Undercover work at a GP surgery.

Yes, growstuff, it was (following a careful protocol)
Thanks to all who have contributed, this is very interesting.

Yet my medic dd says many of the patients she sees could just as easily be treated by a PA or even a pharmacist, such as the 2am visit regarding a stye of 48hrs duration.

Though I imagine most Gnetters wouldn’t dream of bothering a doctor about a stye or a minor graze but believe you me, many people do!

I get that SueDonim, but wouldn't a nurse practitioner be able to deal with that? And they'd be able to prescribe eye drops (or whatever) without being supervised.

I am concerned that GP practices will become like the one in the programme. The chain apparently employs half the number of GPs per head that average practices do. Goodness knows who actually gets to see a GP. Will it become the norm that people are triaged by a receptionist, then given an appointment with a PA, who maybe doesn't have the expertise to diagnose and treat the patient, so refers to the GP anyway? If that's the case, it's a huge waste of everybody's time and could endanger patients' health or lives. PAs are supposed to be closely supervised, which means GPs will have to give up their time when they could be seeing patients. PAs are paid on a higher scale than most nurse practitioners and paramedics, who have longer training and, in some cases, more responsibility.

The Medical Schools Council suggests that the number of new medical school places needs to increase by 5,000 a year for the system to be sustainable, even with PAs and other associated medical staff. The cost is estimated at £1 billion, which I would imagine is the sticking point.

www.medschools.ac.uk/media/2899/the-expansion-of-medical-student-numbers-in-the-united-kingdom-msc-position-paper-october-2021.pdf

It is fairly clear that we just do not have enough GPs to adequately treat all the patients on their books along with all the form filling etc they have to do.

There are many conditions which can be treated very well (and sometimes better than by GPs) by Nurse Practitioners, Practice nurses, Practice pharmacists etc. However, the use of "physician associates" does worry me as they seem to work beyond their scope of expertise on many occasions.

We need more medical students, more young doctors who see GP work as rewarding and a good career move. As patients we also need to ensure that we (and I'm sure all gransnetters already do) use our GP appropriately.

I have spent days trying to get in touch with my surgery.
The econsult has been closed every day with message ti try the bext day, but the next day and the same message appears. They dont show an email address and every time I phone I am always no.12,in the queue, now that cant be coincidence. surely.
If I have dropped a note into the surgery I get a telling off.
Since covid I have seen a dr once, to get my flu jab. I asked when the surgery might return to normal and he said he thought the new system was better. I disagreed politely but firmly.
Its absobloominlutely awful. I have given up for the day,but will try again tomorrow. Grrr

Some NHS hospital Consultants here are using pharmacists to telephone patients for routine appointments instead of seeing patients themselves face to face or even telephoning patients themselves.
There is no point in asking about possible related problems as they just tell patients to consult their GP.

I cannot think that this can be right.

If I have dropped a note into the surgery I get a telling off.

silverlining, what!??! That's outrageous. A "telling off"? How arrogant and unprofessional.

Callistemon21

Some NHS hospital Consultants here are using pharmacists to telephone patients for routine appointments instead of seeing patients themselves face to face or even telephoning patients themselves.
There is no point in asking about possible related problems as they just tell patients to consult their GP.

I cannot think that this can be right.

What!?!?!

(Sorry, I should have written "pardon?" but I was so shocked)

silverlining48

I have spent days trying to get in touch with my surgery.
The econsult has been closed every day with message ti try the bext day, but the next day and the same message appears. They dont show an email address and every time I phone I am always no.12,in the queue, now that cant be coincidence. surely.
If I have dropped a note into the surgery I get a telling off.
Since covid I have seen a dr once, to get my flu jab. I asked when the surgery might return to normal and he said he thought the new system was better. I disagreed politely but firmly.
Its absobloominlutely awful. I have given up for the day,but will try again tomorrow. Grrr

I told the senior partner in my practice what I thought of the new appointment system too. She looked shocked. I'm not sure if she was acting shocked or genuinely didn't know what it's like.

I'm sure it's just a coincidence that Samantha Jones, a former CEO of Operose (the American company which owns the chain of GP practices in the programme), was a senior health advisor to Johnson and has now been promoted to be one of Number 10's most senior staff.

lowdownnhs.info/news/operose-ceo-moves-to-number-10-advisor-position/

www.nursingtimes.net/news/leadership-news/former-nurse-becomes-no-10s-most-senior-civil-service-leader-10-02-2022/

growstuff

Callistemon21

Some NHS hospital Consultants here are using pharmacists to telephone patients for routine appointments instead of seeing patients themselves face to face or even telephoning patients themselves.
There is no point in asking about possible related problems as they just tell patients to consult their GP.

I cannot think that this can be right.

What!?!?!

(Sorry, I should have written "pardon?" but I was so shocked)

Yes, I am mightily annoyed but don't know quite what to do about it.

Ultimately it comes down to how many patients in the UK and how many doctors. I would be interested to know these figures and then compare them to the figures of say 40 years ago when we were all comfortably able to see doctors. The doctor patient ratio must be very different now and that is the issue here. The population in 1982 was less than 50 million and today it is over 67 million. So how many doctors then and now?

I read this and found it very disturbing. Especially the way the company blandly denied the things the under cover worker experienced.

If they run your surgery, find a new one, pronto.

This is a clever way of having surgeries taken out of the NHS.
GP surgeries should not be privare businessed. They should be incorporated into the NHS, with doctors, salaried and management and standards beng the direct responsibility of the local Healthcare trust.

Chestnut

Ultimately it comes down to how many patients in the UK and how many doctors. I would be interested to know these figures and then compare them to the figures of say 40 years ago when we were all comfortably able to see doctors. The doctor patient ratio must be very different now and that is the issue here. The population in 1982 was less than 50 million and today it is over 67 million. So how many doctors then and now?

Very good point Chestnut

I could have died at Easter because one of our GPs who has never met me and knows nothing about me decided I wasn't urgent! Thank goodness for 111! After I came out of hospital I emailed the surgery and told them exactly what I thought was wrong with my treatment and within an hour I had the senior partner on the phone. Give him his due he did start the conversation by asking how I was before we got on to my complaint. Basically my argument was that you can't always diagnose a dangerous condition over the phone if you are dealing with someone you've never even met. His argument was that they are currently dealing with hundreds of patients with breathing difficulties and they can't see them all. Obviously what they need is more GPs.

My recently retired GP would have had a fit if he'd see what was happening to me, but he had known me for 20 years and would have known I wouldn't call if it wasn't serious.

Those poor receptionists.

What a mess

M0nica

I read this and found it very disturbing. Especially the way the company blandly denied the things the under cover worker experienced.

If they run your surgery, find a new one, pronto.

This is a clever way of having surgeries taken out of the NHS.
GP surgeries should not be privare businessed. They should be incorporated into the NHS, with doctors, salaried and management and standards beng the direct responsibility of the local Healthcare trust.

The problem is that this company runs 70 practices already, many of them in London (and there are others). Some people don't have a choice of practices. Moreover, this model is likely to increase, as more and more GPs retire and practices are bought out by profit-making companies.

In future, the only way to see a GP face-to-face in the "traditional" way will be to pay for a private consultation. We're already heading in that direction. Meanwhile, the government will claim that the NHS is still free, but it won't say anything about the quality of the service offered to most patients.

Basically my argument was that you can't always diagnose a dangerous condition over the phone if you are dealing with someone you've never even met.

I do hope you're fully recovered now.

If you don't mind, I might use that argument if I complain about being dealt with over the telephone the last 5 times by a pharmacist instead of speaking to doctor, let alone the Consultant in charge.

Chestnut

Ultimately it comes down to how many patients in the UK and how many doctors. I would be interested to know these figures and then compare them to the figures of say 40 years ago when we were all comfortably able to see doctors. The doctor patient ratio must be very different now and that is the issue here. The population in 1982 was less than 50 million and today it is over 67 million. So how many doctors then and now?

In 1963 there were 22,159 GPs in England and Wales, 19,951 of whom were male and 2,208 of whom were female.
In 2018 there were 41,693 GPs, 17,366 male and 21,736 female (headcount).

digital.nhs.uk/news/2018/workforce-factsheet

The estimated population in 1963 was 47 million.
Today it's about 66 million.

In theory, there are more GPs per head than in 1963. However, more of them work part-time and they have tonnes more paperwork to do than they did in 1963. They also have more elderly patients, who present with an increasing number and range of needs.

Callistemon21

^Basically my argument was that you can't always diagnose a dangerous condition over the phone if you are dealing with someone you've never even met^.

I do hope you're fully recovered now.

If you don't mind, I might use that argument if I complain about being dealt with over the telephone the last 5 times by a pharmacist instead of speaking to doctor, let alone the Consultant in charge.

I assume this wasn't just to discuss medication. A pharmacist always rings me when I change medication, whereas a GP would have requested an appointment in the past.

I agree 100% than it's not possible to diagnose somebody you've never met, unless symptoms are very clear cut, which they usually aren't

Callistemon21 Feel free to use my argument. It makes perfect sense to me - how can you tell how someone really is with a quick phone call?

When DH was on chemotherapy he was seeing his consultant once a month. If he didn't feel like going out he would ask if the consultant could just organise the next lot of meds without us seeing him. The answer was always "No I need to see you in person to see how you really are"

Thank you, Deedaa
My last Consultant was wonderful.
I've never had a face to face appointment with this one.

growstuff

Chestnut

Ultimately it comes down to how many patients in the UK and how many doctors. I would be interested to know these figures and then compare them to the figures of say 40 years ago when we were all comfortably able to see doctors. The doctor patient ratio must be very different now and that is the issue here. The population in 1982 was less than 50 million and today it is over 67 million. So how many doctors then and now?

In 1963 there were 22,159 GPs in England and Wales, 19,951 of whom were male and 2,208 of whom were female.
In 2018 there were 41,693 GPs, 17,366 male and 21,736 female (headcount).

digital.nhs.uk/news/2018/workforce-factsheet

The estimated population in 1963 was 47 million.
Today it's about 66 million.

In theory, there are more GPs per head than in 1963. However, more of them work part-time and they have tonnes more paperwork to do than they did in 1963. They also have more elderly patients, who present with an increasing number and range of needs.

9.8% of the population were over 65 in the 1960s, compared with 18% now according to Dr Google. The biggest growth in numbers is in the oldest age groups, who have the most complex medical issues. Medical advances save more people, but means that chronic conditions management is now a huge and complex part of a GPs workload.

Thanks for finding that out Casdon. I knew that the number of over 65s has approximately doubled over the last 50 years, but I didn't know the exact stats.

People are surviving heart conditions/strokes and cancer in ways which would have been unimaginable 50 years ago, in addition to an explosion in diabetes. I have all three and every consultation with a GP over the last 10 years (except one) has been related to one of those conditions. 50 years ago I would probably have been dead, but at least I wouldn't have been a burden on the NHS! And goodness knows what other ailments I have yet to face.

I do think that routine tests and some treatment could be carried out by non-GP medics, but I have also experienced the difference which a more holistic approach can make. I have found that practice nurses and online/remote consultations only focus on one condition, whereas, in reality, they are all related and I have benefited from being treated as one person with a number of conditions rather than treating each condition separately - hope that makes sense. I am very sad and concerned that the government appears to be undermining the importance of general practice in its drive for greater efficiency. Efficiency for whom, I wonder!