Currently sat in a NHS Hospital treatment Centre with my 12yr old son waiting to see a doctor/GP. This follows two days of trying to get an appointment with his GP as we suspect he has a chest infection and may need a course of antibiotics. The GP practice in question only books appointments by phone from 8am and once they’re gone for the day it starts over agin the following morning. The phones don’t have a queue system so you either get through or you don’t. Eventually I just turned up there this morning which is a bit of a no no but the receptionists said if I wanted to see a doctor the Care Centre at the local hospital was my only choice.
Is this similar at other GP practices?

pretty much yeah. We can book minor injuries for the same day, but again a queue system to get on.

Yes, same here. Just waited 3 days to get a phone appointment for Jnr. I can’t get one.

Welcome to modern Britain, where we are told to “simply pop in and see your GP” on tv adverts.

I’m scared of getting properly ill, I haven’t been able to access a GP appointment for quite literally several years for a variety of minor ailments I’ve ultimately chosen to ignore instead.
(Sheffield)

All systems normal here. No problem getting an appointment if it is genuinely required, but the vetting process is a lot more stringent

Does your surgery have a duty doctor that will do a call-back if you call the reception after the initial rush? That’s what we do if it is something we are particularly concerned about and we usually get to speak to / see someone.

Is this similar at other GP practices?

We can have similar. Our receptionists are either brilliant or a ‘challenge’ in really pushing about how important your need to prioritise is – but then for me that can stray into making medical decisions as a filter.

Agreed that the local community hospital now seems to be the GP provision for pressing concerns.

Can anyone explain why the (lets be honest, privately owned practice) GP can in effect ‘push away’ the more pressing patients and allow the (still directly NHS Owned and run) local hospital to pick up the excess?

I was astonished ( and not a little worried) that I phoned my GP at 1pm, described my symptoms and got an appointment for 1630 the same day!
I queried it with the GP and said I wasn’t sure to be happy with the excellent service or concerned that they thought it was necessary to see me so quickly. He just said it’s how they work and normal 🤷‍♂️
My old practice it was a 2 week wait for a telephone appt

Johndoh
Phone and face to face appointments fall under the same rules for booking unfortunately.
Feel a fraud sat in a hospital waiting to see someone when it’s not an emergency, I think a lot of the people sat here are in the same boat as us and can’t get to see their GP. The NHS seems to be on the verge of breakdown, I wonder how long it can last like this, or maybe it’s always been this way.

I’m very sorry that the system I am part of is broken.
The recent report, chaired by our latest chancellor, explains what the problems are. Have a read of the summary.
https://committees.parliament.uk/publications/30383/documents/176291/default

Summary 3
1 Access to general practice 7
Demand in general practice is rising 7 The NHS does not have enough GPs 8 Patients face poor access 9 GP workloads are unsustainable

Is this similar at other GP practices?

Yup, the same as mine, and then it’s only phone consultation. You don’t even get a specific time for the phone consultation, though last time it was narrowed down to the afternoon 🙄

Sorry if this comes across as unhelpful, but did you try any of the other services – direct to Pharmacy, NHS 111 online/call etc first? Sometimes they can at least eliminate some of the other variables or help with a referral/fast-track in to a Practice or elsewhere.

I work in IT supporting GP Practices and the whole system is absolutely slammed at the moment – backlog from Covid, usual winter flu/coughs/colds, Covid booster jabs still going on amongst other things. We’ve had a number of GPs across the city leave, retire, or just sack it off as they’re getting a lot of abuse from patients and politicians alike, which only makes the lack-of-appointments problem worse.

I’ve never not been seen or had a call same-day. It’s usually an early-morning call to be added to a list and then a call-back.TBH I’m rarely in need of a GP but I do wonder/worry about what happens when I’m more in need.

A friend of mine is a GP receptionist and the abuse she receives daily is horrific.

Click here for the answer

GP practices across the country are experiencing significant and growing strain with declining GP numbers, rising demand, struggles to recruit and retain staff and knock-on effects for patients.

They have been at the forefront of the NHS’s response to the COVID-19 outbreak, delivering vaccines whilst maintaining non-COVID care for patients throughout.

as of October 2022 (latest data) we actually now have the equivalent of 1,896 fewer fully qualified full-time GPs compared to the September 2015 baseline (when the current collection method began).

Over the last year, the NHS has lost 294 individual (headcount) GP partners and 304 salaried, locum and retainer GPs. This has created a net loss of 598 individual GPs since October 2021.

In FTE terms of 37.5 hours per week, this amounts to an equivalent loss of 389 full-time fully qualified GPs in the last year alone.

With over one in 10 (16%) of respondents to a BMA survey telling us they plan to leave the NHS altogether after the pandemic, these losses are set to continue further if the Government does not take appropriate action.

GPs (hi) and other primary care staff are a finite resource. I have a limited capacity to deliver safe healthcare every day.
Once that capacity is reached, you can wither accept unsafe healthcare for all, or seek healthcare elsewhere.
I get tired. My staff get tired. My job is actally pretty difficult, and I need to be alert, aware, and entheused to carry it out well. I can only acheive this up to a certain point.
If you pile more workload onto me, I can’t do it safely.
I am not alone in this.

Unless one of 2 things happen:
1 – less people seek input for their healthcare matters from GP surgeries/expect less
or
2 – there are more GPs and other primary care staff

The system will spiral down further.

DrP

Similar in so far as it’s call at 8 and see what you can get, but they have a queuing system and I have without fail always got an appointment same day, though sometimes have to call back at 1pm for the later in the day slots. In recent years they have started to triage more to give telephone appointments where appropriate in the first instance.
This is city centre Edinburgh in an incredibly stretched practice, but they seem to make it work and I’m very grateful.

@revs1972 Welcome to modern England.

I live in Scotland, our GP practice has an e-consult service where you can submit requests for advice, etc on-line. You’ll get reply within 24hrs offering either an in-person or telephone consultation with the practice nurse, phlebotomist or GP.
If you can’t or don’t want to use that they still have receptionists that you can phone. My experience over the last 9 years is that they are excellent at triaging and the kids have often been seen the same day.

Not at my GPs. If you contact them by phone before 9.30 you get an appointment that day. Used to be a turn up and be seen but reverted to phone during covid. Never once have I not been seen that day if I wanted to be. sometimes its a bit of a wait. There is a phone queuing system and a phone back system. they do phone triage as well. these emergency appointments are unlimited.

They are a bit of an outlier tho I recognise but they have put huge investment ( staff and buildings) in and I think all the GPs are part time. ( which will reduce pressures on individual GPs)

While what DrP states is true and its also variable around the country IMO part of the issue is their status as independent practitioners. I’m sure my local practice have ended up taking less money for themselves out of the business to fund the infrastructure improvements and extra staff. Not all GP practices go this extra mile – they are not being paid to do so.

Just as bad at my surgeries. Son tried for days to get an appointment for a sick note – yes they insisted he come in with Covid. Even explaining he had Covid he still had to go and see someone. Madness

Matt – its because of their status that they can do this. District nurses for example cannot.

My wife currently has a chest infection following Covid about 6 weeks ago. She’s given up hope of seeing a GP for anti-biotics.

I recently mangled my arm in a bike crash – nasty wound. Given the state of A&E/GP’s I just patched it up – probably needed stitching but I’ve a nice bright purple scar now.

So far always been able to arrange a phone appointment the same day, if it’s something that can be photographed I’ll get a text prior to the appointment asking me to upload a photo of the offending body part 😀
A couple of times it’s been serious enough to be called straight in for a face to face (same day both times) other times I’ve spoken to either a doctor or nurse over the phone and advice/prescription given.
Had cause to use the NHS 111 service to this year and it worked well.

Edit: we can book appointments using patient access online.

Can anyone remember back in the day when the doctor would come to your house to see you (I grew up in the 70s).

ours is completely the same. you have more chance of winning the lottery than getting an appointment.

Can anyone remember back in the day when the doctor would come to your house to see you (I grew up in the 70s).

I can beat that. I can remember the doctor visiting me when I was about 13-14. It was a nasty case of tonsillitis or similar. A short while later an ambulance arrived to haul me off to hospital because the doc had been concerned about my temperature. A doctor and an ambulance to the house in the same day, something not seen since the 80s. 😀

(Actually, full disclosure, the GP didn’t contact my parents before asking for an ambulance and I was at my gran’s when it arrived, about half a mile away. The ambulance had gone to my home address and not got an answer so had checked with neighbours and tracked me down. What a service!)

johndo – yes and they still will if needed and even then they only did house calls if the patient couldn’t get to the GPs However the same GP that I used then also had no appointment system – it was turn up and wait and the wait could be hours and no preventative medicine system, no counselor or practice nurse etc etc

Edit – When Julie was ill we had multiple home visits

Pyro
Pharmacist was the first port of call who told us to see the GP for antibiotics. GP receptionist told us not to use 111 due to wait time and to go to local
Hospital if we wanted to see someone today. 🤷‍♂️

It’s hugely variable. There aren’t nearly enough doctors, not enough money, and we’re seeing way more patients than ever before.  I manage a inner city GP practice, and I’ve never seen it this crazy for this long There are practices that I think are probably unsafe, pray for a mild winter.

Doctor’s visits and Panini Football Sticker albums have, for me, always been inextricably linked.

part of the issue is their status as independent practitioners. I’m sure my local practice have ended up taking less money for themselves out of the business to fund the infrastructure improvements and extra staff. Not all GP practices go this extra mile – they are not being paid to do so.

TJ – I appreciate you work(ed) in healthcare, but I get the impression you don’t fully understand the current GP position in England… how we work, how funding works etc.
We all receive extra funding for infrastructure and extra staff (google “PCN ARRS” or look here )… it’s just that often this isn’t even enough! Our PCN’s physio has just quit to set up a private practice..he has offered for us to pay more him to see our NHS patients however…how kind of him!

Also, you frequently refer to the status of independant contractor – what exactly do you think this means? That we can do whatever we want? Cos it’s simply not so! We are (well, partners are) self employed as a partnership, commissioned to deliver NHS care.
It’s like saying you’ll open up a Subway franchise but **** it…”I’ll sell BigMacs and KFC…” we are governed by a contract.
The interesting part is… and you won’t believe it… we USED to do LOADS of stuff that wasn’t part of our contract but as teh workload has increased we’re saying “NO” to the extra, unfunded stuff… For example..

I recently mangled my arm in a bike crash – nasty wound.

THis isn’t GP workload at all. Trauma and injury is not in our contract. Simply put. It’s not our job. So yeah, by all means moan about your GP not being able to see you for a broken foot, in the same way you’d moan about your hairdresser for not changing your car oil whilst you get a perm,…it’s not their job. It never was!

DrP

Yep, it’s the same here. I don’t doubt that GPs are working hard – I’ve had a telephone consultation at 7pm before now.

It’s the same across the NHS. I was referred to a rheumatologist, and finally had my appointment yesterday – 13 months after the referral! The letter said “expect to spend 4 hours at the hospital, as further investigation/treatment may be required”. During the consultation, she says “I’m going to request an urgent physio appointment for you”. So I said “when will it be – today?”. And she goes “Sorry, no, it’ll probably be early next year”.

**** tories 😡

The interesting part is… and you won’t believe it… we USED to do LOADS of stuff that wasn’t part of our contract but as teh workload has increased we’re saying “NO” to the extra, unfunded stuff… For example..

Oh I know this. A mate is a GP. Not intended to be a slur in any way and yes I don’t know the details

I guess my point is that because of their unique status withing the NHS variability is built in to some extent and even locally the variability is huge. One local practice still has steps up to the door and a normal front door. Mine is level access with a wide door

It seems to me ( and maybe I am wrong) that because of their status as independent contractors its harder to enforce standards or are the minimum standards too low?

Stuff like not having a queueing system for the phones as some have detailed or the access issue as above That sort of infrastructure issues

Its the system we have and it aint gonna be changed but IME the variability amongst GPs is far greater than in other parts of the system

we are governed by a contract.

…And the contract pays us assuming that the “average” pat will come to the GP about 3 times a year. I can pull the stats from EMIS (the pat management system we use), but it’s about;

about 5% never come

about 20% come about 3 times a year

about 30% come between 4-6 times

about another 30% come 7-10 a year

about another 10% come over 10 times a year

and the really growing part of our patients,  an admittedly teeny amount or so come about 15-30 times a year. This group take up huge amounts of time and effort to manage. To put numbers on it for out practice that last two groups is about 850 patients. We’re doing vast amounts of unfunded work for this small group of very highly demanding patients, often at the expense of folks who don’t come that often.

Trauma and injury is not in our contract

I’m getting very bored of telling my patients who are angry with my receptionists that we’re not an emergency/urgent service.

Mine got to the point where you could make an appointment for a few days time, or do the first-thing-in-the-morning roulette. Then the bookable appointments got further and further away, and now they barely exist so it’s all “call up and hope”. It’s not like it creates any extra appointment space so I’m not even sure why it happened? Is it just that you get less no-shows? Or is it because they only know the availability on the day?

Not blaming anyone for it, the practice are fantastic and they basically keep me going despite all my best efforts, but it seems weird- you’d kind of expect that under a strained system, efficient booking ahead would be the big thing and getting an appointment right away would be harder, not the other way round

It seems to me ( and maybe I am wrong) that because of their status as independent contractors its harder to enforce standards or are the minimum standards too low?

I think you ARE right there… but efforts are being made to improve things with the introduction of PCNs (essentially, groups of smaller practices ‘pooling resources’ to provide care at a wider level, with more ‘standards’/less inequality.)

I’ll put my hand up…our phone system is shite and unfair! We’ve been trying for MONTHS to get a new contract with ‘in cloud queuing” as I completely agree that not having a queue is unfair… it’s like anything though… getting someone in to do it, amongst all the other work going on (we’ve recently had a slope and electric door added for access) is a hassle…
On the subject – that slope/door cost “our surgery” about 18 grand. Seeing as I’m 66% of “our surgery” it cost me PERSONALLY 12 grand…! Yet people still moan the door is too slow… or opens the wrong way etc!!

DrP

At what age does a doctor who chooses that path become a GP? After medical school, junior doctor, etc?
I’m 32. I was friends with a number of medical students at university of approximately my age. Not all of them, and I’d guess that those I was friends with were the more outgoing and adventurous type.

I’d guess 50% of them, based on facebook, are now living and working in Aus/NZ.

Combine that with the pensions issue meaning that many towards the end of their career are taking part time hours or early retirement as it makes financial sense.

And there is a lack of GP’s to go around.

I don’t blame either group for acting in their own self interest.

On the subject – that slope/door cost “our surgery” about 18 grand. Seeing as I’m 66% of “our surgery” it cost me PERSONALLY 12 grand…

This just shows the madness of the system IMO. I’d much prefer GPs were all directly employed in NHS owned buildings.

The building my GPs are in was bought and converted in the last 10 years. That will have cost them a couple of million at a guess.

You will get your 12 grand back tho when you retire and sell the business will you not? 😉

At what age does a doctor who chooses that path become a GP?

26 / 27 I think assuming they progress thru the training without delay. Then to become a partner you have to buy into the business which is not at all cheap

and the really growing part of our patients, an admittedly teeny amount or so come about 15-30 times a year. This group take up huge amounts of time and effort to manage. To put numbers on it for out practice that last two groups is about 850 patients. We’re doing vast amounts of unfunded work for this small group of very highly demanding patients, often at the expense of folks who don’t come that often

That issue goes wider than health for sure.

Earlier this year I went to a seminar delivered by a senior official from [area redacted – large deprived northern seaside town] who observed that a tiny proprotion of their population – about 200 families – were collectively responsible for a really material percentage of their expenditure on health/social care/policing/flytipping etc.

Did anyone suggest hitting up Therese Coffey and seeing if she’s got any pills your lad could have?