Crisis In NHS GP appontmeant services

Practice Acesses : GP group releases 200 accounts of patients using general practice 'inappropriately'

GP support organisation Resilient GP has found examples of patients requesting sick notes to cover up infidelity and booking appointments to complain they had previously been unable to book an appointment for a sore throat that had since cleared up.

Its report sets out to highlight the public’s inappropriate use of general practice by publishing a list of almost 200 GP experiences that the group deemed an ‘inappropriate use of their time and skills’.

The report recounts anonymised and, reportedly, recent experiences GPs have had with their patients, including a formal complaint for giving unsatisfactory advice on emigrating to Australia.

It follows a fierce debate over patient demand at the Pulse Live 2015 conference last week, where Resilient GP co-founder Dr Stephanie De Giorgio told the audience ‘some patients take the piss’.

The Resilient GP report stated that it was ‘now time to ask whether general practice is being used appropriately’.

The survey found a series of inappropriate patient demands, including a woman asking for an operation as her chin ‘looks too fat on Facebook’ and a man asking for a sick note after going on holiday with his mistress.

The report added: ‘These may sound like extreme examples, but they are all genuine, recent events. GPs report that while such requests are not new, they now occur far more frequently.’

It concluded: ‘It is increasingly difficult to justify spending so much time dealing with matters such as those listed above.’

Speaking at Pulse Live last week, Dr De Giorgio said: ‘You can blame some patients, and I am absolutely sick to death of every time I go on Twitter and say something about patients using the system inappropriately, someone accuses me of patient blaming. Until we deal with that attitude we’re not going to be able to have a reasonable debate.

‘Yes, some patients take the piss, quite frankly. They do. And we have to address those ones.’

Former RCGP chair Professor Clare Gerada said: ‘You’re on a sticky wicket to do that. Last week, I was spat at in the face by a patient; they always have and you have to deal with them.

‘But when you have adverts on the back of buses, saying “go and see your GP if you’ve had a cough for 30 seconds”, do not blame them. That’s what they’re told to do.’

Here Are Some Off Comments :

(1) There will always be inappropriate use of GP appointments. However the demand for our time has increased enormously. This makes us angry when we then do not have enough time to spend with patients who urgently need our attention.

Quite frankly I believe we will have to start charging patients. In fact I wonder whether it would be possible to only charge patients when they make inappropriate use of our time. The idea being to educate patients as to what we are paid to do.

(2) No one is blaming patients for being ill but the NHS is a finite resource and its use has to be rationed appropriately. This means we have to talk about this sort of stuff even though it's really hard and emotive. A debate on managing demand is essential if the NHS is to survive, people have to accept the need to triage out unreasonable requests like those above. There are simply not enough doctors and nurses in the UK to meet the desires of a consumer culture so something will have to change. It would help enormously if more of the medical leadership were supportive of grass roots doctors doing their best to bail out an NHS where crisis has become a normal. No is not a four letter word and sometimes it needs to be said loud and clear.

(3) The problem can be solved in an instant. £30 fee to book the appointment, non-refundable, no exceptions. Every other civilised country does.

(4) What about the malingerer who comes in for backache and you see him running on the street in the evening in a park. After months of investigations when radiologist writes MRI is normal and no explanation found for this gentleman's pain, the patient says but I am depressed and suicidal and grins you in the face. Hapless and helpless?

(5) Fees won't work. What if a patient turns up in pain with no money? Turn them away? Not workable.

(6) You couldn't make it up - or could you......you have already told this story Sanjeev =but added a bit extra on this time

(7) GPs report that while such requests are not new, they now occur far more frequently.

What's the evidence for this? I'm familiar with the admin requests, but I say know if it's beyond contract. Doesn't take a great deal of time.

The clinical queries in the list are fairly extreme - I can't recall anything in last 3 months of this ilk. Maybe 1-2 cases per year. And I'm full time, dealing with anything from 40-100 contacts per day.

I have plenty of frustrations with workload (mostly related to political issues) but I don't see this as is our greatest problem.

Also conscious of numerous patients apologising for wasting my time when they patently are not. Far more worried this debate could push some of the needy and frightened away than I am about a minuscule fraction of my workload.

(8) Primary care has expanded its access only in the past few years. This includes non-funded extra hours worked by GPs and funded GP extended hours, walk-in centres etc. Patients have filled this greater access just in the same way as building another lane on the motorway will be filled with more traffic. Yet patients still want greater access to health care. The issue is that 80 to 90% of this demand Is for self-limiting conditions. In the past if you told the patient they had a viral infection It was more readily accepted.. Today patients want second, third or even more frequent opinions during the course of an URTI infection lasting many weeks. Exactly the same for periods of anxiety, depression, back pain etc.

This is the real change and is plainly not affordable. Perhaps charging is the only way. After all this works everywhere else in the world. What makes this country different?

Sounds like any LUNG COPD suffer on a bad day well apart from jokers.

Gawd what would it be like if healthunlocked BlF was not here.

Fills you full of confidence your receiving best care

I belive in balanced view and not all doctors Gp's are angles but unlike the piss taker gps doctors do get away with murder can same be said about piss takers

pulsetoday.co.uk/your-pract...

[bikergrove]

It is the people who abuse our health service that cause a lot of extra work for GP's etc., but how to weed them out or what the answer is to this dilemma i really don't know.

[rememdium]

Dentists make a charge for missed appointments without due cause so why not doctors

[sassy59]

This sort of thing has been going on for years. It happens with A&E because people cannot get doctors appointments and then you also get those who go to see a doctor for no good reason or fail to turn up in the first place. What can GP's do? They are damned if they do and damned if they don't! People are very clever at manipulation of anything and anyone it seems. Fortunately, we are not all the same and some of us actually care about the NHS. Perhaps charging is the future but quite how it would be done? I have no idea. I am sure the Politicians could stick their noses into that debate though.

Breathe well Daz. xxxx

[undine]

I think we have to be very careful here - this all has echos for me - viz. some people abuse the system (whatever public system you like - previously say unemployment benefit, or disability payments etc. - examples are given (as above re patient's abusing doctors appointments) which raise people's hackles 'shouldn't be allowed', 'unfair to tax payers' etc. - public gets wiped up into demanding solutions (well supposedly but usually some sort of behind the scenes pressure is put on to keep examples of 'bad' behaviour in the public eye) and hey presto - this government our 'saviour' comes in with heavy handed across the board solution - viz. introduces unfair, arbitrary sanctions designed to affect all claimants not just the usually about .01% who actually abuse the system - so when I hear above - 'what we should do is charge to see your GP; as a 'solution' to penalize the very, very, small percent that actually do abuse the system I get worried, very, very worried............ thank you for the warning ......... xx

[stilltruckin]

There are about 32,000 GPs in England: bbc.co.uk/news/health-29741142

There are about 46,000 missed appointments a day: england.nhs.uk/2014/03/05/m...

Assuming every GP works a 5 day week, every week of the year, that's near enough 1.5 Did-Not-Attends per GP per day.

Assuming an 8 hour day and 6 10-minute appointments per day per GP, that's 48 appointments per day per GP (of which 1.5 are DNAs).

So in very round figures at least 3% of all appointments are missed.

[katieoxo60]

Hi Daz , saw this post earlier but no time to read, it is a very emotive subject especially , if your the one who can't see the doctor in an emergency. There is no real straight forward solution to the problem is there? Perhaps a small fee might deter time wasters but I doubt it. Abuse of the system is at the root of some of this problem, as are financial restriction another problem, of course if people had to pay up front many would expect a different service to NHS. It costs around fifty odd pounds for a ten minute private GP consultation and much more for a consultants time. There is still the problem too of what to do with less severe injuries or accidents that still need to be seen by A&E minor injuries departments i.e none complex broken bones, asthma attacks,epiletic fits, stitching of wounds, ect. Gps dont have trauma facilities or the staff to make decisions in border line cases or even the time in small practices. Which results in genuine patients in crises not being dealt with correctly and often prolonged recovery from crises. Daz I speak from experience like many others, for example waiting for a broken bone Xray while others are having a splinter removed from their finger in A&E, but hey minor accidents will always happen and the NHS is obliged to see people even if they are time wasting, it's part of the patients right. We could talk till the cows come home but no one has found a reasonable solution so far but the statements in your post are very true sadly, so where do we go from here in order to go forward and hopefully improve this anomaly??