No politics please!!! And no slagging off GPs either please
Article is here: bbc.co.uk/news/health-61598158 which mirrors a recent post and rebuttal by myself with a lot of similar info provided. I was reluctant to post this but patients orgs like ourselves are concerned about access to appointments in a timely matter and were aware of vast geographic differences. But this article shows the detail and the scale of the issue.
There are places with unsafe patient to GP ratios. But you can also see appointment figures are going up year on year. So lets see what peoples thoughts are but as it could get political and there will be strong views please be mindful of the responses. Also please read the article first
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desquinn
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I'm the same. I have to go through the complaint procedure to get an appointment. I ring at 8am and I get cut off. I ring at 8:15 and the answer phone says no more appointments for today.I make a com then I get an appointment.
How can you keep on top of your health if you can't have an appointment?
I think we must be very lucky here in Wales , well at my surgery anyway, we can book appointments online to see which ever Dr we want at a time that’s suitable , if we ring in the morning we can get an emergency appointment the same day , we were mainly telephone apps during covid, but seem to be back to normal now with face to face.
I live in S Wales. I can like you get an appointment on the same day if I ring by 10am but they are still reluctant to do f2f unless it’s deemed necessary 😔
Wish we could at mine, been registered 2 years and all I have seen is the District Nurses for the Covid and Flu jabs.
We only have one surgery here though, so it's difficult. Just glad I don't have anything really pressing. I can make it through with Ibuprofen and Vitamins, but I'm starting to get arthritic, so I will need to try soon.
I'm in Nottingham. I changed address last year so I had to ch my GP too. I ended up from a very good surgery to a very bad one. I can never have an appointment. I have to write to the manager or go to the out of hours GP
Things were getting very dicey at our surgery with often being in a very long telephone queue and many times being cut off just before you were getting to the top of the queue. Once through they always ring you back either that day or the next morning but actually seeing a doctor face to face was another matter. Actually my doctor apologised for asking me to go into the surgery!
Lately things seem to have got better at our particular surgery. Unfortunately, twice in the last 2 weeks I have had to ring the surgery and twice I have managed to get through within 5 minutes. I have been promised a ring back and both happened before 12 and a prescription sent to the pharmacy which could be picked up after 4. The two practices that seem to have more availability around here are teaching practices as there tends to be more doctors based there. Ours is one of them.
I live in the West Midlands where I know there is a shortage of GP'S but fortunately not as bad as those places named. Many people at nearby practices are having to wait 3 weeks to see someone after they have actually managed to get through on the phone in the first place. Quite a few were being told there were no appointments available and to ring back each day to see if there were any cancellations. They were told there were no doctors at the practice that day or their doctor had gone part time.That is after waiting on the phone, often for 45 minutes. No wonder people in those circumstances end up at A & E.
I've often seen been able to seea senior nurse practitioner if a doctor wasn't available as I have found them excellent for things like urinary and chest infections as they will always refer you to the doctor if necessary. Again not every surgery has a senior nurse practitioner.
It's actually the lack of NHS dentists I'm more worried about.
The rules on this site and our forum do not allow for political discussions as it tends to end in arguments. And this is a support group so we can do without them
I could do with a bit of ranting about politics. Once I start there is no stopping…I stay away from politics in real life even though all my qualifications one way or another leads to politics.
I always wanted to be a Prime Minister….hahaha…wishful thinking 💭 with fibro 🗣
I have every sympathy for GPs. Despite it being a potentially rewarding job, there must be a reason for the shortage. I suspect the pay and/or the conditions are not right. It could also be frustration with not being able to treat patients in the way they feel is correct. Let's face it, there's no shortage of people queueing up to be politicians! Having said that, I would have been able to free up a lot of the appointments I've had over the past two years if I had been listened to and believed the first time instead of having to go back again and again and again with the same health issues. If you listen to any patient group talking about their condition, they all say the same thing... how long it took before their condition was diagnosed and any treatment offered. Perhaps part of the problem of not being able to get an appointment is due to people with chronic conditions having to keep going back with the same problem, often over many years, before they are believed that they know their own body and something is wrong. There is only one GP practice for my local town and surrounding villages. You can get an appointment, at an inconvenient time, if you book a week in advance. Sometimes it is possible to get a quicker appointment but you won't be given a time, you have to have your phone with you and the GP will ring at some point. It's a longer wait if you want to speak to a named GP and I haven't yet worked out how to get the mythical appointments that are after 5pm. The system discriminates against people with cognitive problems, those who don't have a smart phone or can't use one and people who work. I think the problem with GP numbers is political - you can't separate the two.
in reply to
Wow.....spot on xx
in reply to
many GPs only work part time from 1 -3 days a week.i have experienced the same-if doctors listened to their patient and addressed their problem ,patients would not need to "keep going back",i have had symptoms for over 10 years and no diagnosis.cant even get a telephone slot with gp.because when call when surgery opens the phone is engaged and by time do get through all slots are gone ,told to call back the next morning only for the same to happen again.
I find all this very scary. I have a difficult relationship with doctors anyway, partly because of abuse I suffered from a doctor as a teenager (not really bad abuse just to be clear) but also bc I have social phobia so I find phone calls much harder than face to face. As a consequence I hardly ever call them unless I'm desperate.
Trouble is we're all human and if the job ends up being horrible we'll get fewer and fewer GP's, plus Brexit employment complexities and the length of time it takes to train a GP. If the jobs not attractive bc of new pressures I couldn't blame people for not wanting to become a GP.
Hope that's not political, not sure if it is or not sorry, tried not to be.
desquinnPartnerVolunteerFMAUK Trustee in reply to Cat00
its a hard line to walk but I am okay with it and on the point of job satisfaction I have just heard about a further study on the news about increase in abuse and attacks on GPs and their surgeries. Have seen "attacks" on here where there is understandable frustration and then as you and Hidden says our condition and other chronic illnesses piles more pressure on the patient.
But the GP is not the enemy. And as per this report and other previous stats and surveys show there job is not easy and if they are doing 3 days NHS work they are still doing 60 hours a week with paperwork!! They are self employed and all the hassles that brings as well. Plus they need to be compassionate and effective and not kill people accidentally. There will be some uncaring ones but I have great empathy for the situation they are in at present and they are doing their best. More consultations than in previous non covid years but how the banging of saucepans and Thursday night clapping has been forgotten. They need more......
Yes we have to look after the people we need. I know that if someone's horrible to me I become less compassionate towards them as a way to protect myself, I don't see why doctors would be any different.
It's also hard to look at who to blame bc we often want it to be one particular group, nice and simple, but the reality is it's rarely like that. Usually it's many different groups and things that build up over the years in small incremental ways that no one directly notices until there's a tipping point. And then we find ourselves here.
Hi there, I live in Worcestershire and after a lot of hassle to get a dr phone consultation I was really unhappy with the way I was spoken to. I was told giving me advice on pain meds for fibro was harder than giving me the winning lottery numbers. He said there are no real meds for fibro and that it’s a mindset condition. I spoke to the practice manager who apologised, said they are so short on doctors and suggested a different doctor. I spoke to him. He referred me for physio (suspected plantar fasciitis) and that was it. No follow up appointment about trying new meds etc, and this was with the recommended dr! So 6 weeks later I’m no further on with any physio or anything. Thankfully the physio I’m doing myself is starting to work. I decided a few years ago to manage fibromyalgia myself other than physio appointments but it is getting to the point where the pain is affecting my job so I had to seek help.
The system of phone queueing to be told there’s no appointments left and being expected to take a call at any time of the day is not manageable for me as I can’t answer my phone at work but can’t get calls on my days off. Patient Access (online booking ) worked well for me but they said they can’t reinstate it yet although they had secured a new doctor at the practice.
This is one of the things I find hardest, having to have the whole day free to receive a doctor's phone call. I've had to discuss the problems with my bladder standing in an asda car park with a 3 and 6 year old. I've had to shout at a phone while driving down the A14 with 2 kids and a family friend in the car, again about bowel and bladder problems, trying argue for a referral which I didn't get. If you miss the call that's it, they must get a lot fewer calls bc I don't phone them very often bc I find it so stressful.
I saw this online myself and looked to see if I could find any statistics for Scotland, where I live. I couldn't find a similar by area map but I did find a BBC article, from 2019, saying that there were - at that time - an average of 58.1 GPs per 100,000 people in England and 76.2 in Scotland. A big difference! My family all live in the south of England. Those in the south east are particularly hard hit, finding they simply can't make GP appointments without waiting weeks. If they can get through - for a while the local surgery was asking patients to leave message on an answerphone, and then no one calling back! (if it hadn't been a fully lucid family member telling me this, I don't think I would have believed it) Other surrounding practices don't seem to be much better and their 'local' A&E (a 45 minute drive away despite the fact they are surrounded by major centres of population) can be full of people just not able to see a GP.
Contrast this to my situation. If you call in the morning, you will wait in a phone queue - anything from a minute to 10 minutes - and then can ask to speak by phone to a GP that day if necessary. The practice is, however, finding recruitment an issue and it may be a trainee in the very last stages of their training (forget what these are called), before they qualify as a GP.
In terms of waiting times to actually see someone face to face, I don't know - Covid threw everything up into the air. But generally within a week, or on the day if it is deemed urgent but not life threatening.
However mine is a really good practice and I think the recruitment/retirement crisis is going to noticeably bite over the next few years. Equally, I imagine that getting a GP appointment in a major Scottish city is rather more difficult.
I lived in Germany for a few years, some years ago, and I saw first hand what a better funded and staffed service looks and feels like. We need to change our approach in the UK - for patients, and for the staff who continue doing their jobs under conditions I wouldn't fancy at all.
If it's any consolation we have the same problem in some areas of France. They were not training enough GPs due to quotas and it is a liberal profession so they can install where they like and not necessarily where they are needed.
Hi, this article doesn’t come as a surprise and I am glad it has been made public.
I’ll try & break this down so that my post isn’t too long. I live in England.
I belong to a not perfect, but well run practice, but it wasn’t always like that. As you have pointed out Des, GP’s are self employed, and as such, responsible for for all their spending. However, they can’t always do what they would like to do in order to help their patients..
They have to stick to the N.I.C.E. Guidlines. In other words, the first thing is to listen, that is why most GP’s use a telephone first appointment system. Then they decide what has to be done next (according to N.I.C.E.) , start with the simple, then go up the treatment ladder if that is required. For example, if you go along complaining about headaches, which can be due to all manner of things, they don’t right away send you for an MRI scan, but bare in mind, if they are at all worried about you, they should refer you to A&E, or on a “three week referral) system”.
Not only do they have to stick to N.I.C.E. guidelines, after going up the Treatment Ladder, and the patient still has their headache, they might wish to refer the patient either to a Consultant, or for a scan, they then have to get approval from the area (C. C.G ) Clinical Commission Group . So although self employed, they are not free to do what they think best. at the time.
These rules weren’t always in place, they came about in the last 10 or so years, so read between the lines.
There is a shortage of Drs, nurses, dentists, social care workers, and other medical personnel, and along with that, we have the fallout of COVID 19! For the most part Drs want to help their patients. There always was, and always will be bad Drs who shouldn’t be Drs, but on the whole Drs are trying to get us all up and running as best they can under the broken NHS system that they are working under.
I see the lights on in my surgery at 9 o’clock every weekday night, the staff are doing all their paperwork, and making referrals, and often talking to Consultants about a patient, seeking advice from them, while the patient is on a long waiting list to be seen by them.
The telephone first, and Triage, is hindered by amongst other things, not enough telephone lines. Getting more lines put in is not always easy in older practices, and then the staff to answer them.
Our Practice has worked out a system that uses, telephone first, you can get an Emergency appointment same day with Duty Dr, or if you want your own Dr within 3-5 days.
They use a booking system using telephone, on-line, and Facebook, allocating so many appointments to each, the idea being to free up telephone lines for patients who wish to phone in. You can also email the surgery if it is just an inquiry about something..
It came as a shocking surprise to me to learn that in our surgery, despite such shortage of appointments, there can be 30-40 patients each month not keeping their appointments and not informing the surgery! There are notices put up all over the surgery about abuse not being tolerated and in our area all of the Emergency Personnel have seen increases of abuse, both physical and verbal.
I don’t think we will ever go back to the way we were before the Pandemic, and for myself, I have decided to work the best I can with what is available. I have other Medical conditions as well as Fibro, and all the usual problems that come with getting older.
Work with your Dr and Practice staff. Speak out politely if you’re not happy, and ask questions, ask are there other treatments available, try and build up a partnership between you & your Dr. Be honest, and speak out politely as to why you’re not happy. If still not happy, write to the Practice Manager, that can sometimes sort out problems very quickly. If all else fails, complain to PALS, or NHS England, or Medical Council, or even speak to your MP.
Final point is that it hasn’t helped in the least that N.IC.E. Guidlines has altered the Treatment Ladder about prescribing Opioids for Chronic pain conditions, and it has been reported that some Drs have just cut off supplies without consulting their patients, there are guidelines about safely stopping Opioids. At the moment there are thousands of signatures being sent to Parliament about this change of treatments, so let’s hope our voices will be heard.
Once upon a time, medicine was an art. We remember fav Family drs with a comforting 'bedside' manner. We have grown up since then. Drs seldom do home visits of course yet that attitude of confidence and the care taken was as healing, maybe more so than the Jollop doled out.
Drs could decide how to treat individual patients. Now they say, I can't do this or that, for fear of being sued for not following NICE. I fear that kind of response. NICE said my eye drops were too expensive, dropped from the list. There were others the same but cheaper so they told my GP to prescribe these. He had no clue so did as he was told. or his secretary did? What a waste! NICE were wrong and the NICE unpleasant 'know it all' lady that argued I was wrong, was wrong. So much fuss and expense because NICE know better. Had I meekly agreed to take the other drops, I would have been risking my sight. Probably though, I'm the only one that's been given different and wrong meds because NICE know best?
I get the impression from folks in the medical profession many are tired of interferance. Inteferance that gets in the way of caring successfully for their patients. Early retirement is tempting. Gp's are well paid, so going early is certainly possible for them. And when they feel conflicted in their work, leaving earlier is healthier too.
You know you are so right in what you say. Our Drs are being pulled right left and center from above. A lot of our NHS is being run by Private Companies, and profit comes first.
I know and sympathise about the eye drops. After I had a Cataract operation, my eyes became very dry, and my Optician said I needed a particular eye drops on Prescription. I asked if he could let my dr know and I could get a Prescription. He said he would let my Dr know but I wouldn’t get them on Prescription, even though because of age I get free prescriptions. In our County the CQG won’t allow it, but if I lived over the border and into the next County their Drs could Prescribe them there! I now pay £14. 50 for the recommended eye drops. All in all I put out about £40-50 each month for products that my Dr says I need but cannot now get on Prescription because of rules from above..
I decided a while ago that if I didn’t want to make my BP higher, and my other problems worse, I would try and work with all the changes that have been made since before and after Brexit and COVID.. That doesn’t mean I don’t question anything, I do.
The Drs that we have are doing the best they can at the moment, and medical magazines with tempting adverts luring them to sunny Australia can be very tempting.
Hello Greenpeace, can I please ask you what the eye drops on prescription are? Also which eye drops are you paying for now? I too have cataracts and have suffered with very dry eyes for years. I’ve been prescribed Hylo Forte eye drops by my GP but get no relief. Many thanks, take care
I can’t even get Hylo-Forte on prescription- it’s been taken off the prescribing/ pharmacy list! Now have the ‘generic’ Evolve HA’ drops. Apparently the same, not in my opinion grrr
I get one 10ml bottle a month, don’t last and in my opinion aren’t as good as hylo forte( which I buy when I can!) I’ve tried evolve carmelose drops , also on prescription but they didn’t do much.
Optician has recommended ‘Visulix’ or something similarly spelt.. not yet tried.
My ophthalmology appt has been deferred x4 due to ‘unforeseen circumstances’ as per! Am so fed up of waiting. Luckily my optician is local and is pretty thorough .
Just a quick recap. I have had Cataract replacements done in both eyes
I suffered with dry eyes before I had the Replacements, but not too badly, & I used over the counter eye drops.
I had the second replacement done just before first lockdown in 2020, and wasn’t able to get my follow up at 6 weeks. When I did eventually get my follow up, I was told everything was good, but my eyes were very dry.
My Optometrist said I needed to use eye drops daily, and he would let my GP know, but they couldn’t be prescribed & I would have to pay for them myself. I asked him what I should use, and was told Theoloz Duo. I can buy them without Prescription, and at the moment I pay £14.50. He stressed that I should only use eye drops without Preservatives in them.
Gonna hop in here. Hope that's OK? Getting the right drops seems to be trial and error and super expensive now even if you usually get free presriptions! I use Thealoz Duo. (impossible to get locally and expensive, but good. Simple formula. Comes in 20ml bottle or individual doses.) There is also the Thealoz Duo Gel which the online pharmamcy often get confused with which are thicker, and for night time use, but don't suit me.
It's frustrating that drops seem to have been dropped from the prescribing list. They are not a luxury. If we don't take care, our sight will suffer which will result in more expense. For some there is the option of the cheaper drops, and creams, but others of us (because of all the additives) are stuck with needing the expensive ones. There is a huge difference in price.
Before I found my preferred drops, my eyes were irritated 24/7. I had to get savvy and realize I was allegic/ sensitive to multiple ingredients. Imagine putting lanolin in drops and not asking if the patient is allergic? It's a common allergen. The preservatives are also problems for some and contraindicated if you use drops frequently through the day. (cant remember but if I think if you reapply hourly they are not recommended as they furthur dry the eye. Go figure!) Also, if you still have issues, look for PEG. That can be an issue for some.
I think I sort of knew all this and I really do feel for GPs but it doesn't help if you have to tell your story over and over again as you speak to a different time rushed GP each time (and they haven't had time to read your notes). I am actually trying to manage my pain holistically and have asked for referral to a physiotherapist. The first GP I spoke to said 'NHS physios aren't much good, you're better off going private' before refusing to refer me as per the NICE guidelines. The second GP flatly refused to refer me and offered painkillers. The current NICE guidelines, as you have stated, are now suggesting an integrated approach that is not going to involve taking painkillers routinely. I have, as do they, a letter from a consultant saying that I have fibromyalgia. I think my local practice is looking for the cheapest options as the practice is run by a practice manager and the GPs are employed by the practice - I guess it means they have their hands tied. This explanation was given to me by the physiotherapist I have to pay for privately. She tops up her NHS pay by doing private work on her day off.
I have just joined a new practice so can not give my response to waiting times or ease of getting an appointment but the reason I have moved is because of the vast number of people my old practice was covering due to my original practice closing as it has become as shambles two practice’s were merged in our town I know this as my partner and I were at different practices but the doctors did not all want this so left and went on to different places or retired This made the practice under staffed
Then it started to become unworkable and appointment’s suffered the medical board were looking in to provide solutions to cut a long story short with out knowledge to patients it closed all we had was a letter informing us patients had been moved to a new practice about 7 miles to the next town so that left one practice in our town the one I have just moved to and my town is according to the map you showed is in a yellow zone with more surgery’s of over sixty nine to over seventy so I think that this database in out of date
16,823 is around the population for our town with one practice serving the amount of population and a staffing level of around 11 doctors to well over a thousand patients to one doctor they do have the work load
So on looking at this map I can not believe that this database is not really showing the full extent of the problem
After covid we have lost a large amount of doctors and nurses this is going to take time to rebuild and needs the government to have a reality check brexit and covid have happened and we lost a lot of work force in all sectors but unfortunately until this is properly resolved no amount of data showing the problem will result in the government’s head in the sand tactics the nhs has other services affected by lack of staff the dental care system is shot to pieces due to dentist not being able to run business on the money the government are paying for you nhs treatment the cost of the work and the payment falls far short so dentist are out of pocket and unfortunately they go out of business as can’t sustain the over heads you’re nhs payment you make and the part payed by government don’t cover the cost of treatment so if that’s the case is the government really got a grasp on the fundamentals of running the country ! I think not.
So here I am hoping that the move I have made serve’s me well fingers crossed
I do wish they would put the whole of the UK in these graphics........
Cheers, Midori
desquinnPartnerVolunteerFMAUK Trustee in reply to Midori
they cannot do it as they only have the stats for England. Then it is the apples and oranges debate as Scottish stats may measure it differently with different metrics or data points. And then the time they are taken. Devolved healthcare, FOI issues and just plain old data sanitisation make it very difficult to achieve.
desquinnPartnerVolunteerFMAUK Trustee in reply to Midori
I am probably in favour of it as well but worry about unintended consequences. Recent check-up post operation mentioned that a missed hospital appointment cost was £135 but they were fine to rearrange mine when I had accidentally transposed the time and date. Nice and easy to change.
If I am unable to get to the appointment, I always call and let them know, then if the have a waiting list they can call another in, It's the ones who totally waste the Surgery's time by just not turning up that grinds my gears.
Those I would like to fine. If restaurants and dentists can do it, why not GPs? Are we subtly telling them their time is less valuable than ours?
Don’t know if this would help I have now got access to online service patient access ask your surgery if you can set this up as can book appointments through these services I just done the app and it is linked to my surgery and it gives you options to book face to face appointment can link medication management and so on medical advice and has a lot on it you can tailor it your preferences give it a go i and going to 😄🤓🩺
I agree with so much that Greenpeace has said, in particular work with your GP; you are after all a member of the team that's looking after you......do ask questions, & yes, always remain polite. Show your GP respect; ask them what they think first, then counter, if needed, as to what you think, & why.
As far as the NICE guidelines go regarding chronic pain, then this is divided into primary chronic pain (that which has no clear underlying condition), & unfortunately fibromyalgia is the first mentioned here, & secondary chronic pain due to a known underlying condition such as osteoarthrosis or rheumatoid arthritis.
Hmmm, I don't know why fibro isn't recognised as a condition in it's own right after all these years. Possibly prior research into fibro wasn't considered sufficiently robust, or, 'as search terms for the evidence underpinning the recommendations in this guideline, along with more general terms that describe studies in chronic pain populations' were used (nice.org.uk/guidance/ng193/... then fibro may not have been linked to chronic pain.
I know when I was searching the medical literature some 20 years ago to find evidence of a neurological condition associated with the disorder I have (Ehlers-Danlos Syndrome) I only found one medical paper mentioning one patient with both disorders. Now the association is well recognised; well definitely in the USA at least!
However, opioid use is mainly successful for acute, rather than chronic pain whether it's primary or secondary chronic pain. Of course anyone taking opioids should, if deemed necessary, be slowly tapered off these.
I haven't consulted my GP for about 3 years; the last time I saw him I mentioned I was having to migrate to PIP, & he immediately said I'll write you a supportive letter...... I hadn't even asked.
In Wales, the NHS is separate from England and run by Health Boards, funded by the Welsh Government. We have no Hospital Trusts or CCGs. Everything in an area is run by the Health Board. Prescriptions are free for everyone, and parking at hospitals is free. The good news stops there. Primary care is similar to England, - under pressure. Secondary care in hospitals is far worse though. We have a 5 year waiting list for new hips and knees, the worst ever. It's no wonder the private hospitals are doing a brisk trade. The wait for a first appointment for a new fibromyalgia patient, at a NHS pain clinic, is 46 weeks. In England the target to see someone is 18 weeks. In Wales the target before Covid was 26 weeks. For someone in pain, 6 months was a long time to wait. Now you would wait nearly a year. In Wales we do not have the Choose and Book system for hospital referrals. You go where the NHS decides to send you, often for those in rural areas, 40 or 50 miles away from where you live. You get no choice.
The amount of money spent on the NHS across the UK per head of population is now similar to other European countries like France and Germany, and the NHS employs more people than it ever has in its history, so the problem is not funding or resources. It's the way the NHS is organised. Hospitals are under intense pressure all year now. Out of office hours, they are the only part of the system with the lights still on, so patients turn up at A & E, when what they need are out of hours GP and Community Services.
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