e-Consulting: Hiya everyone, Just a... - Atrial Fibrillati...

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e-Consulting

72 Replies

Hiya everyone,

Just a curious enquiry - has anyones local surgery gone into the world of e-Consulting.

In addition to the normal range of services that my surgery offers but which are almost impossible to access, i.e. a face to face or even a telephone appointment with ones GP ..... my surgery now offers an e-Consulting service.

This is where a patient with a health problem accesses e-Consulting is given access to a menu from which one chooses a topic, i.e. medicine, then fills in an e- form, completes it on the basis of tick a box or a brief statement or inserting a number in a box or a circle. Hits a submit button and is then assurred by a pop up that you will get a response in 2 days.

As I say .... just curious. I used it this afternoon. Hmmmmmm !!

John

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72 Replies
Gumbie_Cat profile image
Gumbie_Cat

Yes, this has been introduced in my local surgery. I find it really good for things like test results, but then I hate waiting on the phone.

pusillanimous profile image
pusillanimous in reply toGumbie_Cat

Surely your doctor phones you with test results and discusses them with you?

Gumbie_Cat profile image
Gumbie_Cat in reply topusillanimous

It depends I suppose. These were simply tests for monitoring levels on a medication, so I’m sure they would phone if there was a problem result.

Barb1 profile image
Barb1 in reply topusillanimous

Never!

Buffafly profile image
Buffafly in reply topusillanimous

Only if there seemed to be a problem.

pusillanimous profile image
pusillanimous in reply toBuffafly

Can you get a copy if you want one? I find it quite fun reading all the results of the various tests in a full blood count and seeing have well I compare to the norm with my own eyes !

Buffafly profile image
Buffafly in reply topusillanimous

Never asked, I would also be interested. Only found out very recently that I was tested for coeliac disease in 2016 - I asked because my daughter was recently diagnosed.

in reply topusillanimous

You can get access to all this on the NHS app linked with your local surgery - you can see results, treatments etc. I least I can in North Somerset but I’m sure this is widely available across the country.

in reply to

Thank you Old Grit. I'll play around with NHS App ...... I'm down outside Hayle, Cornwall ... trapped in my home and village due to the influx of tourists so I might as well do something useful and constructive. However, looking at all these responses in the last few days it would seem to me is that it is a more efficient way for a surgery to perform Receptionist duties, thus freeing off Receptionists for other duties. Dosn't seem to affect the number of, or quality of, the skills of, GP's or their availabilty.

Time someone grasped the nettle and made GP Practices open 7 days a week 52 weeks a year and organise a shift system of work. At street level the NHS just aren't organising work in a meaningful way. Perhaps then hospitals will be able to function without queues of ambulances outside A & E.

😂😂

John

in reply to

I remember I set uk my account on the app then the surgery gave me a piece of paper that I signed … so somehow the surgery did something to make my records available to the app. I’m severely un technical but I managed !

Jalia profile image
Jalia

Yes John, our surgery has e - consulting but I haven't used it yet ! ( surprisingly 🙂)

jeanjeannie50 profile image
jeanjeannie50

My surgery has it, but I can speak to a doctor the day I call if I ring the reception at 8am. I give them an idea of what it's about and then doc calls back within hours. If he or she needs to see me they'll give me an appointment for that day. If you call after 9am, well chances are there will be no talking to or seeing the doc that day.

Jean

in reply tojeanjeannie50

Hi Jean,

Thanks for that. Yep, ours still has that facility based on a 8.30 am phone deadline as opposed to your 8am. The problem is a voice tells you ........ you are 23rd in the queue (or whatever your good/ill fortune is) ! Then if you are patient enough to stay on the phone line a human being will take details and add you to a list for your particular GP, there is no guarantee of a return phone call from the GP that day so you end up wasting a day waiting in for a return phone call that may never happen.

John

😱😱

Buffafly profile image
Buffafly in reply to

Ours has an automatic queuing facility so you get a call back and then go into triage.

SuziElley profile image
SuziElley in reply toBuffafly

Same as ours. Receptionist calls back, she gives a telephone appointment with doctor and he himself calls, usually later the same day.

bantam12 profile image
bantam12

My surgery has recently made it the only way to contact them which is utterly ridiculous.

For something routine or a query then ok but to not be able to phone and speak to someone is crazy.

I’m thinking after 31 years with them I should probably move to a surgery that actually still cares about their patients, assuming there are any left !

in reply tobantam12

Hiya bantam,

Ooooooh ! that is beyond stupid. Our surgery hasn't got to that stage yet - but I think it will happen .... sooner rather than later. Your last sentence ............... I think you'll find it is easier to catch a chicken and pull its teeth than find a surgery that cares .... but good luck in your hunt

😂😂😂

John

GrannySmithgs5 profile image
GrannySmithgs5

Yes , our surgery has ……nightmare ! We now have no choice but but to use the system for pretty much everything. I needed to ask for changes to be made to a prescription, by a GP. No allowance for this so ended up having to go through pages of irrelevant questions for which there was no answer ! No point in trying to speak to a receptionist, they take you through the same system ! Sadly , I just don’t bother now unless critical . No idea how one would manage without the basic technical know how and kit required .

in reply toGrannySmithgs5

Hiya GrannySmith,

Well of all the replies thus far yours is probably closest to my experience with my surgery. About as much use as a chocolate fireguard. Re your last sentence --- thats the view Mrs CarnEuny and I have come to.

I might add, that this post came about yesterday when I emailled a letter to my GP extending to her the courtesy of bringing her up to date with my actions in not just reducing my Bisoprolol but asking for a review of three medications I am on, Ramipril, Felodopine and Bisoprolol........ have never had a review in 12 & half years. Anyway I went through the e Consult process and today I'll deliver a hardcopy of what I tried to send by email yesterday .... and I think I'll continue to do that. I have discovered that modern organisations who embrace the digital/technological world JUST HATE getting hard copies ( which I either hand deliver or send by Royal Mail recorded delivery) ! They HATE IT !!!! particularly if you have a persons name on the hardcopy document.

Goodness knows what will happen next March 2023 when I have to have my annual medical to renew my PCV (bus drivers) licence - a medical by e Consult possibly !!

😂😂

John

baba profile image
baba in reply to

I've hand delivered a letter addressed to a specific doctor. It gets noticed!

in reply tobaba

Yes baba ........... thats my new policy and Mrs Careuny is doing that for me this morning. It does get noticed. I've been doing that in other situations lately with a measure of success. Online stuff is too easily ignored. Too automated, not enough human decision making.

John

CDreamer profile image
CDreamer

Yes - for the last 5-6 years. It’s a rather tedious process but useful for run of the mill stuff such as skin lesions & I have to say they had me in within 6 hours when I submitted a photo of a suspicious lesion.

All my test results, appointments & correspondence also available through links although they all seem to use different apps so I tend to link all with my NHS app for ease of use.

in reply toCDreamer

Hiya CD,

Wow ! Our e Consulting system prevents a patient from submitting photos.

I must admire your technological/digital/computer skills in linking everything to the NHS App .............. to keep boredom at bay I might explore all that.

😂😂😂

John

Rosemaryb1349 profile image
Rosemaryb1349 in reply toCDreamer

No such luck with my surgery, I have been diagnosed with skin cancer (BCC) in 2 places on my back by photograph!! Dr referred me to a Dermatologist about 6 months ago. Out of the blue a phone call telling me to Pick up a prescriotion from the chemist for Aldara cream and use is for 6 weeks. Have done that so phoned dermatologists clinic in Inverness to see when I would be seen only to be told I am not even on the list as they are only dealing with their existing case loads and it might be 12-18 months before I am seen. I asked if I could have a private appointment and was told no, not with them. As I can't even get an appointment with my local GP I'm not sure what to do next. 🤷

CDreamer profile image
CDreamer in reply toRosemaryb1349

That’s terrible! Both my previous GP surgery in Devon and my new one in Sussex both ran Dermatology Clinics with GP specialists - I think because of the overwhelming delays in referrals to Secondary Care. It’s very worrying. Could you possibly look at private referral?

Rosemaryb1349 profile image
Rosemaryb1349 in reply toCDreamer

I think perhaps I may have to but that might involve a long journey down to Edinburgh, at the moment my son, who had to apply the Aldara and take photos etc, says its looking healthy and smooth again just a bit pinker than surrounding skin. He is now working abroad for a couple of months so will see how it looks when he gets back.I might also write a letter to my surgery with my concerns and see if I get any response. Thank you for your reply.

in reply toRosemaryb1349

Well good luck with writing to your local surgery with a complaint. I have found that the only effective way of complaining is to write to your MP in Westminster and request he reply after consultations with the Secretary of State for Health. In my case that blew my local Hospital Trust apart and I got sorted.

SuziElley profile image
SuziElley in reply to

You must have a good MP. Don’t think much would happen here…….

in reply toRosemaryb1349

Hi Rosemary .... So sorry to read this. I rather fear that this e-consulting, of whatever brand, is gonna gather apace - until something goes wrong, i.e. misdiagnosis, wrongly prescribed drugs, failure to organise face to face meetings ......... whatever ......... and the lawyers take over. Then the medical world will come down to earth.

John

Rosemaryb1349 profile image
Rosemaryb1349 in reply to

Our surgery has gone downhill massively owing to the head of practice, who specialised in skin conditions but was the most obnoxious person so that no-one would see him. In the end all the other Dr's either resigned or retired and now the NHS has stepped in and is running it. He is no longer anything to do with the surgery but there is so much damage to be repaired it will take ages to restore order and confidence.

Rosemaryb1349 profile image
Rosemaryb1349 in reply to

I have had a misdiagnosis, wrong drugs prescribed and thanks to this wonderful forum I realised I should have been having regular blood tests for liver and kidneys none of which had been offered for any of the 7 or 8 years I have been taking medication for AF. Fortunately a hastily arranged blood test showed that all was well, but it shakes your confidence in the system.

in reply toRosemaryb1349

Yes, this forum is briliant. I rarely open a post and read it without learning something. Its also forgiving as I realise my post was a bit off topic however the response has been incredible and I hope everyone has gained something from this that would otherwise have been denied them.

pusillanimous profile image
pusillanimous in reply toRosemaryb1349

What's in Aldara cream? is it the same as Efudix (Fluorourasiel) which works like a charm on BCCs. How do they differentiate between a BCC and an SCC with a photo? My husband had a lesion on his neck, so the doctor did a biopsy and sent it off to make sure, and it was a BCC.

Rosemaryb1349 profile image
Rosemaryb1349 in reply topusillanimous

I'm afraid I have no idea whether it's the same as efudix. I have never seen the patches on my back nor can I reach them hence my son having to apply the stuff every weekday night for 6 weeks. Saturdays and Sundays off for good behaviour I suppose 😁

pusillanimous profile image
pusillanimous in reply toRosemaryb1349

Keep up the good behaviour! I googled them both, and they are different classes of drugs., but my experience is with Efudix and it was amazingly effective.

CDreamer profile image
CDreamer in reply topusillanimous

It’s quite clever - they magnify & enhance the photo. If it’s unclear they get you in & then take a photo with their smart phone through a powerful magnifying glass & then send through to a specialist dermatologist at the hospital.

ian16527 profile image
ian16527 in reply toRosemaryb1349

Hi have just finished the Efudix cream treatment for a suspected BCC on my shoulder. There's tow red patches that have been there a couple of years. Its taken a year to get the GP to take some photos and the smaller on has come back as a BCC.I have had to wait another 6 weeks after the treatment to go back and get them looked at which is next week.

Cat04 profile image
Cat04

Our surgery has just ditched E-consult and started a new system called Klinik. Still finding my way around it.

Ronnieboy profile image
Ronnieboy

I think this is inevitable,the population is growing so big in this country now ,plus people are living longer ,many more elderly people living longer,the NHS, is in many ways ,a victim of its own success,.

MyScoot profile image
MyScoot

We've had it in our surgery since covid started. If you have a condition that is not on the list it is a nightmare. I find it often tells me to phone the surgery half way through completing the form. So now , if it about my specific conditions, I just phone up and bypass the form.

Pita profile image
Pita

My surgery has a similar system, no point getting through on the phone as you be sitting there for over half an hour and then the phone goes dead. I have used the system a few times, the last being 3 weeks ago, the doc phoned up and wanted me to come in to be examined , that is the first time I have seen a gp at the practice since 2019.

And this is why AandE depts are over whelmed,bring back Walk in centres,Qualified triage nurses, and let Pharmacists prescribe antibiotics !

in reply to

Frankly, I am very anti NHS particularly since CoVid ( and maybe because of CoVid to a degree) - I believe that it has been seriously meddled with in a deceitful and clumsy attempt to downgrade it in order to save money. I think at a grass roots staffing level they do try and do a good job ........ HOWEVER ........... at GP level the NHS are presiding over one of the most incompetent and inefficient systems of organising work imaginable with most GP practices formed around and are part of a Company Ltd. GP's then tend to hide behind the company. I have spent most of my working life in demand pressure environments in the service sector and we overcame ongoing problems by organising 7/52 shift systems which worked well. Its about time the government took on GP's and forced them into 7 day a week/ 52 weeks a year shift systems in which ongoing training could be factored in.

e-Consulting is not any sort of answer ....... doesn't stop my GP from working 4 days a week.

John

in reply to

Totally agree !

pusillanimous profile image
pusillanimous in reply to

I live in South Africa and see my GP just by phoning and making an appointment, same day if required. I was talking to her about these phone consultations the other day when I went for a new chronic prescription, and she just can't believe a doctor can make a diagnosis in any other way than by seeing the patient face to face. There are so many things to check visually and by palpation. A routine visit always starts with a conversation, the BP, throat and tongue, ears, checked, listening to heart and lungs with a stethoscope, sending you to the next room for a nurse to do and ECG, if necessary, also if necessary sending you to the radiologists who sends the image to her at once and you go straight back to her for the result they as are just down the passage in the medical centre. You go immediately to a path lab , also down the corridor for a non-fasting blood test, Pharmacy in the centre, immediately dispenses prescriptions. And this is in a small medical centre - more serious test are referred to the hospital nearby, For example I went for a bone density scan recently, and they gave my the radiologist's report, complete with images, while I waited, It is all hands on, and long may it stay that way.

CDreamer profile image
CDreamer in reply topusillanimous

I was well treated whilst in S Africa in the 90’s but that was through private health.

The UK has an acute shortage of doctors & nurses, especially GPs so since COVID every request for a Face to Face appointment is triaged, either via E-consult or phone - my experience has been very positive through both although there are often long waits to get through to talk to anyone to ask for an appointment - often there will be a queue of 9-12 people ahead of you - hence surgeries need to become more flexible. Most surgeries here will now have 10-20 GPs + Consultant Practice Nurses, Paramedics & some will offer specialist services such as Dermatology, Rheumatology, Womens Health etc. Unfortunately I’ve not yet found Cardiology as a speciality in a GP practice.

pusillanimous profile image
pusillanimous in reply toCDreamer

Yes, I am referring to private medicine, but we pay for that in much the same way as you pay for the NHS, and as I did when I lived in the UK (I'm a British subject). We have Medical Aid Societies that we subscribe to monthly and there are various plans, Often the employer pays at least half for the employee It is not the same as the insurance the Americans operate, yes our taxes are also used for public hospitals and clinics for those who do not have Med.Aid, but they are overcrowded.

bantam12 profile image
bantam12 in reply toCDreamer

Heavens our surgeries have nothing like that number of GPs or other medical staff, my surgery has at most 5 docs but only very part time, a couple of nurses and an hca ! My local hospital is now cancelling all follow up appts, I had one in Dec and it’s been cancelled with no alternative, letter says “ if your condition gets worse see your GP “, what a joke 🤣🤦🏻‍♀️

in reply topusillanimous

Hiya pusillanimous,

Wow !! .... that is so amazing, just like the olden days I remember from when I lived in Sydney. Come to that the olden days in Britain prior to computerisation of our lives. So impressed I've taken a screenshot of your post. Maybe I should consider migrating to SA (Kimberley) as my ancestors did in the late 19th century ( they even produced a SA Test Cricketer in the early 20th Century - William Victor Stone Ling).

Back to the topic - in my view thats exactly how it should be......... back to basics ..... if you can't get basics correct, why on earth would you think you'd get anything more complicated correct. You make sure you treasure your GP, wrap her up in cotton wool, buy her christmas presents. Well done you. Very glad for you.

John

pusillanimous profile image
pusillanimous in reply to

All the Gps are the same, unless they work in a Government Hospital, they get nothing from the government, so they rely largely on Medical Aid members (see above). They have to offer a good service to put food on the table, as patients will vote with their feet. In the place where I live which is little more that a village, plus the nearby areas, there are at least a dozen practices each with several doctors. The re are several private hospitals where the specialists have their offices, which makes it easy to admit you. In my province we are short of EPs, but on one occasion I visited the Cardio, he said you are in AF, would you like a cardioversion? as I am symptomless I was unaware of my status. My reply was 'since I'm here why not? As it happened I had got my son to drive me to the appointment as I always worry about getting a parking. It was in the morning I was immediately admitted to the cardio ward - early in the afternoon he did the procedure, all I recall is having some patches stuck on me and eating a chicken sandwich afterwards. I phoned my son who was in the area and off I went home. If you go to Kimberley, mind the Big Hole. Hahaha!

Lupaal profile image
Lupaal

Yes, often get a faster reply than a phone call.

Cricket24 profile image
Cricket24

Works very well for us. Call back within a couple of hours from Gp or nurse. Appt or prescription issued as appropriate.

Outtheresinger profile image
Outtheresinger

No E consulting yet but we do have the 8:00 am appointment lottery presided over by “Health Navigators” aka receptionists 😂

in reply toOuttheresinger

😂😂😂😂😂😂😂😂😂 .................. love that " Health Navigators" .... just made my day.

John

dogsneedwalking profile image
dogsneedwalking

Aye I live in Aberdeen and we have had this service for a while now. The first time I used it was when I moved here at the end of last year. Not enough room in the 'box' to explain my symptoms and by the time I had gone through the various other questions it told me to call 999 and wouldn't let me finish. Fortunately I didn't require ambulance of that occasion but you also have to wait for up to 3 days for reply................

in reply todogsneedwalking

Thank you .......... yes not enough room in the box. So, they aren't really serious about being interested in a patients health care. I found the same thing and even if I had a PhD in English Language I could never master the dark arts of writing comments concisely to suit their wretched boxes.

John

dogsneedwalking profile image
dogsneedwalking in reply to

Aye sadly a sign of the times - not always for the better. I think we all appreciate the pressures the Doctors, Nurses, Consultants - even the reception staff who man the phones are under these days, but I believe that's why many of the A and E Departments right across the Country are being inundated with large numbers of walk-ins, etc. I personally try to 'self assess' before I call/get in touch with my Surgery or try the Pharmacist beforehand, but sometimes you just need a human voice at the end of a telephone for that re-assurance not a reply to a e consult several days later.

Belle11 profile image
Belle11

My surgery uses Systm Online for same day response. Or you can phone and speak to the triage receptionist. After a couple of Chinese whispers miscarrying of my phone messages from receptionist to doctor, which resulted in being given the wrong treatment, I prefer to be able to write down my symptoms etc to make sure the message gets through accurately. You can attach photos too if relevant. The doctor then decides if you need to be seen, or phones, sends a text message, may write a prescription, or ask the triage receptionist to phone with a message, depending on clinical need. It seems to work reasonably well, and I understand, enables them to treat more patients.

For test results, registering for their online service means you can go online, log in and see your results.

PollyDoodle profile image
PollyDoodle

My surgery does, but the only time I tried using it, admittedly pre covid, it was so long winded and irrelevant I lost the will to live and gave up! (I'm still here 😂😂) I think, hope, it has improved since then

in reply toPollyDoodle

Polly Doodle ............ thats what they want you to do ........ give up ! less work for them to do! Glad you're still here though.

😂😂😂john

Jenmay profile image
Jenmay

Yes my surgery does econsult, it has worked well so far for me.

Vrouse profile image
Vrouse

Our surgery have been using this for a couple of years and it works extremely well. Its like a triage and they decide if a prescription is required, a visit to the nurse, a telephone appt from a GP or a face to face appt. It stops all the time wasters and make the surgery much more efficient. You also don't have to wait for hours for the phone to be answered.

dunestar profile image
dunestar

My surgery has an econsult system which runs alongside the normal services where you can see a doctor. I've used it a couple of times where I've had questions which wouldn't warrant a visit - eg can I change the time of day I take my medication? so it's useful in that sense. I've just seen my GP and rather than waiting to make follow up appointments with her, which take a while, I'm hoping we can continue a dialogue through the econsult. I think it has it's place but is no substitute for face to face consultations if you really need to see a doctor.

Auriculaire profile image
Auriculaire

I think my GP would be horrified by the very idea of e consulting. Today I phoned for an appointment. The secretary asked if it was urgent. I explained that I had had a tick bite several weeks ago and now had a rash at the site of the bite. She checked my phone no was still the same and said she would call back after speaking to the doc. Within 30 mins she called back with an appointment for 14-30 . Even a prescription renewal ( every six months) necessitates a face to face appointment . The doc checks you over, takes BP , listens to heart and lungs , asks questions about bowel regularity, sleep , digestion etc. Because I have had a colectomy he always examines my abdomen.

in reply toAuriculaire

Wow ! Lucky you............. thats what I've been used to in the past, both when I lived in Surrey and when I lived in Sydney. The point is all this e consulting rubbish is only to make up for the inadequacies inherant in the NHS because they can't organise practioners work. Don't know how to organise work. Most GP practices seem to be private companies who tend to do what they want regardless. Even if staff shortages are an issue work practices can always be organised. Maybe a dose of Industrial Engineering is needed.

Auriculaire profile image
Auriculaire in reply to

I suspect one of the real problems is an acute shortage of doctors due to failure to train enough medical students for years. How many students want to saddle themselves with twice the debt of a normal degree? Also how many European doctors decided that the climate in Britain was unwelcoming after the Brexit vote and decided to return to Europe? The other factor is that the UK is a sick society. Ill health due to poverty and poor diet is widespread and growing. Health inequalities between the richest and poorest are extremely wide. Covid has exacerbated this putting a health service that was already staggering ,due to a decade of neglect ,on it's knees. A Parliamentary inquiry has recently announced that the 37 billion spent on track and trace under the illegally pointed Dido Harding had done no good at all. 37 billion down the drain- and that's only on T&T. How much wasted on useless Personal Protection? A Nightingale hospital that could be built but not staffed? Yet Dido has failed upwards to be appointed head of UKHSA. She might well overtake Failing Grayling in the how to waste public money competition. But this government's solution isn't to stop graft and incompetence at the highest levels in health care. It's goal is to make it even more difficult to access medical care with the aim of forcing people to go private. You see it here often - people so desperate that they will spend their savings just to get seen. I don't exactly feel lucky at the moment as I suspect the appearance of the rash at the site of the tick bite heralds Lyme disease which I could do without! I am apprehensive about a prolonged course of antibiotics given my experience with them in the past.

Johnnycyborg profile image
Johnnycyborg

Yes indeed, my previous GP practice brought it in at the start of covid, I hate it, never put that you’ve got a headache or it’ll tell you to seek emergency treatment. I’m not with that surgery anymore, I found one where you can actually make appointments and see doctors and don’t have to fill in junk like e consult.

Yes, ours does. Almost impossible to get a face-to-face any more and three to four weeks wait for a phone call, so that's about the best we get, really.

jd2004 profile image
jd2004

My surgery used this during lockdown and I found it much more helpful than waiting to get through on the phone for over an hour. I received a call from doc within about two hours. I used it a couple of times, once I was asked to attend surgery using Covid precautions and another time I was asked to pick up a prescription. I think it worked really well but surgery now doesn’t use it, maybe because of cost, I’m not sure. It was simple and easy. Also received an evaluation email after each time.

Hi everyone,

Well, I did use the e Consulting service yesterday which prompted my post ........... today around midday I received a phone call from the surgery (in response to my E consult form) saying the Pharmacist will telephone me on 1 Sept and hold a telephone consultation with me on the issue I've raised about 12 & half years without a medication review - particularly in the context of Bisoprolol. Meanwhile both Pharmacy and GP will have now received my outline of medication issues - via hardcopy, not electronically.

Better than a kick in the teeth, but, if she can allocate ( so I've been told ) up to 2 hours, why the hell not make it face to face ?

The 1 September ....... hmmmmmmm !!

John

DevonHubby1 profile image
DevonHubby1

Our North Devon surgery had been using e-consult for a few years but has recently switched to AccuRx. Used the old system which worked OK if a bit repetitive on the questions. Not used the new system yet. Surgery now also has a robot nurse availablexwhen reception is open to take blood pressures /weight and ask general lifestyle questions which I presume frees up a human nurse to do other things.

Yes, we have it here it North Somerset and I works and if deemed important you might even get a call back or invite to the surgery - it’s a route I’ve used when I’ve missed out on the daily ration of appointments. It works well and is my fall back if I can’t book an appointment on line at 8am which normally works ( I never phone )

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