Private GP - any thoughts ?

We have the option as part of our employee assistance program, worth checking if you have similar?

And supposing there is (I guess there must be), is this usually on an ad hoc basis, or do you need some ongoing insurance policy, or … ?

Can work either way...

Can register and have a private GP as your only GP, but this carries a 'subscription' like payment I guess.. plus cost when used..

Or I imagine you can pay as you go - will be more expensive PER TRIP, but if it's once in a blue moon may work for you.

DrP

Addressing the original problem, my GP surgery has a 30 minute window from 8 to 8.30am where you can call or pop a message in the app.

People will then be triaged rather than it being first-come-first-served for appointments, so if you need seeing you'll get seen at an appropriate time.

Are you sure yours doesn't do something like that via app?

My employer does private GP care as one of our sidelines, you definitely can do PAYG, I wrote the brochure for them.

Unless you are very lucky and call before 1 second past 8 it’s impossible to make an appointment to see our NHS GP.

Is that actually correct though? I know there are huge regional variations but it must be possible to see a GP or AHP locally.

My wife is a GP, does mainly NHS but also some private work. Nearly all of her private work is PAYG. Its not cheap, starts at £120 for a 15min appointment. Sounds a lot but if it sorts out your issue quickly without faff than I guess it is money well spent.

I've used private both in the UK and over here (Switzerland). The UK experience was superb, like the OP - couldn't get an appointment at all, the best they could offer was a telephone consultation which would be difficult to diagnose my then problem of a rash! The receptionist was coming out with all sorts of funky things like send her a WhatsApp of MY rash and she'll pass it on or email the surgery with a photo. At this point i gave up and found a private GP on the outskirts of Windsor, was done and dusted with appropriate cream within 5 hours....i'd been chipping away for the best part of a week at my local surgery with precisely zero success!

Would i do it again? If i was being given the runaround then yes definitely.

I paid a one off fee plus prescription, but i'm sure like a dental plan they'll be some kind of insurance subscription.

Good Luck. Given up with our local GP's. Private might be the answer, or wait till your leg drops off (or something similar) and you may get seen in A&E by the time you are dead !

Addressing the original problem, my GP surgery has a 30 minute window from 8 to 8.30am where you can call or pop a message in the app.

People will then be triaged rather than it being first-come-first-served for appointments, so if you need seeing you’ll get seen at an appropriate time.

That's how ours works - I ring about 8.30 to miss the rush, explain what I want, and someone rings me back either the same day or the next, depending on how urgent it was felt to be.

It's not "how it used to be" but it's worked so far for me.

Or use Livi and they can assess you and then doctors receptionist's can make the appointment for you.
That's what happened to me last week.

Any walk-in centres nearby?

difficult to diagnose my then problem of a rash

You could have saved yourself the runaround by just going to your local pharmacy. That sounds exactly the sort of ailment the pharmacist would be well placed to diagnose and prescribe the best thing.

Depends on both can you afford it and can you afford the follow-on (that depends what it is)

Equally I guess it depends can you afford NOT to.... (that depends what it is)

It's a couple of years since I managed to get through to the NHS GP receptionist (maybe 3) because I was bleeding out of my bum and I'm still waiting for the appointment .. private saw me the same day I gave up and had me at the specialists the next week. The priovate GP was my own pocket but the follow up was through my then employee insurance.

Prior to that I had a mole removed 6-7? yrs ago ... I/they still haven't got the results.

my last experience of needing an appointment, I called at the prescribed time and got a recorded message saying I was in a queue, but I could go to the website and make an enquiry / appt there.

So i did, the website was all clunky and not intuitive - I mean how hard should it be to find "book an appointment" - and then when I did find it there's a message saying that because of oversubscription, online booking was suspended and please call the appointment line.

Needless to say, by the time I got back on all the appointments had gone for the day.

all the appointments had gone for the day.

did you need to be seen the same day?

Disclaimer: I’m a PM at a GP practice. I use these sorts of threads as research

did you need to be seen the same day?

It's a bit immaterial when the same thing happens the next day and the one after that... etc. and its the only option to get an appointment.

Last time but one I tried my GP only took booking for up to 2 weeks... everything else is an "emergency" (first come/first served) so you arrive a couple of hours before it opens and join the queue... and hope when you get in there is still a slot and you aren't taking one from someone who's going to die and if not you do the same the next day. Meanwhile the phone was ringing and not being answered so trying to call for an appointment was even more pointless..

Getting into the 2 weeks slots seemed like some rolling triage.

The last time they changed the system and you now do a web form... I was surprised and got an appt the next evening... and then a set of xrays the same week.... it now seems to have broken down as that was 2 weeks ago and they still don't have access to my xrays (as of yesterday)

"did you need to be seen the same day?"

It’s a bit immaterial when the same thing happens the next day and the one after that… etc. and its the only option to get an appointment.

Exactly the problem. I'd be happy to get an appointment, say, next week, but I can't.

Slightly related - there are ads now on telly and social media about going to see your GP if you're worried about something that might be cancer. How does that work if you call the receptionist and tell her that, say, you've had a tummy pain for a couple of weeks and you're concerned. To whom are we delegating the triage? Can we expect an explosion of folk dying from undiagnosed conditions in the next year or two? Just feels like the system is utterly broken.

Practical question - how do you find a private GP? Checkatrade.com ?

I go private for routine tests, q happy to pay as I get tests done when it suits me, get 1 to 1 analysis from GP next day.

Did try using state system, it was free so cant complain, but I d rather pay and have a bit of luxury, time saving and a friendly doc who I've used for 15 years.

My NHS GP (north hertfordshire) are bloomin good with triarge - if someone needs to be seen they will be seen. Generally starts with a phone appt / SMS pics in then they bring you in if it's deemed necessary. I've seen people from the queue be serious enough that they are needed to be seen urgently and they are asked to take a seat and they get seen rapidly

But I think anything other than immediately accute 'this needs to be dealt with today - it's clearly an infection' or 'you are 30 you really shouldn't be having X' and there exists an ever growing 'health gap' where I am sure a lot of early stage disease is being missed because there is no such thing as a yearly gp health checkup any more (for those who can't afford it)

Us decently well off people can go and get all the tests we want privately. Need a mole checked? No issue come in to a clinic tomorrow. Want some bloods done? No issue come in later today, £300 please. But what about people who can't afford this - who don't have an immediate 'doctor needs to deal with this' issue eg a bite that has clearly become infected - but can't get access to a healthcare professional to be effective told (but these people DO need to be told from an authoritative doctor type person) "look you really should be doing much more exercise and eating less bread".

That side of healthcare is going to get worse and worse I reckon. And will lead to more disease and a sicker and sicker population.

Why isn't health studies a regular lesson in school? Same as investing, housework, DIY etc. Such a crazily short sighted country!!! Frustrating.

Can’t see the need for private. GP appointments aren’t something particularly urgent. I’m fortunate though as usually get econsult straight and often face to face same day. Not that I go very often. Probably is people abuse GPS when they could easily see a pharmacist for a rash.

I’d be happy to get an appointment, say, next week, but I can’t.

Yup. Same here. Set time to ring and get appointment (for that day). Can’t book for another day… ‘try again tomorrow”… repeat ‘till lucky… and then it’s a phone appointment with someone you can’t understand on the phone. Pharmacist route is fine in theory… ours used to be good (crazy busy) at dealing with things when people couldn’t get to see a GP… but has now left. Over worked/stressed? Don’t know.

Our GP has an e-reception system that works really well. If you need an appointment, this is all triaged online. Can also be used for repeat prescriptions, physio requests, checking for test results etc. I can't remember the last time I had to phone in to them. It also helps to free up the phones for those who don't have online access.

DrJ

Exactly the problem. I’d be happy to get an appointment, say, next week, but I can’t.

Slightly related – there are ads now on telly and social media about going to see your GP if you’re worried about something that might be cancer. How does that work if you call the receptionist and tell her that, say, you’ve had a tummy pain for a couple of weeks and you’re concerned.

See above... still waiting after 3? years for the appointment to "diarrhoea for months and now bleeding out of my bum"...

and the results still aren't back to my suspect mole that was removed 6-7yrs ago...

did you need to be seen the same day?

Disclaimer: I’m a PM at a GP practice. I use these sorts of threads as research

Possibly not but there wasn't a 'sometime in the few days' option, they'd turned the online booking off, it's try again by phone tomorrow.

I can get a consultation for a couple of weeks away (fine if I want to discuss a vasectomy for example), or I can go to a walk-in centre or A&E if it is urgent, but 'had this cough for a couple of weeks now and not getting better' - you don't want to wait another 2 weeks for, you want to be seen relatively promptly.

Not meant to be a rant, whenever I've needed to be seen I've been very well treated, within limitations of the current waiting lists etc., more a humorous attempt at the 'please use the online booking' - 'we've turned online booking off' circle of frustration.

they’d turned the online booking off,

most practices have a variation of this to control demand (there’s only so many people a GP can see) . It’s as challenging for GP and the staff as it is for patients frankly. Demand seems to have gone through the roof and while we have any number of schemes and systems to divert folks to pharmacists or MI clinics we cannot seem to satisfy pts needs.

Try downloading the NHS app, some practices enable appointment booking via that.

Mrs FD get access to private GP through a hospital fund thing she is in.

We have used it twice and to be honest she has found it pretty useless (bearing in mind she is a doctor). The people that dealt with her, their knowledge was apparently woeful. But still they ended up giving a prescription for what was needed.

They dont have to be qualified GP's, and most qualified GP's are indeed working as GP's. However I am sure this market will grow and more GP's will move to these types of private provider due to low pay and NHS conditions

Slightly related – there are ads now on telly and social media about going to see your GP if you’re worried about something that might be cancer. How does that work if you call the receptionist and tell her that, say, you’ve had a tummy pain for a couple of weeks and you’re concerned.

My Mother in Law had this just now. Visited A&E about 6 weeks ago with stomach pain and loose bowls. Out on holiday had the same and ended up in hospital again.

Rang Mrs FD on return from holiday, and Mrs FD said ring GP straight away. She got an urgent GP appt, spoke to the GP who arranged an immediate CT scan that day. Thankfully not cancer but can now be treated.

I work in the NHS and cringe at some people who should know better, but still demand a doc appt when their kid has a really bad cold etc because they think their kids needs anti biotics !

They dont have to be qualified GP’s

Are you sure about that?
My wife is very much a qualified GP, even when working privately. TBH, you'll struggle to find many GP's with more qualifications than her.

Need a mole checked? No issue come in to a clinic tomorrow. Want some bloods done? No issue come in later today, £300 please. But what about people who can’t afford this –

My most-recent GP appt was to check a mole.

Used to app to request, got a call back next day setting up appt in 1.5 weeks' time.

I'm happy with that.

(False alarm BTW)

I have access to a private GP service on an app called babylon that is part of the heathcare package i get from work. I think I used it for one issue and it was very quick and easy. Phone appointments in a given time slot same day.

I prefer face to face and for that I use the NHS GP. My surgery book most of their apps same day so if its urgent you call start of day, sit in a queue for 30 mins but get seen that day, if its not urgent then its about a 3 week wait currently which is not the end of the world. My old surgery before moving had a turn up at 8am and first come first served for the first hour or so of the day. That worked well, start queuing at 7.45, seen by 8.15. The one my wife and kids are at seems impossible to ever get an appointment but my wife seems to have sussed out the system and can log an e consult query in the morning and have a GP call her same day. There is fair bit of finding out the knack of how to get the service out of your surgery

Then as above, more and more seems to be being pushed out to the pharmacists to do, ears, sinus sprays, rashes, BP checks etc have all been pushed to those guys

Went to GP yesterday afternoon after leaving the wife in charge of getting me an appointment in the morning 8:30-8:45 window ( i was on the school run). I've not been for over 12 years , so booked in for an MOT with the nurse whilst I was there for the usual and bloods next week.

Well it’s all going to be fixed as the government is imposing a new contract on the profession that incentivises access above all else and forbids asking patients to call back tomorrow. I’m waiting with baited breath to see what support is going to be offered to practices to magic this into existence…

https://www.england.nhs.uk/long-read/changes-to-the-gp-contract-in-2023-24/

Are you sure about that?
My wife is very much a qualified GP, even when working privately. TBH, you’ll struggle to find many GP’s with more qualifications than her.

I think the distinction Is between a qualified medical doctor (or surgeon) specifically trained and qualified as a GP?

No one has yet made the connection between the shortage of provision in the NHS and the use of private healthcare?

You people, the "I'm alright Jacks", are the problem.

APF 🙁

You people, the “I’m alright Jacks”, are the problem.

Or, an alternative view might be that people paying to go private eases pressure on an already overstretched state system. And don't assume that in every case private work is taking NHS doctors out of the system. My wife was forced to reduce her NHS hours due to the diabolical pension cap system.

You people, the “I’m alright Jacks”, are the problem.

Bit harsh. The private GP market in the UK is relatively teeny. I’d bet that most GPs in it are doing it as a side gig to their NHS work in their days off

It ain't that simple APF. Maybe the reason some people are looking for private GPs now is because they have found they can't get the service they need through their NHS GP, and that is down to years of under funding, target setting and general mis management by the powers that be. I'd suggest an increase in demand for a private GP is a symptom of a failing health service, not a cause.

I can kind of see APFs point its a downward spiral - GPs work private, presumably to top up their wages (I know they aren't seen as paid well, but compared to what many have to live off, they are). GP's complain about working hours / not enough GPs. People consider using private because they aren't satisfied with the NHS service

My surgery was a nightmare to use same thing with the phones. I just used to walk in and stand there until a receptionist spoke to me - they used to just hang up the phone on calls when busy. They have introduced an online service which I've used once and it was pretty good, write down symptoms and get a call back in a couple of days

Once you see the GP's they are great, but I'm always conscious I've got like 10mins to talk to them, and I have a bunch of things going on I'd like to get to the bottom of it. 10mins is just not long enough for complex issues

I have been putting of returning now for nearly a year, so I am considering paying for private scans and tests to discount things. I've seen in town we have a skincare clinic that covers things like moles.

GP seem to be going the way of dentistry

Someone mentioned livi up there. It’s a service that is paid for to “provide extra capacity “ to support nhs primary care in some areas. At the practice where my wife used to work one of the gps was talking about leaving her nhs post to work for them instead. All online. Working from home. Better work life balance etc. I don’t know if she did leave or not but the point is there is a finite number of qualified gps. All the new online private services need gps to work there and we can’t be in two places at once. There are not enough GPs to go round, to deal with the demand.

Once you see the GP’s they are great, but I’m always conscious I’ve got like 10mins to talk to them, and I have a bunch of things going on I’d like to get to the bottom of it. 10mins is just not long enough for complex issues

I have been putting of returning now for nearly a year, so I am considering paying for private scans and tests to discount things. I’ve seen in town we have a skincare clinic that covers things like moles.

+1 this! GP's are great, when there is an immediate issue evident that they can refer for

Anything in depth and they simply don't have the time. Us public are left to be our own GP's these days. Maybe that's a modern luxury - where in the past people would just slowly over the decades have their health degrade, whereas now we can literally pay our way to better health (through paying to see specialists, have our own scans, have yearly bloods, etc, be the master of our own health when we are in 'good enough health' for the GP to be happy - IE national average (which is shocking, imo, and NOT a good metric) - but not at 100% which some strive for (incl myself and others ^, it sounds like)

However I am sure this market will grow and more GP’s will move to these types of private provider due to low pay and NHS conditions

I don’t understand this. GPs don’t work for the NHS and do not have nhs contracts of employment. They are either employees or owners of the practice they work in with the t&cs that that practice decides to offer.

No one has yet made the connection between the shortage of provision in the NHS and the use of private healthcare?

This. There are a finite number of GPs in the country so they can only work in one at any point in time. They, like consultants, have a perverse incentive to make the system worse. The current GP service contract is based on the number of registered patients at the practice, not how many they actually see. So increasing private appointments makes no difference to the business income from the nhs but does increase the GPS income. I used to work in practice based commissioning and it was common place for GP practices to charge extra for additional services, which was fine. But they carried out that service when they were supposed to be seeing normal appointment, not fine, but because the contract is based on registered patients not seen patients there was nothing you could do to stop it

I think APF has a point - but as an individual should I ‘grin and bear it’ with symptoms I’m worried about being an indication of cancer? Or should I do what I can to help myself? I’d feel a bit stupid dying on the moral high ground while the NHS service is trashed for political reasons.

I don’t understand this. GPs don’t work for the NHS and do not have nhs contracts of employment. They are either employees or owners of the practice they work in with the t&cs that that practice decides to offer.

We literally DO have NHS contracts of employment!!!!
Google GP contract England - it’s all there!

And this is the issue (kinda) - the contracts are becoming more and more driven towards ‘making the government look good’ rather than offering good healthcare.

All this drivel about giving people immediate access looks great for the Tory posters, but isn’t workable.

DrP

because the contract is based on registered patients not seen patients

Indeed. And back in the days of practice based commissioning there might have been some spare time to do extra non nhs work. But we are talking 15 years ago here. Nowadays the contract of £x per patient for all the primary care they need is insufficient to meet the demands/needs. Perhaps it should be changed to a cost per contact model like acute trusts have- that would soon prove unaffordable though by the treasury or they would have to actually explicitly cap access to primary care rather than having it rationed by poor access/waiting times like now.
A new contract model is definitely needed. We can’t keep pretending to offer an all you can eat buffet for the cost of just the first course.

https://www.babylonhealth.com/en-gb/pricing#pricing-section

They offer pay as you go, many employers now including it to get staff back to work quicker if they get ill.

And back in the days of practice based commissioning there might have been some spare time to do extra non nhs work.

Clearly there still is because these practice based commissioning schemes still exist today and these private services are suing the same GPs as the NHS contracts with. My local practice runs a dermatology op clinic for the local trust in the practice. The GP runs it during normal clinic time and then works sessions at the trust as a Gpsi in dermatology. My dad was referred by this GP to the hospital where he was then seen by the same GP as part of the acute dermatology service

We literally DO have NHS contracts of employment

Then why does the BMA talk about contracts of employment for GPs being with the practice and not the nhs. There are pages on how GPs and practices should contract with each other.  About how locums should set their rates with the practice?

https://www.bma.org.uk/pay-and-contracts/contracts/salaried-gp-contract/sessional-and-locum-gp-contract-guidance

I agree that doctors working in secondary care do have employment contacts with the nhs trust they work at

Then why does the BMA talk about contracts of employment for GPs being with the practice and not the nhs.

Because the practice will employ staff, so the practice will have contacts of employment for, say, salaried GPs.... This BMA contact model you speak of is to ensure I don't employ my staff in draconian measures!

I'm a partner. I own the practice/business. I employ a salaried GP.
The NHSE contracts tell me/us/the practice what we have to offer to the public.

I acknowledge - it's complicated!

DrP

Private GP – any thoughts ?

This is exactly what those bastards in power want people to do. In time it becomes normalised and the great sell off will be complete.

There may be a very limited "free" at the point of use NHS left but it won't be worth anything.

The current GP service contract is based on the number of registered patients at the practice, not how many they actually see

Not quite, the contract is based on a weighted patient registration, and takes into account things like deprivation and age. the contract also suggests that patients should be seen 3 times a year on average. I can look at stats that show a good percentage of my patients are coming to the practice many more times than that. The alternative - paying doctors on their activity, didn't go down well with dentists.

No offence @chrismac but I don’t think what you are describing as practice based commissioning is what I think of as practice based commissioning- back in 2007/8 all practices were being asked to get involved with it. Then consortia were a thing for a while then everything was ripped up and thrown out with the emperors new clothes that was CCGs.
There are still some GPs that do other work on top of their nhs gp contract. Eg there are a couple near us that do vasectomies  this brings in more income that probably pays for locums to see their patients while they’re doing it, plus some profit, but it’s still nhs contracted work and it’s not general practice. It’s “any qualified provider” commissioned services. Running dermatology outpatient clinics is also not private general practice. GPs are often very versatile and able to fill lots of gaps in the system. One example is the “gp in a&e” that is everywhere now  I’ve done these sessions myself, so much easier than the day job! Personally I’d prefer the GPs I’ve trained to be working in general practice but I don’t have control of that. Almost anything else you can do as a fully qualified gp is less stressful than being an nhs gp- so it’s no wonder that people are choosing other career options.

The wiki page for pbc refers to it in the past tense like an extinct animal…

https://en.wikipedia.org/wiki/Practice-based_commissioning

@docrobster. No offence taking. I worked I practice based commissioning and then helped set up and create the CCGs in the county I worked in. Yes the model has moved on to AQP based but it’s still fundamentally GPs doing the work hospitals did in their practice when they are contracted as a business to be seeing patients. It’s certainly how it operates round my way with the AQP patients having appointments during the normal clinic lists.

@DrP I’m a partner. I own the practice/business. I employ a salaried GP.
The NHSE contracts tell me/us/the practice what we have to offer to the public.

Agree entirely. Your company has a contract to provide GP services to the NHS in the same was say Virgin healthcare did or boots etc do. You then employ your staff, so they are no more NHS staff than those who work at a private hospital or private primary care provider.

the contract also suggests that patients should be seen 3 times a year on average

Off topic, but does it specify mean or median? A small number of very regular visitors means they're more likely to hit 3 visits per year as a mean, but my gut feeling is that the median would be much lower. (Perhaps I should see a GP about these strange feelings in my gut 😀 )

@nickc I believe it’s more than 6 a year now isn’t it? And the ones that come a lot more than that are the really medically complex ones- multiple conditions, in their 80s etc etc.

I popped on to the pricing page for that Babylon app- payg it’s £50-60 an appointment which is affordable for the archetypal t6 driving £6k bike riding IT professional on here, but more interesting is the subscription service which is £249 a year but limited to 6 appointments a year as this is the traditional average use. Average nhs spend in England is £140 a year per person so either Babylon are making huge profits or the nhs needs to spend more. Or both. Babylon’s patients are also likely to be a self selecting group of healthy working age adults who just want a convenient service for minor quick problems or things that the nhs doesn’t provide. Cherrypicking the simple patients is a good idea if you just want to make profits.

I think the contract still says 3, but I'd have to search it and it's 288 pages long so that ain't happening 🤣

Is Babylon the one that still tells you you to go to a proper GP if they can't sort you out either over the phone or video?

mean or median

Fairly sure it’s mean. The only stats I’ve seen are total number of appointments in general practice per year- so just divided by population to give “average”. It’s an underestimate of work done anyway as so many patient interactions phone calls letters etc aren’t recorded as appointments. NHSEngland has really no idea what we do!

Not sure it matters though. You can’t compare an appointment with an 85 year old with heart failure diabetes copd chronic kidney disease arthritis and dementia who needs to be seen 20 times a year with someone who gets a bad back or urine infection twice a year and just needs it sorting.

For what it’s worth what I think we will see is more segregation between “urgent/convention/minor” delivered by anyone who can diagnose and treat a simple common condition and “complex/chronic/severe” service delivered by named gps with continuity as a more important factor than speed of access. How a system like that picks up patients that need to move between the two types of access is hard to predict. How many minor illnesses before someone starts to look for the hidden cancer?

sadly another example of the people who 'run' my GP practice on a day to day basis letting down the GP's who do a good job.

My wife has fairly textbook symptoms of whooping cough; I'm attuned to this because I had it 10 or so years ago. Mild cold symptoms 10 days ago has quickly deteriorated into a hoarse cough that goes onandonandonandonandon.........until she goes red faced, retches, gasps for breath. Worse at night.

It's not urgent as in must be seen today, so she requested a call back from the GP via the online system, firstly because she can reduce infectiousness if they deem it worthwhile with AB's. Second, because it's a notifiable disease and needs tracking. One for a GP to read and action at an appropriate time.

Didn't get a call back. Got an secure message* back from CN team telling her to get cough medicine to reduce the symptoms - something that is specifically told NOT to do in the NHS advice - and if not better in a couple of days to call back. They have completely missed the important content of the request, and it's only because of my past history and ability to read the internet that we are going to have to escalate by getting in the appointment queue tomorrow.

* which you can't even respond to.

Employer provides Aviva Healthcare, it comes with an online GP through app service.  I’ve only used it once, when my daughter needed physio and aviva’s own policy is not to allow under 16s to self refer.  My experience of that was so mediocre that I don’t perceive it as a solution to the problem the OP thinks he has.  It fulfilled my need but anything which would require physical examination, blood pressure, stethoscopes, blood tests, x-rays etc looked like it would be referred back to the NHS GP!  That said my employer believe it is helping people who don’t work from home to access GPs and so helping the business.

In terms of getting an appointment have you tried walking into the GP either during the day or at the 8am rush to see if the reception staff can help get you what you need?  Often they can be quite helpful if you approach them the right way.

<span style="font-size: 0.8rem;">Pharmacist route is fine in theory… ours used to be good (crazy busy) at dealing with things when people couldn’t get to see a GP… but has now left. Over worked/stressed? Don’t know.</span>

This is the problem - people (including some pharmacists!) perceive asking the pharmacist as doing the GPs job for them.  Let’s be clear, pharmacists are highly trained medical professionals, who are (should) be competent and experienced at doing this.  They mostly (all?) should even have a private consultation area.  It’s not a favour to customers or the GP - it’s their job.  If they can’t deal with it they will tell you to see GP but if you say, pharmacist said I need to see the Dr to the receptionist it might just carry a bit more weight.

I think whilst WhatsApping pics of a rash is clearly not the right solution; and a telephone appointment is unlikely to solve it you might be surprised if you engage with the system they’ve provided how it does work.  “Thanks I’ve looked at your pics, nothing there is concerning me, the pharmacy should be able to provide a topical cream that will clear it up in 7-10 days, come back if that doesn’t work” or “From your description I am happy to refer you to Detmatology” or “OK that doesn’t sound good can you come down to the surgery this afternoon so I can take a look”.

GPs are over worked and under resourced.  But we seem to have a culture where patients are happy to use google for diagnosis but unwilling to do anything other than visit a GP face to face.

@nickc Disclaimer: I’m a PM at a GP practice. I use these sorts of threads as research

Interesting Nick.  I wonder if you see what I see.  This is my experience (and that I have had with my children):

- Google symptoms, already suspect I know whats wrong, certainly know the things the Dr is likely trying to rule in/out

- Call Surgery get appointment (with minimum description of condition)

- Dr discusses the issue, and says "OK we will need (pick from) Blood / Urine / Stool / X-ray". [Which was probably obvious before google but certainly after].

- Phlebotomist appointment / x-ray referral or sent home and return with sample bottle

- Follow up Dr appointment to discuss conclusions of the tests (or in some cases the results have nothing remarkable on them so the patient doesn't get a follow up and then has to refer themselves back to the start of the process to begin another cycle of investigations).

Assuming that pattern is common (and I'm guessing that patients fall in 3 broad groups: 1. People with an ongoing / chronic problem having follow up; 2. People with some symptoms that require investigation like above; 3. People who genuinely need seen today - for treatment etc to start today.). Is it feasible that a very quick telephone or online screening process (it could be half a dozen questions in an online "wizard") identify the tests the Dr is likely to order, and miss the first appointment completely freeing up slots for people in group 3.

that's what E consult SHOULD be doing, TBH..

DrP

The real problem is not training enough doctors. The reason is lack of proper funding . The restriction is demonstrated in the ridiculously high entry requirements for medical schools. Obviously required grades should be of sufficient merit, but they are actually set so high that only the very top academics can be considered. Will an elite level academic perform better than a very good academic? That along with other barriers to entry such as having related experience means the UK has a shortage of doctors and has to import many qualified doctors from overseas.

Actually, the big issue is no one want to work in the NHS as a doctor any more. Especially general practice. There's lots of doctors..they're all over my facebook feed galavanting around NZ or Oz. The 2 facebook GP groups I'm part of are FULL of people asking about emigrating to Canada/NZ/Oz.. why... becuase, simply put, the current atmosphere towards GPs is S H I T.

I'm lucky that I enjoy my job and my patients are mostly nice.
But the nation is angry. The service is dying. And GPs really are mostly the messenger being well and truley shot.

You don't get threads about "I rang up for a table at the fat duck and they can't see me for months" or "I wanted to book a taxi for ten minutes past midnight on 31st dec and there's WEREN'T ANY RANT RANTRANT" do we.... but yet everyone assumes the right to see a GP at any time (24hrs a day now) for any reason (i don't want to pay for sun cream...genuinely) is unfaltering and infallable.

Genuine question. If my apointmetns for teh day (which is based on number of staff, and a safe amount of workload, coupled with all the OTHER work I have to do, coupled with the fact I like to eat, and piss, and shite etc)..when they are all full, what SHOULD I do when the N+1 person rings in wanting to be seen?

DrP

and I’m guessing that patients fall in 3 broad groups

Pretty much, we have a triage that goes;

Emergency: seen today

Urgent: 24-48 hours

Routine: everything else (in effect pts are normally offered "something this week" or "something next week" )

Add to that mix is people telephoning in, and people coming in off the street. folks with LTC that need reviews, check ups, regular check ups, groups of folks that our contract says we need to manage a particular way, and so on. Add to that the fact that most patients see the GP as dealing with them and their prescriptions, when our list of daily things includes (but not limited to)

Reports,

Flu jabs

covid jabs

home visits

nursing home rounds

revalidation

daily weekly monthly CQC requirements

policy updates

revalidations

mandatory training

Learning disability reviews

chronic health reviews

recruitment (constant)

ICB assurance reporting

safeguarding

combatting health scares in the press

GP training

managing local targets

out of hours

etc etc etc....

Now, every GP practice is it's own thing. We have a KPI that says the reception team will answer 95% of calls within 1.30mins. I've known some GPs that just don't answer the phone at all, others that won't allow on-line consultations, and everything in between. The reason that happens is that every GP practice has a capacity limit of how many pats they can see in one day, and that's generally about 1% of the pt. population (that's a pretty much SOP for any well functioning GP practice), how they reach that limit....I've met GPs that will send every urgent case to A&E and I've met GP who fill their sessions with on the day bookings, there's no rule book

generally about 1% of the pt. population

Blimey.. I think we see about 2 and a bit % daily..oof!

DrP

Sucka!

🤣

The restriction is demonstrated in the ridiculously high entry requirements for medical schools

The restriction is also the Government limiting funding to medical schools to restrict number of students coming through the system. Unbelievably, the Gov is limiting supply of new Doctors.
https://www.theguardian.com/education/2023/jan/14/ministers-refuse-fund-medical-school-uk-doctor-shortage

Sucka!

ha!!!

Our PCN released appointmetn data recently..we weren't even the highest...will check...

DrP

It's a tricky one. I think most people are just trying to do what's best in a system that's basically broken, but it's not clear what actually is best.

I certainly feel the OP's pain. I'm sure it is possible to get an appointment at our local (Aberdeenshire) GP but I've never had the time to work out how. In theory you can phone during some small window around 8am but the line is permanently engaged. There is now an eConsult service, which I have used but there are at least 3 big issues with it i) even that is only available for a short window each day ii) you can't just put in a free text description of the issue but have to go through a long list of seemingly irrelevant questions, which takes ages iii) if you put the "wrong" answer to any of those questions it just says it can't help you. No idea of where you should go next, just sorry we can't help! Fortunately you can go back and just change the answer though, which makes the whole exercise pointless.

So, what to do? I could afford to pay for an appointment, but haven't done so as it just feels wrong to buy my way to the front of the queue for something as essential as a GP appointment. But the reason I have that cash is that I'm time-poor, which is why I can't work out how to "play the system" to get an appointment. If my cash goes to subsidise the visit of Elsie who doesn't have the cash but has the time to try and get through the system is that so bad? Probably, which is why I haven't done it.

But I do something similar in other areas. I managed to damage something in my leg on a run and haven't been able to walk without pain for the past three weeks. So I paid to see a local physio who I know is good at sports injuries. That's not really any different. If I was being consistent I should have waited to see an NHS physio, but somehow that seems different.

The physio did say that I should really see a GP to rule out a few things, but as I said to her I'd need to be in pain for a bit longer before I was ready to face the misery of trying to get an appointment 🙂

The real problem is not training enough doctors. The reason is lack of proper funding . The restriction is demonstrated in the ridiculously high entry requirements for medical schools.

That does seem to be getting addressed, at least in Scotland. Our medical school has seen a big increase in students this year with more increases planned (mandated by the government in Holyrood). For the first time ever they are having to consider trying to actively recruit students rather than the usual "selection" approach and I think the entrance tariff has dropped a bit. There is quite a bit of good work being done around widening access too although obviously still a way to go.

we weren’t even the highest

I'm being a bit loose with the stats, that's just GP appoints and it's a little over 1%, it doesn't include the 25-30 triage (from the online system) I give them every morning, and doesn't include the nurses or the HCA (doing a blood clinic that we won' get paid for...)

 even that is only available for a short window each day

We do the same, It's a capacity issue. I imagine every GP practice does. You know that everybody recognises that adding a lane to an already busy motorway ultimately does nothing for congestion? Allowing online requests for consultations is exactly the same thing.

We do the same, It’s a capacity issue. I imagine every GP practice does. You know that everybody recognises that adding a lane to an already busy motorway ultimately does nothing for congestion? Allowing online requests for consultations is exactly the same thing.

I kind-of understand this but as a patient one advantage of an online system should be that I can use it to report symptoms that aren't urgent. It's not about adding extra capacity, it's about giving patients who are short on time a convenient way to say "I've got these symptoms, do you think we need to do anything about them". As it stands it just seems to be another version of the "phone for an appointment" system and doesn't offer any advantages so what's the point?

I think what frustrates a lot of people with the current system is that we know our GP is busy and we're happy to make allowances but they don't seem to understand that the rest of us might be busy too.

Going back to the original question it seems to me that we all think it's wrong for those who are cash-rich but time-poor to use their cash to get an appointment with a GP, but we don't think it's wrong for those who are cash-poor and time-rich to use their time for the same purpose.

I kind-of understand this but as a patient one advantage of an online system should be that I can use it to report symptoms that aren’t urgent. It’s not about adding extra capacity, it’s about giving patients who are short on time a convenient way to say “I’ve got these symptoms, do you think we need to do anything about them”. As it stands it just seems to be another version of the “phone for an appointment” system and doesn’t offer any advantages so what’s the point?

So the ideal would be that I cancel 6 face to face appointments per day, in order to deal with, say, 18 eConsults (in reality, my practice doesn't have numbers that high).

But if we do that, we'll be berated for cancelling 6 appointments.

'people' (BBC, mail, patients, hospital staff) don't understand the complexity of running a GP practice. Time and time again we've tried letting people know.

DrP

You don’t get threads about “I rang up for a table at the fat duck and they can’t see me for months”

If a proportion of my earnings were given to The Fat Duck every month I'd be disappointed if I struggled to book a table. 😀

If you have the money and can go private pay I'd say so you can get on with life.
It would be nice if GP practices did late night opening for people who are employed so we don't have to cancel/take time off work though I appreciate this would make being a GP even less appealing.

pats they can see in one day, and that’s generally about 1% of the pt. population (that’s a pretty much SOP for any well functioning GP practice),

If the business cant see enough patients in a day then surely it should either hire the staff to do so or be honest and stop taking the revenue for work it knows it can’t deliver.

I agree we need to train more doctors but the professions representatives , mainly the GMC and BMA, do all they can to restrict entry to the profession to keep salaries high for those already in it

https://bmj.altmetric.com/details/5571179/twitter

it’s about giving patients who are short on time a convenient way to say

I understand your frustration, I really do. If I could trust patients to use these systems like that, I'd happily open them for longer. I know that other practices they've had to close on line appointment requests because patients abuse it. Plus at the end of the day, it's still a triage that ultimately I have to give to a clinician to sort out, and annoyingly they get upset with me if I don't let them out their chains to go home occasionally

If the business cant see enough patients in a day then surely it should either hire the staff to do so or be honest and stop taking the revenue for work it knows it can’t deliver.

How many patients is enough patients? I do have to abide by laws that tell me I can't actually work my GPs until they drop dead from exhaustion. I know, it's frustrating, but what can you do? NHS GPs see something like 95% of ALL NHS activity, as the population ages, the need for GPs is only going to increase. There is a finite supply of trained GPs and while I have enough I know that other GPs practices struggle. You cant remove patients from your list just because you can't recruit to fill a vacancy.

Interesting responses. Thanks. It does sound as though the eConsult patients are viewed as an extra set of patients somehow different to the ones coming through the traditional route (hence comments about having to cancel other appointments to deal with these “new ones”) rather than just a different way for the same patients to interact with the service.

note “” denotes my interpretation here rather than a literal quote.

i think what they're getting at is that if you open up an extra method for patients to contact you. it doesn't mean that the previous number of enquiries simply gets spread across two communication methods making it easier for patients to reach the practice.

Because the service is so stretched, the second method of contact just brings an "extra" set of contact requests that need to be dealt with/ triaged by a GP so it creates "extra" work.

Maybe im wrong but i think that's they mean.

Also as noted, (IANAGP but i know quite a few) it doesnt matter how many new Dr's you train if they dont want to become GP's or even work in this country. Further driving down GP pay / increasing work related stress/ responsibility/ burn out will not help this.

Recruitment to rural areas is a huge issue for lots of GP practices even to reach previous staffing levels.

Remember that these are all hardworking intelligent ethical people who could have worked hard at any career and achieved a high level in that field. They mostly chose healthcare because they want to help people. If the career falls behind other similar "high" level jobs in management/ law/ finance etc from a life work balance/ quality of life point of view' those poeple will (are) choosing other careers.

rather than just a different way for the same patients to interact with the service.

Counter intuitively; the number of phone calls coming into my practice to secure an appointment does not vary if I open e-Consult longer. Many patients seem to see on line consultation requests as  "in addition to" as opposed to "instead of" For some things (repeat scripts) online services can be really useful and save time, as a way of getting an appointment I'm not sure it helps.

Counter intuitively; the number of phone calls coming into my practice to secure an appointment does not vary if I open e-Consult longer.

A GP friend of mine said the same recently, except he included the word 'timewasters' a few times. 😀

I've just, a few minutes ago, had a conversation with my wife which has some relevance to this thread, so I shall report it with no judgement. 😀

This morning, my 19 yo daughter did an AskMyGP request for the urine sample results she gave last week. A short while later my wife received a call from the surgery re those results. She gave my daughter's number who then missed the call but rang back and left her number. A few minutes later my wife had another call from the surgery re urine results. She gave the correct number again and my daughter managed to get her results a few minutes later.

The surgery tends to be decent, most of the time, but they did refer me to a COPD surgery a year or so ago, which is a surprise as I don't even have asthma. (My wife has serious, properly nasty asthma!) 😀

I will bet money that your wife and daughter (and probs you) are a "family group" on the patient system and they have your wife's mobile as the listed contact phone number, hence she gets the call.

God, I'm such a nerd.

Private GP – any thoughts ?

This is exactly what those bastards in power want people to do. In time it becomes normalised and the great sell off will be complete.
There may be a very limited “free” at the point of use NHS left but it won’t be worth anything.

In the far east the private GP is much more reliable than the government provision for minor health problems. Not cheap but not expensive as well. Say per visit the bill is minimum £50(conversion rate) to no upper limit, which need to be added on top of the prescription (yes, they prescribe medication too). If people go private for serious problems they will need to sell their house to pay for the bill if they are average earner. Either that or slow torturing death. For the poor they will have no choice but to go to the government hospital and to be "experimented" on by junior doctors. No guarantee of end result but at least they get some treatment whatever.