Doctor First - Or should it be patient last?

Undervalued

Until a couple of years ago I had a generally high impression of the fairly large GP practice I use. Fortunately these days I don't need them often, although there was a period many years ago when I did. I have always been happy with the doctors and nurses I have seen and the administration was at least tolerable.

More recently the service has become, quite frankly, dreadful. Although they apologise on their website etc it is all blamed on an inability to recruit staff or replace partners who have retired or moved away. So, they now use a system they call "Doctor First"!

The only way to get an appointment is to call first thing in the morning (if you can mange to get thorough) and frankly plead with a receptionist to get a doctor to phone you back. Assuming you don't miss that call, which can be hours, if the doctor feels they need to see you face to face you will get an appointment "generally the same day".

The previously excellent online booking system can now only be used for blood test appointments or to book a 5 min telephone appointment with your preferred GP, which will be at least a week away. Although that offers specific times, the confirmation then says that the time is not guaranteed. The twice I have done that in the last year my call back has been between 3 and 5 hours after the booked time!

Generally, if you have something to discuss with your doctor, you want to do it in private and when you can concentrate. The system makes that impossible unless you are housebound and have no visitors!

Does this level (or lack) of service actually comply with NHS guidelines?

Is this becoming the norm? As far as I can see other local surgeries are still allowing more normal appointment booking, although I have no idea of the waiting times.

I live in a medium sized and largely prosperous city that is generally thought of as a desirable place to live. Property is expensive but if doctors can't afford to live here what hope is there for much of the workforce?

Finally, any experience of private GP services? Our local private hospital offers 30 min GP appointments for £100. If you go down that route, but then end up needing anything more major, how easy is it to switch back into the NHS system?

Thoughts or experiences would be very welcome.

Toothsmith

Yep - this is a common problem. It's been building for years, and warnings have been given, but no-one in a position to do anything about it (DoH) have done anything about it and now it's all falling apart.

Medical workforce, GP training, age profile of current GPs, are all things that have been known for years, but the fact that most GPs are approaching retirement, and not enough medical students/junior Drs want to be GPs has never been a concern so long as the system muddled through.

The final straw has been changes to pension taxation which is now meaning many older Drs are actually ending up paying to be at work if they carry on in the NHS!

It's absolutely crazy, has been warned about for years, but hasn't been taken seriously by Governments for many years.

Hermia

I go to a big city centre medical practice and I am actually pretty impressed with how they handle things. I certainly don't have to wait weeks for an appointment or ring on the day etc. The way they seem to deal with the issues is to have a big team of nurses who do many of the appointments and will essentially then talk to the doctor if they feel you need their expertise. In the four years I have been with them I have only needed to see the doctor once as the nurses are able to do so much. They are also very hot on preventative healthcare. I am asthmatic and the care I get from this practice is the best I have ever experienced in my life. As a result of that I don't need to see the doctor for my asthma as any issues are caught before they get to the stage of needing treatment. A local pharmacist also does appointments in the surgery and again that has really helped me manage my chronic conditions so I don't get to the stage of needing to see the doctor.

pollypenny

The country needs far more GPs. It's down to that.

Undervalued

pollypenny wrote: »

The country needs far more GPs. It's down to that.

Well yes, I am sure most people would agree the country needs far more GPs.

What I'm trying to judge is whether, notwithstanding that, my surgery is providing an unacceptably poor service.

As I understand it, most GP surgeries are private businesses (usually partnerships) who have a contract to provide NHS services. Presumably, in addition to having to meet certain clinical standards they also have to meet other service criteria? How often is this reviewed and what happens if they consistently fall short.

As a patient, apart from anecdotal reports from friends, it is very difficult to judge if somewhere else would be better. As I said, until a couple of years ago my surgery was fine but sadly not now.

kirtondm

The situation is not ideal but then the whole system is struggling as outlined above. The situation is even worse in more rural areas It is not a case of generally that GP's can't afford to live in the areas it is more that they choose to live in London and the big cities as often they have a partner who works in another profession that requires a big city location.

Every surgery is trying to find ways to cope , the practice can't magic up additonal GP's.

Not sure the fact they are contracted makes any diffrence - If they were directly empolyed like hospital doctors their would be the same issues and probably not as efficently run!

maman

I agree with many of the sentiments posted. For me the crux of it is that we've done insufficient training over the years (and that applies to many fields not just medicine), the salaries of GPs are sufficient that many can choose to work part time and it's become such a thankless job (as is the case with many public services) that recruitment and retention is very difficult. It's likely to get worse if we doggedly stick to the plans on immigration.

What I do find unfortunate though is the slogan that OP cites. 'Doctor First' is rather blunt although it may well be true! I dislike those bossy signs that are often to be seen in surgeries telling you where to stand, where to queue and not to be abusive to staff. It's just not the tone I expect from a public service.

fred246

Sadly the NHS is a political football. The Tories want to close down the NHS and privatise it without being seen to be doing so. By cutting off the resources it needs they hope that the people who use the service AND those working in it will be disillusioned and want change. I think they are doing quite a good job at the moment. You are unhappy and the doctors are unhappy BUT you aren't blaming the government.

brook2jack

maman wrote: »

What I do find unfortunate though is the slogan that OP cites. 'Doctor First' is rather blunt although it may well be true! I dislike those bossy signs that are often to be seen in surgeries telling you where to stand, where to queue and not to be abusive to staff. It's just not the tone I expect from a public service.

75% of gps have been assaulted or threatened , every gp receptionist will have been threatened. The bossy signs are there to try to protect staff from the increasing violence from the general public. http://www.pulsetoday.co.uk/news/gp-topics/legal/three-quarters-of-doctors-have-been-assaulted-or-threatened-at-work/20038110.article

Strangely enough being assaulted and threatened is not what health workers expect from the public but it is increasingly happening.

Where to stand and queue is an attempt to maintain privacy for the person at reception desks.

The GPs at my local practice field all of this for a salary of £56,000 . Three of them have just retired , exhausted from the increasing pressures and no work/life balance . No one has replaced them except for one advanced services practice nurse.

The young doctors I know do not want to touch gp practice with a barge pole , the pressures are intolerable.

We are training more doctors than ever but they cannot be persuaded into GP practice whilst the present hamster wheel of pressures continues to build up.

humptydumptybits

I know about the pressures but I'm not sure the levels of triage helps If I phone for an appointment I have to tell receptionist my symptoms then I might get a call back from a doctor or I might not, you never know If the doctor phones back I go through the symptoms again and I might get offered a blood test/prescription/advice or an appointment. It just seems so long winded but sometimes a telephone appointment is great and I can see it is timesaving. We can also send in an online request for advice/prescription and that is also very good.



My husband needs regular medication, he fills in the form and sends it in. The surgery employs a paramedic who goes through repeat prescriptions and every now and then he decides DH doesn't need the med so then husband has to go through process to see GP who will authorise the prescription. Again I understand prescriptions need to be monitored but if the GP says my husband needs the med shouldn't that be enough?



We used to have a nurse practitioner who was great but she left. I do think nurse practitioners/prescribers are very useful.


I'd love to go back to the days when you just turned up and waited to see your GP.

brook2jack

Part of the problem is the number of times per year , on average, a patient sees a gp has more than doubled in the last decade.

On average each patient registered at a practice sees a gp 7 times a year and this is creeping up year by year. The rates for seeing nurses in practice are also creeping up year by year.