[Closed] Reasons you can't see your GP when you want...#32

Completely dismissed me on the basis I rode me bike in and riding on a regular basis.

I had an irregular heart rhythm a few years back and was on a 24hr recorder. Although they did tell me not to have sex that night as it "messes up the recordings", they didn't tell me I couldn't ride my bike. So I rode in to the hospital to have it removed the next day and got thoroughly scolded by the nurse 😳 Still don't really understand what the problem was - don't they want a representative sample of what I usually do?

You need to raise this with the practice manager - this sounds like a phone line fault (auto switching error) and is actually a significant critical incident for the practice. They may not be aware of it....

DrP

Obviously you live on a different planet to your patients Doc. As you may have noticed there is little sympathy for your no show predicament. Most peoples experience of a GP's surgery nowadays is pretty damn negative.

Appointment system: Phone after 8:30 to make an appointment fot that day. Really ****ing helpful if you happen to have the discourtesy to work some where else and start before 8:30. My experience is once I actually get through, which on average takes no less than 18 minutes of constant calling, the answer is invariably I can get you in in 15 minutes can you get here then? When I say I'm actually at work and it will take me at least half an hour thats answered with a sigh and well thats all we've got available. So the obvious next step being can I make an appointment for another day. Answer No! Phone tomorrow at 8:30. When pressed, they will give an appointment. The soonest I've been offered to date was in 24 days time!!
So I wrote to the practice manager. I got a reply full of patronising platitudes back. Basically saying how I as a mere mortal couldn't possily understand the complexity of the demands on Doctors and more still their support staff.

To me its blatantly obvious that if there is a 24 day wait for a pre booked appointment, there will obviously be no shows, (they've probably snuffed it while waiting to be seen) and more so there aren't enough prebooked appointments available. I am not alone in working away, about 95% of the working age population of my village are in the same boat.

Every morning there is a queue outside the surgery trying to beat the jammed phone lines that can't cope. In fatct when I asked about that the half wit practice manager did admit that it was an issue for them, becuase all the demand comes at once..... (no shit sherlock!) Unfortunately, he couldn't see the connection between the idiotic appointments system, no shows, and jammed lines. Let alone the increase in stress related problems with the reception staff who have to deal with irate patients.

Do you know, I couldn't even get a timely appointment for my wife who is in recovery from breast cancer???

If anyone ever asks me again "is it an emergency?" I'll ****ing scream "no you halfwit, if it were I would have dialled 999 and have been half way to A & E by the time you answered this ****ing phone.

The system is bust. Don't come on here and moan about it. Fix it.

PS: My wife who also works, normally takes the first appointment of the day at the lcoal cancer unit. The earliest she has been seen is 25 minutes late. One time ti was 2 1/2 hours!! I'm sure there is a logical explanation somewhere, but it probably invovles the phrase "couldn't organise a cluster**** in a brothel"

...... and yes I am pished off with it.

I can phone up now and probably get an appointment for today but certainly get one tomorrow, so Berm Bandit what is it you want DrP to fix?

[i]it's been like that for 6 years.[/i]

Has the rash cleared up by itself or do you still need treatment? 😉

and yes I am pished off with it.

so as stated several times, change doctors.

our is pretty good. rarely go for myself but they've been really good with my son.

Are you a real doctor posting things anonymously on the internet? Tut tut 😉

One of my patients came in yesterday to say they didn't want me to treat them. Luckily I had my bike with me so was able to go for a ride for an hour 🙂

so as stated several times, change doctors.

Have you ever tried to do that in a rural setting??

The next nearest practice is the same outfit, as is the one after that. So basically if I could I would, unfortunately the concept of choice is not one that the NHS is that familar with generally.

what is it you want DrP to fix?

I would have thought that was blindingly obvious, but as apparently its not, if his system is not working, rather than come on here moaning about his patients how about having a little think about why its happening and what active steps could be taken to prevent it. I suspect my experience is not that different from most, certainly that is the case anecdotaly if not measured scientifically

I would have thought that was blindingly obvious, but as apparently its not, if his system is not working, rather than come on here moaning about his patients

Well no it wasn't as you were complaining about having to wait a whole 24hours for a Dr's appointment which is pretty good I'd say. I can't see how people not turning up for an appointment is DrP's fault. Maybe if by some chance your practice is DrP's then just maybe if people didn't waste appointments you could get one the same day.

I think he said 24 day wait which seems unlikely.

I'm looking forward to suggestions for DrP to make sure his patients attend.

maybe they went online and got their tablets cheaper and delivered next day free of charge.

there is no place for the modern GP surgery these days, I do all my own analysis online and dont have the time to wait in a doctors surgery to be told what I already know from talking to intelligent multi talented like minded people on forums like www.fevertrackworld.com

in fact I havent seen a doctor or dentist for years as I can now do all my own minor surgery after seeing it on youtube. and following the steps.

The LGPS needs to change how it deals with the public if it wants my business, like opening when I'm walking past, or organising group surgeries, and lending me their equipment if I pop in with some jaffa cakes

😉

Berm-Bandit - you are clearly frustrated, and I'm actually willing to be your punchbag for the remainder of this thread, but yo should also understand the difficulties faced by the other side (i.e. the practice's side).
Yes, the system IS in trouble, but in part that's due to a multitude of factors:
[b]Patient expectation[/b] - everyone can google their symptoms and come up with something terrible, so they MUST be seen ASAP. However, the fact is the vast majority of conditions seen in primary care are self limiting - they usually get better by themselves, though you'll feel a bit 'iffy' whilst it heals. The demand to be seen ASAP for simple conditions really fills up lots of slots... "I can see your well child does have a temperature, but they've only had it for 6 hours, haven't had any calpol, and are running around like a wild thing. I don't know what's wrong, but chances are it isn't serious, but it's too soon to tell" may as well be tattooed on my forehead....

[b]Ageing population[/b]- if everyone died by the time they hit 60, we'd have a lot less chronic disease management requirements. Chronic diseases are time consuming and tough.
I'm not saying everyone should be culled at 60, I'm just saying how it is...

[b]Appointments systems are flawed[/b] and I'm not sure what the answer is TBH.
In response to your comment:

If anyone ever asks me again "is it an emergency?" I'll * scream "no you halfwit, if it were I would have dialled 999 and have been half way to A & E by the time you answered this * phone.

Then it comes to the concept of "waiting" - and I agree that's an issue I can't put my finger on....
Most 'pre-bookable' appointments fill up very early, so when I wanted to see my GP about migraines I felt daft taking an appointment [/b]that day[b], but there was no other option. I could have waited 7 days. I could have waited 10 days. As long as I knew I was due to see them, that would have been fine. But I couldn't, so went that day. Daft.
This then makes every appointment 'same day', and of course then it returns back to the 'first come first served' principle, which again is flawed - as you demonstrate in yor difficulty getting an appointment.

So...
In summary, to fix the system, we need:
-plenty of same day appointments for those needing to be seen that day.
-Those who have booked same day appointments (see the OP) to turn up.
-Plenty of pre bookable appointments, that only become 'open' after 10am, 2 weeks in advance. This means you don't even need to ring in at 0830, as if you're happy being seen in 2 weeks, ring in later in the day.
-Those who book pre-bookable appointments must also turn up.

Not that hard, but you try getting patients and staff to respect the idea, and acknowledge that they must hold some responsibility for looking after themselves, checking their meds aren't 'urgent' because they let them run out, and make sure they aren't talking on their phone when they go through checkouts.....

DrP

last time i went to the drs [ specialist]about 6 of us had the 9 30 appointment and i got seen at dinner time- my degenerative eye condition had not improved [ surprising eh] so I was still entitled to NHS treatment; so it was not a complete waste of time 🙄

Neither side of this equation seem very good with appointment times IME

On monday I waited with my 3 year old lad to have his fracture clinic appointment for his 1050 appointment time, we were seen at 1400.

I didn't get special treatment or nuffin', even when I paraded around with my stefiscope around my neck...

DrP

(though I did see a celebrity in the waiting room)

Have you ever tried to do that in a rural setting??

This is a real issue, all surgeries near me are the same lot. Though its possible the receptionist at one of the other surgeries may let me make an appointment without pre-diagnosing my condition. Oddly she wants to know my ailments before giving me appointment (she's leakier than a sieve and the best way of spreading information round the town), but the online system tells me to see a GP, when the asthma nurse will do. Sorry that turned into a rant.

But serious question, is it a cunning trick that asthma nurse tells you different and sometimes contradictory information each time you get dragged to go and see them? And is it possible to get out of going to see them every year? I can put a peak flow off the scale, have been using an inhaler for 25 yrs and am not about to forget how it works and start putting up my arse or anything, and if my asthma got bad, I promise, I would go to the doctor, myself, spontaneously.

(though I did see a celebrity in the waiting room

surely you can tell us who as you were there in your non profession Joe Pleb capacity.

DrP, stop wasting your time on this thread with a bunch of whingers who probably won't even turn up for the rest of the thread, and get back to my thread where you belong and diagnose my back problem. Sheesh - you just can't get the attention of a real doctor moonlighting on a bike internet forum any more - what's the system coming to...

I think he said 24 day wait which seems unlikely.

😳

"I can see your well child does have a temperature, but they've only had it for 6 hours, haven't had any calpol, and are running around like a wild thing. I don't know what's wrong, but chances are it isn't serious, but it's too soon to tell" may as well be tattooed on my forehead....

Oooh maybe if I get one done too they'll do discount.

Our GP (AFAIK) only does same-day appointments, aside from referrals from other places. You've to ring at 8:30 on the dot and wardial until night services switches off, at which point the recorded message changes from "we're closed" to "you're position 18 in the queue, please hold." That said, once your call finally gets answered there's rarely any difficulty in actually getting an appointment.

The receptionist asks what it's for, but is quite happy to take "I'd rather not say here" as an acceptable answer. Presumably it's either to help with selection of doctor (eg, to ask if you want a female doctor if you're ringing with ladybits plumbing issues) or to gauge whether a double appointment slot might be necessary.

Waiting time is hit and miss. We've just got back from there now and we were seen today within about a minute of arriving; sometimes there's horrendous backlogs but generally they're pretty good.

Hospital appointment waiting times are exponentially worse IME. I touched on this before but we've been to 9:30am consultancy appointments and been sat waiting for an hour or considerably longer, and that's far from an isolated incident. I really do fail to see how there can be such a long delay so early in the day, when there's just not time to build up a backlog and they're not the sort of consultants I'd expect to be called in to attend emergencies. What's really wee-boiling though is there's no feedback; no apology, no word from the receptionists as to how long you're likely to be sitting there quietly growing a beard, and if you dare to ask how long it's likely to be you're treated like Oliver Twist asking for more. Then when you do see the consultant it's like you've been granted an audience with the queen as they swan around (slowly) with their noses in the air.

So yeah, my GP's practice walks on rainbows compared to our hospital appointment system.

I think he said 24 day wait which seems unlikely.

That is precisely what I said, and precisely what was offered. Bascially everytime you call its a battle with the receptionist as described. Ridiculous

Patient expectation - everyone can google their symptoms and come up with something terrible,

I'm sure what they really mean is "do you need to be see urgently".

Regarding missed appointments: My dentist sends an invoice for the time wasted for a missed appointment. Amazing how memory improves when that happens.

Out of interest what I was trying to make an appointment about was shortness of breath over a period of time i.e. as in weeks. I was not asking for an immediate appointment, quite the reverse in fact.

Given that one of the more serious of problems especially amongst men is a reticence to go to the GP even when obviosuly necessary, run it past me again as to why making it such a massive problem to so is a good idea?

A shrug of the shoulders and a statement like this:- Appointments systems are flawed and I'm not sure what the answer is TBH, is the entire reason for my original ranty post. Especially in respect of such an obviously and fundamentally failing system. In my line of work thats enough to close you down.

The self evident answer is that to repeat something that isn't working expecting a different outcome is indicative of madness. So the answer very simply is try something else, and keep trying something else until you find something that works.

Berm Bandit your bad experiences with French GP's may not relate to here in the UK.

Merci.

My old GP used to be ace. The past two just take what they see in front of them and shoe my away. Oh your riding bikes you must be ok. Ignoring the fact that I'm weak as a kitten barely able to stay awake & often failing asleep in the waiting room & in their surgery.

Yet when I had a mole on me arse I'd had an appointment in two days and it was removed within 4 days : )

What really irritates me is my outpatient's clinic... The care is really good, but you can't make an appointment in person or on the phone. You have to tell them "I want an appointment in about 6 months", and they post you one. Which you can't attend, so you phone them about 20 times, and they never answer, so you email them and leave it at that and it turns out they don't read their appointments emails. Or you never receive the letter, so the first thing you know about is the rude "You missed an appointment, you ****" letter. So the sign in that particular clinic about the no-shows really annoys me, because I've been a no-show twice for that clinic and it's entirely their fault.

My GP reckons there's a direct correlation between the rate of no-shows and the average waiting time to an appointment. But there's all sorts of reasons that could be. I reckon a big part has to be that if people are unhappy with the response when they call- come back in a week, or call back at exactly 7.03 on an even numbered date- and so they think "Well if they don't treat me right, why should I treat them right" when it comes to cancelling or not.

Regarding missed appointments: My dentist sends an invoice for the time wasted for a missed appointment. Amazing how memory improves when that happens.

Ah yes. That's a proper can of worms when it comes to medical care. Who administers that? Who collects the money? Where does the money go? What happens if you don't pay? Are you then barred from further treatment? Then what?, etc, etc.

Any more ideas?

That's a proper can of worms when it comes to medical care. Who administers that? Who collects the money? Where does the money go? What happens if you don't pay? Are you then barred from further treatment? Then what?, etc, etc.

Any more ideas?

Pretty straight forward actually. The intention is not to be in a position whereby banning/charging people etc is necessary. In fact it is quite possible for GP's to ban people, and they do use that power. The idea is the precise reverse, which is to generate a situation whereby the desired outcome is achieved. i.e. show up or cancel in a timely fashion. IT IS NOT TO ACTUALLY INVOICE PEOPLE. There is a well trodden path that is summarised by the saying easy come easy go. Which basically means people don't value that which does not cost them much to obtain. So the reverse of that coin is give it a value and people then treat it better. For example putting a price on catalogues is a well know tactic to stop them going in the bin.

So advertise the fact that missed appointments will be charged, and indeed send out invoices. It won't take long to get around, and I guarantee that the outcomes will improve.

I do similar with debt collecting in my business. Sending out a County Court application made out in their name and address normally extracts an outcome within 20 minutes or so of it being emailed/faxed. I rarely ever actually get past filling out the from. Same principle.

The waiting times for appointments with consultants at clinics does seem to take the wee wee in many places - like when you have an 8:40 appointment time for a consultant who doesn't start work until 09:30. I mean, seriously, what the blooming heck is that about? I can understand running late as the day goes on, but this was deliberate. And, to be clear, we were told the consultant started at 09:30 when we turned up (for our 08:40 appointment), so it wasn't that they were running late that day or something. [/breathe]

my GP ( who rides an Orange and has bike mags in reception) has it fully dialled in..

turn up on spec before 11.30am and you ll be seen by a gp there and then.. make an appointment 3pm - 6.30pm and you ll be seen roughly on time.. i usually snap up the last one of the day .. we have a good chat as he has loads of time because no one wants to come at tea time..

Trouble with charging for missed appts is that some people may not pay. I understand what you're saying and I appreciate it works in business and I also get that it's not an aim to be sending out invoices but if you do and people don't pay, then what? Some people actually don't have any money and these may be the same people who miss appts because their lives are chaotic, or they're drunk, or drugged up somewhere, etc, etc. I appreciate that the majority of patients are not like that but there may be a significant number of those who don't attend on a sunny day who are. I'm speculating here but there may be some evidence for this. So what happens then? Are they barred from that practice and blacklisted elsewhere? Do they then turn up at A+E and clog that service unnecessarily?

I don't have any answers either. It may be that the lack of perceived value is the problem, along with a lack of concern about the consequences of your actions generally and failure to consider other people. If we live in a society that cares then these are problems that we need to care about and the answer is not always financial, either as punishment or reward.

I don't have any answers either.

You probably didn't read it, but what I actually said was:-

The self evident answer is that to repeat something that isn't working expecting a different outcome is indicative of madness. So the answer very simply is try something else, and keep trying something else until you find something that works.

I merely pointed out that my dentist uses an invoice for a missed appointment to good effect as an example of thing that can be done. Apparently in Singletrackworld a dentist doing so is not a problem, but a doctor doing the same is apparently an insurmountable issue.

But people generally pay for dental work ANYWAY on the NHS, and those who don't pay (free entitlement) are unlikely to be able to pay for not showing up.
This means the 'concept' of paying a dentist is much more acceptable whether you do or don't turn up.

As no-one (bar private patients) pays at the point of service for a GP, it will be a complete outrage if they were to be asked for money for missed appointments. people simply do not expect to hand over money in a GP practice.

There are plenty of efforts to incentivise the idea of keeping appointments - most of these are along the lines of 'advertising that month's missed appointments' in order to highlight the issue to the wider patient group.

I also agree with your statement alluding to 'ownership of a service you've paid for' (which is one reason why people paying for chiopractor/osteopath services have "great outcomes" - the financial investment made skews their perception of the actual outcome). However, as raised, the idea of charging at the point of service for GP is a very muddy one. I'd like to see a better system, but I'm not sure it involves charging for appointments....

DrP

I think it depends where you live. Ours in Preston isn't that great. Last couple of times I've had to see the nurse instead. Who then had to have a quick word with the doctor. At least i got some decent pain relief (sciatica). Daughter is at uni in leeds and the service over there is superb. eg. she's at home at moment and her doc planned apointments for physio etc at another practise after he'd seen her so we could do it all in one journey 'cause theirs was holiday.

DrP beat me to it. Dentists and doctors are remunerated differently and as well as people being used to paying the dental practice already has systems in place to send out invoices, etc. My point is not that this is an insurmountable problem to do this in a medical practice but that there will be people who do not pay a fine and then how do you sanction them? People don't commonly go to dentists with life threatening problems (although they can) so barring them may not have the serious consequences that barring them from medical services might have.

You probably didn't read it but what I actually said was:-

I read something about patronising platitudes somewhere . . .

You suggested the answer is to try something else. I'm just explaining to you why the only 'something else' you've suggested isn't such a good idea IMO. It's the question 'what else?' that I don't have any answers to. And neither, apparently, does anyone else.

I do sympathise with your problem and agree the system you seem to have to operate in is bad. I've a feeling this may be a system that was introduced relatively recently (I mean in terms of the age of the NHS) and clearly it isn't working. On the face of it more staff are required, to answer phones, see patients, etc but that has implications for the profit of a medical practice (business and care don't always mix well) and the OPs OP suggests that he is only 33% occupied anyway. Pretty inefficient use of an expensive resource.

I'm sure what they really mean is "do you need to be see urgently".
If it's to discuss sexual dysfunction/pill check/8 months of niggling headaches - that can wait can't it.
If it's because you've been vomiting blood, or have severe ear pain, then that should be seen that day.

The trouble is, that's applying a yes/no criteria to something which isn't yes/no. Quite often when I go to see my GP (which isn't to imply I see my GP often - I'm one of these men who tends to put off going longer than I should, and have been told that I should have come in earlier) the problem isn't life threatening, but neither is it something I want to wait over a week to see somebody for, which is the typical earliest I can get an appointment if I book one. Also, exactly how urgent is depression which is sufficiently bad to drag somebody reluctant to see a medical professional in? OK, so maybe I will actually be better in a week's time without seeing anybody - until the next time that is...

To some extent our practice is better than others being mentioned as I don't have to deal with reception staff at all - they have an online booking system. However that doesn't get around the basic issue that there never seems to be an online appointment available the same week, and if there is it's invariably with a female doctor I don't want to see. Oh, and when I asked to make an appointment with the gateway worker, I was told he wasn't available and given some convoluted process to see somebody, the sort of thing I can't cope with when I'm depressed - all those who speak of the benefits of going to see your GP with depression presumably don't go to my surgery, I feel like I've slipped through the cracks.

I must be with the wrong GP practice,I've just gone on line and booked an appointment hor 11:00 this morning,as the pain from my #clavicle appears not to understand OTC pain relief.I had the accident 2 days ago,walked into Barnsley A&E at 16:00,left at 17:30 having been seen by triage nurse,junior medic,had Xray,seen again by junior medic,quick review by registrar,sling fitted,treatment plan explained,and given a fracture clinic appointment for yesterday.Yesterday 's appointment was for 15:55,rocked up at 15:45,nurse explained there might be a slight delay due to numder of recent cases,actually seen by consultant at 16:00,left at 16:15,having had reviewwith him treatment plan explained by him,and follow up fracture clinic appointment given.It can work,and is bloody marvellous when it does.
P.S. I refused the extra pain control offered in A&E as the adrenaline was running and I thought I could cope.

I think what we all agree on here is:
-experience varies from practice to practice
-there is no ideal answer, as Aracer pointed out (I completely agree with you - illness isn't so black and white)

Soo.......

From this point onwards let's all agree to only post proposed, workable solutions, rather than complaints (complaints have all been duly noted....)
I'm sure the thread will slow down now.....

DrP

From the jist of this and the other thread.. it appears you have trouble tying your own shoe laces without needing a large group of people stood behind you coaxing you on.

If all GPs started as early as you? 😀

^^
Where was that comment from?!

DrP

Try living in a town full of the nearly dead . All appoitments booked up really quickly as the old have nothing else to do and a trip to the docs is the highlight of the day .
The coffin dodgers love it in the waitng room as its like the social club and all their aged friends are there waiting to speak to a nice young Dr.

My GP's practice uses Emis Patient Access for booking appointments and repeat prescriptions on line,they deliberately keep blank slots for one of the gps in a 4 til 6 surgery every weekday,the receptionist has never asked me what is wrong with me,her question is "Do you need to see a doctor today,or will it wait until the next working day?" and she will then tell you what appointments are available.If you are not happy,she will get a GP to ring you at home.They run separate clinics for things like annual flu jabs,and seem very efficient.

Where was that comment from?!

Oops, sorry. Copy'n'paste failure. 😳

It should have been

From this point onwards let's all agree to only post proposed, workable solutions

I'm actually quite lucky in that my GP Surgery is pretty good and do at least try to accommodate patients with urgent needs for appointments.

I've got a Asthma and when it's about to cycle out of control due to a honking chest infection that's arrived at the speed of an express train from nowhere the surgery are pretty good at getting me in that day for a check up and medication.

They will also prescribe over the phone i.e. you phone them, say you need to speak to a doctor, they take your number and the doctor rings you at a given time - particularly helpful if you're already at work - the script can then be picked up from the surgery after the docs have all gone home.

Having said that, the system that my surgery operates appears to be the exception rather than the rule. My experience of other surgeries, and the experience of other local friends and family across the UK is that most surgeries:

- haven't ever thought about their booking process from a patient point of view
- designed their processes at a time when most patients lived and worked round the corner and haven't felt the need to update them since
- operate a set of stupid inflexible and arbitrary rules on repeat prescriptions e.g. requests have to be made in writing and posted through their letterbox, some accept faxed requests, most don't do emailed requests
- don't address staff absence / lateness. When GPs are strolling through the door an hour late for their first session it's in most cases nothing to do with home visits and just a lack of organisation
- operate most processes on the principle that endless visits to the surgery by the patient is better than using the technology that other surgeries have adopted.
- still operate on a 9-5 rota and won't operate 8 till 8 which is actually what's needed to keep the working population well. Obviously in a small partnered practice that's more difficult to resource, which is exactly why we should be pushing for larger practices (not to mention the fact you're much more likely to get bad care in a small / single handed practice due to the lack of peer review and learning).

There's also an issue with some surgeries clearly taking on more patients on to their list than they can service with the actual working hours of the GPs - who in many cases are working significantly less hours than 10 years ago.

Dr P you are often on here proposing various rides and invite others to join you. May I suggest that you organise a specific consultation ride where we can come along and each get a 5 minute turn at the front with you while quizzing you about our various ailments. At the end of the consultation the rider can then peel off and as they go back down the line will have the chance to get random second opinions from the STW peleton. Any DNA's will naturally be replaced by the next in line. The route should be carefully considered to pass various hospitals, minor injury clinics and specialist units where you can drop riders as necessary.
I look forward to our discussions regarding my elevated potassium levels if I can be arsed to turn up. 🙂

^^

It would be an incentive for me to really push my limits of 'breaking away from the peleton' I think 😉

Oh, avoid bananas, prunes, and tinned tomaoes as your ride snacks (to name but a few foodstuffs high in potassium!!! (I'm such a geek! I love metabolic disorders!))

DrP

I'm off the bananas already, greater hardship is hard to imagine, everything I like eating, in fact everything that's good for you is high in potassium!

Solutions to the problem would include.

Mandating the number of appointments practice must offer per 1000 registered patients. At the moment the practice is only required to provide what it thinks is sufficient.

Stop half day closing. It is ridiculous that where I live all practices are closed Thursday afternoon. Guess what the A&E attendance rate rises for these practices on Thursdays

Match the number of staff answering the phones to the demand. Practices know from their phone systems, or should, when the peak demands are so should rota their staff to match, not have 2 people sat there all day

Offer telephone appointments. There are many cases, such as repeats etc where by a 2 minute phone call with the GP will be enough to either reassure the patient that they don't need to be seen straight away or to confirm they are ok to have a repeat scrip that they can then just come and collect.

Have all the full time GPs actually working full time hours seeing patients not running additional clinics that they are paid extra for running. The payment for running these extra clinics should be used to fund additional clinicians time so the normal appointment system doesn't suffer. Unfortunately I know of many practices who staff the extra clinics by reducing the appointments for normal patients. They can do this because of my first point about appointments. Tis allows the fees for running the extra clinics to be taken as pure profit for the practice.

In a previous job I spent 3 years working in practice based commissioning and have seen all of the above, both the positive and negative ones.

OK - solutions...I have AS and need various meds on a monthly basis. I won't get the meds unless I have a blood test every four weeks. I understand the principles behind this but when I get offered a blood test "next one is a week on Thursday at 9.15am...yes, that's all there is". OK - i'll have to take time off work so can I book the following one at the same time and get a more convenient option? "No, you can only book 2 weeks in advance"!!

Various GPs at the surgery didn't particularly care. However, I was due a review and a locum called (she was S.African and had no idea why she was calling). I explained the predicament and told her that I had asked for a pack of blood forms from the GPs on numerous occasions so that I could just rock up at the hospital and have the test done there - no taking up space at the surgery or having to call for appointments etc. She simply said good idea and couldn't believe the resident GPs hadn't agreed. Two weeks later I had a pack of forms and now its massively more convenient for me and the practice. Moral is - we need more South Africans in the health service.