This is in response to a post by a lovely sister who has been having trouble with her GP- no issues with the post itself but the comments about:
1) GP working remotely
2) Receptionists being bitches
3) Resistance to give any information to receptionists because they’re non-medical
4) Being on the telephone for more than an hour and no slots for appointments being available
These comments are truly unfounded for the majority of primary care, because behind the scenes most of the general public has no idea how difficult it is for most GP surgeries to meet the demands of the population with lesser staff and funding.
- Technicalities and logistics
Most GP surgery buildings are not fit for purpose and are housed in smaller residential areas or with small to moderate waiting rooms. Many won’t have enough parking spaces for doctors let alone the patient: in this Covid driven era where government advice is to keep a 2 metre distance, I know my own surgery where I’m registered can not have more than 4 people in at any time where before it could fit 18. There are no outside spaces to makeshift tents as well. A face to face appointment time is anything between 10-13 minutes (set by governing bodies, not by GPs) and let’s say doctors stick to time voraciously, how can you logistically accommodate the remaining 12 people? Bear in mind, after every face to face appointment it is the GPs responsibility to wipe down/disinfect every surface that the patient has touched, that includes the chair, doctors desk, the equipment, the examining couch etc.
Solution– wait for the pandemic to be over, use available resources in a pharmacy, NHS self help website and some self care management if possible.
- Time
GPs have only those 10-13 minutes to call patients in, listen to them, examine them, make management plans, see them off and write their notes before it’s all forgotten. And that’s for discussing one straightforward issue. If the patient starts talking about 2-3 issues, complex issues (and let’s be honest most issues could be related and many are complex in our society) then excuse my rudeness but the appointment times are well and truly f****d. If my GP gives me time to listen to all my problems it will invariably be at the cost of patients’ time coming after me.
Solution– if you know your issues are complex or you have more than one issue to discuss, ask to be booked for double appointment. Respect the one appt, one issue rule. Campaign to your MP and governing bodies to give GPs more autonomy on how they manage patients and appointment times.
- Telephone and receptionists
Receptionists are human beings who are literally there to take anything between 1000-5000 calls a day. YOU are calling, and then denigrating them as dragons, bitches, witches, giving them grief over something they have no control over is absolutely inhumane. Where I used to work there were 5 phones and three full time receptionists, other admin staff would help out as and when they became free- but the phones were constantly ringing.
Receptionists deal with all sorts of queries and all sorts of patients, yes they’re not medically trained to judge severity of medical conditions but the reason they ask those questions is because they’re given a list of symptoms to allocate to appropriate clinician with appropriate urgency. If you do not tell them what you want to see the Dr for they have to judge it as non urgent despite whatever you say. I know of receptionists who are off sick and many who will be going off sick because of the daily verbal abuse that rains down on them over the phone. Many cry daily at and outside of work. If you don’t want your child to be treated like this at work them don’t do it to others as well! They’re not sales people and you’re not receiving an unsolicited phone call, YOU are the one who needs them.
I’m currently working in A+E, and do you know how much time I get to see one patient- 4 hours. 4 hours to bring them to a cubicle, take detailed history, do an examination, do bloods, ecg, keep them under observation, put a cannula in, give iv fluids, IV antibiotics, call another specialty or senior doctor for advice, do x-rays, sometimes even get other scans organised and make instant referrals. And even then sometimes people have to queue for up to 6-7 hours.
How much time does a GP get to see one patient- 13 minutes max
How many instant resources does a GP have at hand- none of those except for their trusty stethoscope and the basic nursing stuff.
How many patients are dealt with per doctor in a 10 hour shift in A&E: 10-15.
How many patients are dealt with per GP in a 3 hour morning shift that includes face to face, phone calls and e-consults pre-covid- about 15; during the pandemic it’s increased to anything from 30-50.
Do you know what the recommended number of patients is for patient safety in a full 8 hour shift?- 30 a day.
And that’s just to deal with actual patients. There is usually a 2-3 hour admin work which includes looking at blood results, hospital discharge letters etc. Asking GP’s to do this and that, scan results, forms for insurance, forms for benefits, school reports, coroner’s reports etc etc to be seen and dealt with DAILY. I don’t know of any GP who comes home at 6 sharp. My husband is a GP and he starts his Monday work on Sunday afternoon.
- Why can’t the GP give you a time to call and stick to it?
I say see my 2nd point, we’re running late because we’re talking to other patients or seeing them. Not because we’re standing around water coolers chatting about the latest Harry Meghan drama. Also, people will wait for an Amazon delivery, plumber, etc to come during the day at any time and eventually they run half an hour to any time late. But GPs are apparently supposed to call you on the dot? You can’t have the phone turned on, can’t excuse yourself from work for ten minutes. Well, if your employer isn’t allowing this, that’s your problem with your employer, raise concern with HR, don’t bash the GP about it. I know of GPs who call patients on Friday evenings, weekends etc to make sure they’re reaching them. Which is disgusting as they’re certainly not being paid for the weekend service like the hospital doctors are.
Anyway, I’m sure I’ll get a barrage of ‘that may be your experience, but my GP sucks’ ‘my GP killed my family member’s, ‘my GP misdiagnosed’, ‘my surgery is rated worse by the cqc’.
All of these comments may be true, but all of these comments apply to any doctor be they GP or hospital doctor, junior or consultant, and to any institution as well. No one is perfect. No one is perfectly poised to take the abuse day in day out as well. No one is paid for it. Yet primary care which is clearly underfunded, understaffed and under supported is beaten like a dog by the media, general public and hospital colleagues. To the point that many are thinking of retiring early in droves. Then when you have to go to paying £50 per consultation and extra for every prescription for your child then you’d remember these days where you’re harassed-looking GP who had been keeping their pee in for the last six hours to deal with one more patient, one more phone call, one more blood result actually apologised to you for waiting so long and tried their best to deal with your multiple problems without asking for an upfront fee.
Would you agree?
Maria is a Mum of two girls, wife to a slightly overworked GP, proud to be an immigrant worker in NHS, currently a GP trainee in a specialist deprivation scheme in Northwest.
