Letter to GPs to remind them that patients can see their GP if they need to

[holyshedballs]

Classification: Official

Publications approval reference: 001559 To:

• •

NHS England and NHS Improvement Skipton House 80 London Road London SE1 6LH

GPs

Clinical Commissioning Groups

14 September 2020

Dear GPs and their commissioners,

Many of you will be aware of reports by some patients that they are experiencing difficulty

in accessing their GP for needed face–to-face appointments.

We are writing to reiterate the importance of providing face to face appointments for those who need them and to share materials designed to support your clear communication with patients about how they can access the right type of appointment for them.

We know that the vast majority of practices have made significant efforts to remain accessible to patients through the pandemic, and to keep staff and patients safe.

However, it remains critical that information for patients about how they can access services is clear, encourages patients to consult where necessary, and that face to face care always remains available when clinically appropriate, provided in line with these requirements.

With that in mind, we have created the attached communications toolkit. We would be grateful if all practices could review their communications to patients across the board, in line with these recommendations, and you may need to ensure that reception and other staff are aware of the key messages.

It is important that no practice suggests in their communication that the practice is closed or that the practice is not offering the option of face to face appointments.

Classification: Official

We will continue to provide public messaging through the media and campaign materials which explain how patients can safely access healthcare services and the importance of coming forward with any health concerns.

As would normally be the case, local commissioners will investigate any complaint from a patient that they are being refused face to face consultations when there is an identified need, or that they are being directed to Emergency Departments inappropriately.

All practices are reminded that adjustments should be in place to ensure that those who find it difficult to engage in virtual consultation are able to access the appropriate care.

As set out in the phase three letter, we are calling on all parts of the NHS to ensure patients know how to access the care they need. Thank you for your continuing efforts to restore GP services while preparing for winter, including delivery of our most ambitious ever flu programme, and providing high quality and safe services to our NHS patients.

Yours sincerely

Dr Nikita Kanani

Medical Director for Primary Care NHS England and NHS Improvement

Ed Waller

Director, Primary Care Strategy and NHS Contracts

NHS England and NHS Improvement

2

[nellie237]

In the past 3 months I've been into the reception area at my GP surgery about 8/9 times. On 3 of those visits I saw one patient waiting to see a GP. I think the letter was 'lost in the post'

I heard/read something a few weeks ago about 'official figures' estimate that there had been 32m fewer appointments. - I expect that was during the 1st lock-down.

Does anybody see their GP face to face anymore?

[shaws Administrator in reply to nellie237]

No I haven't had a face to face appointment. - it was all phone consultations for myself and husband. Not so effective, I believe not to have a face-to-face appointment.

[nellie237 in reply to shaws]

I agree - nowhere near as effective.

[Ellie-Louise in reply to shaws]

Plus it feels rushed on the phone, you certainly don’t get your 10 minutes that’s for sure.

[Cheese14 in reply to nellie237]

I haven't seen a gp in over a year. My last appointment was nearly a week after a gp consult. Was on my record as face to face. My appointment was actually a telephone call nearly 2 hours after given time. Disgraceful. Had blood test the other day and was told by a nurse,they Don't see gps and no idea where they were, Office or working from home and things didn't look to be changing any time soon

[nellie237 in reply to Cheese14]

I don't get given a time - fill in an e-consult and up pops "You will receive a telephone call or text by 6:30pm tomorrow"

[Cheese14 in reply to nellie237]

That's what a I got, then the go I wanted to respond wasn't there for 3weeks so was passed by a gp to another gp and a time put down which apparently I shouldn't have been given. Hence the later call

[nellie237 in reply to Cheese14]

Its new for the surgery staff too I suppose. Every time I've been to my surgery the admin staff have been very, very busy. It does seem crazy not to give an appointment time though. I don't think that is very efficient at all.

[Dee-ivy06 in reply to nellie237]

Iam like that but I work and can't get to my phone they should work around the patient,when we can speak to them.majes me angry

[Cooper27 in reply to nellie237]

Most GPs are as busy as ever but holding video appointments instead of face to face. I had a video appointment with my GP a month ago, subsequently went in for blood draw but was the only person in the waiting room then.

[nellie237]

I hope that you are OK Scrumbler.😟

[Ansteynomad]

We have been told that there will be no face-to-face appointments for the foreseeable future accepting very exceptional circumstances. However, just what those exceptional circumstances are is not clear. I have a number of health issues and have not been able to see a GP face-to-face for over a year now. All communication with the surgery is over the telephone or via intercom to the receptionistsThe surgery doors remained firmly locked.

[holyshedballs in reply to Ansteynomad]

Dont accept that. us the letter to tell them you want one if you need one!

[Timetraveler67 in reply to Ansteynomad]

I know what you mean, I had a painful abscess down below and rang and begged my Dr to please see me as I could hardly walk and was in so much pain, he told me to send a pic of my private parts because he would not see me. I refused to send a picture as I didn’t feel comfortable doing so. He sent some antibiotics to the pharmacy for me to collect. I’ve come to the conclusion that unless it’s covid related they don’t want to know.

[nellie237]

No, it isn't clear. Up to a point I can understand that our GP's need to be protected - we don't have enough of them, and can't afford to lose them. Locked doors seems a bit extreme though.

[Mionaonthehill]

I don’t even get a phone call. Fill in the eConsult form and usually get a txt reply. But I have good news to report - the missing GPs are alive and well and I found them when I had my Covid jab! Actually ran into my GP who didn’t know me because he’d never met me in person before so I introduced myself.

[Bearo in reply to Mionaonthehill]

So GPs are giving COVID jabs? I wasn’t sure about that as there are a lot of volunteers at vaccination centres. That would explain a lot - but it hasn’t been communicated to patients.

[birkie]

Hi holysheadballs.. 💗

Don't know about seeing your gp it's a real pain trying to see an endo, I was diagnosed last Aug with hyperparathiyroidism ( history removal of thyroid in 2018 after diagnosis of graves) I've been struggling with the meds, but I'm on T3 only now and seem to be tolerating them.. (I'm lactose intolerant so some of the meds did not work for me especially T4) I still had these awful symptoms which at first my gp and endo put down to the thyroid meds.. Then they did full pannle blood test and found high calcium and high PTH.. I've been given 2 app both of which were phone consultations, my gp requested face to face as I have a slight swelling on the left hand side of my neck. I've now received a face to face on the 2nd june😩personality I don't think I can wait that long, I had this condition in 2003 but they did a wait and see approach and never followed up after they said my levels were normal, I have now found out I have ostiopein of the spine, ostioporosis of both knees and ankles and were in hospital last year after passing a kidney stone.. All symptoms of untreated hyperparathiyroidism 😠 I now know the only cure is to remove the offending gland or glands, why do doctors and endos feel its OK to let you suffer 😩😩😩

[Mionaonthehill]

Birkie yes I’ve got that too. GP refused to send me to an Endo for two years but finally referred me and I have an appointment end of May!

[birkie in reply to Mionaonthehill]

Hi mionaonthehill. 💗

Can I ask you how its affecting you, when I was first diagnosed in 2003..i never knew anything about the condition and believed everything my gp told me. The endo and gp did a wait and see approach several weeks later my test came back as within range, I never asked to see the results as then I was blind to what you can ask for at your surgery, I tried to carry on but could not, no further bloods were done for pth or calcium. I moved surgerys and the new gp sent me to Newcastle where I got a diagnosis of ME/fibro cfs.. I lived with this till my thyroid failed in 2018 then removed due to it being toxic in 2019..more blood work last year in Aug showed high PTH and slightly raised calcium the endo wrote to my gp saying I have hyperparathiyroidism, his only treatment was to put me on vitamin D, this has brought the PTH down but my calcium has shot up to 2.80..range 2.10..2.60....anytime my calcium goes up I feel awful, I've got an app for June 2nd as I said, doctors have just rang today saying they are trying to bring this appointment forward and a face to face.. Crossing finger this happens, leaving patients with hyperparathiyroidism is not good as it ravages and destroyes the body, I've had really bad headaches the last 2 weeks and bad body pain.. My heart is pounding to and I'm never of the loo also I drink loads to... I hope you manage to get sorted at your appointment in may

Good luck💗💗

[Mionaonthehill in reply to birkie]

It’s difficult to say because a lot of the symptoms of hyperparathyroidism are similar to hypothyroidism so I am never sure which is which to be honest. Like you mine was discovered by accident. Long term outcome is not good if you don’t have it treated so it’s good you are finally seeing someone. Good luck I hope you get the treatment you need.

[birkie in reply to Mionaonthehill]

Hi

Actually I find my symptoms reminiscent of hyperthyroidism especially the sweating which never went even after thyroidectomy, I had the same symptoms in 2003, so I knew it was hyperparathyroidism before my gp did, as when I had the full blood panel last year I told my gp the symptoms were like hyperparathyroidism I had back in 2003, I also can tell when my calcium is high and my last blood draw I told the new gp he would see a high calcium, and he did... He called me back for a double appointment, he is the one getting the ball rolling for me, 👏👏👏

[Niteflite]

I have been having telephone appointments with my doctor and was becoming increasingly frustrated and depressed with how they went. She said she would like to see me so I had a face to face last week. I managed to say just about everything I had been bottling up in the over half an hour appointment (!) and I came out feeling so much more positive. Although we didn’t agree on everything my dr accepted my concerns and took me seriously. I think it’s really important to actually see the doctor to hopefully have a good relationship with them.

[annnsandell]

The difficulty is when they say need, not how that need is defined. Our GPs are hiding mainly at home but you will get a telephone appointment. Plenty of nurse appointments for blood tests. Actually saw a GP the other day for my vaccine, probably paying them more to do that. No physio face-to-face appointments just telephone, my husband has been waiting nearly a year. As you can hear very critical of the current situation.

[endomad]

In France Drs seem to be working as normal. I picked up my t3 prescription 6 weeks ago and he said 'lets do your covid vax while you are here' I am 60 with no risk factors so i was gob smacked. I hear in uk drs are just not seeing anyone, a customer who has a history of heart disease has only been given telephone appts in last year, no examination or blood test, told he was fine on the phone. He collapsed recently and rushed into hospital and now on waiting list for surgery, his prognosis is not good. No way of knowing if out come would have been better if seen by dr or referred to his cardiologist promptly.

[holyshedballs]

If I can somehow I'll attach the pdf of the letter. it really important to show the surgery that the NHS wants face to face consultations if they are necessary.

[FancyPants54]

My busy but rural medical centre has been brilliant throughout. I've had an ECG, several blood tests as I monitor my thyroid and a face to face with the practice nurse. Can't fault them.

[holyshedballs in reply to FancyPants54]

That's great!! just shows how it can be done. I had a blood draw for monitoring thyroid function done in a surgery. all COVID compliant.

BUT they're different when it comes to a Vitamin B12 injection.

[FancyPants54 in reply to holyshedballs]

Really? Why? That's odd. My surgery did the whole winter flu vaccinations in what was slick military style. It was so impressively carried out I felt like applauding. The building was opened up. You were told to arrive on time, not early or late. Walked up to the open entrance where a woman zapped our foreheads whilst another with a clip board asked a couple of questions and pointed to the doctor you were headed too through the glass wall, into the waiting area (where there were 3 doctors stationed far apart), up to my GP, sleeve up on the way in, needle in before I knew what was happening, out through a corridor and the fire escape. Never touched a thing and the ventilation was complete.

[birkie in reply to FancyPants54]

Hi fancypants54💗

Yes it is diffrent in surgerys, mine is a very small practice in a very small town, I had thyroid removal in 2019 not done to good on the mixture of thyroid meds they had me on,, no consultation face to face just blood work saying see doctor but just a phone app. But my gp and the nurse were doing covid vacations. Anyway I took charge and now I'm doing great on T3 in other words I'm tolerating it, its OK seeing the nurse for the blood drawn, well they can't do a thyroid blood pannle any other way, I have had a few bad blood results concerning high calcium and parathyroid hormone, so I have been able to see the gp in these last few months, but still have never seen an endo even after thyroidectomy! They keep saying that they are snowed under, I have now received a letter saying I have an endo app on june 2nd a long time to wait with hyperparathiyroidism, its really strange as my endo in Newcastle who I spoke to last month said his department had never been quieter 🤷‍♀️ makes you wonder what's going on with some surgery's and endo departments 🤷‍♀️

[Dee-ivy06]

I find the receptionists can be very rude,

[birkie in reply to Dee-ivy06]

Hi Dee-ivy06💗

I just sent my surgery a letter stating that very thing, in my surgery its very hard getting past the receptionist for appointments and print outs of blood work, the last time I had a run in with one was in connection with my thyroid meds I was to increase the amount so my prescription would need amended, she asked me in a quite condescending tone who had said I should increase my thyroid meds... I'm afraid I was not so good with my answer, she got me on a very bad day, I said I'm sorry but that's my business and when did you become a doctor.. 🙈.. Hence to say when I come in to the surgery she is off with me, I couldn't care less lady... 😠

[Hidden]

My gp surgery is very small 3 Gp not all on at once mind you but fir some reason we have 13 part time receptionists 2 nurses each do different things like blood test draw s the other does b12 n other medical routine things I have never yet seen the surgery with more than 2 people in waiting room that's before covid now you havent got any hope of actually getting to see a GP it's not acceptable if the nurses had to do b12 injections and blood draws still throughout covid why now cant GPs get back to work face to face some things you need to show them in person

[Immie]

So my 85 year old parents GP practice closed when the original lock down began, it opened for a couple of days to do flu vacs in Oct 20. They shifted all medical appt to other practices which now means I have to transport my parents to any GP/nurse appt, a 75 mile round trip for me!