The service you get from your GP

[susanmt]

Doing a little bit of market research for my dh here!!
His practice has just been ctiticised by the local health council, and they are a bit upset about it. Basically, the health council think that the two docs (dh and his partner) live too far away from the surgery to provide a good service.
So - how quickly would you think a doctor should come to see you in (1) A life threatening emergency (2) a Serious situation and (3) for a routine house call out of hours. In fact, how many of you get house calls at all, and, out of hours, are you covered by a call centre (cooperative cover by several practices) or by your own GP?
We are a bit hurt by this criticism as he works really hard and we have chosen not to live next door to the surgery as we don't want people turning up at the door at all times of the day and night (as happened to the previous doc - who said 'Under no circumstances live close to the surgery!!)
Thanks for your input!

hi, susan. I had a 1) - excruciating pain in lung on breathing - turned out to be a pulmonary embolism. This was mid-afternoon, mid-week, called surgery and my GP landed on doorstep within 10 minutes - gave me a painkilling injection (forget exactly what but he described it as "Harold Shipman's drug of choice" which cheered me up enormously as you can imagine. Fortunately he is an old friend so I trusted him!)

He does live v close to surgery but I think he was at surgery when I rang.

Does this help at all?

(I ended up in hospital for 8 days with assorted injections and pills, and subsequently spent 6 months taking warfarin with 2/4 weekly visits to hosp to have blood checked.)

Out of hours, there is an emergency medical centre at local non-A & E hospital up to c. 11pm weekdays, plus all day Sat & Sun, and outside those hours there is an emergency service where necessary, but this is a fairly quiet rural area and I think we are a bit spoilt. (Emergency service is covered by local GPs + locums.) We have used this a lot with kids and "emergencies" have almost always turned out not to be, when they are we get referred on to proper A & E 15 miles away.

Erm, bit difficult for me to answer this as I have rarely called a doc out of hours.

In answer to your questions:

1. I wouldn't call my GP, I'd dial 999
2. I'd call NHS direct who would probably tell me to call an ambulance or go to A&E. If NHS Direct wasn't around, I'd call the surgery, take whatever msg was on the phone and go from there.
3. same day

I have had one house call in my life which was IMO strictly unnecessary but the doctor chose to come out and I was amazed!

I don't know what our current out of hours service is. I have only called our current practice once in what I thought was out of hours but someone answered, I spoke to a doctor (who had previously seen DD) and he recommended a trip to A&E, where we ended up on a short stay ward so I guess his advice was sound

We have a friend who is a GP who lives about 5 miles from his surgery. In London this would probably equate to an hour's travel but here it's more like 10 mins.

I live in a rural area and the GP's provide the emergency service during daytime hours based at the surgery. I've never needed them but from hearing of others experiences, the Dr will respond immediately so it's just a matter of how far you live from the surgery. That would be about 10mins for me. Just recently an ambulance has been based in our nearest town although I'm not sure if it's included in the 999 response units.

For No2, I think I'd expect someone to to come within an hour or two, while for No3, same day.

Out of hours, we're covered by G-Docs and on the few occasions we've needed a visit or been told to go to the local cottage hospital, it's been one of our GP's.

I can't see that living or not living next to the surgery is terribly relevant. A patient could be taken ill anywhere - they surely can't all live within 100 yards of the surgery!! Presumably your DH has a full range of equipment in the car so he doesn't have to go to the surgery first before he does a housecall?

Maybe this little story from the paper in Indonesia would cheer him up, Susan. Because of the Idul Fitri holiday, stocks of blood are running low. The health authorities have issued the advice that if you need to go to hospital and think you require a blood transfusion, would you kindly bring the blood donor with you?!?!?! I have visions of someone having a car accident, then thinking 'Oh heck, I'm gonna need some blood.' and flagging down passing motorists to ask them what their blood type is!! At least the UK isn't that bad!

It seems to matter if you are in a city or rural. I am in London and there are 2 hospitals with A&E within 5 min. drive. It would never even occur to me to call my gp in 1) life threatening emergency or 2) serious situation. I'd either call 999 or go to the hospital. For a routine out of hours call I would hope that the doctor could sort it on the phone ie. prescribe the medicine on the phone (can you do this in the uk? If it took them an hour to come and visit me I don't think I'd be surprised or dissappointed. At my last gp's I had to wait that long to see a gp as they didn't take appointments. It's no wonder gp's are leaving the nhs in droves. You work hard, get little gratitude and THEN get criticism from the local authority for stupid things. My sympathies susanmt.

In a life threatening emergency I would call an ambulance or go to hospital myself.

Serious situation... I'd either phone the surgery to talk to my GP or still phone an ambulance/go to hospital.

Would an "out of hours" housecall be routine? I'd expect someone within a couple of hours for out of hours. I think our GPs do "routine" housecalls between 11am and 4pm as this is when they're not taking appointments at the surgery.

They also offer a telephone advice service where you can phone, leave a message with reception and your GP will phone back to discuss it with you.

Out of hours stuff is handled by "Croydoc" which I guess is your co-operative cover. If you phone your surgery, you get an answerphone message with the Croydoc number. They have a surgery at the local big hospital as well as coming out to you. We also have a NHS drop in centre in the high street.

SofiaAmes, my GP has prescribed medicine over the phone but DH had to go and pick up the actual paper prescription from the surgery.

We have a co-operative system for out of hours cover - which includes not only house visits if necessary, but an out of hours GP service which covers the whole town. You have to call first and go through the situation/symptoms with them before they ask you to go to the night surgery if they think it sounds necessary though - you can't just turn up. In practice I'd probably call NHS direct first anyway. For anything more obviously serious/life threatening we're only 5 minutes (at night - longer daytime) drive from the nearest A&E, so we'd go there directly.

Agree with other urbanites here - 999 or the local A & E for an emergency; serious situation - out of hours, would ring our excellent local coop scheme Grabadoc first for advice (they would either visit or get you to come to their all night surgery); routine housecall? Have never been in a chronic illness situation where that would apply.
Sorry to hear this, susanmt, people clearly have different expectations in a rural community and I can quite see why dh and his colleagues feel they have to keep some miles between them and the practice premises.

We live in a village in Yorkshire and have never had a doctor visit the house. For your answers:

1. call 999/go to A&E (but thats about 12 miles and 1/2-3/4 hour drive).
2. go to A&E 3)are covered by a co-operative and there is an out-of-hours surgery at the hospital (ie 12 miles and 30-45 mins drive away.

We used the emergency surgery once last Easter when DS had a bad ear/throat infection over the Bank Holiday weekend. While its fine for DH or me to do the 40 minute drive (we have two decent cars and two car seats) it wouldn't be so easy for someone without a car with a poorly child or the elderly/infirm.

DS had a pyodermic granuloma (collection of protruding blood vessels)on his face which used to bleed copiously when knocked. This happened once at nursery (which is less than 100 yards from the surgery) but the GP refused to go (which upset me - DS was only 11mo at the time) and so they rang an ambulance which took us (I drove the 23 miles home from work in the same time!) to A&E. The next time it happened in the bath and we got a neighbour who was a GP (now moved) to help. The other bad time we just took DS to A&E ourselves.

How far from the surgery do you live Susan?

Thanks folks, its nice to hear we are being reasonable.
We are in a remote/rural area, and the main population centre in out area is the village where the sugery is, which is 15 mins normal drive, 10 mins 'emergency' drive for him. The local A&E is 45 miles away for the folk who live there, but there is am ambulance in the village for emergencies. About 1/4 of the practice population live between us and the surgery, and the other doc lives about 10 mins drive the other side of the surgery, down the main road to the other village. They do all their own on call, which means every second night and every second weekend. They are not toally strict about it - for example, when our neighbour had a heart attack on a night the other doc was on call, he called my dh to go, to save time. They both have a boot full of emergency gear, such as defibrillators and nebulisers.
In the 4 years dh has been a fully qualified GP he has NEVER been called to a situation where he felt that the outcome would have changed if he had got there sooner.
For the record, all patients are seen on the day that they call for an appointment and they do about 6 housecalls every day mainly to elderly/housebound patients.
Thanks for your input. I get annoyed with this kind of criticism of docs - dh works incredibly hard and his patients have no idea how much he cares about them and how much work he puts in on their behalf.

Susanmt, the set up sounds entirely reasonable to me.

Susanmt - if your DH's patients are all seen on the day that they call for an appointment, then they're probably getting a much better service than most of us elsewhere in the country. Here it's more like a week, and even then the receptionists will usually try to tell you that the problem might have cleared up in that time, so why not wait that week before making an appointment?

Wow - appointments on the day patients call - wish I could say the same for my GP's surgery! There are about 8 GPs there and only if the triage nurse deems it necessary are you given an appointment for the same day! To see my own GP I have to wait at least a week, sometimes 2! Can't believe your DH fits in 6 housecalls a day too. Can't imagine why your dh's practice is being criticised for providing what sounds like an excellent service!

It sounds like your dh is giving excellent service. The last time I went to a doctor I had to wait 7 weeks for an appointment. Usually the wait is 3 - 4 weeks. Having said that, they are much better with children, if you turn up with an obviously ill child they will try to fit you in the same day.

As for life threatening situations and serious situations, thats what 999 is for. Any other queries, NHS direct is what I use.

I have used NHS Direct a few times for DS (never for me or DH)and think it is a good idea to have there. And Susan I agree with the others. Have to really pressurise to get an appt in the next day or two and I've no idea where any of our doctor's live.

emergency: obviously phone 999, or just rush to hospital myself. at the weekend dd's eyes were v sore and NHS Direct advised she should see someone before surgery opened again on Monday am..so rang our out-of-hours service, Camidoc, someone phoned back in 10 mins and took dd into local hospital where they're based. got antibiotic drops at Safeway chemist. when I had mastitis big-time, Camidoc just left the antibiotics at the local Boots for me to pick up

Sounds fantastic! Home visits - what are they? Haven't a clue where my doctor lives, emergency service is usually covered by somebody at the end of the phone - where they are based I have no idea. Have to say since I had a baby, I have found the NHS dreadful - terribly under-resourced. We went to A&E with DS with a temperature (first time, panicky parents) and waited for five hours and still didn't see a doctor, went home with a bottle of Nurofen. It's not just the level of care, it's the whole way the system is organised. To use that dreaded phrase, "back home" you could see a doctor on the day, without waiting for 2hrs and begging the receptionist saying yes it is an emergency. I could see a doctor near my work AND a doctor at home if I wanted. The downside was that I had to pay £10 a visit (care for under-fives was free, and for low-income earners). But seems cheap to me compared to waiting for hrs and hrs to get five min with harassed doctor (although all the doctors at my GP surgery are very nice) Someone I know locally didn't go to the doctor for a year - at which point they removed her from their list, and when she wanted an appointment had to go and register elsewhere!! What a reward for being healthy. This is one area where Londoners definitely miss out.

My GP practice is also brilliant. For routine appointments (repeat prescriptions etc) you may have to wait a week or two, particularly if you want to see your own GP not one of the others. Otherwise same day appointments if it's an 'emergency'. After booked appointments they save about an hour or so with one GP that is turn up and wait (you have to ring first) so you can always get something for a sick child, or a really bad throat infection etc.

Life threatening I would call 999, or go directly to hospital, but I live about 3 miles away, so it's 10 mins. Housecall I wouldn't expect, unless it's really out of hours and usually they try to give advice over the phone rather than come out. If they came out I think and hour or so is fair.

Sounds like your DH is offering a great service, what the hell do the health council know!

susanmt, this is interesting. We were not allowed to register with one surgery on the grounds that we lived more than two miles away from it, and the surgery could not therefore provide effective emergency cover, even though it was close to where my children spent their day, with a non-driving child-minder in those days. It never occurred to me to wonder how far away from the surgery the doctors lived, but I am willing to bet anything that it was more than two miles, as the surgery was in a truly grotty area!

I must say, I would expect the health council to sort out a network of cover, rather than trying to dictate where their staff should live.

the doc I met at camidoc told me his (single-handed) practice in N.London was sending out letters to patients who had 3 DNAs (did not attend) threatening to bump them off the list if they didn't smarten their act up! good idea, if you ask me..

Susanmt - only had examples for serious situations - I was staying with my Auntie near Cirencester and had an astama attack and after the kids had gone to bed, I had to get my sister to come and take me to the night surgery in Swindon a good 20 mins away as the doctors won't do home visits. My husband was staying in REading, and the doctors won't come out either and he ended up getting a taxi to A&E and staying overnight with food poisoning. have call NHS direct out of hours when dd got her plaster wet in the bath, and still ended up going to A&E which then took 5 hours to get it re-plastered.

1. Life threatening emergency. Never had one but would dial 999 or go straight to hospital A+E

2. Serious situation. Both in and out of hours, I have phoned the GP, been given advice over the phone and either waited until next morning surgery or been advised to go to hospital or met the GP at the surgery out of hours (small village/town). 3. Never had this situation but our excellent GPs would probably deal with it as in no.2 or decide if a house call was warranted.

Patients in our area don't have a choice of surgeries, mainly! There is only dh's practice to cover our area, and many patients live furhter than we do from the surgery!