I can see a dentist, an osteopath and have an x ray. Why can't I see my GP face to face?

[pinkprosseco]

Where I am Registered the GP only does telephone triage and almost never invited anyone in for face to face appointment whether that's a persistent cough (not Covid), abdominal pains or potential arthritis, a ? Lesion on the skin etc etc. I feel that long after other key workers have gone back to normal, GPS who we depend on as a first line of advice and diagnosis, are shirking responsibility. Surely the missed diagnosis the BBC and other current affairs websites are referring to are only going to get worse. Why isn't there a mandate they return to work properly. Anyone else?

My son had a really bad cough and go just gave him anti biotics over the phone. I thought we were trying to get away from over use of anti b's. Seems a bit weird.
I also think if you aren't confident you will be fobbed off.
My 19 yr old DD sent a message saying she needed contraception advice and that she was feeling very low.
She got an appointment for 6 weeks later.
I emailed them to voice my concerns and she got a phonecall the next day.
Had I not intervened she would have just waited for 6 weeks which I find really shocking for the things she had stated she needed help with.

I can't see my dentist either. It's been a year and a half for my children now. They have cancelled three appointments due to COVID.

I have also noticed a reluctance by GPs to refer you to a specialist. The default if they are not sure is "go to A&E".
Being cynical I wonder if it is government policy to drive people towards private health care due to poor service from NHS.

OP, I understand your frustrations, and this if others on this thread, but you surely must realise that changing the system back to one where all patients can demand a f2f appointment is just robbing Peter to pay Paul.
There are a finite number of patients any one surgery can “see” safely in one day, moving away from total triage and phone and video appointments and returning to phone to request an f2f appointment will mean returning to a time where if you don’t get through by 8:45am all the appointments will have gone and you are left with call back tomorrow or seek medical advice elsewhere.
There isn’t enough stretch in the system to have it both ways, same day access and f2f for all.

My husband is a GP. He summarised their current system for me yesterday. One day last week the surgery had 200 phone calls in one day. 100 were requesting appointments. All those 100 patients received telephone triage that same day. 70 of those were managed by the advanced nurse practitioners or GPs (by phone or video) and sorted. A further 10 following their telephone consultation were advised to come in. The final 20 were given f2f appointments immediately. Because of total triage the patients that are seen f2f are usually highly complex and take a long time to manage appropriately.
All patients who requested a consultation that day received a consultation that day.
To my mind that’s a pretty efficient service.

I asked my husband how many of those patients who received a telephone or video consult would have requested a f2f appointment if they went back to the system they operated pre pandemic.
“Oh about two thirds”.

A total triage system has its problems, sure, but given the demand placed on primary care at the moment it’s a reasonably good solution for the majority.

It’s utter madness as it’s not only GP appointments here, it’s Consultant appointments. My DH has been a first out-patient appointment on Wednesday with a Cardiologist after being admitted 3 times with a heart issue they haven’t resolved. It’s on the phone 😡 how can they examine him or check his heart on the phone?

@Dunlin I tend to agree that telephone and video appointments will be with us going forward. I really wish my practice did video appointments because I'd find it much easier if I could see who I was talking to. I find it very difficult to open up about personal things to someone on the phone whom I've never even met!

I thought the econsult might work when I couldn't get through on the phone (after several hours of trying) but I find the system clunky, difficult to use and, no matter how carefully I explained my symptoms, I just didn't seem to be getting through to the GP. I had diarrhoea, so he prescribed a laxative and advice about not being constipated (no explanation why a laxative was indicated). I was too scared to take the laxative! Only once has the econsult led to a phone call from a GP, the other times it was a text message from different GPs saying they'd sent a prescription to the pharmacy, so I'd no time to query it. The one face to face appointment I had, after which I was sent straight to hospital, was excellent and the care at my surgery is very good if you can see someone.

I think telemedicine has a place and maybe econsult will improve but it has just led to frustration for me because I feel like I can't get in touch with anyone who will listen.

@Piggywaspushed

I totally understand much of the need not to see doctors face to face but this is combined with pharmacists stopping services too.

I am suffering recurrent migraines and puffiness. Need to get bp checked I assume. Pharmacy said not doing it, call GP. GP not doing blood pressure appointment. Buy a machine or call 111...

BP can't be checked via Zoom.

Pharmacies don't get paid to take your BP. You know they are private businesses, don't you. The pandemic meant they could re-think free services like this that take away from the ten million other activities they have to do each day. Why should they put themselves at risk of covid for a non-essential non-paying service? GPs get paid to do your BP.

@110APiccadilly
Also, they need to get better at giving timed appointments for phone calls with doctors. I was just told that the doctor would ring me, "Sometime this morning," which was fine for me on maternity leave! Not (I imagine) suitable if you're working the tills in Tesco, you'd need a time so you can tell your manager that you have a medical appointment at such and such a time.
This exactly! I needed an appointment and I’m a teacher. I can’t have my phone in in class obviously, plus I would have to have someone in the room to cover my class even if I could have my phone on. I ended up having to ask for the morning out of class, meaning the additional cost of someone to cover, just to have a review of my asthma medication because they couldn’t give me a specific time. My DH has a Consultant appointment on the phone, they’ve given him a 3 hour window when it will be, meaning he’s having to take an afternoon off work.

Well, the GP isn't doing it either...

I'd argue that BP is quite essential.

I was told it was because of cleaning the equipment ; nothing to do with f2f contact as they acknowledge it is fleeting, masked and side on.

The fact that I can get eyes tested, teeth cleaned but not (potentially very important) info about BP is causing me some considerable cognitive dissonance when I go to work every day (now unmasked , thanks to Boris and co) and surround myself with 100s of other people.

I have no issue with phone triaging in principle. If pharmacies aren't taking BP, then GP surgeries should be, surely?

The system isn't working and I do think a review of primary care moving to a hub approach with other healthcare professionals doing triage might help. There aren't enough GPs for the demand, A&E can't cope either so unless it does move to a private insurance type approach something more radical needs to change.
A community hub where you see a paramedic, nurse, physio, psychologist straight off depending on your perceived need, basic assessments are done, then they refer you to a GP, X-ray, dietician, OT, or specialist consultant. Each hub has a radiologist and phlebotomist, a gynae clinic etc. Surely that would be more cost effective in the long run because people would get help sooner
Hospital could be reserved for people who really needed it

GP here. It's always disappointing to read when people either have been or feel they have been failed by us. The bottom line is though we need more GP's but not enough medical students are considering it as a profession. I train medical students and it's very rare to get one that is seriously considering General Practice as their specialty. Especially when they see the reality of it.
I'm the named GP for 7000 patients. This has doubled since 2013. Our LMC has audited our work and our workload has increased by 20% over the last 2 years.
I've worked as a GP in all 4 countries. The challenges are the same wherever you work. An allocated 10 minutes per patient. An expectation to see at least 30 routine appointments per day (either by phone or face to face) then to also see any emergencies on top of that. I come in at 730 each morning to around 40 blood results that need processing and at least 20 letters from secondary care. I usually have at least 25 prescriptions that need looking at and reauthorising. I usually do 2 house calls per day and then I also have all the usual message, insurance reports and then the partner/business stuff on top of that. To be honest dealing with patients in actual appointments is probably the least stressful part of my day. We're also coping with the move towards bringing care out of hospitals and into the community. In England we've had to form primary care networks with no choice in the matter. We've also had to organise the covid vaccines (I'm clinical lead for this in my area)
The move is also towards training up nurses to be advanced nurse practitioners to try and plug the gap left by there being too few GP's. The idea is that these highly trained nurses will carry out the initial triage and then escalate anything they can't deal with to GP level. This also has a major knock on affect though that previously I would at least have a few "quick" appointments such as pill checks or skin conditions or UTI's to deal with. I've lost those quick appointments which now means that every patient I see is complex which invariably means I run even later with my appointments as 10 minutes is never enough to deal appropriately with these patients.
I really don't know what the answer is. I think patients expectations are becoming ever higher and we are now living longer with ever more complex co-morbidities. This coupled with lack of secondary care beds and the loss of a lot of rehab beds as well means the system isn't coping. And the more the pressure rises the less likely you are to attract the kind of people that we want and need to train as GPs. Obviously explaining what the issues are though doesn't help the people who are struggling to access the service.
As I said I don't know what the answer is. It's the same wherever I've worked and no matter what model is tried the primary problem is the same, not enough appointments as we don't have the people to staff them. I do think we need to looking more to the European models of health care and taking ideas from places who seem to have got the system working better than we have. I honestly can see myself burning out sooner rather than later if I have to continue like this and it will mean me leaving and likely moving more into medical education rather than patient facing. And that just means another experienced GP has left and the worsening cycle continues.

@Piggywaspushed

Well, the GP isn't doing it either...

I'd argue that BP is quite essential.

I was told it was because of cleaning the equipment ; nothing to do with f2f contact as they acknowledge it is fleeting, masked and side on.

The fact that I can get eyes tested, teeth cleaned but not (potentially very important) info about BP is causing me some considerable cognitive dissonance when I go to work every day (now unmasked , thanks to Boris and co) and surround myself with 100s of other people.

I have no issue with phone triaging in principle. If pharmacies aren't taking BP, then GP surgeries should be, surely?

Obviously BP is essential, but I'm saying in the middle of a pandemic why should pharmacies do BPs when they don't get paid for it? Would you be willing to pay to have it done? Yes GPs should be doing it but I was responding to your grumble that pharmacies have stopped doing it

I just think I am stuck in a rock and a hard place situation and know other areas where GPs absolutely are doing things like BP checks.

Yes, I would pay, if that was what it took. I think it is a flat no from them, though. They will make the money by selling the machines, though!

When I did speak to a GP on the phone eventually on Friday she was great but I did end up very confused by everything and I am not vulnerable in any way. She mentioned a prescription and I don't know where it is! She also spent quite some time talking to me and a visit to the nurse would have been quicker for everyone. and I still don't know what my bp is

That is a real eye opener oli. I am coming from a place where I really didn't want to bother a GP at all and ended up, as I saw it, wasting her time on the phone.

@Piggywaspushed

That is a real eye opener oli. I am coming from a place where I really didn't want to bother a GP at all and ended up, as I saw it, wasting her time on the phone.

Your GP should be seeing you or getting you to see a nurse for BO. Mine asked me to go in for BP last year but was pleased when I said I have a machine at home, so he had me call back and give the readings to reception. They are £20-70, less on a deal and actually really useful to have at home if you have any blood pressure history just to do your own quick check from time to time. The Omron M2 is good and £23.85 on Amazon right now, my dad is late 70s and learned to use it fine (I bought him one pre-pandemic so he could check more frequently as he is on various medications).

I might but one MRex but am presently --sulking_ sweating over the principle that not everyone could easily afford this. I have no real need to regularly check BP so it seems a bit of a waste. However, thanks for the recommendation and I will look it up!

Bit of a crossing out fail there!!

Yes, of course I agree that nobody should be forced to buy one due to GP surgeries not making appropriate arrangements. It is a useful thing for the family first aid kit though if you can afford it. (Also loaned ours to PIL and 2 different neighbours during the pandemic, so it's had plenty of use.) An oximeter is also useful to have.

I have one of those, at least!

@Olidocky Thank you for the post explaining how GPs see the current situation. I’m not someone who thinks GPs have been doing nothing for a year - I know from my inability to get through on the phone how busy they are. As I said, my GPs are good if I can see them. I think the current technology doesn’t work properly (in my experience) and it must be causing frustration for GPs as well. If total triage is to continue, there has to be better infrastructure and training to make the process easier and safer.

My last post was badly written as I was so annoyed at the time.

My Gp has refused to let me have any tests into why I'm gaining wait. They insisted it had to be dietary.
Now I've been asking for 4 years.
I finally spoke to a dietician last week who has ruled this out.
However I now have liver changes.
I 100% blame my Gp for this.
Dependant on their response to the dietician letter depends on my next step.

I may take legal action. Sorry if that makes me sound like a bitch. However I feel my care has been negligent.

Weight dammit

I'm surprised people are getting calls back from their GP's. We get a nurse if we're lucky.
As of yesterday they had to start seeing people face to face.

Yeah I'm thinking they won't advertise that fact

Abraxan if it was a new machine it would more than likely be more accurate than that used in the surgery! Although calibrated once a year(!), ours are several years old.
As you have proved, despite your initial reaction it is extremely reasonable to ask patients not to come into surgery for every little thing.
Our receptionists get asked for hundreds of f2f appointments every day. Due to social distancing rules if these were all granted without triage you wouldn't be seen until Christmas.