41 gp surgeries

cornergran yes I do wish you luck. At least the results of the MRI should not be too long a wait?

I was assessed and treated by spinal neurology over two years ago. An intervention (rhizolysis) gave much reduced pain for a few months then back it came. The consultant clearly said come back when the pain returns - the intervention could last up to two years, in my case several months.

As it had been over a year since my last appointment with him I needed a new referral. My GP was regretful, unable to refer directly. The referral has to be via the Muscular Skeletal Service (MSK). After waiting five months for MSK I have been dispatched for an MRI (no problem with that) but told unless they assess the outcome as being suitable for surgery I will not be re-referred to spinal neurology. Instead a pain management course. When working I taught the wretched things! Happy? Of course not, frustratingly the consultant I saw has now retired so no hospital contact to ask for help. The original consultant was clear, there are other things to try before surgery. Could I convince the MSK assessor? It seemed not. Currently waiting the outcome of the MRI, wish me luck.

A consultant who recognises that the patient needs to seen by a different team but can’t refer a patient because they work in the ‘wrong ‘ hospital?
Absolute madness!
And not his (the doctor’s) fault or decision!

A GP who isn’t allowed to follow the advice of a consultant and so can’t refer a patient to the correct team? That’s not the GPs fault, it’s whoever devised the pathway.

This is not about poor doctors, the doctors did everything they could. My GP had already explored the most usual possibilities, hand X-ray, carpal tunnel conductivity test, etc. This is/was about doctors being restricted from doing their job efficiently and effectively because of pathways devised not by themselves. It is designed to keep patients away from diagnosis because diagnosis opens the door to treatment and many patients need the spinal team’s expertise.

I agree it’s about managing scarce resources, and I want to see more resources put into the health service. But using physiotherapists to keep patients from seeming the correct consultant/team is wasting money, because it puts the patient on the waiting list to see a physiotherapist rather than the spinal team!

Physiotherapists do a wonderful job, where it is appropriate. They shouldn’t be used in this way, in my case twice, to prevent patients accessing the care they need.

I’m sorry you suffered the same difficulty that I did growstuff. It’s a painful condition.

In my recent experience, I was put on the 2 week urgent cancer pathway even though cancer was not considered likely by my gp. She warned me that the hospital would assume that cancer was present.
So do I feel cross that I had to wait 2 weeks for the results of a biopsy after hysterectomy, with the worry that it might be cancer? Or do I say that I needed to go that route to receive much needed timely treatment? Or do I ask why there are no other fast track treatments for non cancer patients?

Clinical pathways are the way clinicians manage their workload maddyone, it’s that simple. If there were no restraints on budgets and other resources they wouldn’t be necessary. I’m not denigrating clinical professionals’ ability to do their jobs, they are the only people who can do what they do - and they are the only people who can decide how to best manage patients when there is not enough resource to go round. I know it’s easier to blame ‘the system’, but this situation is not about the system, nor about the ability of individual clinicians. It’s about resources.

maddyone As I explained on another thread, almost the exact same thing happened to me about 25 years ago. It took about 18 months before I was given any treatment, but modern "pathways" can't be blamed. With hindsight, the problem was that the GP didn't recognise or acknowledge that pain in my hand was caused by a problem in my spine.

More recently, treatment for breast cancer was delayed unnecessarily for six months. It's still affecting me because I had more of my breast removed than would have been the case if I'd been officially diagnosed earlier and a second tumour was found in the same breast. I kicked up a fuss and had meetings with the GP senior partners and managers from the clinical commissioning group. They both denied responsibility (not surprisingly), but the root cause was because the GP had used the wrong referral pathway. I should have been put on the "two week" cancer pathway, but I was instead referred for a routine mammogram, which was refused because I wasn't due for a routine scan. It was complicated by the routine service and the emergency cancer pathway being run by different trusts. Although I knew there was something wrong and cancer was found in exactly the same place I was experiencing pain, the GP didn't really believe me (because I had no lump) and saw no urgency.

In both cases, the fault was human error rather than any flaws in pathways.

Just to add, none of the above is the fault of the doctors I saw. All were exemplary in their treatment and concern. The problem was not the doctors. The problem is the pathway!

Casdon
Whoever devised the ‘pathways’ it was devised with the express intent of delaying proper diagnosis and therefore treatment. I find it hard to believe that doctors really want to do that. I have a degenerative condition of the cervical spine. This can only
be diagnosed by an MRI scan. After the hand consultant said there was nothing whatsoever wrong with my hand/arm, and the surgery he had performed some years earlier was fine (I knew it was) he said the problem was most likely to be my neck and I needed to be referred to the spinal team, but he couldn’t do that as he worked in the wrong city hospital, although he could have referred me had he still been working in the other city hospital (these hospitals are about 3/4 miles apart.) He advised me to go back to my GP who he said could refer me to the spinal team. However, my GP told she couldn’t refer direct to the spinal team either, she must refer me to the physiotherapist, who would decide if he should take my case to the spinal team meeting. He did decide to do that, and I was then accepted by the spinal team, who then referred me for the MRI. After that I had to go back to a different physiotherapist who explained the results of the MRI to me, not completely correctly, and he then referred me back to the spinal team to assess for possible spinal injection. I then went to see the spinal consultant, hurrah, it only took almost a year to get to the correct consultant! All the time, in pain, taking painkillers and the vile drug Pregabalin daily. And steroids to enable me to take the long flights to and from New Zealand. Next week I’m having the long awaited spinal injection to block the pain, but only temporarily, and so possibly surgery next.
There is no way that any reasonable person would devise a pathway such as I was on thinking that it was in the patient’s best interests. It’s to keep patients off waiting lists in my opinion.
My daughter is a doctor. She would not devise a pathway such as this which aims to keep patients away from a proper and prompt diagnosis and then treatment.

Another thread maybe if the result of failings in the NHS led to admissions of failure and the death of a loved one due to gross errors /negligence/failure to follow protocols and procedures/unqualified staff etc .
Thank goodness people like the parents of young Martha fight for changes such as Martha's Law to try to make a difference to other people where it's clear that improvements - urgent improvements - are needed. Martha's Law will enable families to escalate their concerns if they feel something isn't quite right in the treatment being given - and to access an urgent second opinion/another clinical team. It can make all the difference. Everyone makes mistakes - but there are way too many.

ronib

TinSoldier and as one young gp once said - I don’t stop learning. The idea that ten years of training makes for a fully competent professional is debatable given the changes in medical research and practice.

In my town (where they cannot recruit GP's) I know of 2 misdiagnosed patients by the same GP practice where you are lucky to get an appointment within weeks, or you can get an appointment with the nurse prescriber or paramedic. One patient had a cough for 18 months (despite the surgery putting out adverts saying 'if you have a cough for more than 6 weeks see your GP) but you can't! She was given loads of anti-biotics, an inhaler to no avail - eventually because she pestered they let her have see the GP and have ,an x-ray, by which time it was too late. She died in December as the cancer had spread from her lungs to her brain and spine. The other did see a GP who fobbed him off as did the nurse several times before things got so bad he attended A&E where he was scanned. He died in October of a brain tumour.

The introduction of these nurses, pharmacists and paramedics are because they are CHEAPER but they don't have as much experience. Because of that there will be a lot of things that are missed. They are trialling it in London - you will be seen, but at a surgery with just one GP 'just in case something dodgy crops up', but I suspect that these cheaper members of staff will be reluctant to escalate things anyway, as it doesn't look good on them?

Maybe, the management of the waiting lists and appointments is an administrative function, but administrators don’t have any involvement in deciding clinical pathways, quite rightly.

Casdon

maddyone

I also haven’t had the best experience this last year myself with the NHS. I actually made a thread about my experiences but I haven’t at any time criticised the NHS staff. However I did comment on the thread about the pathways devised by management to prevent patients reaching either a diagnosis, or treatment, in my case it was both. The doctors I have seen have been exemplary in their care, indeed the physiotherapists have been responsible too. None of it was their fault, it was the fault of the decision makers, those in management who want to keep people off waiting lists. I am finally to get my first treatment next week, following more than a year of trying to get a diagnosis. It’s a long story and it’s under the Health forum if you fancy a read. The point is, we are all frustrated by the situation in the health service, but it is not usually the doctors who are at fault. The people responsible are managers and behind them, the government, who are simply not willing to put enough money into the NHS in order for it to function as it should.

Just to clarify maddyone, no clinical pathways are ever devised ‘by management’. They have always been, and remain the responsibility of clinicians themselves. The development of NICE and other guidelines is done by clinicians who are nominated by their peers, not by faceless bureaucrats.

Perhaps maddyone meant administrative pathways.
I think many of us have been the victim of errors and omissions.

maddyone

I also haven’t had the best experience this last year myself with the NHS. I actually made a thread about my experiences but I haven’t at any time criticised the NHS staff. However I did comment on the thread about the pathways devised by management to prevent patients reaching either a diagnosis, or treatment, in my case it was both. The doctors I have seen have been exemplary in their care, indeed the physiotherapists have been responsible too. None of it was their fault, it was the fault of the decision makers, those in management who want to keep people off waiting lists. I am finally to get my first treatment next week, following more than a year of trying to get a diagnosis. It’s a long story and it’s under the Health forum if you fancy a read. The point is, we are all frustrated by the situation in the health service, but it is not usually the doctors who are at fault. The people responsible are managers and behind them, the government, who are simply not willing to put enough money into the NHS in order for it to function as it should.

Just to clarify maddyone, no clinical pathways are ever devised ‘by management’. They have always been, and remain the responsibility of clinicians themselves. The development of NICE and other guidelines is done by clinicians who are nominated by their peers, not by faceless bureaucrats.

I'm absolutely sure it's true, but it's not going to happen. Nobody can force GPs to stay in the same practice and the government itself is encouraging the salaried doctor rather than partner model, which means that GPs have more flexibility to move around.

As it's not going to happen, I think the next best thing is to make sure that available scarce resources (ie staff) are used efficiently.

It’s one of those obvious truths isn’t it. We bumped into our retired GP out walking. He referred to that research, laughing “well who knew continuity of care especially as we age could be beneficial “ 😳🙈

I read a report recently that acknowledged that patients who regularly saw the same GP for continuity of care had much better clinical outcomes and quality of life. They felt safer and more reassured. Sadly those days are long gone. I think there was a drive a while back to give all elderly patients (I was taking of my stepfather) a designated doctor at the surgery. A good idea I thought but this never happened.

Moreover, my patient record is available online, so I feel more in control of my own health.

It wasn't always like this.

I think it depends how efficient communications and pathways within the GP practice are.

I have annual (sometimes six monthly) diabetic checks, which also check my heart and general health. Sometimes those checks trigger appointments with all sorts of other people, such as the practice pharmacist, GP, podiatrist, nurse for ECG and/or brachial blood pressure test. I've also been referred to the practice physio because I have ongoing problems with my spine/hip, which affects how much I can walk and, therefore, my blood sugar. I could see a counsellor and/or dietician if I wanted (I don't). I feel that everybody knows their role and it's quite efficient. My notes seem to be accurate, so I don't wast time explaining what's wrong each time.

I’m sorry you’ve had such problems, Ronib and hope you’re on the road to recovery.

If your concern now is about ongoing care, I think you need to ask yourself exactly what it is you are expecting from your surgery. Do you have dressings that need care, ongoing medications or just someone to talk to? Those are just a few thoughts, I’m sure you have other expectations.

Medical practise today is very much about what the patient indicates they are concerned about/want, not what the doctor sees fit to provide so I hope you feel able to voice what you require to the surgery.

It does sound rather like the system in other countries is being introduced here, ronib and I agree that it could be impersonal. Someone I now went to work in New Zealand years ago as a GP but didn't like the system there as she did not have her own list of patients. I realise even in a small practice the GP may not have seen you previously but there could be more liaison.
I'm sorry your problem has been overlooked.

I’m sorry you have had difficulties with getting a diagnosis ronib and from my own experience it is frustrating to say the least. I imagine you have been in pain. I also have daily pain, take painkillers all day and every day, and have tried to get on with living my life whilst trying to manage the pain.
I realise it must be difficult to see a different doctor every time. I’m in the lucky position of being able to see or speak to my own GP usually, unless she is not there, as our surgery tries to maintain the doctor/patient relationship wherever possible. I know many surgeries don’t or can’t do that.

Okay my gripe is how do I cope with past misdiagnosis and mistreatment plus recovery from major surgery in a gp practice with so many unknown new faces?
In my case, there’s no point blaming a NHS manager for poor clinical outcomes.
Also even the doctor handling my complaint was trying to make sense of how my ovarian cyst had grown to 20 cms/8 inches without being picked up. Probably over 25 years or so.
I am very lucky so far and am probably coming out from the trauma of it all. I think to calm down, stay put for the time being and possibly change practices and/or pay for a second opinion if it’s needed.
Hopefully no more medical interventions for quite some time ….

None of it was their fault, it was the fault of the decision makers, those in management who want to keep people off waiting lists
Oh yes! They keep finding new ways of massaging the figures to make waiting lists seem shorter than they actually are.
I've just experienced a new wheeze!

funding not finding

I was seen at my local GP practice by a paramedic who misdiagnosed my problem. I asked to see a GP to review the diagnosis and was re-directed to the same paramedic. When the case was eventually reviewed by a GP he changed the diagnosis which was later confirmed by a consultant.

The paramedic was polite and considerate but was clearly at the limit of competence. The practice was clearly under pressure. I think the direction of travel needs looking at and that includes finding and training places.