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Doctor required in GP's office

Started by canadagoose, January 10, 2022, 03:58:18 PM

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canadagoose

Is anyone else having endless bother trying to contact a doctor lately? Our practice seems to have done away with routine appointments entirely, and if you want to speak to a doctor you have to phone at 08:00 sharp - if you're one second late, you'll get an engaged tone for the next ten minutes and then all the appointments will be gone and you'll have to start again tomorrow, unless it's an "emergency". This has resulted in me having problems that weren't emergencies to start with becoming worse until they did require urgent care. Why do they have this daft system? Surely it can't be the most efficient way to triage patients. I've now got umpteen things to talk to the doctor about and I can only get enough time per day for one issue, if I'm lucky.

Is this just how things are going to be from now on? It seems so dysfunctional. Something needs to be done. What have your experiences been like lately?

ZoyzaSorris

Yep. Can't get appointments at all. Totally dysfunctional.

Zetetic


Hat FM

tories underfunding the NHS making you feel like you have to go private. fuck the tories.

Dr Rock

Say it's an emergency. If it really isn't come up with an emergency to get your foot in the door about the real thing. Shouldn't have to do this of course.

Zetetic

January 10, 2022, 04:55:13 PM #5 Last Edit: January 10, 2022, 06:06:32 PM by Zetetic
As to why this is the case:
It is widely recognised - as @canadagoose indeed touches on - that prevention is better than cure. It is better - both for the system and for patients - to get to people earlier in their illnesses rather than later. More efficient and more effective.

However - we are now at least a couple of decades into multiple workforce crises and at least a decade into a funding crisis. Pretty much part of the system is now massively oversubscribed and yet - beyond that - pretty much every part of the system has also massively suppressed demand because of how bad access is (as this thread shows).

Most attempts to dig any part of the system out of the mire and go 'upstream' tends to:
1) Involve deresourcing services for the extremely unwell in the short term at a minimum. (This is only openly viable in certain vulnerable populations that are disgusting to public and policymakers alike.) Can your GP practice see fewer emergencies? Without your MSP/MP kicking off? What about when they're mentioned in an FAI report?

2) Push the extremely unwell on to other services. People who can't be seen by your GP will turn up at A&E, possibly in the back of an ambulance, or GP Out-of-Hours - who are already desperately trying to get people to fuck-off to see their GPs.

3) Fail to have the preventative impact required to seriously improve efficiency. This is often because the resources rarely exist to achieve the scale required to actually mitigate urgent demand, and because you'll often just uncover a whole bunch of already urgent demand that was previously being suppressed by your lack of capacity.

I note that Advance Bookings in Scottish GPs began to seriously slide about 5-7 years ago:
https://www.gov.scot/publications/nhsscotland-performance-against-ldp-standards/pages/gp-access/

This is despite trying to harder to retain a GP workforce than England:
https://www.cookdandbombd.co.uk/forums/index.php?topic=87302.msg4567505#msg4567505
(But not as hard as Wales or NI)

Tony Tony Tony

A few tips from my experience (gained through having an ageing Mother)

1. If your doctor has an email address (even if only slated for repeat prescriptions) send a vague message asking for a call back. Even if you don't get your regular doctor your get a call from a locum. Though I would say they generally refer you to 3. below.

2. If you have a few hours (let's say three) to spare go to your local walk-in centre

3. If you have more than a few hours (let's say seven) to spare go to your local A&E

For 2. and 3. be prepared for a looooong wait so take along supplies (eats and entertainment). My experience last week was that even on a quiet Thursday night in a big Manchester Hospital waiting time varies massively, if you happen to be there with a small baby you will jump the queue (no problem with that) otherwise it seems the older you are the longer you wait. Mind you if you have bits hanging off you that might get you seen quicker! 

Janie Jones

As other posters have noted in various threads, especially over on the Dead Soon boards, primary care in the UK is fucked because we don't have a salaried service. GPs, dentists, pharmacies and opticians are small to medium sized private businesses that hold a contract with the NHS - the NHS funds their premises, pays them to run clinics etc - but they are not really part of it.

The NHS has to 'influence and persuade' these independent contractors to meet its targets on prevention stuff like bringing down BMI, monitoring blood pressure, smoking cessation, exercise etc. This usually means giving them fucktonnes more money.

We also have the arcane system of GPs being the gatekeeper to secondary (basically, hospital or outpatient) care. You hear Americans talk about 'my gynaecologist', 'my gastroenterologist'? This means that when they have a health issue, they (subject to health insurance, of course) immediately refer themselves to the appropriate specialist. We can't do that. We have to wait for a GP who probably knows less about your ailment than you found out in an hour of googling, to refer you to an appropriate specialist.

canadagoose

Quote from: Zetetic on January 10, 2022, 04:18:01 PMhttps://www.poetryfoundation.org/poems/48246/rabbits-and-fire
That's an interesting analogy. And thanks for the summary in the other post - it's all a bit depressing. In terms of politics I think equal blame can probably be placed at Conservative and SNP hands, but feel free to disagree (I know you're a lot more informed than I am).

Sadly my doctor has no email address that I'm aware of (I mean, he will do, but he's not letting on). I ended up having to go to A&E at one point in the middle of the night a few months back, and the taxi fare there and back was a bit extortionate - I can't really afford to do that regularly. I don't think they'd be very chuffed to see me regularly anyway - it's embarrassing enough when the nurses recognise me from the last time I was in. I probably exhaust their supply of sick bowls every time.

canadagoose

Quote from: Janie Jones on January 10, 2022, 05:26:30 PMAs other posters have noted in various threads, especially over on the Dead Soon boards, primary care in the UK is fucked because we don't have a salaried service. GPs, dentists, pharmacies and opticians are small to medium sized private businesses that hold a contract with the NHS - the NHS funds their premises, pays them to run clinics etc - but they are not really part of it.

The NHS has to 'influence and persuade' these independent contractors to meet its targets on prevention stuff like bringing down BMI, monitoring blood pressure, smoking cessation, exercise etc. This usually means giving them fucktonnes more money.

We also have the arcane system of GPs being the gatekeeper to secondary (basically, hospital or outpatient) care. You hear Americans talk about 'my gynaecologist', 'my gastroenterologist'? This means that when they have a health issue, they (subject to health insurance, of course) immediately refer themselves to the appropriate specialist. We can't do that. We have to wait for a GP who probably knows less about your ailment than you found out in an hour of googling, to refer you to an appropriate specialist.
It is a bit of a duff system. If it was more like the French one, it would be a bit easier.

Zetetic

I increasingly think that salaried vs. contractor thing doesn't make much difference, and it's made less and less of a difference over the last decade (perhaps particularly outside of England, since GPs (etc.) are much closer to government). Broad reasoning:

1) It's not as though it's easy to manage salaried consultants, particularly given how difficult is to obtain and keep one in much of the UK in any given specialty.
2) Many places are the UK, particularly outside of the imperial core, are having to run at least a couple of salaried practices now because independent ones have simply collapsed in the face of workforce crises. (As with all such positions, this also usually involves offering extremely pleasant job plans to compete with the core.)
3) Wales has gone a long way towards abolishing cash-based incentives in the GP contract in recent years because everyone hated it, hating it more and more as the crises bit.

American etc. direct access to specialists relies on massive amounts of excess capacity amongst those specialists, and in the American case in particular of course that depends on restricting demand by keeping the poors out. If it's any consolation, I imagine we'll see this become a much more visible model across the UK in the coming decade, accelerated by the millions-long waiting lists, for those who can afford it.

"Gatekeeping" is tricky to unpick. Yeah, often this is sticking someone with relatively little skills and knowledge in a position where they can't actually divert demand away from a scarcer resource (so all you've done is create new demand & capacity problem without fixing the one you already had) - but I don't think GPs really fit into this box, and where they do specialist services usually can offer direct access if they want to. They don't, because they're already drowning and already trying to get GPs to hold back the tide.


Al Tha Funkee Homosapien

Basically what Zetetic has written (very well as always) is my experience of working in primary/urgent/emergency care (especially over the last 5-6 years.

Secondary care is fucked at the mo, consequently other services are fucked (ambulance services), and the waits for referrals are crazy (although locally 2ww cancer services are still functioning).

So primary care is having to manage people waiting for their referral getting more unwell and frustrated. On top of dealing with the massively increased demand for immediate access to health advice (111 has imo trained people to seek advice about the most vague of symptoms as soon as they appear.)

Access for appointments has long been an issue. The PCN I work for uses econsult which allows new to seek advice by using an algorithm and questions to direct to the right people. It is good and does work well, but again we get hit by a mass of people instantly enquiring about self-limiting conditions as soon as they appear at 3am. This all then needs to be triaged and results in quite unwell people getting lost in the deluge.

Reading that back it all sounds like I'm blaming people for accessing healthcare, I'm not, it's the systems fault. Just a bit burnt out probably.

dissolute ocelot

Waiting till Friday evening and calling the out of hours service has worked in Scotland, pre Covid at least, seen at clinic very qyickly.

canadagoose

Quote from: dissolute ocelot on January 11, 2022, 09:07:03 PMWaiting till Friday evening and calling the out of hours service has worked in Scotland, pre Covid at least, seen at clinic very qyickly.
Nowadays you have to be on the phone to 111 for about 45 minutes, repeating everything twice, then waiting 3-4 hours for a callback and then they might see you.

kngen

Quote from: Dr Rock on January 10, 2022, 04:48:52 PMSay it's an emergency. If it really isn't come up with an emergency to get your foot in the door about the real thing. Shouldn't have to do this of course.

The golden ticket used to be, if you get a chance to list your symptoms to someone, add 'chest pains' to it. Not sure if they give a fuck about potential heart attacks as much as they used to, but that tended to open doors for me six or seven years ago.

Twit 2

QuoteIt was in a clinic waiting room: an old woman was telling me about her diseases. . . . The controversies of men, the hurricanes of history—in her eyes, trifles: her sickness alone prevailed over time and space. "I can't eat, I can't sleep, I'm afraid, there must be some pus here . . ." She began caressing her jaw with more interest than if the fate of the world depended on it. At first this excess of self-concern on the part of a decrepit crone left me torn between dread and disgust; then I left the clinic before it was my turn, determined to renounce my discomforts forever. . . .

I went a bit mental last summer and needed to see GP, mental health team and pharmacy. Whole experience was ghastly and I was determined to not bother again. Just totally jaded and demoralised by the whole rotten charade. Next time my brain plays up I'm going with the noose. They lost a good customer!

canadagoose

Quote from: Twit 2 on January 11, 2022, 10:34:47 PMI went a bit mental last summer and needed to see GP, mental health team and pharmacy. Whole experience was ghastly and I was determined to not bother again. Just totally jaded and demoralised by the whole rotten charade. Next time my brain plays up I'm going with the noose. They lost a good customer!
Did you have the problem I have where when you're feeling really low, you feel unworthy of any medical help so you find it hard to get it? It's a shiter, I wish there was just a button you could push and then that would set everything in motion, like some sort of Wallace and Gromit depressio-matic thing. Flings you out of bed, dials the number, tells the receptionist the problem then catapults you to the surgery. Would be handy.

Twit 2

No, not really. I feel I have a valid complaint and should be helped, but the farcical bureaucracy and threadbare systems in place just make me even more depressed and confused. If the system was funded better and worked properly I'd be much happier to use it. It's just a case of "Oh for fuck's sake; why am I bothering with this shit?"

willbo

I honestly feel like I've needed some kind of help, and some kind of medication, for years. I have really bad panic attacks when alone. But I can't face my GP. Not any doctor in particular, I just can't face going.

TrenterPercenter

Quote from: willbo on January 11, 2022, 10:59:25 PMI honestly feel like I've needed some kind of help, and some kind of medication, for years. I have really bad panic attacks when alone. But I can't face my GP. Not any doctor in particular, I just can't face going.

Why not try e-consult and get a virtual appointment - might be less anxiety inducing that way.

imitationleather

Quote from: willbo on January 11, 2022, 10:59:25 PMI honestly feel like I've needed some kind of help, and some kind of medication, for years. I have really bad panic attacks when alone. But I can't face my GP. Not any doctor in particular, I just can't face going.

I know this probably won't help, but if you do manage to get yourself to a GP you'll find them a lot more understanding than you're fearing. I get the impression most of their appointments these days are people like us with our mental health issues.

Also the suggestion of an online appointment is a good one if you think that might be easier to face.