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Sick/elderly have to wait outside in the cold for up to an hour before a GP surgery opens - help me write a complaint!!


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I’d be ecstatic if someone knocked on my office door and said “here’s the solution to your capacity issues” but we know it doesn’t work like that. Imagine that, “there you go TAI, there’s the keys to a new building that’s big enough to house everything you need to do and there’s no big maintenance costs creeping up on you, we’ve found 2 extra experienced GP’s for you too, and a telephone system that can cope with the influx of calls that doesn’t cost £30,000 then there’s a total re-jig of the GMS contract too so you can afford to recruit enough people to help out and what’s best is that we’ve re-educated the patients about how to manage self-limiting illnesses, fixed the benefit systems so that the most vulnerable people in society don’t need constant exactly dated Med3 sick notes, made prescriptions free so that people can afford their medication and we’ve bolstered hospitals and social care too so that you’re not having to surrogate those services as well. Enjoy...”

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think about it - why is England the only place in the UK that has to pay for prescriptions ?

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It’s a good question CitB, I’m in Wales so I can only assume that it’s a policy decision as both devolved nations offer patients free prescriptions. Interestingly enough we’ve recently (as in about 10 days ago) been told not to prescribe OTC medication because it represents such as massive cost to the Welsh NHS but is remarkably cheap to buy. So your 19p generic paracetamol would cost the NHS perhaps £10 by the time you factor in dispensing fees.

 

We also offer a pharmacy led minor ailments service here in Wales which provides all of the medicines we’ve been asked not to prescribe for free. It seems the driving force is to take the coughs, colds, lice and yeast infections out of our waiting rooms for the first treatments (always with the caveat that the patient should seek a GP opinion if not improving) and into pharmacies where the per-consultation cost is significantly lower.

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My Dad used to be deputy director of recuitment at our NHS trust...

 

There simply is not the GPS to fill all the jobs hence the current shortage of slots

 

And to be honest some are employing GP'S they really wish they didn't have in desperation (told to me by receptionist of local gp surgery after making complaint - autistic daughter who went in with anxiety issues was told 'unless it's a cold or the flu I don't want to know' by gp...)

 

The only way to fix it is solve the NHS crisis which none of the parties seem bothered about

Please note:

 

  • I am employed in the IT sector of a high street retail chain but am not posting in any official capacity,so therefore any comments,suggestions or opinions are expressly personal ones and should not be viewed as an endorsement or with agreement of any company.
  • i am not legal trained in any form.
  • I have many experiences in life and do often use these in my posts

if ive been helpful kick my scales, if ive been unhelpful kick the scales of the person more helpful :eek:

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I read that some gp's are now doing 15 mins appointments instead of the usual 10.

just a side, as it was mentioned on thread (eg #49).

:)

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I've seen a chart (Health and Social Care Information Centre) which shows that, in England at least, (full-time) GP numbers increased year on year from 2004-2009, fell very slightly in the next 3 years, but has since returned to 2009 levels.

 

However, the number of GPs per 100,000 population is lower than 2009. The population is growing faster than the number of GPs. Probably faster than any other country in the EU.

 

All other countries in the UK spend more per head on health than England. Although Wales has shown the greatest decrease over the years, it's still higher than England. Health spending, however, continues to grow. So more money, just less to go around.

 

 

I thought Mariner51's suggestion of the first hour being a walk-in surgery was a good one. Can anyone suggest why this would not work? Those that couldn't be seen, could queue up at the desk to make a 'proper' appointment or take their chances the next day.

 

Only one question remains, do you get many people with lice in your surgery TAI?

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Hi Sali, quick answer first - Yes, mainly because the over the counter treatment for them is expensive and seeing as children share head lice in a heartbeat in the school environment it’s a very common request.

 

Secondly, first hour open surgery is unmanageable in the most part, say for example 20 people are waiting at the door but if we’re using at least 10 minute appointment then with two GP’s you only have capacity for 12 patients in that first hour then the remaining 8 are either turned away or you have a 40 minute delay starting your scheduled appointments at 10:00 am.

 

The whole idea of the appointments system is that it acts as a safety net with regards to capacity. First hand experience of an open surgery was not pleasant - arrived at 08:00 with poorly child, gave his name at reception and then waited until 11:30 in a waiting room with other people who may have communicable diseases trying to keep a 5 year old who was decidedly unwell calm and relaxed. No, open surgery is wholly incompatible with the needs of our patients, the requirements of employers (instead of taking an hour off you need at least a half day) and it can put the practice in a situation that it cannot control. That’s why we don’t do it.

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Yes, I can see why mothers would want to save cash.

 

I'm still not convinced that the first hour would not work well as a walk-in in some circumstances. My GP practice has 13 doctors, so a few could carry on with the standard appointment system.

 

I'm a rare visitor to my GP, but I have suffered the torture of the eternally engaged tone when trying to ring for an appointment. If there was an option for a walk-in with the understanding that I may not be seen, but would be able to make a later appointment at the desk or try my luck another day, I'd take it. What's important is setting the patient expectation and giving them options.

 

This is not doing away with the appointment system - it would still operate as normal the rest of the day - it's modifying it to suit the patient need.

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Boris's request later today for an injection of £100M/wk is risible.

Even if UK donated all of GDP to NHS, in few years this would insufficient to maintain current service levels.

The rationale for NHS was access to GP/hospital services free at point of use.

We need an interpretation that such action is permissible.

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Mariner, it's an interesting point

- however it's not borne out by the data available.

 

For example, in 2016 the NHS accounted for 6.6% of GDP, in comparison with 7.4% in the previous year, 2014 accounted for 9.8%.

So, we've seen a 3.2% fall in terms of the percentage of GDP over those few years.

 

I'm the most ardent supporter of the NHS however even I could not reconcile spending 100% of our GDP on healthcare, especially when that would account for a 15 fold increase in current figures.

 

So, is Boris' suggestion so far out of whack?

Well, it would seem that a figure 3.5x the one he's proposing was good enough when it was printed on the side of a bus in 2016, so why the concern?

 

His proposal is the addition of £5.2bn to the NHS budget, the current deficit is said to bee in the region of £800m so, that's more like £4.4bn in terms of 'new money' which accounts for 0.268% of 2016 GDP. That brings the total NHS spend to 6.868% of GDP. A country mile from your concern over 100%.....

 

Facts are the new punk rock.

 

sorry, it's wrong of me not to state my sources:

 

https://www.kingsfund.org.uk/

https://www.ons.gov.uk/

http://www.health.org.uk/chart-nhs-spends-about-eu-average-percentage-gdp-health

 

Also BBC, Financial Times and cracking online percentage calculator that saves me having to open excel at this late hour.

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The USA (and other countries) spend more of their GDP on healthcare than the UK. Who wants a system like theirs?

 

I'd like to know where the cash is being spent and practical and imaginative ways to save money, rather than just throwing more and more money at the problem.

 

Missmermaid, as far as your letter is concerned, yes, send one to the practice. However, unless all the staff are sneaking in the back door like rock stars, they are fully aware of what is happening. I'd involve the local MP and newspaper too.

 

You are in the trade TAI. Would you just step over the bodies or would you think of ways to resolve the problem? Say it was your mum or your nana stuck out in the rain?

 

Would you not spend some time finding out why these people feel they have to wait outside before the surgery opens? Cannot get through on the 'phone, the telephone numbers are premium rate, have no access to the internet or don't know how to use it?

 

The 'cake' has always been too small, but I would expect those in certain positions to at least look at ways of ensuring everyone has equal access.

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Being ‘in the trade’ you’d think that I might have explained some of the issues earlier in the thread. Oh wait, I have; at length.

 

‘Stepping over the bodies’ or acting like rock stars as you put it is not what we do; instead we arrive at our nationally agreed opening time, unable to control the actions of those who arrive any earlier than we do.

 

So, as I’ve said at least twice already:

 

1. if we were to open the doors any earlier then people would arrive earlier to be at the front of the queue.

2. Fair access is what we do, everyone has the same opportunity as anyone else to secure an available appointment.

3. My colleagues and I, regardless of the emotive language used cannot simply create capacity in a system that’s being bled dry.

4. Open surgeries DO NOT WORK – I honestly can’t be bothered to type out the reasons for a third time.

5. We cannot control the number of times someone presses redial on their telephone clogging up the lines.

6. Our funding does not stretch to employing n+1 reception staff and then equipping them with n+1 phones to answer every single incoming call at 08:00.

7. Never mind my mother. I too am registered at a GP practice and go through the same process as everyone else to book an appointment.

8. Surgeries were banned from using premium rate numbers in 2011.

9. What do you think we actually do with our time other than try to ensure that we’re operating as well as we possibly can?

10. What do you think the newspaper will actually do? Make us pull that doctor we’ve been hiding in the cupboard out?

11. What do you expect the MP to do, other than be complicit in the systematic defunding of the NHS?

 

We spend every blinking waking moment worrying about the size of the cake, because sometimes we have to take a slice too. We don’t ignore what’s happening and pop our blinkers on as we arrive at the practice but there’s only so much we can do, only so many ways we can slice the cake.

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I love it.

TAI says “I wish I had the answer. I’m doing the best I can with what I’ve got, and believe me : if there was an answer I hadn’t tried that I though would work I’d try it. If you think you have an answer that will work, suggest it”

Others : “answers that won’t work”

TAI : “here’s why that won’t work, but I’m still open to viable suggestions”

Others “it could be because the staff are rock stars.

Will no one think of the children? (Well, in this case, ‘Will no one think of the elderly?’)

 

A vastly experienced GP in the practice I’m registered with has just retired early.

If he could be cloned, many of the problems of the NHS would disappear. He wasn’t perfect, but was caring, passionate about patient care, and both highly skilled and highly experienced.

He just got fed up (I asked him if he was going to ‘locum’, and he said no : as that too came with all the baggage that were his reasons for taking early retirement)

 

“The beatings will continue until morale improves”. Just how much “beat up the practice manager” is needed until they, too, start to look towards early retirement (like that GP, who was someone that you’d really want to keep!) or non-practice manager jobs?

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It’s a good question CitB, I’m in Wales so I can only assume that it’s a policy decision as both devolved nations offer patients free prescriptions. Interestingly enough we’ve recently (as in about 10 days ago) been told not to prescribe OTC medication because it represents such as massive cost to the Welsh NHS but is remarkably cheap to buy. So your 19p generic paracetamol would cost the NHS perhaps £10 by the time you factor in dispensing fees.

 

We also offer a pharmacy led minor ailments service here in Wales which provides all of the medicines we’ve been asked not to prescribe for free. It seems the driving force is to take the coughs, colds, lice and yeast infections out of our waiting rooms for the first treatments (always with the caveat that the patient should seek a GP opinion if not improving) and into pharmacies where the per-consultation cost is significantly lower.

 

 

Many thanks for your response - apologies for the delay in replying.

 

 

I did notice a memo on the surgery notice board regarding a lot of OTC medications and what will no longer be available or not to request them on prescription. I guess if it can be purchased from a chemist/supermarket then it shouldn't be prescribed. Although I do worry that some people will go that route and perhaps not then ask for advice from the pharmacist or GP when it might be necessary that they do.

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PLEASE DO NOT ASK ME TO GIVE ADVICE BY PM - IF YOU PROVIDE A LINK TO YOUR THREAD THEN I WILL BE HAPPY TO OFFER ADVICE THERE:D

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20 years ago when I first registered with the surgery I attend, I am sure there weren't half the problems that they now have.

 

 

The surgery was staffed with 4 Partners - and a couple of locums. There were 4 Nurses + a Diabetic Nurse and I am not sure how many administrative staff + 2 Practice Managers.

 

 

I dont recall ever having a problem seeing the Doctor of my choice and within a reasonable period of time and the GP would give as much time as was necessary.

 

 

Over the time since, our small village has grown considerably with new properties being built on every square inch. Most of the farmers have ceased employing local people and started to employ migrant workers - these apparently are required by law to register with a local GP even if they dont live in the village which most of them dont as they are usually bussed in. Since several of the neighbouring villages have lost their Surgeries for one reason or another - the surgery in my village has taken up the slack there.

 

 

The Surgery staff are now...

 

 

1 x Senior Partner

1 x Partner

3 x Salaried GPs

2 x GP Registrar (what are these) ?

4 x Managers - Practice, Deputy Practice, Finance and Dispensary

3 x Practice Nurses

2 x Health care Assistant

15 x Dispensers - 2 of them being a Receptionist/Phlebotomist

6 x receptionists

2 x Secretaries

3 x Data quality/Administrators

1 x Administrators

1 x Driver

1 x Housekeeping

 

 

A couple of years ago, I believe along with the local hospital being put in Special Measures (whatever they are), the surgery had to suspend some of their services until they were improved!

 

 

The average pay for GPs working in the Practice in the last financial year was £53,329 before tax and national insurance. I am assuming that this doesn't apply to the Partners.

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Advice & opinions given by citizenb are personal, are not endorsed by Consumer Action Group or Bank Action Group, and are offered informally, without prejudice & without liability. Your decisions and actions are your own, and should you be in any doubt, you are advised to seek the opinion of a qualified professional.

PLEASE DO NOT ASK ME TO GIVE ADVICE BY PM - IF YOU PROVIDE A LINK TO YOUR THREAD THEN I WILL BE HAPPY TO OFFER ADVICE THERE:D

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2 x GP Registrar (what are these) ?

 

To become a hospital consultant, after finishing medical school a doctor will spend :

2 foundation years (what used to be house officer and year one SHO)

A few years as a “core trainee”, then

5-7 years as a Speciality trainees (what was Registrar and Senior Registrar, then it became “Speciality Registrar”, and is now “Speciality Trainee”).

 

Of course, it takes time to become a specialist.

Yet, a GP is a specialist ; they specialize in being a GP.....

 

So, for GP, after foundation years, they can try and get on a GP training programme, but will often need to undertake more training before GP training.

GP training is 3 years (a total of 18 month hospital based, and 18 months GP practice based)

 

Those based in the practices during those 3 years of GP training are GP Registrars. How else did you think they became a fully qualified GP? What did you think happened “between the end of medical schiol and being a fully trained GP”?

 

At one time they were known as “GP Trainees”, but it wasn’t unheard of for patients to mistakenly believe they were still medical students from that description.

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Yet, not a day later and the BBC report:

'Undervalued' GPs fuelling a 'crisis'

http://www.bbc.co.uk/news/uk-england-42905115

 

Even measures to boost numbers entering training (a good ‘soundbite’ !) won’t compensate for GP’s leaving now, as:

a) takes at least 2 years from start of training

b) training will produce a qualified GP, but not one with the same years of experience as those leaving ......

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Should of instigated the surgery method when I was working i.e. Oh! coach loads for food, turn them away, as I only have ten minutes to prepare serve their meals, Emergency situations = need emergency actions,

 

Back to Hey Germans we are on T break catch up later, GPs leaving now = well their choice hope reflects in their pensions

:mad2::-x:jaw::sad:
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Did you get coach loads turning up, at start of business, every day of your working life?

If you did, at least your employers could have said “hey, we should expand the business”, and had the possibility of doing so.

Practices don’t have that option, as TAI has pointed out.

 

 

“Emergency situations” : yet it isn’t an unpredictable emergency.

 

It is every working day. Predictably.

Any patients with true emergencies (needing urgent action to prevent / treat a life threatening event) will either be seen or should have an ambulance called for them and treated until the ambulance arrives.

 

They may call them “emergency appointments” as in urgent / unplanned, but to say “it’s an emergency, just get on and cope with it” is daft.

Are you really saying they should do that? Stop doing any of the “routine” appointments to just see “emergencies”.

All those “routine” appointments will then either rebook as emergencies, or not rebook : Some of those who don’t rebook will then deteriorate and need to be seen as emergencies, or deteriorate, become more unwell long term and need to be seen more.

 

Be careful what you wish for. We are back to “the solution to not enough cake isn’t to slice it differently”.

Nor is it to have a situation that means your most experienced bakers retire early.

Of course, the bakery managers are getting it in the neck too, as clearly the issues in the surgeries are all the fault of those uncaring practice managers who have so many options available to them, but just sit in their offices twiddling their thumbs.

 

“Last one out, please turn off the lights.”

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