Author Topic: Todays view from General Practice  (Read 7372 times)

barakta

  • Bastard lovechild of Yomiko Readman and Johnny 5
Re: Todays view from General Practice
« Reply #25 on: 06 July, 2021, 07:06:39 pm »
I see that frequently doing medical reports. Severe pain but last prescription 6 months ago.

I've been that patient in the past.   Don't like the side effects so hold off taking the pills until essential as opposed to 3 or 4 times a day as prescribed. <snip>

This is me as well. I hate the effects of codeine but everything else we've tried worsens my migraine and vertigo, both of which are bad enough without exacerbation. So I only take meds if I really need them.

hellymedic

  • Just do it!
Re: Todays view from General Practice
« Reply #26 on: 06 July, 2021, 07:20:45 pm »
Thankfully, gabapentin isn't giving me side effects; I'm not sure if it's doing much; trigeminal neuralgia is a weird fish.
Carbamazepine was effective but left me weaker, which I accepted, but limited when I took it. Then I got a rash, so stopped it.

barakta

  • Bastard lovechild of Yomiko Readman and Johnny 5
Re: Todays view from General Practice
« Reply #27 on: 06 July, 2021, 07:54:22 pm »
GP Trainee friend is most unimpressed that government has told people with health-vulnerabilities to "talk to your GP" about the reckless reducing of covid restrictions and masks being voluntary...

I feel for GPs, nothing GPs can do that isn't common fucking sense. And of course doesn't stop employers being shitty and demanding people return to work (which mine are trying to do).

Re: Todays view from General Practice
« Reply #28 on: 06 July, 2021, 09:35:58 pm »
GP Trainee friend is most unimpressed that government has told people with health-vulnerabilities to "talk to your GP" about the reckless reducing of covid restrictions and masks being voluntary...

I feel for GPs, nothing GPs can do that isn't common fucking sense. And of course doesn't stop employers being shitty and demanding people return to work (which mine are trying to do).

I respect GPs, they are doing a job that they are trained for - it's the modern system that's wrong IMHO.  I recall my old GP, who I knew from childhood (possibly if I recall also turned up to assist at birth), and who I recall coming round during the mid-day home visit round.  Long after he retired, if he met my mother on the bus he'd ask after myself and sister.

Nowadays, I can't imagine a home visit, and if I need to get an appointment I can either sit in a phone queue for an hour and get an appointment in a month's time for a random GP at the local surgery; or as I did last time I really needed help then camp out on the doorstep in order to see the receptionist as they opened and get one of the reserved slots.

The GP I saw then was good, took time with me, ignored the "10 minute allocation" (which actually stressed me out more than it did him), and booked me in in his diary for next appointment in his break - which backfired as I couldn't get past the automated check-in system on arrival to say I was there.  I saw him a few times, and personally he was good and a help, but in reality I could see that he could remember little about me and was going just from the 1 minute skim read of my notes as he waited for me to walk from the waiting room to office.

Other relatives have been let down by their GP surgery, but again it's a case of turning up and seeing where the dice roll lands as to who they see and what that GP can glean from the notes.


The "common fucking sense" resonates with me.  I despair of the number of parents rushing down to A&E at the drop of a hat - I just apply a plaster or calpol.  When I had my bad ACL separation coming off the bike my plan was to cycle home and take a paracetamol, but as I was going past A&E I thought I'd stop.  I knew it was a bad injury as they got all the trainees in to look at me.  Diagnosis though was that I should get a lift home and take a paracetamol (i.e. I wasted 5 hours plus NHS time).  NHS physio was undertaken, and when it ran out I went private and the person asked why I hadn't had any treatment.  When I cracked three ribs (note to self, don't ride a Brompton down a flight of uneven off road steps) I didn't bother with GP or A&E as the advice is to simply rest - which I did.

barakta

  • Bastard lovechild of Yomiko Readman and Johnny 5
Re: Todays view from General Practice
« Reply #29 on: 06 July, 2021, 09:51:21 pm »
To be fair about your injury Nuttycyclist, you didn't know it wasn't serious till checked, and my view is A&E is there to eliminate the not-injured from the injured... Not always easy to know.

I kinda feel for modern parents who're scared of having social services go after them if a child is injured and it's not 100% checked out. Some places have good 1st line check options but many don't. I wish we could invest better in different levels of support for need.

I don't think I blame people for asking their GPs for help with this new reckless opening either; it's not clear what is safe and what is not, and employers aren't always prioritising staff safety.

Re: Todays view from General Practice
« Reply #30 on: 06 July, 2021, 11:17:34 pm »
It was a serious injury.  Grade 3 ACL separation.  Took months of physio and even now 17 years later it is giving me grief.

However on the night, the A&E advice was simply "go home and take paracetamol if it hurts, and come back in 3 days to see a consultant".  Consultant's proposal was to slice me open and wire the collar bone to a rib.  I asked how that would repair the injury and he said "it won't, it'll just make you look more symmetrical and better".  Since I thought the scars would make me look worse, and it had no medical benefit, and had risks of surgery, I chose not to go down that route.


In hindsight, and seriously, had I followed my gut instinct it'd have been the same as the advice A&E gave me, but I'd have saved my time and freed them up for others.  Had it been 200 years ago I'd have had no choice and I'd have just done what I thought instinctively.  Had I not bothered A&E and paid for a private physio I might have recovered more quickly (one eye on TDF where I think some riders are suffering similar this year).    I was on the bike the next day, but only because walking hurt and cycling one handed didn't - my parents were not impressed when I visited and insisted on driving me home.



I took my son's toenail off a year or so back, his fault he shouldn't have been behind the bathroom door when I opened it.  I didn't feel a need to rush to A&E to get it checked out or get my name on social services register, I just patched him up and he is fine.    Similar to me taking the end of my toe off on some building work (you should have seen the blood, and my ability to get a 5p piece inserted in the wound) - I patched myself up, cleaned the claret from all rooms I'd run through, and am now fine with the exception of a little nerve damage that'll go over time.  It has never crossed my mind to go after the builders for compensation, nor bother the GP for the contents of a normal first aid kit.   Other people have more need.


As for your comment of "reckless opening", in reality I thought it had already happened.  I have been amazed at the increase in the last month or two of maskless people in supermarkets, mass gatherings outside (I've taken the children to a park when visiting relatives and it was more crowded than in 2018, and nowhere to sit due to the number of people picnicking), I went to a local restaurant the other day as they had an outside event with live music and whilst it was "table service only" the number of groups of people walking around arm in arm and dancing in front of the singer was amazing.  As my wife said to me, it was completely pre-pandemic activity and as our first night out in 18 months was a pleasure to see. (we obeyed the rules and just sat at our table with food, drinks, music, and watching the sunset.)    I feel more that the public have decided it's time to re-open and the government are bowing to public pressure accordingly.     Your views may vary.

IJL

Re: Todays view from General Practice
« Reply #31 on: 07 July, 2021, 08:22:10 am »
Quote
Nowadays, I can't imagine a home visit, and if I need to get an appointment I can either sit in a phone queue for an hour and get an appointment in a month's time for a random GP at the local surgery; or as I did last time I really needed help then camp out on the doorstep in order to see the receptionist as they opened and get one of the reserved slots.

lots of changed over the years we still do home visits for the housebound but they take a lot of time and its time that is in the shortest supply

Demand is higher than its ever been, up 18% in the last year and significant recruitment issues

Care is more complex, conditions that once received little attention are now tested, treated, monitored and reviewed, all very important but very demanding in terms of time. 

We live in a 24 hour society, people expect instant access , I frequently speak to people before they're ill, a sore throat at 09.00 that started that morning. 

Many people who should self care but want to speak to us, at this time of year 100's of calls about hayfever, many wanting a prescription for cetirizine.  (No its £1.50 for 30 at Wilco's)

it's a great area to work in but few people have much idea of how much work is being done in general practice.







T42

  • Patron saint of the dry joint
Re: Todays view from General Practice
« Reply #32 on: 07 July, 2021, 08:37:59 am »
My GP still does regular rounds two or three days a week and his waiting-room is always full during consulting hours.  I've often thought how soul-destroying it must be to be seeing the same ailments and hearing the same wails day after day. My own career was fascinating and varied, and gave me insights into many industries from building nuclear power plants to developing implantable cardiac devices. How he stays so cheerful in the face of such doleful repetition I'll never know.
But they never got to Carcassonne.

MikeFromLFE

  • Previously known as Millimole
Re: Todays view from General Practice
« Reply #33 on: 07 July, 2021, 09:33:03 am »
I increasingly feel for those working in General Practice. They have a microcosm of everything that's working badly in the NHS , and can only patch up the cracks, and not deal with the fundamental problems.

There's the lack of continuity of care, valued by many patients, and in particular those with chronic conditions - extremey difficult to manage given the pressures coming from the demand for quick appointments, and more appointments. (I do wonder if more could be acheinved with the use of Practice Nurses to give more continuity of care)
Instant appointments? A lot of conditions don't need to be seen by a doctor the next day, but it can be very difficult for the worried patient to tell the difference, so 'everyone' demands to be seen straight away. Would increased use of AI help here, but that requires investment in IT and for the worried well to both use and to trust the AI
Too many appointments - yes, increasingly, as pointed out above many conditions and issues don't need professional medical intervention, but again it can be difficult for many people to understand the difference, particularly those whose parents dragged them along to the doctor with the slightest sniffle. Despite my initial misgivings, many years ago, the use of community pharmacists has been a success in keeping some patients away from the appointments desk, and I feel more could be done, perhaps, again, using Practice Nurses to do more triage.
Investment in General Practice is a murky pool that I still don't understand. Most GP practices are private businesses that contract to the NHS, and are therefore responsible in part (as I understand it) for investment in their own businesses - what is the incentive to invest in advanced AI and other technology to improve services for their patients? Dunno.
What we've also seen upthread is the inconsistency of approach between GP practices (and possibly between individuals in the same practice)  - to some extent this is inevitable, but I do wonder if more standardisation might temper patient expectations (eg around repeat prescritions, and in appointement booking systems).
Equally, there does seem to be - and I've experienced this - an occasional malicious attempt on the part of surgery management (lay managers) to deliberatly piss off the customer by making the appointment process as difficult as possible. I suspect this is in a misguided beleif that the 'worried well' will give up and go away, but the really ill pateint will persevere - which is wrong on so many levels. Thankfully my experiences of this show these efforts only last a matter of months before sanity prevales - YMMV.
GPs are also bearing the brunt of the increasing backlog to surgery and other services caused by The Plague, not to mention caused by chronic underfunding of services such as mental health. Mrs M is a prime example of being 'at the top of the waiting list' for surgery almost 2 years ago, and now in chronic pain and depressed with it. The GP can do nothing at all about the causes, just apply the best possible sticking plaster and hope it holds just long enough.

I can't see any solutions to this jigsaw of problems, and I don't think that just throwing money at General Practice will solve the root causes. Other solutions may be politically (and socially) extremely difficult. Again - dunno!
Too many angry people - breathe & relax.

ian

  • camera nazi
Re: Todays view from General Practice
« Reply #34 on: 07 July, 2021, 11:22:43 am »
Surgery management, in my experience, seems to run the gamut of bad to worse. Our local one isn't too bad, which isn't to say it's good, but it's better than the ones that went before which were advertisements for attending the local A&E instead.

It's a big ask though that doctors effectively run a business (I know they delegate, but it doesn't seem efficient or consistent). I think there needs to be more triage, that's the way it was in the US, you'd generally get triaged by a nurse or GP practitioner before you got near the doctor (admittedly, not altruism, that's competition between the healthcare provider wanting to bill your insurer and the insurer wanting to avoid paying the full rate for the doctor).

Giving that we're already in an epidemic of chronic lifestyle problems and ill-health combined with an ageing population, the pressures on primary care can and will only grow. I don't think the current system is sustainable. But that's a wider issue with engaging people on their lifestyle, something governments haven't shown any enthusiasm for.
Authoritarian Thought Leader, the Pol Pot of Powerpoint, the Stalin of Spreadsheets

Re: Todays view from General Practice
« Reply #35 on: 07 July, 2021, 11:30:34 am »
I regularly watch GPs behind closed doors. Amazed at what people turn up for. As above, first day of sore throat or first day of slightly bad back etc.  Plus some turn up just to request some pill they’ve obviously found on a search engine.

Re: Todays view from General Practice
« Reply #36 on: 07 July, 2021, 11:46:49 am »
Our local GP surgery is very good, but they definitely have a triage system - the receptionists. You phone up saying "I'd like to see a doctor as my leg is falling off", and they say "how long has this been going on for?". You respond "a couple of days, but it's definitely got a lot worse in the last 24 hours", to which the answer is always "that doesn't seem urgent - I can offer you a non-urgent appointment 3 weeks on Thursday". If you can convince them that it is urgent, you can probably get an appointment within a day.

They have various different online offerings as well, from 3 different ways of getting a repeat prescription to a form where you can send them details of your issue and pictures, and then the doc will phone you back. And the Covid vaccination system has been incredibly efficient.  :thumbsup:

ian

  • camera nazi
Re: Todays view from General Practice
« Reply #37 on: 07 July, 2021, 11:54:24 am »
That's part of the problem though, receptionists shouldn't be doing triage. You may as well show your rash to the postman to see if thinks it's serious.
Authoritarian Thought Leader, the Pol Pot of Powerpoint, the Stalin of Spreadsheets

Re: Todays view from General Practice
« Reply #38 on: 07 July, 2021, 12:00:27 pm »
I have absolutely no idea as to how I would go about seeing my GP.  It's been at least a decade since my last visit and I am grateful that my health requires no comment, intervention or medication still.

I dread the day that I might need to start popping pills.  Fingers crossed for never.

IJL

Re: Todays view from General Practice
« Reply #39 on: 07 July, 2021, 12:05:20 pm »
Quote
Our local GP surgery is very good, but they definitely have a triage system - the receptionists. You phone up saying "I'd like to see a doctor as my leg is falling off", and they say "how long has this been going on for?". You respond "a couple of days, but it's definitely got a lot worse in the last 24 hours", to which the answer is always "that doesn't seem urgent - I can offer you a non-urgent appointment 3 weeks on Thursday". If you can convince them that it is urgent, you can probably get an appointment within a day.

The clinicians do the triage were i work, reception put the call on the system with a few details, we then call and see if what we need to do for example

Me: hello, i'm calling about Jonny, what's been happening

Parent: he's awful, he got a fever of 102 (whatever that means, I don't do F), he can't walk or get out of bed, he's not eating and hasn't drunk anything in 3 days

Me: that doesn't sound very good can you gets here for 10.00

At 10.00 I go to call Jonny from the waiting room, he's running around in a manner that suggests breakfast was a caffeine energy gel.  He has redistributed the leaflets over the whole waiting room and an old lady is cowering in the corner as she not keen on playing Rugby with Jonny.  Using 25 years of clinical skill I come to the conclusion that Jonny is going to be OK.


Kim

  • Timelord
Re: Todays view from General Practice
« Reply #40 on: 07 July, 2021, 12:12:22 pm »
Problem with receptionist triage is that it's effectively a magic word system, that just filters out those who don't know you have to say 'urgent' (and that it isn't the same thing as 'serious', because that gets you sent to A&E).



Effectively all it means is that you're adding an assertiveness test to the deferral to the medical expertise of the patient.  Which is already at the "I don't know, that's why I want to see a doctor about it" stage.

Top tip: If you have an urgent medical problem and can't get a GP appointment, get a nurse appointment.  They're less contended, and chances are the nurse will take one look at your peak flow of 200 / gangrenous arm / meningococcal rash and summon a doctor.  Which is probably the way triage ought to be done.

Re: Todays view from General Practice
« Reply #41 on: 07 July, 2021, 12:16:55 pm »
I think I must be really lucky with my surgery.
I turn up fifteen minutes before they open.
I get to see a doctor within 30 minutes of their opening.
Every time.
No questions from the receptionist other than 'What's your date of birth?'

ETA - I should add that this was pre-covid.
These days I phone up to request a telephone consultation, on each occasion I've done so, the doctor has called me back within the hour.

ian

  • camera nazi
Re: Todays view from General Practice
« Reply #42 on: 07 July, 2021, 12:24:32 pm »
That's the problem with receptionist triage, effectively if you're someone like me, who knows enough medicine to be annoyingly assertive*, you can break through the receptionist barricades and storm the castle (I also call all my doctors by their first names to annoy them, we still have a curiously deferential relationship to medical care which I think isn't helpful in involving people in their care). Little old ladies who don't want to bother that nice GP with their gangrenous leg will get forever trumped by shouty mothers demanding Jaxxon's sore throat be attended to NOW!

Triage should be clinically informed by people who know to triage. And it's not really triage if it gets passed back to the GP to make the decision.

*recent phone consultation with consultant ended with him saying 'I don't know why we're bothering with this' to which my only response was 'well, I don't have access to an MRI machine and you do.' He was forced to acknowledge my wisdom on this matter.
Authoritarian Thought Leader, the Pol Pot of Powerpoint, the Stalin of Spreadsheets

Gattopardo

  • Lord of the sith
  • Overseaing the building of the death star
Re: Todays view from General Practice
« Reply #43 on: 07 July, 2021, 12:47:57 pm »
Quote
But you only have a certain amount of repeats....

only needs to be reauthorized annually, (at least on the system we use)

I get 3. The monthly one can be a pain to get.  Sometimes a week before med end is too early.

T42

  • Patron saint of the dry joint
Re: Todays view from General Practice
« Reply #44 on: 07 July, 2021, 01:06:39 pm »
Our local GP surgery is very good, but they definitely have a triage system - the receptionists.

In France we have a web site called maiia.com.  You register (might need a French social security n°, I forget) and then you can find the doc you want and book an appointment directly.  All the receptionists do is recept.
But they never got to Carcassonne.

Gattopardo

  • Lord of the sith
  • Overseaing the building of the death star
Re: Todays view from General Practice
« Reply #45 on: 07 July, 2021, 01:09:04 pm »
Bet IJL is wishing they didn't mention they were a GP.

To mitigate any comments Remember Dr Phil Hammond is/was a GP.  He has some great stories.

IJL

Re: Todays view from General Practice
« Reply #46 on: 07 July, 2021, 02:30:18 pm »
I work in General Practice but i'm a Nurse Practitioner rather than a GP.

I deal with much of the new acute illness that the surgery deals with as well a chronic disease case load

At the minute i'm on alert for youngsters fainting after their Covid vaccination, the 18-29 age group seems rather keen to wail and faint.  I do my best to be sympathetic but unfortunately my sympathy gland withered and died years ago when I worked in A&E.

(People do like to tell us "I don't like needles"  it would be bloody weird if you did like them) 



 

Re: Todays view from General Practice
« Reply #47 on: 07 July, 2021, 05:28:06 pm »
Quote
Nowadays, I can't imagine a home visit, and if I need to get an appointment I can either sit in a phone queue for an hour and get an appointment in a month's time for a random GP at the local surgery; or as I did last time I really needed help then camp out on the doorstep in order to see the receptionist as they opened and get one of the reserved slots.

lots of changed over the years we still do home visits for the housebound but they take a lot of time and its time that is in the shortest supply

Demand is higher than its ever been, up 18% in the last year and significant recruitment issues

Care is more complex, conditions that once received little attention are now tested, treated, monitored and reviewed, all very important but very demanding in terms of time. 

We live in a 24 hour society, people expect instant access , I frequently speak to people before they're ill, a sore throat at 09.00 that started that morning. 

Many people who should self care but want to speak to us, at this time of year 100's of calls about hayfever, many wanting a prescription for cetirizine.  (No its £1.50 for 30 at Wilco's)

it's a great area to work in but few people have much idea of how much work is being done in general practice.

I couldn't agree more, and my frustration is on behalf of the GPs (and the patients in real need that can't get the appointments).

Last time I was there, did need the help, although in hindsight maybe had I just hibernated at home I may have pulled through alone, I was annoyed in the waiting room at the volume of elderly/parents who were clearly there just to obtain the benefits the NHS could supply.  Seeing them joking and laughing about their weekly visits, medications, and how they enjoyed it all...    It annoyed me as they (as per late relatives of mine) were clearly there to get the benefits the NHS pay for as opposed to being actually ill, and thus preventing the appointments for those that were ill.   As you said "We live in a 24 hour society, people expect instant access , I frequently speak to people before they're ill, a sore throat at 09.00 that started that morning. "

I'm glad to hear that home visits for housebound are still available despite time constraints (I was referring earlier to I think a time I had mumps or some other issue as a child and Dr came round - we weren't housebound).    As a family we've had a few calls to Dr in last decade and we've had excellent "phone call back" appt on same day which I think is a good way to avoid the time wasted on travel and surgery time.


This is why I avoid visiting the practice unless essential.

MikeFromLFE

  • Previously known as Millimole
Re: Todays view from General Practice
« Reply #48 on: 07 July, 2021, 05:50:53 pm »
I work in General Practice but i'm a Nurse Practitioner rather than a GP.
<snip>
At the minute i'm on alert for youngsters fainting after their Covid vaccination, the 18-29 age group seems rather keen to wail and faint.  I do my best to be sympathetic but unfortunately my sympathy gland withered and died years ago when I worked in A&E.
(People do like to tell us "I don't like needles"  it would be bloody weird if you did like them)
Mrs M was in a different life a School Nurse, and she gave plenty of HPV vaccinations to girls of a certain age who would delight in causing & benefiting from the very definition of mass hysteria! She was (apparently) the very model of nasty-nurse! (She moved on to being a Looked After Children's Nurse which had it's own set of interesting features).
Too many angry people - breathe & relax.

Re: Todays view from General Practice
« Reply #49 on: 07 July, 2021, 05:58:41 pm »
It’s usually so long between my appointments that some of my GPs have retired or died in between them.