Who is supposed to do what

I have AF and I have had an ablation. So i have an EP and I saw a cardiologist before that. But my GP doesnt seem to be interested in anything to do with the AF and certainly isnt looking to see if there is a cause. I keep seeing others say their GP is looking at this and that.

Anything i say they just say we will be led by your EP. EP says your GP needs to investigate. There is no joined up thinking

Are your GP's looking for what could be a cause - if there is indeed a cause?

14 Replies

  • I have seen numerous GP's and they have nothing to say about my arrhythmias. The last one that I asked whether my EP should do this or that said "What's an EP?". That sums up my GP practice. They are great at many things, were a godsend when I had Shingles in my eye recently, but with AF they are dangerously useless. If they think you do not know about the condition, they over-reassure to a worrying extent. If they think you do know about it, they will not comment.

    I ignore my GP's when it comes to arrhythmias. My EP does not rely on my GP at all except for repeat prescriptions. If he did I would tell him how out of touch they were and if he still insisted on that route, I would either change my GP, or my EP.


  • I think most GPs know what AF is in theory but have not got any in-depth knowledge. Most practices are too busy for them to start looking at any one patient in huge detail I guess, which is a shame (not least for us).

    In some ways, looking for a cause implies looking for a solution. I wish it was the sort of condition where you could stop doing something or take a tablet and everything would be okay... There seem to be all sorts of possible causes - extreme exercise for instance. Other people (like me) may well have a family tendency. Others have other heart conditions. Plenty of people never know exactly.

    I guess we are all looking for solutions, ways of keeping this at bay, but I don't think GPs are the people who are going to do it for us sadly.

  • There is no cause as such. AF happens to some people for no reason. Others may bring it on by over exercise or binge drinking but in most cases it just happens. Events can sometimes be reduced by diet or life style changes but these are not cures. We all present in different ways and suffer likewise.

    The man or woman who actually finds a cause will be very famous. In the meantime we rely on ablations or long term drug regimes for control of symptoms and to be honest GPs are really at the bottom of the food chain where this is concerned. Few have any real understanding of it and how it affects our daily lives but things are improving very slowly. Twenty years ago you would have been told it was a benign nuisance and left to your own devices. 8 years ago the link with stroke was noticed and now we have stroke prevention by anticoagulation but still many GPs shy away from dealing with this.

    I say as always we need to become our own experts on AF if we ever want to progress.


  • You're not on your own.

    My GPs are next to useless and I have no faith in them. I showed one an alivecor tracing and she said 'I'm afraid I don't know anything about ECGs'.

    There is no ECG machine at my surgery, no blood tests ( I have to make an appointment at the local hospital) and no GP with a 'heart' interest or any other special interest. They also don't know what an EP is. I found my EP myself.

    Another GP at my surgery once said to me 'and what do you want me to do about it?'

    This is why I didn't want my EP to refer me back to them even though he's had to now. Although he's referred me back to the GPs, he sent them a letter asking to refer me back to him in 9 months time. I think this is a way round the NHS pressuring consultants to refer patients back to their GP after a while.

    GP are no substitute for specialists.

    Some very lucky people on here seem to have good knowledgable GPs who take an interest and care about them.


  • Might I just add my two pence worth in agreeing with the general opinion re GP's knowledge, and add Cardiologists to the list, at least in my limited experience. Whilst not doubting their abilities in general, and the fact that surgeries and departments are seemingly overworked and understaffed,and as Pat says, you have to be very lucky to find a GP or Consultant with a good knowledge of, and the time to concentrate on any one particular patient's AF problems.

    Like a lot of others have done, at the start of this year I booked myself a consultation with an EP privately, and armed with his report, started to get refered to the right people in my area, with at last a plan of action and far more knowledge of my condition, than I ever had in the three or more years since I was diagnosed.

    I suppose in truth, the same probably applies to most medical conditions and always has done as they are discovered, and treatment or cures are developed. It's all down to cash and training, so I suppose I have just scuppered my own argument.

    Hope you are all having a good Sunday.

  • Kernow, I don't think it is just about cash and training. Each to their own. Cardiologists are plumbers. EPs are electricians. You wouldn't ask a plumber to re-wire your house would you? Nor a general builder./odd job man.


  • Would not argue with that at all Bob, it just appears that there are so few of the "right people" to go around and that must make it harder to get the right time and treatment from them when you need it.

    I think I must have had the odd job bloke for a bit, but things are looking now.


  • meant to say looking up now, senior moment....

  • Bob. Some people do get in the general builder / odd job man to do electrics and then wonder why it is a mess or causes problems!!!!

  • Oh yes, I bought a house like that once. Darn near killed me when I found an open live wire under the floor boards!

  • The co-ordination of care is a big problem (I had an ablation and thyrodectomy). Some months ago my GP made an unguarded comment and asked 'So who is co-ordinating your care?' to which I replied: 'You are'. Ever since he tries to do just that. Perhaps worth mentioning these magic words, and insisting, and if necessary write to the chief your NHS trust.

    'Co-ordination of care'

  • I think that we all need to remember that GPs are independant practitioners and are NOT employed by the NHS, in effect they run as a private business. Therefor the local NHS trust has absolutely no control over GPs - that is the way they like it and personally I am with them although there are limitations with any system.

    My understanding is that your GP enters into a contract to supply certain services for which they are paid between the local Comissioning Council who hold a pot of money given to them directly by government. The hospital system is directly funded unless it has NHS Trust status in which case it has a governing body and more autonomy.

    This means there is no direct line of management between hospital services and GPs, hence a lot of confusion, especially for patients. Your GP has 'buying' power so what comes out of whose budget is sometimes relevant in accessing what a patient needs eg NOACs. EP may prescribe but GP practice will not pay for them.

    My understanding is that there is no direct cause of AF but there are contributing factors such as poor diet, lack of exercise, high blood pressure or other medical conditions such as thyroid, being overweight and smoking and drinking. I wonder if this is what your EP might be suggesting your GP investigate? If this were the case it should be in the report letter to your GP.

    My understanding is that your GP is a specialist in General Practice to consultant status, but will have their own special interest so unless your GP has a special interest in arrythmias he/she will always refer to your specialist's advice, usually sent in writing and which you should be sent a copy. If you don't receive copies of correspondence ask your hospital to do so and your group GP practice.

    Hope this throws a little bit of light on the subject, best wishes CD.

  • My main GP is very good on the AF, tachy but hopeless on my lung problems. It is a fact that GP's believe it or not are Human too, and do not know everything? I have new GP's check my right lung and seem bemused that it is not making any noises. But if they read my notes they would know that I do not have any lung to listen to half way down where it should be. I had my heart and lung consultant argue in the same room about the change of tablets. The Lung man won but was hit with "It will not make your lungs any better?"

    Persevere with another GP if they have one?

    Be Well

  • All GPs vary...just like AF sufferers. My GP is always very interested in what is going on with my AF and shows a good grip on the basics of the condition. He recently attended a discussion hosted by one of the top Cardios at our hospital and was telling me what he had learnt about AF and its treatment. He is happy to monitor and adjust the drugs I take and the hospital are just as happy for him to do so. It all works very well. I guess there are GPs out there, who, for one reason or another, are just not willing to look into AF in detail.

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