What do GPs do?

[Threesmycrowd]

This isn't a GP-bashing thread, it's a genuine attempt to understand why things have changed with doctors surgeries.

This thread is prompted by me arriving on time for the first appointment of the day and waiting 30 minutes to be seen. When I said I'd been waiting a long time the doctor was visibly annoyed and replied that she was the on call Dr and had been dealing with other things, I asked whether appointment times were not booked out and she replied "oh that would be nice wouldn't it". It seems like utter madness to me that at a scheduled appointment time a doctor would be given alternative work to do. It is nearly impossible to get an appointment at this or any other local surgery in the first place.

So my question...why is this? Can anyone explain to me what's happening? 10 years ago, you could ring up in the morning to make an appointment and get one. Now it's nearly impossible to get one and when you do, the dr has other work they should be doing at the same time. And it's the same everywhere. My gp was a helpful, busy woman and I don't doubt she is very hardworking. I dont think the delay was her fault (and I did make that clear). I do want to understand more about the system.

I wonder the same. My surgery has still got a "due to the pandemic" message when you ring. I had to take a friend to A&E recently after she had a fall. We quickly realised that there were two lists on the go. One for actual A&E emergencies and one for the hospital GP service. The wonderful doctor we saw said this is how it is now because people are unable to get GP appointments at their actual surgery. She named a local one that was particularly bad.

Yet I had to attend my own surgery for a flu jab and there may as well have been tumbleweed in the waiting room. It was most bizarre. Yet I was unable to secure an appointment for my 12 yo due to "no availability". Where are all the patients then? I just think it's a big push towards forcing us into private healthcare.

They fit triage and pre booked phone appts around F2f appointments at ours so if you're waiting for a phone call it could be any time that day. They also have to go through bloods and test results that have come in that day and arrange referrals/ follow ups. They also have to sign off prescription requests. It's been like thins since before covid. They're not given alternative work to do, they are just doing the work that needs to be done.

Our population has grown by 5 million in the last decade and the number of practising GPs has, I'm sure, reduced although I don't have any figures. I would also hazard a guess we have more old people/more people with co-morbidities than we did a decade ago. It's all a shit show.

I work in a GP surgery and the way it works is that we have a duty doctor each day, this doctor does not have any pre booked appointments for the day but deals with everything urgent as it comes in.
The only way they would see a patient with a pre booked appointment would be if the doctor due to see them was off sick/ called to an emergency home visit etc and there wasn't enough time to re arrange the booked appointment.
So it could have been a similar scenario for you op but obviously things may work differently in different practices.
I would say that we are constantly short staffed and are really struggling to provide anything like a decent service at the moment, and I'm sure that's the same everywhere so waiting 30 mins for an appointment wouldn't be unusual.

The only way I get to see a doctor is to pay for it. And it was Labour who privatized GP services.

The UK now has fewer GPs than it did 10 years ago, more patients, more patients are living longer and with complex health issues and long waiting lists mean people develop other issues eg someone waiting a long time for a knee op now has a problem with their hip due to being able to walk properly.

They keep insisting that telephone appointment triage is so much better for everyone. But I couldn't even get a telephone appointment for almost 3 weeks, and that was just to ask for a simple medication prescription. They wouldn't pass on the written form that you fill in online about what you want and let the doctor decide if she could do it without seeing me or speaking to me, but the receptionists made the decision that I needed to have a phone appointment and nothing could be done until then.

I'm taking the painkillers now and for the next 3 weeks, so wanted something to protect my stomach, and it would be such a simple thing to be able to email a request for. How can they be so booked up that it takes 3 weeks for a phone appointment, and they also don't want to let something simple be done without one?

So Thatcher and the Royal Family went to NHS GP’s before Blair?😂

Aye, l bet they did. There was no public GP’s pre war either. So it’s nothing to do with Labour.

I'm equally baffled! I called my GP yesterday, couldn't get through. Recorded message said to use e-consult. I went on the website to try that and got a message to say they weren't taking any more e-consults because they were 'full'.

There was also a message on the website saying that, due to staff sickness, there would be a delay in answering the phone. Dated September.

Plus GPs are involved in managing & commissioning services. GPs are grouped together in Primary Care Networks and these PCNs work with local integrated care partnerships to plans & commission health & care services . These ICPs feed into Integrated Care Boards which make the final decisions around commissioning services.

I sit on a number of these boards & sub groups and they all have GPs on them so that’s taking up their time as well

It's been bad for years but really since Covid it's as though there is just the bare bones of a service so I don't buy the chat about short staffed. It seems to me GPs liked the telephone/online way of doing things and have resolutely refused to go back to seeing patients if that's their preference.

Ours still has every second chair taped off, massive cracked tiles beneath the hand santiser stand and warning signs about masks everywhere. An appointment in person is a distant memory, unless with the nurses who crack on as before.

What do GPs do?

Appointments every 10 minutes morning and afternoon.

Visit about three patients each a day the housebound and dying.

Sign prescriptions.

Refer patients to hospital

Insurance reports

Deal with emails from lots of other healthcare professionals

Have clinical meetings

Have other meetings

Health promotion work

Run their business if not salaried

Medication changes from consultants

Lots of clinical paperwork that the government says they have to do to make money for their business to survive.

Clinical supervision of other Heath care professionals in their practice, such as ANP and practice nurses.

Training fully qualified doctors to me gps

Answer lots of queries from patients

Seeing lots of 'emergency' patients who need to be seen today.

And those are just the things I can think of in a couple of minutes

Our surgery is quite good, but they try and palm you off to the nurse if you ring up needing a same day appointment with a doctor. This is fair enough for people that can see a nurse, but for some things you need a GP.

I've seen the nurse when I've been really unwell, and my son also has, and it's been really poor. Eg their advice for a bad chest infection has been just to monitor, when I've then had to return to see the GP who has been really concerned and prescribed antibiotics and steroids. (Asthma sufferer).

I know not all nurses are like this so not a nurse bashing reply, but at our surgery they are no good for dealing with poorly patients.

You start the day and you come into tens of tasks from Out of hour GP's, nurses and patients needing something urgent dealt with. For example, most mornings there are several requests for palliative medications or requests to write an urgent prescription chart for a person who is dying in agony, this needs to be done immediately.

Its unfortunate that people are made to wait but patients have to be prioritised. Every health care professional will prioritise End of life patients, patients in severe pain and patients at risk of a life threatening condition. The work load is unbearable and that is before you even factor in in person patients (oh, and you need to read their history first too).

I've just found out that our e -consult has a section marked admin where you can raise simple requests and not have to complete pages of questions.
I used it successfully to request swabs needed for MRSA monitoring.
Although can't be used when surgery has reached capacity.

Our GP clinics are booked up for weeks. Our ANP's deal with most of the urgent stuff day to day.
Very often our waiting room is quiet though because we have next to no staff working (struggling to recruit, another GP and practice nurse out in the New Year).
Statistically there are now less GP's seeing more patients f2f than before Covid. The demand is incredible, so many over 65's, 75's, 85's with multiple co morbidities.

On top of all the things previously mentioned is the expectation of the public to 'check out' very minor symptoms that have only just occurred - what is called 'the worried well'.

This has not been helped by media panics over errors / rare presentations and even NHS messaging that urges people to 'get checked over'.

There simply isn't the capacity for this. It takes up time that should be used for treating acutely and chronically ill individuals.

Yes some things need checking. But first go onto the NHS website and look there - they have very good advice for the most part.

I do think part of it is our society of instant gratification coupled with workplaces that do not tolerate sickness of adults or children - meaning people want 'quick fixes' for things that simply need time and home based care until they go away.

My surgery is really good.
You ring and choose the option of an appointment, you're then in a queue but you hang up and they ring you when you're at the front of the queue.

I have severe asthma and I always get a f2f appointment.

Can't complain

I spend most of my time applying for jobs abroad. Now just waiting for my visa.

GPs are self employed. They can do what they like.

People think that GPs are in the NHS - they aren't. They have a contract with the NHS to provide services. They are not employed by the NHS.

Zombie post

If you are asking from my personal perspective then very little, mess stuff up and get confused by care pathways and referrals really. Problem is l know they are paid and commissioned to do more. But just don't. Can't or won't it's unclear really 🤷‍♀️. Confusion reigns. Only 1 GP at my surgery appears to have a brain

When advised that they are doing things wrong then they get cranky and defensive but still don't do much. My personal favourite is when the GP complained about me "going on". Because after 3 separate appointments spanning 6 weeks they still hadn't bothered to do a referral. Eventually they do a referral to the right place -it gets declined as they can't be arsed doing the right blood tests. They then do nothing as they are "too busy to deal with declines" apparently. I remind them again and they refer to the wrong department -gets declined funnily enough. I remind them yet again and they appear to do it but no there's another issue with the referral despite the right blood tests being done eventually. Do another referral with no information, gets accepted as it's private, l get the appointment but the consultant can't help as it's the WRONG DEPARTMENT AGAIN

It's a Kafka type nightmare. I can only speak to them with condescension and contempt. Professionally the relationship has broken down. I will get a new surgery once they eventually sort things out -it's only taken 2 years 🙄

I’m not sure why you think your experience is a new thing. It’s always been the case.that doctors may have to deal with urgent cases at the beginning of morning or afternoon surgery, or could be delayed coming back from a home visit (I suspect the latter reason is less likely these days as doctors do far fewer home visits than they used to). They also only have 10 mins for an appt so sometimes these will inevitably overrun. If anything I find that I have far fewer waits/delayed appts at the GPs than I used to. But I suspect it also varies from surgery to surgery as they all run different systems and have different numbers of doctors.

I don’t think 30 mins is that long to have to wait though. I have far longer waits at my dentist when he overruns! It’s medical practice/treatment, not a factory conveyor belt, thank goodness.

Mine are great. No complaints.