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Author: Subject: GP's
LBMEFM

posted on 16/2/22 at 08:14 PM Reply With Quote
GP's

I know that it's not a Locost topic subject but it is the only online site with members who are reasonable sensible.

Why is it I can now go shopping, visit the pub, go to concerts, hairdressers and even my local hospital has an A&E department with a doctor so why can I not visit my GP. It.does not make any sense, off topic rant over.

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joneh

posted on 16/2/22 at 09:39 PM Reply With Quote
Probably short staffed making more money jabbing and dealing with the catastrophic backlog they helped create.
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roadrunner

posted on 16/2/22 at 09:39 PM Reply With Quote
It's the same with our GPS. It's very disappointing. They tell you that they are working as normal but the only people we can see are nurse practitioners.
It's like calling a plumber and you only end up seeing his apprentice.

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ianhurley20

posted on 17/2/22 at 08:56 AM Reply With Quote
We have had no problem at all throughout the varioius lockdowns and resrictions, I live in North Norfolk, my daughter lives in Nuneaton and son lives in Barrow in Furness and the same applies to them. What we do find is that the Drs work a sort of triage system where you phone the surgery and the duty doctor rings you back the same day. After a conversation you may already have the answer but if required an appointment will be made for you which may well be a few days away if no urgent or as in my case last it was within an hour of my original phone call.
So, for me Drs get a big thumbs up.

Now dentists are another issue, not seen mine for 2 1/2 years and they are still doing only emergency appointments!





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BenB

posted on 17/2/22 at 09:19 AM Reply With Quote
As a GP (on half term holidays) I'm possibly in a position to comment!!

There are four main issues

1) lack of GPs- this is the main issue. You just can't get any. Despite the government promising 5000 extra X many years ago in reality numbers have dropped massively. Add to this the fact that compared to when I was training (when more GPs were male) nowadays most are female. And without wanting to be accussed of sexism my experience is that female GPs work full time until the kids come along at which point they drop to 2-3 days per week. This aggravates the fundamental lack of GPs
2) Government response to lack of GPs is introducing nurse practitioners, Physician Associates and Clinical Pharmacists. These are great. Except they all need supervising as they frequently need help with tricky cases, can't prescribe independently (other than some CPs and restricted formulary for NPs). So I spend all my time seeing the tricky cases the associated clinicians are stuck on rather than having my own list
3)The Government decided to introduce a requirement for "digital" and for most practices this is electronic consultations. Which are ridiculously inefficient, take up loads of time and are actually incredibly very difficult to do. So again these go to the senior clinicians even though they're unfiltered and many of the requests are things the admin team used to do.
4) Work transfer from secondary care. Over the last decade more and more stuff done by Consultants in secondary care has been transferred to General Practice (hospital appts cost, GP appts don't!!). So we're doing more and more complex chronic disease management. Which means fewer appts for other stuff.

Anyway, that's why there aren't any appointments!!!! Blame years of serial mismanagement by the government.

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nick205

posted on 17/2/22 at 09:57 AM Reply With Quote
BenB - thanks for your real world input here, valued and appreciated.

From a "customer" perspective with 3 kids getting a GP appointment for 1 of my kids was a PITA and just didn't happen.

In the end we used the e-consult (if that's the right name for it) service where you send in photos and a a written description of the issue.

Result was a phone call from a duty GP, who was on the ball and resolved the issue very well. He didn't (wasn't) say so, but I got the impression he was as frustrated as I was with the whole thing.


ianhurley20 - NHS dentist has been a problem here (Hampshire) too. Emergency appointments only for a long time. When they finally got back to regular check-ups, most people (myself included) needed treatment (e.g. fillings) to make up for the lack of check-ups. Thankfully back to regular check-ups now.

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Mr Whippy

posted on 17/2/22 at 12:31 PM Reply With Quote
To be fair I had some possibly serious symptoms very recently that I wanted checked out (fortunately turned out to be not a problem) and was seen the next day. The waiting room was totally empty and I don't think there were many doctors there. However if they think it could be serious they don't seem to delay a visit.

When my daft kid stuck a stone in her ear three times, not once were we waiting more than a couple of hours to see the GP, who I'm sure had much more important things to do.

My poor brother in law has recently been diagnosed with terminal cancer and his initial visit & treatment have been immediate.

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BenB

posted on 17/2/22 at 01:59 PM Reply With Quote
quote:
Originally posted by nick205
BenB - thanks for your real world input here, valued and appreciated.

From a "customer" perspective with 3 kids getting a GP appointment for 1 of my kids was a PITA and just didn't happen.

In the end we used the e-consult (if that's the right name for it) service where you send in photos and a a written description of the issue.

Result was a phone call from a duty GP, who was on the ball and resolved the issue very well. He didn't (wasn't) say so, but I got the impression he was as frustrated as I was with the whole thing.


ianhurley20 - NHS dentist has been a problem here (Hampshire) too. Emergency appointments only for a long time. When they finally got back to regular check-ups, most people (myself included) needed treatment (e.g. fillings) to make up for the lack of check-ups. Thankfully back to regular check-ups now.


Yup, most of the old guard are fed up with rubbish like eConsults (which is how I spend my days when I'm not debriefing).
Unfortunately things are only going to get worse. When I started as a GP it was a running joke when you asked, in an interview, why someone wanted to be a GP it was always the same "to run a practice and have autonomy over the care I provide my patients". The autonomy has slowly been eroded and now there's a plan to give control over all practices to the local hospitals. So the practice I've spent 15 years of my life turning from a small, dysfunctional practice to a training practice with almost double the number of patients and one of the best reputations of local practices is going to be taken from me and handed over to the local hospital to mismanage? Well I won't be around to see it! Many old school GPs are understandably proud of the practices they run and the care they provide to their patients, to remove this from them and force them to become employees of the local hospital is going to cause a mass exodus of the old guard- who typically are the ones working full time....

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Sanzomat

posted on 17/2/22 at 02:10 PM Reply With Quote
quote:
Originally posted by BenB

4) Work transfer from secondary care. Over the last decade more and more stuff done by Consultants in secondary care has been transferred to General Practice (hospital appts cost, GP appts don't!!). So we're doing more and more complex chronic disease management.


I certainly recognise that. My eldest (now 30) has suffered from various chronic and debilitating conditions since they were about 9. The specialists in the field that used to provide care/support no longer seem to even exist. The GP is left trying to "manage" the conditions but can't do much other than refer to specialists who either don't exist or have 4 year waits for appointments so basically no care is given at all and they are left to suffer. Basically the only people giving any kind of support are us.

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SteveWalker

posted on 17/2/22 at 02:41 PM Reply With Quote
quote:
Originally posted by BenB
Yup, most of the old guard are fed up with rubbish like eConsults (which is how I spend my days when I'm not debriefing).


I assume that is telephone/Zoom consultations? If so, they may be a pain for you, but for many patients with ongoing conditions, they are a real boon. For me, it means borrowing a meeting room at work for privacy and using my phone or company laptop; for my disabled wife, who I take to her appointments, it means she can do the same from home.

Without that option, in either case, it means me taking half a day off (unpaid) to be available for a 5 to 7 minute appointment that is often running very late.

For urgent appointments, it is even worse, as I may have to take the morning off, to be ready to take my wife, only for her to be told (if she can even get through) that that all the morning appointments have gone and so we have to phone back later in the day, meaning me taking the afternoon off as well, then there still may be no appointments and having lost the full day, we have to do the same again the next day!

The cost and disruption to the economy (and the individuals) of millions of people taking significant time off for short appointments must be huge ... and it is definitely intensely frustrating.

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Mr Whippy

posted on 17/2/22 at 04:22 PM Reply With Quote
On a slightly different note and since we have a doctor in the house. On the news it says that there is expected to be around 14000 men with undiagnosed prostate cancer. Anyone who watches Family Guy knows what this check by your GP involves. However when I asked my GP last month about it, I was told there was no effective check or screening process available other than taking a biopsy (which did not sound nice at all). I have to say I am now completely confused...
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David Jenkins

posted on 17/2/22 at 05:00 PM Reply With Quote
Mr Whippy,

As someone who was diagnosed with it, I can speak with some experience...

The first check is the PSA test - a blood sample is checked for Prostate-Specific Antigen. If it is very low then it is unlikely that there is cancer. The doubt comes in if it is above normal, as there's always an element of doubt - false positives. However the first check is a digital check of the prostate - I'll leave that to your imagination! Uncomfortable, but manageable. If it feels smooth then the medics will have a think about what to do next, but if it's lumpy then it's almost certain that a biopsy will follow.

The biopsy is unpleasant but, again, not too bad. At this point the medics will have some idea whether there's cancer or not (but it's still not 100% sure). If there are signs of cancer then the next stage is a CT scan, to get some idea of the scale of the tumour - self-contained, or liable to spread. There's a 4-point scale: from 1 = "you've got it, but we'll watch it for now, maybe give you some drugs", up to 4="It's throughout your body". I was diagnosed as level 2, which is "it's self-contained, but it needs immediate treatment". There are other factors to define the level of risk, but they're quite technical. There is also likely to be a scan for bone cancer, in case the prostate cancer has spread (thankfully I was clear on that front).

I ended up with 4 weeks (Monday to Friday) of daily radiotherapy, combined with hormone therapy for 3 years.

I'm now 4.5 years after the start of treatment, and all of the reviews since treatment ended have shown a very low PSA score, so fingers crossed. I guess I'll have another review at 5 years and then, with luck, it'll just be an annual PSA check.

For all males: if you have ANY issues with urination, recurrent urinary infections (my problem), or any other issues with your man bits - GET YOURSELF CHECKED.





The older I get, the better I was...

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BenB

posted on 17/2/22 at 05:01 PM Reply With Quote
Telephone consults and video calls are fine- particularly as you say for chronic disease management. Occasionally one will turn into a F2F for chronic stuff but the main issue is patients not answering when rung at the agreed time! We tend to ring three times over the space of 5 minutes but thats obviously wasted time. I know some hospitals have virtual check-in systems so patients have to ring and only get connected if checked-in at the appt time. Trouble is that's a PITA for the patients. Not sure what the solution is to that one TBH. Most patients answer but in a standard clinic we'll have three or four who are difficult to get hold of and that's obviously a half an hour that could be spent on 3 normal appointments instead. And probably 50% of telephone consults the first minute is spent listening to silence while the person at the other end finds an empty office / toilet at work to go into to have the conversation- again understandable but wasted time. So telephone consults convenient in one way but not when one result is fewer appointments.

eConsults are frustrating. They're inefficient, unrewarding and by definition (unless we convert them all into a telephone/F2F appointment which defeats the point) means we can't involve the patient in decision making or have a discussion about what happens. It's actually nice when someone is off sick as we take over their clinic and get to do some normal consultations- good old fashioned medicine (even if some of them are telephone). But the eConsults (which are unlimited in number) build up in the background and then we end up working until 10pm responding to them. So they're a frustrating mix of unrewarding but actually quite challenging to deal with. When we've got trainees we make all their appointments F2F because it makes assessment of the patient simpler and more accurate- the more you interupt the engagement between the patient and the clinician the more difficult (and medicolegally risky) it becomes. Also a fair proportion of time / brainpower is then spent thinking / deciding whether it's necessary to bring the patient in to examine them- when they're in the consulting room that's not an issue. IE a video call doesn't allow examination of the patient but at least you can eye-ball them, see what condition they're in- a telephone call doesn't do that but you can discuss options, try and get a handle on their condition, eConsults provides none of this. So they're tricky to deal with. Which means in my practice it's only the most senior team members who do them, even though they take longer and often end up with a F2F appointment anyway. Doesn't make sense to me!!!! They take a significant degree of experience yet that experience isn't being made best use of.

That's why the Government accussing GPs of not seeing patients F2F was so galling. It's so much simpler, more rewarding and more time-efficient to see patients F2F. And the patient gets better quality care. All these new-fangled methods of providing healthcare are done on the basis of patient convenience but actually result in poorer quality, time-inefficient care and I'm not even sure they're that convenient for patients half the time!

To an extent it's a self-fulfilling prophecy, the fewer appointments there are the more patients get funnelled towards these inefficient remote tools like eConsult but these just aggravate the problem and reduce appt numbers, which then encourages even more use of these systems. In an ideal world they'd close Pandora's box and we'd go back (Covid allowing) to F2F for the vast majority of appts. More appointments, better quality healthcare albeit less convenient for patients sometimes.

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BenB

posted on 17/2/22 at 05:21 PM Reply With Quote
quote:
Originally posted by David Jenkins
Mr Whippy,

As someone who was diagnosed with it, I can speak with some experience...

The first check is the PSA test - a blood sample is checked for Prostate-Specific Antigen. If it is very low then it is unlikely that there is cancer. The doubt comes in if it is above normal, as there's always an element of doubt - false positives. However the first check is a digital check of the prostate - I'll leave that to your imagination! Uncomfortable, but manageable. If it feels smooth then the medics will have a think about what to do next, but if it's lumpy then it's almost certain that a biopsy will follow.

The biopsy is unpleasant but, again, not too bad. At this point the medics will have some idea whether there's cancer or not (but it's still not 100% sure). If there are signs of cancer then the next stage is a CT scan, to get some idea of the scale of the tumour - self-contained, or liable to spread. There's a 4-point scale: from 1 = "you've got it, but we'll watch it for now, maybe give you some drugs", up to 4="It's throughout your body". I was diagnosed as level 2, which is "it's self-contained, but it needs immediate treatment". There are other factors to define the level of risk, but they're quite technical. There is also likely to be a scan for bone cancer, in case the prostate cancer has spread (thankfully I was clear on that front).

I ended up with 4 weeks (Monday to Friday) of daily radiotherapy, combined with hormone therapy for 3 years.

I'm now 4.5 years after the start of treatment, and all of the reviews since treatment ended have shown a very low PSA score, so fingers crossed. I guess I'll have another review at 5 years and then, with luck, it'll just be an annual PSA check.

For all males: if you have ANY issues with urination, recurrent urinary infections (my problem), or any other issues with your man bits - GET YOURSELF CHECKED.


Absolutely! Rectal examination and / or biopsy are often not required. It's quite scary to hear what you were told Mr Whippy. I would respectfully suggest that your doctor was talking based upon information from the 1980s. It's true that back in the day PSAs weren't so useful (we didn't get free PSA ratios) and multiparametric MRI scans weren't available so a "prostate assessment" tended to be a digital rectal examination (which was often unhelpful) and then biopsy (which was often done in multiple parts of the prostate in the absence of information to go on).

Nowadays it's very different

1) PSA test with free ratio
2) Digital rectal examination if high risk / required
3) Multiparametric MRI if #1 or #2 abnormal
4) Biopsy only if #3 abnormal (and even then guided by the MRI result so usually just a small number of biopsies rather than the traditional 15/20).

Lots of patients don't need #2 or #4.
PSA screening isn't perfect but it's the best screening we have for asymptomatic men. As you say for men with symptoms it's crucially important to get checked. And it's certinly not worth being put off asking for help due to the fear of things that nowadays often aren't needed (particularly given the risks of ignoring prostatic cancer).

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Mr Whippy

posted on 17/2/22 at 05:35 PM Reply With Quote
Thank you very much David and BenB for taking the time to clarify that so well. None of that I was aware of. Bit of a shame as I asked my GP specifically about it and didn't get anything like as good an answer.
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perksy

posted on 17/2/22 at 11:03 PM Reply With Quote
Very interesting read this gents, Thank you
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nick205

posted on 18/2/22 at 09:14 AM Reply With Quote
quote:
Originally posted by BenB
quote:
Originally posted by nick205
BenB - thanks for your real world input here, valued and appreciated.

From a "customer" perspective with 3 kids getting a GP appointment for 1 of my kids was a PITA and just didn't happen.

In the end we used the e-consult (if that's the right name for it) service where you send in photos and a a written description of the issue.

Result was a phone call from a duty GP, who was on the ball and resolved the issue very well. He didn't (wasn't) say so, but I got the impression he was as frustrated as I was with the whole thing.


ianhurley20 - NHS dentist has been a problem here (Hampshire) too. Emergency appointments only for a long time. When they finally got back to regular check-ups, most people (myself included) needed treatment (e.g. fillings) to make up for the lack of check-ups. Thankfully back to regular check-ups now.


Yup, most of the old guard are fed up with rubbish like eConsults (which is how I spend my days when I'm not debriefing).
Unfortunately things are only going to get worse. When I started as a GP it was a running joke when you asked, in an interview, why someone wanted to be a GP it was always the same "to run a practice and have autonomy over the care I provide my patients". The autonomy has slowly been eroded and now there's a plan to give control over all practices to the local hospitals. So the practice I've spent 15 years of my life turning from a small, dysfunctional practice to a training practice with almost double the number of patients and one of the best reputations of local practices is going to be taken from me and handed over to the local hospital to mismanage? Well I won't be around to see it! Many old school GPs are understandably proud of the practices they run and the care they provide to their patients, to remove this from them and force them to become employees of the local hospital is going to cause a mass exodus of the old guard- who typically are the ones working full time....




Again, thank you BenB for your real world (frontline) feedback.

That ties in with my GP practice I've used for 20+ years. The GP I had for the first 10 years was staggeringly good with excellent "bedside manner". I happen to know he was a major shareholder in the practice at the time. He then retired and the turn over over GP's since has been staggeringly fast and many have not been anywhere near so good.

Whether the practice was taken over by the local NHS hospital trustor not I don't know.

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