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British Lung Foundation
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"Dr First" scheme

Has anyone experience of this? My surgery is about to introduce it. You phone the surgery, the receptionist gives you a time-slot when the GP will phone you, and during that call the gp decides whether you need a face-to-face appointment

I am worried about this (a) it seems to be a way of keeping patients at arm's length, and (b) the potential for mis-diagnosis must be huge.

I found a website which listed 7 advantages of the scheme from the GP's point of view, the first 2 being that it enables them to work less and earn more!

My surgery has always been brilliant so I feel a bit like "if it ain't broke, don't fix it", but would be interested to hear other views?

ff x

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28 Replies

I suppose it has advantages for the GPs, mainly saving time. It must be so much quicker to speak to five people and only see two than to see all five. But I agree with your misgivings. Most people tend to play things down anyway, we are far from a nation of moaners on the whole. And if we are saying we have a headache how will he notice the rash we don't mention because we don't think it is connected? And how long will it be before someone else takes over the ringing back? Maybe a nurse (or eventually someone with a first aid certificate?)? It would worry me too.

You've hit the nail on the head - that website actually mentions "doctor or senior nurse". And I don't like the idea of being prescribed a drug without being examined.

A close friend phoned the out-of-hours service recently with abdo pain & vomiting, she is very stoical and wouldn't have phoned unless she felt really ill. The on-call gp diagnosed that old favourite "just a virus". Actually she had peritonitis and nearly died. Scary.

ff x

I once had this with an out-of-hours service. They said my continuing violent sickness and abdomonal pain should be treated with dyoralite (s?). Thankfully my husband took me to A & E. I had a strangulated hernia and was rushed straight into surgery. They told me I would have died before morning if I had waited. You hear so many horror stories.

There was someone here recently, can't remember who, who said the nurse at their gp's said she'd never heard of copd!

God help us all!

It would'nt suprise me if they started to skyp patience

Fairyfootsteps, my doctor's surgery runs the same triage system. It is a pain in the behind! I like to see the same doctor each time which the triage system doesn't accomodate. Most of my doctor's appointments are spent discussing when went on at hospital appointments. So for me it is OK to use their internet booking system which allows me to book appointments a month in advance. Goodness knows which doctor I would see if I needed an emergency appointment. Fairyfootsteps, are there any NHS walk-in centres in your area or out of hour services in your area? They can be good and they do see you face to face. Good luck. Regards Mandy

Mandy, thanks for your input. At my surgery there won't be any advance appointments! It would be no good me using a walk-in service as I have complex medical problems, I just need occasionally to see a gp who knows my history . I manage my conditions well myself but when I do need a gp I like to see the same one (and the surgery has always previously encouraged this). This system might work for some people but I think it will really be difficult for me. It's very unsettling.

ff x

It's very interesting they can list 7 reasons why it would be good for the GPs. I thought the service was there for the patients. I am surprised they had no consultation with the patients ff about this change of service. It really doesn't surprise me - much of the NHS seems to be changing and I am wondering if it has anything to do with GPs taking over from the PCTs. (some of the work will have to go to tender and it is privatisation by the back door is you ask me).

I do think this is very worrying, as illustrated by the posts above. Will it really save a lot of time - medic talks to you on the 'phone and then sees you in the surgery. I think you are right it will end up not being the doc who makes the initial call - makes a bit of a mockery of patient confidentiality.

Really sorry this is happening at your surgery ff. I know you are more than able to fight your own corner, but it is worrying for many: those with speach difficulties from stroke: elderly folk who I have seen come into surgery to be told their appointment was tomorrow or yesterday: to name but a few. Sadly I think this is the way they will go. GPs have already cut out of hours and get paid quite handsomely. I have even heard they are thinking about charging to see a GP.

Love C xxx

I am both upset and annoyed, so am drafting a letter to the Practice Manager, even though I know it won't change anything, I still want to flag up my concerns. When tragedies start to happen (or near-tragedies as with my friend and with auntymary, above) maybe they'll think again, but by then they'll have got used to the extra income and won't want to give it up.

I don't understand why gps think they can earn so very much money anyway without putting in a lot of hours. I heard a gp on the radio complaining of arriving at work at 8am and not getting away until 6! And her problem is? The average annual salary of a GP partner, after practice expenses, is over £100,000, according to the NHS Information Centre. Do they really expect to earn that for a 9-5 job? Grrr.

ff x

We have this system at our surgery, most of the time it is ok and at least if the GP decides he needs to see you then you will be seen that day. Having said that there have been times when the GP has decided that my hubby does not need to be seen and has said things like "take a paracetamol and see how you go", recently hubby kept complaining of headaches, GP decided over the phone that it was stress and told him to take paracetamol, perhaps if he had seen him and taken his blood pressure we would not have ended up in the mess we did.

I will be interested to see how it goes. The only good thing I can imagine is that it might cut down on time wasters, and there are people who go when it's not needed, or people who make appointments and then don't turn up.

Lynne xx

hello i do think that this is a step forward, you can still do the old fasioneed method if you want go in and see them etc, i find that often it is just a formality that they see you they rarely examine me if ever and it is all down to verbale description, of what is the matter,

bye Richard

What a flipping crazy system system of health care we have ?

We all want good health, yes we do, Do we have a right to good health?

By and large I hear nothing other than moans and groans on this site and from other people about the treatment they get from the health service, so if the NHS serves them so badly why would they want to keep it!? I was fortunate enough recently to have some digestive issues investigated at a private hospital which is contracted to my local NHS trust, and the service was superb,treated like a human being, with dignity and respect and the investigation went well too. If this organisation, UKSH can do it why can't the NHS? It is not rocket science, but sometimes is brain surgery:-)

I watched the recent series on tv about the neurology services at John Radcliffe Hospital Oxford, what amazing people they were. And my own son is a 'Grown Up Congenital Heart' with Pulmonary Arterial Hypertension. He has fantastic service from the Bristol Heart Institute.

I met someone recently on a PR course who sadly has Alpha and is smoking, he was in a sorry state- slow suicide for sure, poor soul. :-(

Let's try to ensure we keep ourselves as fit and well as we possibly can and then perhaps many of us will need the NHS less often.

The NHS means a lot to me, I was born on the day the NHS began and worked in it as a nurse for 39 years.

Enjoy this Eastertime folks! Enjoy the chocolate, whoop, whoop! <3

i think it depends on what you are wanting ,the last time i saw my consultant at leeds chest clinic he asked me to consider going onto oxygen i told him i did not like the idea of being onit 16 hours a day,he then he could do no more for me and siad he would refer me back to my gp to do the 6 monthly checks ,i now think i need to go on oxygen ,i ph one for a phone appointment talked to a gp who made me a appointment to see the consultant so it was a good thing for my case i saved me time and the jorney to the surgury,

I just want to reinforce the concerns of those folks who said that soon it would not be doctors who make the decision.

My surgery in Gloucester employs a triage nurse who calls back & makes the decision. The first thing she asks is "Is it urgent?". How do I know.? I know I wouldn't have called unless I felt ill, but I'm an ex-accountant, not a doctor! If I just want an appointment about something routine it can now take 16 working days - and I don't have the choice of doctor, so none of them know me as an ongoing case, let alone a person.

The comment about my being an ex-accountant is relevant too. The practice has cut down on partners and is employing salaried doctors (fewer to share the profits so the share goes up) and is also now offering minor surgery not only to it's own patients but to other surgeries nearby. More profit & less time for patient care! I recognise the pattern from my whole working life - they've been taken over by bean counters!


I think it might cut out some early morning journeys to the doctor though matron comes to the house when going through a bad patch. The unknown is full of fears that must be faced with friends and family supporting the world will not stand still.

My surgery has been using this system for over a year and it proved to be excellent the three times I used it. The doctor called me and we discussed my symptoms. Each time he (or she) left a prescription at the surgery for me to arrange to be collected. It works really well so I wouldn't worry about it too much.

At my surgery you can request a telephone consult. They do not offer it. I have used it more than once when I have known that all I need is a new script and the once I tried it for another problem the doctor told me off by saying I needed an appointment because they needed to see me and they aren't mind readers. As I mentioned a couple of weeks ago my doctor also rang me when it was flagged up that I hadn't called for extra meds for a period of time. Maybe I am lucky with the surgery I use but it is a large one (12 doctors) and you are able to see a doctor at short notice but if you want an appointment with a specific one you may still have to wait. My answer to that though is that if you are genuinely ill almost any doctor will do :)

I do think sometimes we expect too much and are not always willing to say Thank you

Hi Polly

Re your quote: 'By and large I hear nothing other than moans and groans on this site and from other people about the treatment they get from the health service, so if the NHS serves them so badly why would they want to keep it!? '

Personally I have been treated by the NHS since it began in 1948 and thank God for it. The point is we do want to keep it - that doesn't mean we can't question the changes which the government or docs want to bring in and discuss changes such as ff's thread. My concern is they don't throw the baby out with the bath water.

Have a happy healthy Easter.

Love C xxx

At my surgery you can already get a tel appt if you want one anyway, so there's clearly no advantage to patients. We'll just have to hang around all morning waiting for the dr to phone, and then if we're lucky go to the surgery later to see someone.

I have several other health problems, on top of 3 lung conditions, how am I going to explain all that to whichever dr is on the phone that day? I always see the same one, who is fabulous and has really helped me manage my health & stay out of hospital as much as possible, and thanks to my own efforts and his care, in fact I don't very often need to see him!

Like cofdrop I am a huge fan of the NHS & have never had cause to complain about my treatment, but am very worried about these changes.

Frank, GPs are indeed becoming bean counters of course, as part of the CCGs due to start work on 1 April. In my own area, the CCG has only just been authorised, and its website is mostly blank, yet it's supposed to be taking over the budget on MONDAY! What a joke. Chaos usually leads to mistakes, or even disaster, in my experience.

ff x

Recently phoned my doctors (large practice) on a Wednesday was told sorry no appointments available until next Tuesday, tried to explain I needed medication for copd,

told sorry you will have to go to a walk in centre.

My daughter also tried for an appointment for her baby as she had a rash on her stomach, she phoned on a Tuesday and was told no appointments until next week. So I suppose with this new system we would at least get to speak to a doctor at some point during the day. What a mess.

We have just changed our doctor: they were dreadful! Very rarely got to see our 'official' dr (she was part-time, and also seemed to have an awful lot of holidays!) and then got told off by one of the others in the practice for not seeing her (!); they stopped doing 'phone-on-the-day' emergency appointments and started a drop-in clinic (you still have to phone and get a time-slot, which means nothing!) and you sit and wait till a dr deigns to see you (something my husband can't do because of assorted mental health problems); then when you actually get through these barriers and see one of them, they ask what you want. Occasionally you were fortunate and saw a locum, who seemed interested in you as a patient and not a cash-cow! Oh, and for a non-emergency appointment you'd have to wait anything up to 3 weeks!

Thankfully, our new practice so far seems up to speed :)

Jude xx

Yes, ours do it and that is why my husband was given steroids after steroid without being seen and also given the wrong antibiotics as the doctor never did a sputum sample. My husband had to ask for it and the doctor said, what a good idea. The sputum sample results came back and stated he had been on the wrong medication all the time.

Our Matron has now told us to go to her for anything we need, and we ask the specialist, when we see him, to send a copy of the letter to her as well as the GP., because when there are quite a few GP's in a practice you never know who has seen the letter.

Have words with your Patient Participation Group if you have any queries about the practice.

my surgery near bristol follows this practise. you cannot make an apt at all in advance with a doctoreven for follow up apts. you canmake\apts with nurse for bloods and bp etc, We have to phone by 10am and ask to speak to dr of choice who will ring back within 2hrs and decide if we needto be seen or advice or prescriptions\given without being seen, For later apts we have to ring before 1.30pm and again the doc of your choice contacts you back within 2hrs. It means you have continuity of care and are seen on the day if you need to be seen. The only downside is as i work sometimes it would be good if apts could be made in advance for follow ups etc. All in all it seems to work

My surgery has now adopted this system...and I don't like it. Mostly for the reasons that everyone else here has expressed. I want an appointment time that suits me because I don't have transport and so either have to walk???or stand around waiting for a bus??? This is hard to do on the spur of the moment, or impossible if too unwell - in which case they have to come to you - and they don't like that. I also feel the doctors just don't want to see us. The only way to make an appointment here is with a locum GP and fortunately there is a very good one who used to work there full-time.

I hope my surgery don't start doing this. I have my fave doctor but don't mind 3/4 other ones. But there are a couple I will not see under any circumstance.

I thought doctors had to see you within 48 hours? Or have they changed all that now?

Bev x

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