GPs... is 2 weeks alright with everyone?

Soldato
Joined
9 Mar 2012
Posts
10,072
Location
West Sussex, England
Thank you all for your thoughts.

It's a strange one, sudden onset reflux like nothing I've ever had before, relentless acid even in my nose, ears and I had to keep brushing my teeth because it was in my burning my lips and gums.

Docs prescribed medication over the phone (it's £1 a tablet in the pharmacy or 56 on prescription), I was eventually seen months later by a GP with referred for an ultrasound, which again took weeks and came back fine. Next step is barium swallow which they won't authorise without speaking, nothing's changed it's just the next logical step bar an endoscopy.

It's not a 'new issue' so I can't do an emergency appointment and they've said they only deal with one issue per appointment to me in the past too. What if the issues are connected?

Anyway it's incredibly frustrating. I have muscular dystrophy so my muscles are basically dying and there's nothing I can do about it and I was just about holding on until I got this issue where I can't eat. You lose weight from you muscles first so time really is of the essence for me. I don't have the time to jump through the normal hoops.

I know the NHS is straining at the seams, facing cut after cut whilst governments award jobs to companies they're in bed with. The whole thing is screwed really but it is something we pay for and it should be fit for purpose. I wonder how many lives have been lost having to wait and wait and wait.

I think a lot of people will be in similar situations where they'd like to of had a GP appointment for existing issue(s) but have had to put it off due to lack of appointment availability in the current pandemic situation. If you're surgery has an online portal it's worth signing up for that as I can log in and request repeat prescriptions using that instead of trying to get through on the phone. It also seems more reliable to deal with the surgery direct rather than via the pharmacy, who seem to regularly mess things up or take longer to complete the whole process. Some appointments are also reserved for the online system or you can see what's available easier than going through reception. Best to book the appointment even if it is a few weeks out and if it gets any worse ramp up the insist-ency for an emergency appointment. Only you can judge whether the meds are not coping to keep things in check as to whether an emergency appointment is warranted or not. Maybe you could get a phone appointment where the GP rings you or failing that maybe try NHS direct.
 
Last edited:
Caporegime
Joined
21 Jun 2006
Posts
38,372
I've got an on-going digestive issue, acid reflux. It's making eating and even drinking a nightmare, I'm losing weight and have another condition that means I really can't afford to lose any muscle mass.

It's been dragging on for 6 months and this is mostly due to the fact you can't actually speak to a GP, let alone see one.

Every time I call I get 'the nearest appointment I've got is... 3 weeks away", if you're lucky it's two weeks.
"You can do an online consultation"
...fills it out and receive a message to call surgery.
"The doctor says they need to speak to you before making a referral"
Ok, great, let's do that
"Best I can do is February 17th"

Is this the norm? Is everyone ok with this?

If you've got something that can wait two weeks it'll probably clear up on its own or needs looking at.

I did ask the receptionist what the issue was, do they have too many patients or not enough doctors?

Doctors seem to work 3 days a week between 9 and 12pm then go on holiday for 2 weeks.

We pay for this service right?

Just frustrated and venting...

Find a new GP.

GP's are paid by the number of patients they have.

So if you don't like the service leave. That will hit them where it hurts.

If you just stay with them they get paid for having you and giving you poor service.

People shop around for stuff but once they get a gp they tend to stick with them until they move home and leave the area.

It shouldn't be like that and therefore GPS stagnate and offer crap service as a result. They have no incentive to do anything because once they have you they are set for life.

For example a surgery which offers crap service but has 12,000 people on the books will be paid more than a surgery offering an amazing service with 11,500 people on the books.

People who don't like the service need to shop around and find a better surgery.
 
Soldato
Joined
16 Oct 2007
Posts
7,427
Location
UK
I've got an on-going digestive issue, acid reflux. It's making eating and even drinking a nightmare, I'm losing weight and have another condition that means I really can't afford to lose any muscle mass.

It's been dragging on for 6 months and this is mostly due to the fact you can't actually speak to a GP, let alone see one.

Every time I call I get 'the nearest appointment I've got is... 3 weeks away", if you're lucky it's two weeks.
"You can do an online consultation"
...fills it out and receive a message to call surgery.
"The doctor says they need to speak to you before making a referral"
Ok, great, let's do that
"Best I can do is February 17th"

Is this the norm? Is everyone ok with this?

If you've got something that can wait two weeks it'll probably clear up on its own or needs looking at.

I did ask the receptionist what the issue was, do they have too many patients or not enough doctors?

Doctors seem to work 3 days a week between 9 and 12pm then go on holiday for 2 weeks.

We pay for this service right?

Just frustrated and venting...

GP is incredibly underfunded. They do 80-90% of consultations with less than 9% of the funding.
People are living longer, with more complex multiple co-morbidities. The funding hasn't increased in line with the demand.
The average number of complaints/conditions per consultation these days? 2.6 per patient per consultation.

The amount doctors work is irrelevant, whether they have many part time or fewer full time. They will have a certain number of sessions covered as needed for the population. They can't take on more than is DICTATED by the local health board/CCG. GP is attractive because it fits with working parents, multiple jobs etc.
The accepted max amount a GP should have on their list is 1600 patients. That is an ENORMOUS workload but it is expected.

My advice -

Are you under 40? 40-55? Over 50? (This determines the guidelines followed by the GP)
Did you try those tablets you were prescribed? Did you complete the full 8 weeks? The tablets are not 56 quid.
Have you had bloods done? Any vomiting?
Have you avoided all possible causes? Ibuprofen, aspirin, SSRIs, alcohol, etc

Make it clear on an e-consult that you a) have muscular dystrophy b) losing weight c) have tried 8 weeks of tablets (if you haven't, then take them) d) request referral for endoscopy due to i) persistent indigestion ii) persistent reflux iii) limiting oral intake iv) weight loss v) mention if any adverse blood results

Note - if you're under 40 and haven't tried the tablets, you won't get an endoscopy under the guidelines, but highlight the MD which should change things. It will look for pathology but dyspepsia and reflux could be part of MD progression.
Barium swallow doesn't have a role here.

So depressing to see so many bad experiences of GP though. I work bloody hard, as do my colleagues. I see 25+ patients a day and I'm still in training. I can guarantee every patient has multiple issues and I address every one I can. People get upset when they have to wait 45 minutes in the afternoon if I"m running late. It's because the previous 20 patients wanted to talk about more than one issue. But then have no hesitation about pulling out a list of five or six issues they want to talk about. It's a vicious circle that isn't fixable with current funding.

If you need to be seen same day, you'll be seen same day. All GPs will have a triage service of some sort but so many take advantage and say the right things to get their 3yr history of ankle pain seen the same day because it's convenient. Which means those people who actually do need a review sooner don't get seen. Vicious circle fuelled by the entitled.

And don't ring 111. That's for urgent medical advice. You become part of the problem if you abuse this.
 
Soldato
Joined
16 Oct 2007
Posts
7,427
Location
UK
Find a new GP.

GP's are paid by the number of patients they have.

So if you don't like the service leave. That will hit them where it hurts.

If you just stay with them they get paid for having you and giving you poor service.

People shop around for stuff but once they get a gp they tend to stick with them until they move home and leave the area.

It shouldn't be like that and therefore GPS stagnate and offer crap service as a result. They have no incentive to do anything because once they have you they are set for life.

For example a surgery which offers crap service but has 12,000 people on the books will be paid more than a surgery offering an amazing service with 11,500 people on the books.

People who don't like the service need to shop around and find a better surgery.
Well that's not true. Just having a patient on the books isn't just how they get paid. Providing that better service (ticking the boxes for things like annual reviews for diseases, providing services) brings in a lot of funding.
 
Caporegime
Joined
21 Jun 2006
Posts
38,372
Well that's not true. Just having a patient on the books isn't just how they get paid. Providing that better service (ticking the boxes for things like annual reviews for diseases, providing services) brings in a lot of funding.

It isn't the only thing which brings in income but it is one of them.

The more people on their books the more they can claim for.
 
Soldato
Joined
16 Oct 2007
Posts
7,427
Location
UK
It isn't the only thing which brings in income but it is one of them.

The more people on their books the more they can claim for.
As I said, it isn't just how they get paid.
You were wrong with your example - looking after 11,500 patients well would earn more than 12,000 patients badly. (Approx 66% of income is providing basic appointments ("MPIG"), 33% is from providing a 'good' service with different facilities/services (QOF, DES, LES)). The MPIG is audited by the CCG and if more patients than available appointments, they would have their income reduced.

It all comes down to overall resources. There just isn't enough to go around.
 
Associate
OP
Joined
5 Jul 2016
Posts
571
GP is incredibly underfunded. They do 80-90% of consultations with less than 9% of the funding.
People are living longer, with more complex multiple co-morbidities. The funding hasn't increased in line with the demand.
The average number of complaints/conditions per consultation these days? 2.6 per patient per consultation.

The amount doctors work is irrelevant, whether they have many part time or fewer full time. They will have a certain number of sessions covered as needed for the population. They can't take on more than is DICTATED by the local health board/CCG. GP is attractive because it fits with working parents, multiple jobs etc.
The accepted max amount a GP should have on their list is 1600 patients. That is an ENORMOUS workload but it is expected.

My advice -

Are you under 40? 40-55? Over 50? (This determines the guidelines followed by the GP)
Did you try those tablets you were prescribed? Did you complete the full 8 weeks? The tablets are not 56 quid.
Have you had bloods done? Any vomiting?
Have you avoided all possible causes? Ibuprofen, aspirin, SSRIs, alcohol, etc

Make it clear on an e-consult that you a) have muscular dystrophy b) losing weight c) have tried 8 weeks of tablets (if you haven't, then take them) d) request referral for endoscopy due to i) persistent indigestion ii) persistent reflux iii) limiting oral intake iv) weight loss v) mention if any adverse blood results

Note - if you're under 40 and haven't tried the tablets, you won't get an endoscopy under the guidelines, but highlight the MD which should change things. It will look for pathology but dyspepsia and reflux could be part of MD progression.
Barium swallow doesn't have a role here.

So depressing to see so many bad experiences of GP though. I work bloody hard, as do my colleagues. I see 25+ patients a day and I'm still in training. I can guarantee every patient has multiple issues and I address every one I can. People get upset when they have to wait 45 minutes in the afternoon if I"m running late. It's because the previous 20 patients wanted to talk about more than one issue. But then have no hesitation about pulling out a list of five or six issues they want to talk about. It's a vicious circle that isn't fixable with current funding.

If you need to be seen same day, you'll be seen same day. All GPs will have a triage service of some sort but so many take advantage and say the right things to get their 3yr history of ankle pain seen the same day because it's convenient. Which means those people who actually do need a review sooner don't get seen. Vicious circle fuelled by the entitled.

And don't ring 111. That's for urgent medical advice. You become part of the problem if you abuse this.

Thank you for this helpful reply.

The point about the PPI was in response to someone suggesting I self diagnose and buy from the pharmacy, to buy PPIs OTC costs about £1 a tablet, my prescription is 56 tablets so much cheaper.

I've been on them for 6 months barring 2 weeks I had to come off them to check for h.pylori. Bloods normal. No other causes involved, not a drinker, no other meds.

Given the sudden onset my guess is hiatal hernia, hence wanting a barium swallow. I'd rather avoid endoscopy if possible, greatly increased risk for sedation also given my condition and I wouldn't want to go through it without it.

Without getting into my complete medical history on a computer forum (lol), I'll leave it there. Like I said I'm just incredibly frustrated and literally don't know how much longer I can hold on with all these delays.

It was good to get feedback and it's certainly not a simple equation: resources, funding, general practices etc.

Maybe I do need to look around at transferring to a different surgery.
 
Soldato
Joined
16 Oct 2007
Posts
7,427
Location
UK
Thank you for this helpful reply.

The point about the PPI was in response to someone suggesting I self diagnose and buy from the pharmacy, to buy PPIs OTC costs about £1 a tablet, my prescription is 56 tablets so much cheaper.

I've been on them for 6 months barring 2 weeks I had to come off them to check for h.pylori. Bloods normal. No other causes involved, not a drinker, no other meds.

Given the sudden onset my guess is hiatal hernia, hence wanting a barium swallow. I'd rather avoid endoscopy if possible, greatly increased risk for sedation also given my condition and I wouldn't want to go through it without it.

Without getting into my complete medical history on a computer forum (lol), I'll leave it there. Like I said I'm just incredibly frustrated and literally don't know how much longer I can hold on with all these delays.

It was good to get feedback and it's certainly not a simple equation: resources, funding, general practices etc.

Maybe I do need to look around at transferring to a different surgery.

Yes I don't blame you, I wouldn't look forward to an endoscopy either! Agreed sudden onset could be hiatus hernia.
Chest X-ray would be a simple, cheap, easy investigation that would likely pick up a hiatus hernia of a size where it is causing significant problems, although with the symptoms you describe it would be better to have a scope to check for issues. Certainly indicated if its been 6 months on PPI.


I do empathise with your frustration though. The few occasions I need to see my GP, I don't get any special treatment, I wait like everyone else and it is frustrating.
But it is not down to lazy GPs that enjoy annual leave every few weeks or money grabbing partners that take on millions of patients to fund their yachts. It is a much, much bigger problem. (But changing GPs is definitely worth a look just in case they have registered millions of patients to fund a yacht..)
 
Associate
Joined
19 Jul 2011
Posts
2,343
Our local is rubbish for appointments. 2-3 week minimum (and that's callback appointments mostly) unless you can get thru the reception who seem to think the general public shouldn't be allowed to speak to a general practitioner.

When you do get an appointment, they haven't read your notes, don't listen to details, and then go on to patronise about using their online services... Which are inadequate, not kept up-to-date or are just plain broken... Grrr. Rant over.
 
Soldato
Joined
25 Nov 2005
Posts
12,452
they haven't read your notes

I'm yet to meet a doctor who has actually bothered to read my medical history, I find it annoying and counter productive especially when they ask about medication, just read the bloody notes and know exactly what I'm prescribed rather than hoping I remember what I'm prescribed ?
 
Caporegime
Joined
21 Jun 2006
Posts
38,372
I'm yet to meet a doctor who has actually bothered to read my medical history, I find it annoying and counter productive especially when they ask about medication, just read the bloody notes and know exactly what I'm prescribed rather than hoping I remember what I'm prescribed ?

Pointless as the system keeps everything on file including stuff you could have stopped using.

For example if you were given antibiotics it would flash up even though it's a 5 day course and you were given them a month ago.
 
Caporegime
Joined
21 Jun 2006
Posts
38,372
Because the system can't say it was a 5 day course ? :rolleyes:

Just an example. Plus you would be surprised. Do you think the government gives enough budget to build or update to adequate standards.

No you have to wait until the system completely fails before they get investment for a new one.

The system crashes a lot too. I think your exaggerating how well public services are funded.
 
Caporegime
Joined
29 Jan 2008
Posts
58,912
I don't think 2 weeks is too bad for a non-acute appointment or a follow-up. In the case of a follow up then you know it is coming so just book in advance.

For acute issues just book on the day by phoning in the morning or even the night before if your practice offers online booking (in the case of online booking you can often choose the GP too).
 
Permabanned
Joined
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12,236
Location
UK
2 weeks is the norm here, I've had 2 months before, which I had to be a Karen about to get it shortened. They've built 4,000 new houses and no new GP. Another 4,000 houses planned and no new GP in that plan either.
 
Associate
Joined
21 Jun 2004
Posts
1,607
I would have thought barium swallow/manometry would be what is needed. Endoscopy would be able to see if there has been reflux causing mucosal damage, whereas Barium would allow the passage to be followed. Manometry would show if there is a failure of the lower oesophagus to tighten after swallowing as it could be related to the MD affecting the muscle working, or any poor regulation of peristalsis.
 
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