call the patient. This doesn’t always work however.

[quote therestissilence]@ExpulsoCorona

I did read that link. But it doesn't answer why so many people who need them have not been able to get appointments. It doesn't answer why paramedics, and A&E staff, are complaining that they are dealing with cases that should have been dealt with by patients' practices. It doesn't account for those with conditions that have gone undiagnosed, or parents' at their wits' end who haven't been able to get an appointment for their sick child. I think most people are aware that there are thousands of brilliant GPs and practices, but the system is currently failing many people. I expect you will come back with another cavalier and defensive comment along the lines of 'people are just whinging and moaning', which is beyond insulting to many who are having serious issues. I'm sure you are a fabulous GP, or whatever other medical professional you are. Massive respect for you on that score. But absolutely no respect for your pretty weird denial of an obvious issue, which you seem to be taking personally.[/quote]
I'm pretty sure it has already been explained upthread that there aren't enough GPs for the population. 1000 more consultations per week and there are still not enough. Paramedics and A&E staff have always complained this is nothing new. A few years before I became a GP I was that complaining member of A&E staff. Having done both jobs I see it from both angles.

We literally can't do everything at once. Either stop voting for people who are underfunding our NHS, fund our NHS properly or have a sensible discussion regarding whether NHS General Practice is feasible to continue in this format. Personally I hope that the NHS is able to continue otherwise our vulnerable patients will lose out.

What a fucking mess.

@kerankeedoo 'the all you can eat buffet'. Nice! I'm generally a prolific NHS avoider because I know the pressure its under. But my daughter did have an issue this year, and was neglected. You clearly hold a lot of people in contempt, whether it's 111, ED staff, paramedics or your actual patients. Like I said...what a fucking mess.