GPs – what are they for?

I’m trying to work out what purpose GPs, and the long waiting times that they come with, serve in the NHS. My experience of GPs is that you wait ages and then have a 30 sec conversation during which they do nothing useful except refer you on (and sell your details to BUPA, Experian and Google).

For anything non-trivial you need a hospital specialist (e.g. heart conditions, cancers, orthopedics) or a physiotherapist.

For diagnosis you need a nurse and a lab (e.g. blood tests), or hospital equipment and a specialist (e.g. X-ray or NMR).

Nurses can handle routine stuff like bandaging, chronic pain management, diabetes and antenatal.

So that leaves reassuring parents that their kid is fine and trying to balance the drug cocktail for old people. And, of course, failing to diagnose meningitis. Which could be done by health visitors.

I can’t help feeling that we could replace GPs with a decent phone book and remove the bottleneck between patients and the care that they need.

Gate to the specialists – Imagine the queue if everyone with a cough ended up seeing a a specialist
Deal with ongoing health problems -Diabetes and other stuff
Mental Health

they do nothing useful except refer you on (and sell your details to BUPA, Experian and Google).

I’ll let a GP or 2 come along and bash you for that cheap shot but seriously have a think about it.
The GP is the front line in Health Care, keeping people out of hospital and in good stable health is vital to a continuing health service.

Change GP’s then.

Once you get past the receptionists, ours are really good.

I’m trying to work out what purpose GPs, and the long waiting times that they come with, serve in the NHS. My experience of GPs is that you wait ages and then have a 30 sec conversation during which they do nothing useful except refer you on (and sell your details to BUPA, Experian and Google).

They mustn’t like you (or see you so frequently for minor problems that thye have you down as a time waster). The times I speak to my GP are generally lengthy affairs (10 mins or more) and very productive.
It must be you.
I knew someone who booked appointments on a fornightly basis just in case, but never went or cancelled last minute if she wasn’t ill that particular week.

For anything non-trivial you need a hospital specialist (e.g. heart conditions, cancers, orthopedics)

Shame on GPs for not being able to cure cancer.

My GP has been wonderful while I’ve been dealing with mental health problems. Quick and prompt referrals, loads of links to non NHS and on line support, listened properly for as long as it took while I went through the problems and symptoms, understood my reluctance to go down the drug route due to the impact the side effects may have on my cycling till she came up with a drug and dosage that has helped.

All while 3 of the 6 GPs in the practice were off sick with skiing injuries and/or stress.

I genuinely don’t know where I would be without her.

She’s not bad for a Cervelo riding roadie.

I can’t help feeling that we could replace GPs with a decent phone book and remove the bottleneck between patients and the care that they need.

Move the bottle neck up the system. GPs filter people out who don’t need a specialist and make sure that they get to the correct one.

Under your system an orthapaedic surgeon would spend all day seeing people saying actually you need a physio, actually you just need to rest and take ibuprofen, actually you needed a rheumoloigist.

Why would that be better?

Deal with ongoing health problems -Diabetes and other stuff
Mental Health

Nurses.

And GPs for mental health – seriously? MCTD’s experience aside, Mind did a survey a few years ago which discovered that the majority of GPs were of the “pull yourself together” school.

(or see you so frequently for minor problems

I’ve need my GP three times in the last 15 years.

Gate to the specialists

Two of those I turned up with a letter from a hospital consultant advising a course of action. What does your average GP add to the party when you’ve got Prof X, leading cardiac specialist advising that their patient gets checked for hedititory disease of the heart Y? Absolutely nothing except delay.

So your experience of 3 visits in 15 years makes you an expert??
Seriously, I assume you don’t see the people they actually help, the stuff that they deal with that nurses don’t have the skills or training to do, the detailed knowledge and experiences etc.
Health delivery is a multi level process, it’s got different needs and requirements and the GP is one of them, there should be more matching of need to speciality and experience of the provider but sometimes a GP being a broadly qualified and experienced person is the right one to see the mass of people and lift out the urgent etc. to the next level and when happy allow nursing staff etc. to deliver where they can.

GPs are a filter. It’s first point of contact for most. They are not specialists, they know enough to assess, give advice, reassurance, prescribe a few drugs, and maybe refer.

A lot of people have nothing wrong with them or a condition that will self treat and really they would be better off going to a pharmacy who can advise. In a lot of cases nothing is required other than rest.

Some may need a prescription, or more likely are demanding one and GPs will prescribe them just to get them out the door. Hence the problem with too many antibiotics prescribed.

Anything potentially serious or needing referral is done on a repeat appearance basis. i.e. You go initially with a concern, they say it’s probably nothing or it will probably go away. In most cases it self heals. In some cases it doesn’t so the patient comes back. Then the GP might treat it more seriously.

Main problems I see is too many people going to GPs for stuff the pharmacy could deal with, or even things they could get a nurse to treat or walk in centre. Then there’s a problem of not being able to see the same GP on each appointment so you get the initial diagnosis each time. Appointment slots are also filled up with the worried well, the hypochondriacs and people who fail to turn up.

My GP is excellent

OP you sound like a typical whinger who goes in to see their GP with an attitude thanks to the guff you’ve been reading in the Daily Heil. Is it any wonder they don’t feel particularly enamoured towards you

jam bo – Member
Change GP’s then.

Once you get past the receptionists, ours are really good.

Other way round down here.
2 of the 3 in the practice I’m with are absolutely useless and have over 250 complaints between them at the last count!
Rude, ignorant, dismissive, etc.
One refused a repeat prescription for drugs on my chronic list.
Without even looking at the form.
The same one refused a prescription that was on the hospital TTO saying it wasn’t necessary.
The other repeatedly refused to prescribe the full amount of a drug despite the pharmacists asking for it, the practice manager asking for it and another GP telling them it was necessary.
Ergo requiring me to submit a repeat every 12 days instead of once a month.
Like EVERY other drug on that particular list.
Just happened to be the main pain relief drug too!
F’ing idiot.
Add in the Nurse Practitioner stating that I needed a referral as nerve impingement was worsening on four occasions yet the idiot above put in writing that there was no need.
Same Nurse Practitioner then was at my house a week later when my legs stopped working needing an ambulance.

Nurses can handle routine stuff like bandaging, chronic pain management, diabetes and antenatal.

Routine diabetes and antenatal. 😆

Two of those I turned up with a letter from a hospital consultant advising a course of action. What does your average GP add to the party when you’ve got Prof X, leading cardiac specialist advising that their patient gets checked for hedititory disease of the heart Y? Absolutely nothing except delay.

You went to the consultant before consulting your gp and are complaing about people buggering up the system?
What Houns said.

Two of those I turned up with a letter from a hospital consultant advising a course of action. What does your average GP add to the party when you’ve got Prof X, leading cardiac specialist advising that their patient gets checked for hedititory disease of the heart Y? Absolutely nothing except delay.

You have that problem where you know how the world works for you so you assume that because the world works that way for you it works the same way for everyone.

What the GP added for you was clearing a space for you with the specialist. As I said before if I could just phone Professor X and get an appointment he might be a bit busy?

I’ve need my GP three times in the last 15 years.

Thus proving that at this point in your life you are atypical. One day you might have prostate cancer, depression and diabetes. At that point a local professional who can try and manage this complex medical mess might be handy.

You do know that the NHS generally will spend most of the money it spends on you in the last 6 months of your life

So your experience of 3 visits in 15 years makes you an expert??

Not just me ambulance drivers too

and lift out the urgent

How can you lift out the urgent when your waiting time is in the weeks?

If you don’t have the capacity to respond quickly, don’t put yourself in the way. “Either help or do no harm”.

Not just me ambulance drivers too

No such thing.

How can you lift out the urgent when your waiting time is in the weeks?

If you don’t have the capacity to respond quickly, don’t put yourself in the way. “Either help or do no harm”.
Here is a problem, your ortho specialist probably won’t be spot on for your cardio problems so who you going to call? Batman isn’t an option.

Urgent is not always time based, it’s a needs based service, most surgerys will have on the day appointments. An oversubscribed service doesn’t make it bad, funding it and resourcing it properly is the key.

Sounds like your just one of those grumpy people looking for a bit of sky to shout at today.

You went to the consultant before consulting your gp and are complaing about people buggering up the system?

Come on, you’re on a bike forum, and you can’t think of a scenario when you’d go to hospital before a GP? Think blue flashing lights and a helicopter.

…but in the specific example you missed the word “heritory”, which kind-of implies that there might have been someone else involved.

raymeridians

Currently waiting time for an out patient appointment, referred from a GP, is about 18 weeks

Do you believe that this number would be better or worse if we stopped having Gps next week and just booked a hospital specialist directly ourselves

It sounds to me like your the drive who thinks that traffic congestion would be less if everyone else used public transport.

Come on, you’re on a bike forum, and you can’t think of a scenario when you’d go to hospital before a GP? Think blue flashing lights and a helicopter.

Yeah you haven’t a clue have you?

…but in the specific example you missed the word “heritory”, which kind-of implies that there might have been someone else involved.

That makes even less sense now.
Happy ranting, but I’d say take a chill pill if there’s any hereditory heart disease or there’ll be more blue flashing light. I hope you get sorted soon.

Come on, you’re on a bike forum, and you can’t think of a scenario when you’d go to hospital before a GP? Think blue flashing lights and a helicopter.

and when I had a lovely fungal toe nail infection the GP was the best person to deal with that.
Same as when I got ill or needed some serious travel advice and jabs at short notice for a work trip – proper risk based conversation with somebody who knew
none of those were things that should be done by people who were not the GP

When I crashed big I went straight to A&E

Sounds like your just one of those grumpy people looking for a bit of sky to shout at today.

I’m a bit grumpy ‘cos the pain kept waking me up all night and I’m woried that I’m going to have a chronic problem due to delay in being seem be a specialist…

…but yes, I am venting steam.

Providing 90% of the nation’s medical care for 10% of the budget.

shuffling old people off this mortal coil with a conciliatory nod from the relatives and an extra press of the morphine pump?

I’m a bit grumpy ‘cos the pain kept waking me up all night and I’m woried that I’m going to have a chronic problem due to delay in being seem be a specialist…

If it was seen as urgent you’d be seen very quickly, clearly they’re not concerned enough. I hope you get sorted either way though.

Perhaps the OP’s GP should adopt the Doc Martin approach

“Any one here with a genuine urgent medical problem?

If not, Bugger off”

What would the OP do? Sit or stay?

In all seriousness, the workload pressure on all NHS staff at present is not really sustainable. As GP’s are the primary care point, they often receive all the frustration from patients. I couldn’t do their job, nor that of the reception staff. You would be appalled at some of the things that have been done and said to the receptionists at the three surgeries I Have worked for in an admin role.

Unfortunately many junior doctors are also seeing the flack that GP’s are getting due to pressures that are not of their making and are not opting to train as GP’s.

“I’m woried that I’m going to have a chronic problem due to delay in being seem be a specialist.”

Pay for a first private consultation and then have the treatment on the NHS. (I *believe* this is possible.)

which brings us back to the part where it’s the funding and support that are the problem not the system

which brings us back to the part where it’s the funding and support that are the problem not the system

I genuinely think it’s the system that’s inefficient.

Rather than 1 GP on £100,000/yr you can have 3 nurses on £30,000/yr. You get dedicated skills and see more patients. You don’t need a doctor for your fungal infection or your travel jabs, both can be done by a nurse (mine were). My referral could have been done my someone in India for peanuts because there was no clinical judgement necessary at all.

Specialist nurses are awesome value for money, whereas doctors are expensive.

No neither could actually, the toe required a good look and an honest assessment of the treatment options. The Travel jabs needed a serious conversation about the implications of getting certain jabs or not and the risks based on a number of factors.

Rather than 1 GP on £100,000/yr you can have 3 nurses on £30,000/yr. You get dedicated skills and see more patients.

Bur seriously you have no idea… what happens when the nurse misses something?
On salary costs whats the actual cost? As anyone in business knows the salary is not the main cost of employment, by the time you add the building, infrastructure, CPD and more along with ongoing management and employment costs what is the overall difference between the cost of employing a GP over a nurse?

My referral could have been done my someone in India for peanuts because there was no clinical judgement necessary at all.

Very good a tiny and trivial part of the GP’s life. The process of bouncing a referral because it’s not needed or the wrong thing will save an even higher paid medical professional wasting their time.

You cant make appointments in advance to see our gps and you cant necessarily see our gps because they go through a telephone triage system and it often takes an hour to get through on the phone to arrange that.

Rather than 1 GP on £100,000/yr

😆

It gets better.

My referral could have been done my someone in India for peanuts because there was no clinical judgement necessary at all.

So they sent you along for shits and giggles?

I’ve had really poor experience with GP’s over the last year or two, some I’ve already posted on here so wont go into it again but safe to say I would have been better served with some kind of online service, preferably one where I could access and monitor my own vitals and book referals aa needed.

wilburt – there’s plenty of companies who do blood testing, some you can do yourself, some at private hospitals or use a private phlebotomist.

My doc’s are great and even the receptionist are friendly and helpful.

I have MS, I’m at my GP surgery reasonably often as things randomly stop working properly. They’re great and always able to help, be it advice or prescribing something to assist with whatever the issue is. My initial diagnosis I presented with issues that I had no idea wtf what was causing them, I thought it might have been diabetes. The GP wound up referring me to the right place/MRI scan. If you just have specialist nurses then wtf do you do when someone presents with a range of random symptoms and no idea what’s wrong.

Nurses do not have diagnostic skills. Its not part of our skill set even for specialists or practitioners.

NOt all healthcare systems use GPs as gatekeepers but its one important role for them. Stops the specialists time being wasted with people they have no need to see