Doctor’s appointment.

To redress the balance a bit, I have been having side-effects from some drugs I've been prescribed. I am going away tomorrow, and am not sure whether to continue to take them or if I need something different, and if the latter if I can get an urgent prescription.

I used the econsult form to explain, and within the hour I got a call from a receptionist to see if I can take a call from the Nurse Practitioner this afternoon. That's a good service by any standards.

cornergran

Our surgery is one of 8 which are part of a large group practice spread over a large geographic area. E-consult was introduced pre pandemic as an option, it has been essential for four months. Anyone without a computer, or who frankly would rather not complete the horribly complex thing can, in theory, complete a much shorter paper form or ask a care navigator (aka receptionist) to do it for them. It should work.

As a PPG member I sit through meetings where we are assured by the attending doctor it does work. It doesn’t. We are also assured patients with urgent issues can phone at any time in the day and be triaged by a doctor. Oh no they can’t.

Our neighbours still report being told to go on line when they don’t have access and to phone between 8 and 10 with urgent issues. Reporting back at the next meeting I am assured training has been completed and neither issue occurs. I could weep with frustration.

Our GP’s do work very hard. There are a range of medical professionals available once past the booking system. Recruitment is however a huge issue. The group needs 7 more full time equivalent doctors. As none currently work full time probably 14+ in number. New housing developments increase patient load weekly. It’s a disaster happening.

I joined the PPG to make a difference, that’s seems impossible but at least I know what’s happening. If we need an urgent appointment I know I can insist, the majority of patients don’t. If a non urgent appointment is needed we complete the paper forms, again many patients don’t know they can. Neighbours ask me to make appointments for them. Whether e-consult or paper form it takes 72 hours for requests to be reviewed.

Information about changes is in a monthly newsletter - only distributed electronically. Apparently it’s now too expensive to distribute paper copies as pre covid. Patients are simply lost sight of. I’m back to wanting to weep.

Interesting post cornergran. Thank you.

I could weep with you.

Our surgery offered e-Consult until recently, and has now changed to PATCHS. I’ve been lucky and haven’t had to use either, but I have heard concerns from friends about both. I did sign up for PATCHS as advised so it’s there if needed - I see myself as reasonably tech savvy but it took ages. And I still haven’t worked out how to register another person using the same email address (DH doesn’t do “online” so it’s easier if he uses mine).

I know it goes against the principle of GP autonomy, but can’t help but think it’d make sense if all the different systems of booking appointments, ordering prescriptions etc were to be tested nationally, and the best ones rolled out across all surgeries. With a central contact point on the NHS website to help with any problems.

Our surgery is one of 8 which are part of a large group practice spread over a large geographic area. E-consult was introduced pre pandemic as an option, it has been essential for four months. Anyone without a computer, or who frankly would rather not complete the horribly complex thing can, in theory, complete a much shorter paper form or ask a care navigator (aka receptionist) to do it for them. It should work.

As a PPG member I sit through meetings where we are assured by the attending doctor it does work. It doesn’t. We are also assured patients with urgent issues can phone at any time in the day and be triaged by a doctor. Oh no they can’t.

Our neighbours still report being told to go on line when they don’t have access and to phone between 8 and 10 with urgent issues. Reporting back at the next meeting I am assured training has been completed and neither issue occurs. I could weep with frustration.

Our GP’s do work very hard. There are a range of medical professionals available once past the booking system. Recruitment is however a huge issue. The group needs 7 more full time equivalent doctors. As none currently work full time probably 14+ in number. New housing developments increase patient load weekly. It’s a disaster happening.

I joined the PPG to make a difference, that’s seems impossible but at least I know what’s happening. If we need an urgent appointment I know I can insist, the majority of patients don’t. If a non urgent appointment is needed we complete the paper forms, again many patients don’t know they can. Neighbours ask me to make appointments for them. Whether e-consult or paper form it takes 72 hours for requests to be reviewed.

Information about changes is in a monthly newsletter - only distributed electronically. Apparently it’s now too expensive to distribute paper copies as pre covid. Patients are simply lost sight of. I’m back to wanting to weep.

I wonder about online booking systems - they sound like a sensible option at first, but don’t they lead to people taking up appointments with issues that could have been dealt with by a pharmacist, or booking themselves in with the doctor for things a nurse should have dealt with, etc?

A good point.

I think that's one of the purposes of the online 'econsult' form - a doctor can review the symptoms and make the decision whether the patients needs to be directed to a nurse, pharmacist, etc. It acts as a 'filter'.

The issue I have with this is not the form in principle - but the way it has been designed - it has to 'anticipate' every possibility and therefore is overly long, far too generalised, and repetitive. And some surgeries, including mine, only allow access to it between 8-10 am.

So we're basically back to the early morning scramble. First come, first served. After 10 am - you've had it! I can't imagine it's very helpful for those who are working.

I feel sorry for reception staff - they can only work with the systems they’re given, crazy though some of them undoubtedly are, and most of them are trying their best. Of course they’re not qualified to diagnose anyone, and they are actually human, so mistakes are going to be made. But their remit is to try to prioritise obvious urgent cases, and to get patients matched with the correct health professional - somebody’s got to do it. The number of calls each day must be overwhelming, and some sort of triaging system has to apply, surely, when there simply aren’t enough doctors?

I can’t imagine it’s an easy task, and on top of that they have to deal with abuse and contempt from some of the people they’re trying to help. It’s certainly not a job I would relish, particularly at the low salaries most of them are on.

I wonder about online booking systems - they sound like a sensible option at first, but don’t they lead to people taking up appointments with issues that could have been dealt with by a pharmacist, or booking themselves in with the doctor for things a nurse should have dealt with, etc?

Norah

Dickens We're going to be at the mercy of whichever receptionist takes the call. Some, of course, are really good-tempered and helpful - and knowledgeable, but there's no guarantee you'll speak to that one. I'm not optimistic.

Agreed, It's worrisome.

Judging by the calibre of a receptionist I spoke to last week, I don’t hold out much hope either!

Her reply to a question I asked about why an appointment had been cancelled was “ prob’ly the strikes or suffink.”

Dickens We're going to be at the mercy of whichever receptionist takes the call. Some, of course, are really good-tempered and helpful - and knowledgeable, but there's no guarantee you'll speak to that one. I'm not optimistic.

Agreed, It's worrisome.

Doodledog

No, it feels very much like a sticking plaster solution.

No, it feels very much like a sticking plaster solution.

Which is, of course, exactly what it is. And you know what happens with sticking-plasters after a few day's wear...

No, it feels very much like a sticking plaster solution.

Nor me.

Germanshepherdsmum

Absolutely, Dickens. The signs can be subtle and a spot of on the job triage training is going to result in fatalities. I predict it won’t be long before we hear about them. Unfortunately when one is feeling very low due to illness it’s easy to be bullied by a receptionist - it happened to me many years ago. I was particularly ill with asthma (the hot summer of 76) and needed steroids. She had me in tears trying to prevent me from seeing the doctor.

...it happened to me many years ago. I was particularly ill with asthma (the hot summer of 76) and needed steroids. She had me in tears trying to prevent me from seeing the doctor.

😠😠

Utterly disgraceful. I remember '76 - you must have been especially sensitive to the heat... I would've been panic-stricken.

We're going to be at the mercy of whichever receptionist takes the call. Some, of course, are really good-tempered and helpful - and knowledgeable, but there's no guarantee you'll speak to that one.

I'm not optimistic.

Dickens

Doodledog

I think there is a new government directive that patients cannot be told to call back tomorrow - instead they will have to be directed to an appropriate service, whether that is to a doctor, a nurse, a pharmacist, a walk-in centre or 111. Receptionists will be trained to triage and make judgements on which service is appropriate.

That's all very well in theory, and will help ministers to field questions about the NHS on TV, as they can say that nobody will be waiting more than a day for an appointment, but it won't create appointments where none exist. I'm not sure how helpful it will actually be.

Receptionists will be trained to triage and make judgements on which service is appropriate.

Am I the only one who finds this worrying?

We are, in a way, now going to be preliminarily diagnosed by receptionists!

It's the usual short-termist, sticking-plaster, solution to a complex problem that's been festering for years - and I'm not just blaming this current government for it, they inherited it from the previous one - which also inherited it from the one prior.

I understand that there are not enough doctors, and their numbers cannot magically increase instantaneously. But what is needed is for them to have more time available in which to see or talk to their patients - surely, there must be a way of relieving them of some of their other duties - the paperwork, online form-filling, and all the other admin jobs that they have to do?

The more that patients are able to consult with their GPs, the less likely they will end up in A&E through not being able to get an appointment.

One of the reasons why I’m such a hypochondriac is because, having worked for the NHS for a long time I realise how something quite innocuous can potentially be something quite serious and something that seems quite serious actually isn’t. I don’t see how a receptionist can ascertain things like that over the phone. Anyway, weren’t nurse practitioners given extra duties years ago to take pressure off the doctors eg being able to prescribe antibiotics? Now it seems that is going to be passed onto pharmacists. Having seen a few pharmacists over the past couple of years for minor problems ( and, thinking about it I could go back many years to when I sometimes asked pharmacists for help regarding my children) I have no faith in them whatsoever. Imo they are trained to dispense the drugs that have been prescribed by a qualified doctor. Looking back 13 years did any of us foresee the state the NHS would be in ( both medical and dental) after over a decade of Conservative government. Also, given that most of us can’t get an NHS dentist are people aware that doctors get no training in anything dental and some of my doctors would refuse to treat anything to do with the mouth and would insist on patients going to see heir dentist because they weren’t qualified in that area. The whole situation has crept up on us over several years and if it had been implemented in one foul swoop the electorate would be up in arms.

Absolutely, Dickens. The signs can be subtle and a spot of on the job triage training is going to result in fatalities. I predict it won’t be long before we hear about them. Unfortunately when one is feeling very low due to illness it’s easy to be bullied by a receptionist - it happened to me many years ago. I was particularly ill with asthma (the hot summer of 76) and needed steroids. She had me in tears trying to prevent me from seeing the doctor.

Germanshepherdsmum

You are not alone in finding this worrying, Dickens. Poor Jaffacake has suffered from being triarged by a receptionist. I know that there are people who have little in the way of common sense but most of us know if we need to be seen by a doctor or nurse rather than popping along to the pharmacy.

I have to say, most receptionists I think would have the intelligence to recognise the fact that the test Jaffacake needed could not be conducted over the 'phone!.

...but most of us know if we need to be seen by a doctor or nurse rather than popping along to the pharmacy.

That's food for thought GSM - because you're right. By the time we hit our 70s+ we know our own bodies well enough to understand what might need a doctor's attention.

I have two semi-permanent in-dwelling catheters. One is wired into the superior vena cava and it has to be handled in a completely sterile environment to reduce the risk of infection and sepsis.

The first sign of infection, is itching / irritation. When I (a while back now) mentioned this to a receptionist, she suggested I "pop" into the local pharmacy for some "cream". Fortunately, I know that is entirely the wrong procedure. First and foremost, a blood test is required to check for infection markers, then the temperature has to be monitored (for obvious reasons). This vein carries blood to the heart!

I took my own temperature which was raised, and then - because I couldn't 'get past' the receptionist, went to A&E. And I did have an infection. Fortunately, one that was caught early and stopped in its tracks with ABs. The doctor in A&E said I did the right thing because an infection could so quickly overwhelm the system. In fact, he told me not to 'bother' with the surgery in future, but to present immediately at A&E!

Receptionists cannot be expected to understand complex medicine. And it's wrong to place such a burden on them. If I'd been less 'aware' and on the ball, I might have taken her 'advice'... and ended up with full blown sepsis.

The 8.10 slot on Today this morning had a government minister whose name i didnt catch who quoted in answer to the question 'is the government ditching their manifesto promise of 4,000( or was it 6,000) new qualified doctors by next year. He just repeated that there are 2,000 more qualified doctors than there were in 2019. Plus many thousands more nurses and other para medical staff.

Whether 4000 or 6000 its strange that its now almost impossible to get an appointment.

Yes I am aware of the fact that we are desperately short of GPs, but I am a little concerned that some of the work being taken on by differently qualified people may pose a risk to patients. On two matters recently I have seen an O T and a practice nurse. Neither could prescribe so I'm back in the system to consult a doctor again - all taking time which is concerning ( the practice nurse's reaction to my blood pressure reading was a splendidly unprofessional " jesus" ). In defence of pharmacists, however, I must say loud and clear that one of these saved my daughter's life by recognising that she had developed diabetes, when several doctors appointments ( well, nurse appointments, obviously) had not suggested this.

You are not alone in finding this worrying, Dickens. Poor Jaffacake has suffered from being triarged by a receptionist. I know that there are people who have little in the way of common sense but most of us know if we need to be seen by a doctor or nurse rather than popping along to the pharmacy.

Doodledog

I think there is a new government directive that patients cannot be told to call back tomorrow - instead they will have to be directed to an appropriate service, whether that is to a doctor, a nurse, a pharmacist, a walk-in centre or 111. Receptionists will be trained to triage and make judgements on which service is appropriate.

That's all very well in theory, and will help ministers to field questions about the NHS on TV, as they can say that nobody will be waiting more than a day for an appointment, but it won't create appointments where none exist. I'm not sure how helpful it will actually be.

Receptionists will be trained to triage and make judgements on which service is appropriate.

Am I the only one who finds this worrying?

We are, in a way, now going to be preliminarily diagnosed by receptionists!

It's the usual short-termist, sticking-plaster, solution to a complex problem that's been festering for years - and I'm not just blaming this current government for it, they inherited it from the previous one - which also inherited it from the one prior.

I understand that there are not enough doctors, and their numbers cannot magically increase instantaneously. But what is needed is for them to have more time available in which to see or talk to their patients - surely, there must be a way of relieving them of some of their other duties - the paperwork, online form-filling, and all the other admin jobs that they have to do?

The more that patients are able to consult with their GPs, the less likely they will end up in A&E through not being able to get an appointment.

Jaffacake2

Recently have been unwell with shortness of breath . Gp said to have an asthma check with the practice nurse to measure peak flow rates. The receptionist was adamant this would be over the phone. Finally managed to convince her that I needed face to face to breathe into the peak flow machine. She was not happy !
Then had to use the automated heath check kiosk in the surgery. Took blood pressure then answered various questions. Didn't have glasses and pushed wrong button. Next morning had a text concerning my increased alcohol consumption, think I pressed the over 10 units a day by mistake !
Loved the days of talking face to face .

Gp said to have an asthma check with the practice nurse to measure peak flow rates. The receptionist was adamant this would be over the phone. Finally managed to convince her that I needed face to face to breathe into the peak flow machine. She was not happy !

Good grief! If the receptionist doesn't have the intelligence to realise that appointment could not be conducted over the telephone, then clearly she shouldn't be fielding calls.

Why was she "not happy"? She was completely in the wrong!

My asthma review is now done by phone (with some company which produces inhalers). It is less than satisfactory. No substitute for seeing the asthma nurse at the surgery. However the person who conducted the review did get me a peak flow meter prescribed. Perhaps you could request one Jaffacake, then you will have some ammunition for when you have to convince the receptionist you need an appointment.

Recently have been unwell with shortness of breath . Gp said to have an asthma check with the practice nurse to measure peak flow rates. The receptionist was adamant this would be over the phone. Finally managed to convince her that I needed face to face to breathe into the peak flow machine. She was not happy !
Then had to use the automated heath check kiosk in the surgery. Took blood pressure then answered various questions. Didn't have glasses and pushed wrong button. Next morning had a text concerning my increased alcohol consumption, think I pressed the over 10 units a day by mistake !
Loved the days of talking face to face .

So what if a receptionist misses the fact that a patients symptoms are life threatening? How on earth did we reach a point where most people can’t get a NHS dentist and now can’t get a doctors appointment? And it’s crept up on people in such a way that it’s now regarded as acceptable.

I think there is a new government directive that patients cannot be told to call back tomorrow - instead they will have to be directed to an appropriate service, whether that is to a doctor, a nurse, a pharmacist, a walk-in centre or 111. Receptionists will be trained to triage and make judgements on which service is appropriate.

That's all very well in theory, and will help ministers to field questions about the NHS on TV, as they can say that nobody will be waiting more than a day for an appointment, but it won't create appointments where none exist. I'm not sure how helpful it will actually be.

I filled in the online service link for my practice about 8 years ago. Unbeknowns to me, it had to be validated (understand that) but... that involved an unplanned phonecall to my mobile by practice receptionist, I was in a meeting at work, I left the room to answer but next office was very noisy. I'm deaf & always have been, & this is flagged on my medical records. Even after getting under a desk to try & blot out the noise, I couldn't hear what I was required to, so phonecall was abandoned. Never heard another thing. Surely they could have texted me some code or something, or to arranged a time with me at home to take the call? Anyway, this has reminded me to have another go at registering & hope for better luck this time!