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?

"I explain that I’ve done an assessment and they need to be seen within a certain time frame"

You don't seem to understand NHS pathways. There is NO service level agreement for General Practice to see any patient within any timescale set by 111. Your outputs are "Patient should contact the practice within 1 hours" etc - NOT "The practice needs to see you within 1 hour. You do not have the ability to say that the patient should be seen within a certain timeframe. This is a common misconception.

And NHS pathways is utter shit, it was brought in to replace NHS Direct which was mainly nurse-led. This had its problems but was head and shoulders better than 111 which is basically a Yes / No decision tree with limited clinical referral availability.

[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]
Demand basically outstrips supply. It’s as simple as that. I’m not sure exactly why demand is so great now, but a few things spring to mind.

The mental health of the population is in tatters. I’m spending way more time speaking to depressed patients than previously.
Hospitals have been swamped by Covid so hospital tests/treatments have been delayed, causing people to need more GP support.
The vaccine programme of course - massively time consuming for GPs. We’ve had to put some chronic disease reviews on hold because otherwise there aren’t enough staff available to do the vaccines.
Staff illness - like everyone else, some GPs and staff have had Covid, or had to isolate due to Covid contacts, which has caused staffing issues at times.

But like I say, bottom line is that demand outstrips supply. Like trying to pour 2 pints of water into a 1 pint jug.

We can’t work any harder.

@therestissilence

We agree - it's a mess. I know plenty of good ED staff (I used to work in ED). I know plenty of shit staff. I know some good paramedics. I know many than want to put me in between them and any significant decision. I know that my GP colleagues are mainly working very hard. I also know there are some that I wouldn't trust my family with.

But I'm giving you an honest view of the service, and I've seen it from many sides. Ex-ED middle grade and now NHS and Private GP.

Even more weirdly why are podiatrists not back working face to face?!?

You kidding right. I'm an NHS podiatrist I've been working right through covid seeing patients GPs should be seeing, hospital consultant.s patients for them and having to upload photos and a report for each one, we only get 30 mins per patient and God knows what. I've never been so busy in my life.

Today I left work at 8pm, my working day is supposed to end at 5.

All the private pods I know are working, they can't afford not to.

And in healthcare terms it is an all you can eat buffet.

And those don't generally tend to be high quality.

Many of us feels that GPs should be paid per consultation. Then the lazy ones wouldn't earn anything.

But HMG will never go for that because (massive problems aside), General Practice is STILL a bargain.

Hospitals are overwhelmed too, so they put more and more work on to GPs.
A typical example would be patient admitted with severe anaemia. In the past they would be admitted to hospital, they’d have a blood transfusion, a blood test afterwards, and some investigations to ascertain the cause (endoscopy, colonoscopy etc). Then they’d be treated and sent home with an outpatient follow up.
Now they’re admitted to hospital, transfused, and sent home - with a letter asking the GP to do everything else. Massive addition to our workload.
I don’t blame the hospitals - they’re too busy too.
Demand supply mismatch.

The telephone consultations were already being phased in before they pandemic in our area. Face to face has always been available where necessary. I prefer the remote appointments when appropriate.

@Bagamoyo1

It's definitely escalating and ties in with the demise of the General Physician and the rise of the Subspecialist (that's not a criticism, that's just how medicine is going).

We had another gem today - patient under the care of colorectal follow up (recent Colon Ca) with open follow up specifically stated on the last letter. Called the department and told - wait for it - we can't see you without a new 2WW GP referral. This was done by us (although totally unwarranted). The gem: patient had been seen (phew) but the referral had been flagged on audit for not sending a new FIT test. FFS!

[quote kerankeedoc]@Bagamoyo1

It's definitely escalating and ties in with the demise of the General Physician and the rise of the Subspecialist (that's not a criticism, that's just how medicine is going).

We had another gem today - patient under the care of colorectal follow up (recent Colon Ca) with open follow up specifically stated on the last letter. Called the department and told - wait for it - we can't see you without a new 2WW GP referral. This was done by us (although totally unwarranted). The gem: patient had been seen (phew) but the referral had been flagged on audit for not sending a new FIT test. FFS![/quote]
Ffs - honestly, you couldn’t make it up!

@kerankeedoc
When I said you need to be seen within a certain timeframe, because of COVID it’s mostly telephone appts.
Well, I never knew that. We just get told to tell patients that their gp has a duty of care. If they can’t speak to their own gp for example, they are fully booked. we’d normally advise to go to an urgent care centre or walk in. If not, then call back in the evening and we’ll put them through to the out of hours doctor.
I would imagine it was better when it was ran by nurses who would pick up the call. But there isn’t enough nurses to do that. We get hundreds/thousands of calls every day. Nurses can’t deal will this. I will regularly triage people where I haven’t agreed with the outcome. I will flag this up and speak to a clinician. But I am finding quite often the outcome doesn’t seem appropriate. I am not medically trained as you know. So it’s a lot of responsibility as we are told you need to trust pathways. But it’s doesn’t get it right all the time.

@Isadora2007

Even more weirdly why are podiatrists not back working face to face?!?

I've seen one twice during lockdown and I had face to face appointments with a GP and a nurse last week.

@Cokecake

It's not aimed at you - you're in a tricky situation and you are doing as you are told and following the rules. But many of us with ED and GP experience predicted that 111 would lead to a spike in ambulance calls etc and of course it did. They've refined it a bit over time, and now there is more clinical input than there used to be but it's still not good. But it's cheaper than NHS Direct.

It was never (contractually) the case that 111 could define when GP sees patients. GP patients should be seen in a timescale at the discretion of the GP ( or to quote the GP contract "he is then offered an appointment to attend again within a time which is appropriate and reasonable having regard to all the circumstances and his health would not thereby be jeopardised").

Now we can certain debate that many patients aren't offered an appointment in a reasonable timescale - but it was never for 111 to decide.

Personally I would find it very uncomfortable to be in a medical setting as you are without the backing of medical knowledge - so for patient safety all you can do is follow the rules and ask for clinical help as you think it is required.

But 111 is a compromise, which is unfortunately what much of GP is also becoming, despite people working hard.

I think it’s appalling that in my area the sexual health clinic and the nhs gynaecology is not open (emergencies only). Thankfully my DH has private health insurance through his employer and I’ve seen a gynaecologist 3 times and had one Scan in the space of 6 weeks. The gynaecologist I saw works at the local NHS hospital, although I’m not exactly sure she’s busy there as you can’t get to see a gynaecologist on the nhs for love nor money.

I’m lucky many women are not.

I work in a school if the GP telephone appointment is at 11am I don’t think it’s acceptable for my phone call to be 2 hours later and have no answerphone message. I’ll just answer the phone in the middle of the classroom shall I?

I get that GPs may run a bit late, but they shouldn’t then chastise you if you can’t take the call. Are we expected to bow down and kiss the feet of the holy NHS worker? I don’t think so. I make no apologies to the receptionist if I need another phone appointment, this covid excuse needs to stop now.

I always find the attitude to you as a patient is so much different when you’re a private patient and not an nhs one. I’m respected a lot more and treated more civilly in private appointments. Even my GPs in the past have totally been more sympathetic when you’re asking them to write a letter for a private referral and not an NHS one: they can’t write it fast enough to get you seen by a private specialist when it’s not the NHS involved. But it’s never that way when you want something on the NHS.

There’s no point in even trying to call my local surgery : you’re left hanging on the line in a Q and then they never have any slots available. The only way to see a doctor is to to use private GP services at local BMI Hospital.

"But it’s never that way when you want something on the NHS."

Yes, because we're not subject to arbitrary and nonsensical NHS criteria dreamed up between the CCG and the hospital. Example in point:

Your child has three bad episodes of tonsillitis. I want to send you to Mrs Jones, Super-ENT Consultant on the NHS. Can I? No. We'll all have to wait for another two episodes within the year. And if it has been more than a year since the first one, it stops counting. However, want to see Mrs Jones privately? No problem, I'll do a letter for you. You're happy, I'm happy (because it takes me only a minute) and I can move on to my ever increasing list of other calls. And most importantly your child gets the care that they should have had on the NHS.

As for the calls thing, we try at least twice in our surgery, normally three times. Final time we'll leave a message. But there's also a limit as to how much we'll do and yes, you may need to make yourself more available despite your commitments....in the same way that I do when I'm expecting a call from Sky or my accountant or in fact anyone that I've left a message for.

Make myself more available? How do I do that then? Wait to be ill in the school holidays? Maybe if my surgery opened more than 6 hours a day that would be a start, and that’s only 4 days a week.

Just because you have hoops to jump through with your rubbish nhs guidelines don’t take it out on the patient. Maybe explain that rather than employing the condescending tone you’ve just demonstrated here!

My tone is relatively mild considering how rude you sound.

Lots of people have jobs where it's hard to answer the phone (myself included).

We all manage. You're not special.

In retrospect I suspect the reason that you get a private referral ASAP is it's the quickest way to end the displeasure of having to deal with you.

Also I’m pretty sure Sky don’t threaten to kick you off their books because you don’t answer the unidentifiable phone call that left no message 2 hours after they rang...

I'm pretty sure your GP doesn't easier.

But I can see why they would want to.

easier = either.

Oh yes of course how dare anyone criticise their crappy GP on mumsnet or highlight the difference between service standards. You are taking this personally and I have not made this about you. However I really do treat your patients a lot better in real life.

If you'd actually read what I posted in this actual thread you'd see that I'm highly critical of GP services (where they deserve it) and I simply haven't claimed that there is no difference between service standards - maybe you could point out where you think I said this?

If you really do work in education I hope you show more comprehension skills than you've demonstrated here.

You quoted my post then went on to say:

“As for the calls thing, we try at least twice in our surgery, normally three times. Final time we'll leave a message. But there's also a limit as to how much we'll do and yes, you may need to make yourself more available despite your commitments”

Well that is all very nice of you but I and many other people on this thread are not experiencing this level of service.

What has this got to do with my situation?

Or were you not aiming that post at me, just quoting the bit you didn’t like from mine and expect me not to assume you were talking to me?

Patients are allowed to find this situation shit. They do not need your permission to moan about it on here. If I spoke to my students or their parents in the manner you get spoken to by some doctors I would quite rightly get complaints against me.

I am never rude to a GP I may ask a hundred why questions to understand what is the reason for the denial of service.

@CallmeHendricks

Well, I suppose technically you can see one, but at our place it's like getting into Fort Knox. I've always wondered how come it's supposed to be so risky for a GP to see one person at a time, yet teachers are rammed into small rooms with around 30 with zero safety mitigations and if they object, are ridiculed and told they're being lazy shysters and to just get on with it.

I thinks it's more that patients are at risk from going into a surgery where people with COVID are more likely to be and that people going to the surgery are more likely to be cev.

@Fucket

"I and many other people on this thread are not experiencing this level of service."

I never said that all patients were experiencing this level of service. I was simply explaining in our surgery (and many surgeries).

"Patients are allowed to find this situation shit. "

Yes, and as I've indicated NHS GP is on the verge of imploding. It is shit. I never said that patients weren't allowed to find the situation shit.

"They do not need your permission to moan about it on here. "

I never said that they did.

I honestly have no idea why you are setting up these presumptions based on what you think I said and are then disagreeing with them.