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?

It’s the decision of NHS England as to how GP’s are to operate although DH, a GP is now doing a mixture of phone and f2f appointments.

Don’t blame the GP’s is not their decision and unfortunately there aren’t enough GP’s to go around- hence a longer wait for an appointment.

Paid to see f2f a private clinician today as I've had severe back and leg pain for a year which my gp, who hasn't seen me once has just throws prescriptions at. He thinks I have piriformis syndrome and is hopeful an injection into the muscle will make a massive difference. Being seen, examined and listened to face to face was powerful. I am a big fan of the NHS but i feel very hurt and let down by my GP over this issue.

stress if your BP was that high with a headache that wasn't resolving, you don't wait until day 8 or 9 to seek review. Didn't you ring 111 at least? Why wait so long?
No ones calling you a fuckwit but I'm the third person that said a GP appt was not appropriate.

I guess the waiting for the call is a kind of self triage: if you feel well enough to go to work or go out you take second place in the queue to someone who feels so lousy that they can't go out.

When you are really ill, you don't want to go out do you? Last thing you want to do is go to a GPs surgery.

There are a million things which definitely require medical attention but don’t make you feel so ill you can’t go to work, including many symptoms which should get you straight onto a 2 week wait. How lousy you feel is not a reliable guide to whether you need to see a doctor.

I had a persistent cough which the NHS tells you to get checked. I felt well enough to work and see a GP. The GP would only do a telephone call and referred me to a chest X-ray and prescribed inhalers. All without listening to my chest or seeing me. Turns out it was a different problem, picked up by a pharmacist who was not working from home but took the time to see me. But not before I'd taken unnecessary steroid inhalers and had an X-ray. The pharmacist said GPS really need to see people.
I'm actually wondering if we even need GPS now? Would it be better to have nurses and paramedics and physios at a health centre ordering basic tests like bloods and X-rays and then having more hospital consultants to be referred to rathe4 than spend money on GPs?

It has been announced today that GP’s will restart f2f appointments. DH has been doing so along at his surgery but they are continuing with phone appointments where appropriate as they can get through more patients. It’s a three week wait for a f2f appointment.

I think a lot must depend on the gp surgery. Mine has been fantastic, fill out a form online for doctor to review and call you back (form will stop you going too far if you give a 'red flag' answer and prompts you to call reception to arrange emergency callback or 111) I suspect they get more info from that form than a f2f appt would necessarily allow. We've have calls for my mental health, allergies, DD1s skin infections, persistent cough, but equally called us in for a f2f when I was worried and unsure if she maybe had a UTI or was diabetic (turned out to be neither and she was fine!) But they didn't hesitate to see her when it wasn't something they could do over the phone, and I've no doubt they'd have seen her for the other problems if needed but despite my initial scepticism they were able to sort us out without seeing her and that meant I didn't need to take time off work to take her

I do sympathise with those who haven't had such good experiences, I'm able to trust the system as I know they'll call us if needed (and also I suspect if I asked to see someone for reassurance) but I can't say I'd feel the same if I thought they were potentially going to fob me off to avoid bringing us in

I’d like to add a view on this.

Pre-COVID, I had peri menopause symptoms. Hot flushes, weight gain, mood swings, depression, absolutely classic meno stuff. I went to the GP and she said I was too young for peri (43) and insisted on blood tests. The blood place was only open 9am to 12 noon three days a week at a place where parking is impossible and it was first come first served. I tried to work from home one morning to go but I got there 45 minutes before opening time and the queue was already 20 people and I couldn’t wait so I gave up and suffered the symptoms.

After the pandemic started, it was only phone appointments so I tried again and got prescribed HRT straight off the bat. I even said that I was surprised because I’d been disbelieved and given the runaround before and was told that the COVID situation meant they trying to move things along quicker.

It does piss me off in a way, because they are basically admitting that making patients jump through hoops before wasn’t necessary.

@mellicauli

I guess the waiting for the call is a kind of self triage: if you feel well enough to go to work or go out you take second place in the queue to someone who feels so lousy that they can't go out.

When you are really ill, you don't want to go out do you? Last thing you want to do is go to a GPs surgery.

Yet the day I was rushed to hospital with a risk of heart attack or stroke, which was actually being caused by covid, I was in work. I was still awaiting the Gp call back later that day and was already in a hospital bed, having had scans an tests, by the time they called me back.

And I have a chronic health condition that meds regular checks which means I need medication and checks, but can work with it.

We can't make regular appointments, it all goes via phone triage right now. I can work with my health condition but still need to speak with medical staff regularly as part of the treatment. I can't take a day off work (school) every 2 months so they can phone me when they like, rather than specifying a time I can actually have a phone on me,

@SylHellais

I’d like to add a view on this.

Pre-COVID, I had peri menopause symptoms. Hot flushes, weight gain, mood swings, depression, absolutely classic meno stuff. I went to the GP and she said I was too young for peri (43) and insisted on blood tests. The blood place was only open 9am to 12 noon three days a week at a place where parking is impossible and it was first come first served. I tried to work from home one morning to go but I got there 45 minutes before opening time and the queue was already 20 people and I couldn’t wait so I gave up and suffered the symptoms.

After the pandemic started, it was only phone appointments so I tried again and got prescribed HRT straight off the bat. I even said that I was surprised because I’d been disbelieved and given the runaround before and was told that the COVID situation meant they trying to move things along quicker.

It does piss me off in a way, because they are basically admitting that making patients jump through hoops before wasn’t necessary.

Exactly. It's whatever suits the GP not the patient

I’ve used e-consult twice recently for the same problem and the issue I’ve had is, no matter how carefully I put in exactly what the problem is, it’s not read properly.

I’ve had intermittent diarrhoea for a few weeks, one severe bout caused grade 4 thrombosed piles (sorry, TMI). I couldn’t get through on the phone, so used e-consult, carefully pointing out I wasn’t constipated, I had diarrhoea. The text message from the GP came back - laxative prescribed and advice about avoiding constipation! After another e-consult I managed to get a telephone appointment, followed by a face-to-face appointment and was immediately sent to hospital ambulatory care (this bit of my GP care was excellent). The hospital wouldn’t help unless I had necrosis, so back to GP. Still couldn’t get through on the phone after 3 hours, another e-consult, explained all the background (still having diarrhoea), another text from a different GP with more laxative, Anusol cream and advice about constipation. I’d been on Anusol for 2 weeks with no improvement (mentioned in e-consult).

I’ve given up for the moment, the e-consult doesn’t work for me and I can’t get through on the phone. I’m as clear as possible on the e-consult but it is not being read properly and the GP jumps to conclusions without reading all the facts.

Yesterday I was booked in for a telephone consultation (by a nurse I'd been able to see face to face on Monday) Our GP is not doing face to face appointments.

Call was scheduled for 2.15 and actually happened at 3.40. During the call the GP told me I needed blood tests. To get the paperwork I then had to travel to the surgery anyway and go into the reception area to collect it. I'm now booked in for bloods at the local clinic....in 2 weeks.

In the past I'd have seen the nurse who'd have shouted in to the GP "Can you action bloods?", been given the paperwork there and then and been able to nip in the local clinic all within the same hour.

Utter madness.

@SylHellais

I’d like to add a view on this.

Pre-COVID, I had peri menopause symptoms. Hot flushes, weight gain, mood swings, depression, absolutely classic meno stuff. I went to the GP and she said I was too young for peri (43) and insisted on blood tests. The blood place was only open 9am to 12 noon three days a week at a place where parking is impossible and it was first come first served. I tried to work from home one morning to go but I got there 45 minutes before opening time and the queue was already 20 people and I couldn’t wait so I gave up and suffered the symptoms.

After the pandemic started, it was only phone appointments so I tried again and got prescribed HRT straight off the bat. I even said that I was surprised because I’d been disbelieved and given the runaround before and was told that the COVID situation meant they trying to move things along quicker.

It does piss me off in a way, because they are basically admitting that making patients jump through hoops before wasn’t necessary.

Ideally at your age we would do bloods first but during the pandemic we had to be pragmatic and were not always able to follow gold standard best practice. On one hand the GP could have said you need to wait until things open up and have the blood test before considering any other treatment, on the other hand the GP could have thought it's not ideal to prescribe but this poor lady is suffering and we are in a pandemic and gone ahead with the precipitation. It sounds like the latter happened and I think it's really really awful that you are mistaking that kindness and empathy with incompetence.

@Abraxan General practice is not an emergency service. General practice has never been an emergency service. If someone thinks they are having a heart attack or a stroke, the appropriate thing to do is to seek emergency medical attention from an emergency service (e.g A&E).

111 is the service for when you need immediate medical advice and guidance, however it is NOT a life-threatening situation. So basically you call 111 if you need medical help that cannot wait for a GP appointment, but isn't serious enough for an ambulance.

I've just read on Twitter about GP surgeries having received notification that from 17 May they must start offering face to face again for patients who need them. They can retain online and online triage if it's for the patient's benefit, but if face to face is needed, including accessibility to using phones, online services, etc then face to face should happen.

I'm not sure if this is actually going to the case and what that might mean if you specifically say you want f2f or not then it has to happen, or if it was local media misinterpreting what has actually been said.

[quote ExpulsoCorona]@Abraxan General practice is not an emergency service. General practice has never been an emergency service. If someone thinks they are having a heart attack or a stroke, the appropriate thing to do is to seek emergency medical attention from an emergency service (e.g A&E).

111 is the service for when you need immediate medical advice and guidance, however it is NOT a life-threatening situation. So basically you call 111 if you need medical help that cannot wait for a GP appointment, but isn't serious enough for an ambulance.[/quote]
For me, it wasn't, to my knowledge, an emergency at that time. I phoned with breathlessness and the kind of symptoms you get with a chest infection. I've had it before and always been seen by the GP, and only once before sent to hospital due to it being pneumonia.

My symptoms were a Gp issue based on past experience,

As it happened I had incredibly high blood pressure (hadn't had it before) - which I wouldn't have known unless a doctor or nurse had checked it for me. Hence the rush to a and e. I found this out by going to a drop in near work and seeing a nurse, as the Gp simply wasn't getting in touch and I couldn't have my phone on waiting for a random call.

It was by finally being able to have a f2f appointment that discovered a potential dangerous situation. If I'd waited for the gp to call I'd have been in more trouble - I needed to be seen f2f to have discovered the issue.

At the time I did not know I was at serious risk from something which needed a and e or an ambulance. That was only discovered by being seen f2f. And even then it was a nurse who saw me, not a doctor.

My own gp hasn't seen me f2f for over a year. I even had to buy my own Bp machine afterwards in order to message them with the readings, rather than going in to have it done there.

The nurses, however, have done f2f from the start. I go every 2-3 months for blood tests and have continued to do so since March last year,

It's clearly not working even for 'routine' stuff. Pre-pandemic f2f appointments were held and I was exploring different HRT treatments. Except a shortage meant lots were not available. I was taking the least worse until something more suitable was available.

But then post-Covid I couldn't even phone the GP and econsult was useless. I ended up emailing only to get a phone call from a pharmacy asking what I wanted them to deliver. I had to explain I don't know and don't have a prescription. They said they would go back to the GP. Heard nothing. So have to continue with the stop gap.

Meanwhile I am being phoned and texted by the surgery to book a 20 minute f2f appointment with a nurse to review my 'long term condition' complete with blood test and blood pressure. To my knowledge I don't have a long term condition and am only on HRT. They phone me when I can't talk and are not available when I can - in fact it's not possible to phone the surgery at all and speak to someone as it's just a recorded message. And now they want me to book a smear test.

So combination of unavailable when I need them and harassing me for unknown reasons or non urgent screening tests. Or can't access a GP when needed because of the pandemic or 'we are still open' (for nurses) despite the pandemic when not needed.

Where is patient choice or individual risk assessment? It's too risky for me to visit the surgery for a GP appointment discussing and prescribing when ill but OK for me to visit the same surgery to see a nurse for hands on and invasive testing when well?

If I were to start HRT or even continue it for a patient I'd want an up to date blood pressure and possibly bloods depending on the situation. This would need a HCA appointment for the bp and bloods but since I would not be physically examining the patient for HRT the consultation to discuss could happen by phone/video/f2f it doesn't really matter.

Personally as a GP, consultations that need a good chat through various options are quite well done over the phone rather than f2f where the masks feel like a bit of a barrier, especially if the patient struggles to hear and also especially where someone might want to think through their options before making a final decision. I do totally understand that not everyone finds it comfortable to discuss their mental health on the phone and for those patients it would be better done f2f. A lot of my elderly patients are better off coming in for f2f appointments and so I do offer them quite quickly. A lot of my younger patients have loved doing their contraceptive pill checks over the phone and have happily bought their own BP monitor from Amazon to save themselves having to come in. That generation are already quite happy to monitor their step count, heart rate, oxygen days etc on their watches so owning a home BP monitor doesn't seem so strange for them.

Abraxan home BP readings are now widely accepted to be more accurate and reliable.
No need to go to the GP surgery for this. We have hundreds doing their own BP's. It frees up appointments for the nurse to be vaccinating children, doing smears or administering injections for cancer etc etc.
Next time you complain about your wait for an appointment, it's partly because GP's and nurses time is taken up seeing patients who insist on coming in unnecessarily.

@bloodywhitecat

Diagnosis's are being missed because people can't see their GP face-to-face and people are dying as a result.

Yep. I'm not sure how many months have been chopped off my cousin's life expectancy by his GP's refusal to see him in person for 3 fucking months.

GP’s have been doing limited f2f as instructed by NHS England. It wasn’t their decision but they are now back to f2f and phone appointments. Unfortunately there still aren’t enough GP’s for people to have an appointment as quickly as they would like.

@cptartapp

Abraxan home BP readings are now widely accepted to be more accurate and reliable. No need to go to the GP surgery for this. We have hundreds doing their own BP's. It frees up appointments for the nurse to be vaccinating children, doing smears or administering injections for cancer etc etc. Next time you complain about your wait for an appointment, it's partly because GP's and nurses time is taken up seeing patients who insist on coming in unnecessarily.

I'm in a position where buying one isn't an issue. Lots of people won't be though.

Also, this was a very new situation which needed monitoring, which had taken months and a mix two different medications to regulate. The hospital were very clear I was to be monitored closely, but this hasn't really happened bar me paying for a machine and being able and happy to phone in my results. I was supposed to have my home machine taken into the surgery to have it checked against the surgery's readings to check it was working fine but this took the surgery 3 months to sort.

I'm actually wondering if we even need GPS now? Would it be better to have nurses and paramedics and physios at a health centre ordering basic tests like bloods and X-rays and then having more hospital consultants to be referred to rathe4 than spend money on GPs

Yes, it is a pointless waste of time and money taking the most academic high-achievers, training them for years and years, paying them over 100K a year to operate at a lower level than a senior nurse.

Other countries have a different pathway with shorter training for GPs, larger numbers trained and more realistic salaries.