GP Ratings in England

www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptioncosts.aspx

If it hasn't been abolished, I'm a bit dubious about the victim narrative, dj.

Does the prescription pre-payment system not still exist in England? Surely people on a lot of medication can use that if it does still exist? When I used it I used the option to spread the cost over the year by paying in instalments so that it wasn't a big lump expense all at once.

I knew about it because my mother had used it yonks ago and I sometimes collected her prescription for her, but my Oxfordshire GP also told me about it, as I would expect many GPs do.

Yes Anya, it was clear- and there are far too many of them.

My lovely neighbour told me she was going to the doctor's last Thursday with her 19 year old son. She was furious because it's half day closing at the surgery, her GP does a stint at the local hospital- and she had trouble making an app. with the doctor on call for him. So I was concerned- how long has he been coughing and had a cold. Oh since yesterday- she said. Didn't know what to say !?!

DJ I was clearly talking about those who waste their GP's time. Did you not understand that?

What about people who need medication to keep them alive, Anya? Should they be made to feel guilty because they are costing the NHS so much?
As it is, it's well known that some people have to choose between which medications to take because they cannot afford all their prescriptions.

I agree Mollie.

My BiL is at the GP surgery almost every week for something. Last week it was constipation - as if there are not enough effective over the counter medications available.

I wish there were more GP's like yours too Bags - hopefully BiL would be sent away with a flea in his ear and told to eat more healthily or to visit the chemist and/or health store and sort himself out.

There was talk of presenting patients with an annual account to show how much the NHS had spent on them each year. That would come as a shock to some.

Would that there were more GPs like mine.

And, perhaps, more people willing to listen to them!

When Minibags had an ear infection some years ago, my GP told me that 70% of ear infections clear up by themselves within 72 hours so if I could could control DD'S pain and fever (dosing her with both paracetamol syrup and ibuprofen), then it might be worth a try rather than using an antibiotic. He prescribed me penicillin in powder form with instructions about how much water to add if we needed it. The pharmacist was dubious but I told him I could measure 110ml accurately. I guess he though the GP wouldn't have trusted me if I wasn't capable .

Anyway, DD didn't need the antiB because the infection did clear up within 72 hours and I had managed to keep the pain and fever down as instructed. The pain is the worst thing about an ear infection, as I only discovered in my thirties when I had one for the first (and hopefully last!) time in my life.

Its become second nature to look for instant relief to a problem including a pill or potion that cures what ails us. My lovely dil, some sensible in many other ways, goes to the doctor the minute something is wrong. Is it that we have been convinced the medical profession can perform miracles? I don't know. But you only need to read any of the forums concerned with an illness to realise how many people willingly swallow handfuls of various pills and still complain of side effects etc. to wonder if stopping a few rather than taking more might actually help. I realise I'm in a fortunate position of not taking any prescribed drugs and I do have a GP who is very cautious about prescribing so she has my total faith.

Indirectly though, that is how it works in free markets- as it is in most of Europe where patients are not registered with a GP. In my area, people know which doctor will give them the sleeping tabs, antibiotics, when they want it, or a medical certificate to be off work, etc- and those- often much better doctors, who will not (unless it is clinically necessary of course). Guess which doctor makes the most money? Many patients will choose a doctor that will tell them what they want to hear- and give them the drugs the internet told them they 'should' take.

What it did say was that GPs whose patient satisfaction suffered because of their under-prescribing ought to be supported, presumably by paying them more for under-prescribing?
They cannot pay them more for talking to the patient longer as they are paid by results for the numbers of patients they see, too.
What a tangled web.

x posts. I agree that paying GPs according to Patient satisfaction doesn't seem quite right.

The survey didn't see causal link either, dj, only that the same phenomenon (lower patient satisfaction where GPs prescribe fewer antiBs) showed in "other studies in other countries". I may have misunderstood the funding thing but it did seem to depend a little on patient satisfaction.

Surely it's wrong that GPs are paid according to patient satisfaction. That can depend on many factors, including the area in which you work.

I did not mean I did not see the link in the OP, bags. I meant I did not see the link between doctors who under-prescribe antibiotics and patient satisfaction. GPs who under-prescribe antibiotics could be perceived as unsatisfactory for lots of other reasons. They are assuming cause and effect where there might be none.

I'm not sure one would have to literally 'follow the news' (telly, radio) to have picked up the changes with regard to antibiotic use. The information has been around for a good number of years. The subject has been covered in ordinary magazines and GP surgeries often have posters about colds and sore throats not only not needing antiBs but antiBs actually being useless to combat that type of infection.

I don't think it's as simple as doctors just changing their minds as if on a whim (not that anyone actually mentioned whims). They have changed their minds about antibiotic use, certainly, but the change is based on research done since antibiotics were first introduced. Treatments change in medical care all the time as more is found out and more is understood. Operations (e.g. dilation & curettage under general anaesthetic after an early miscarriage was once standard treatment; it isn't any more) change, medicines change, knowledge changes.

I trust my GP. He doesn't know everything but I think he does his best and he's very good about explaining things. What more can one ask of a mere human?

I agree granjura but not everyone thinks the same , not everyone trusts their GP's, not everyone follows the news

But surely one's 'thinking' has to change with new and compelling information re the dangers, surely- makes sense.

Not being really fair to people. If GP's have stuffed patients up with anti biotics over decades and with the problems of cut backs in the NHS not so easy to think suddenly , - I have had them before a sore throat but now I don't need them because the doctor has changed his mind

Agreed- I didn't spot the link at first.

One thing I have noticed, is so many people agree that giving antibiotics all the time against medical judgment, will then say 'ah but not for me, because I am a special case, and I, ME, need them asap'.

At a coffee morning at a good friend's, some of the mums started to discuss GPs, etc. And one of them said 'ah getting antibiotics from Dr Jura is like looking for hens' teeth' and went on, with others nudging each other- until my friend said 'Oh you don't know Jura, do you' - we all laughed- now that was in the 70s, before we became so aware of resistance.

Teetime is right- the new contract was aimed at reducing poor practice- but did the opposite- and more importantly, put the trust between GP and patient at risk. So many patients say 'you want to immunise my child' or 'put me on statins' so you can get more money- which is so so wrong, and an insult to al those really well qualified, up-to-date and caring GPs out there.

The link is the first six words of the OP, dj. We keep telling HQ that the blue doesn't show up well enough.

The problem is in my view as someone who has managed GP practices is that the payment system works in reverse in cases like this rewarding them for poor practice. Its only one of many anomalies in the contract and with the Quality and Outcomes Payment Framework- a bonus system to you and I.

The old days of doctors on pedestals and patients doing what they are told because doc is always right- were wrong. But like so many things- like discipline in schools and at home, things have swung too far the other way. There is huge pressure on doctors now to do what the patient wants, has read on the internet, including medication, be it antiobitcs, sleeping pills or HRT- against their better judgement. This is even much more so here where people are not registered with a GP, but can roam at their heart's content. So if a patient has bronchitis for the 2nd time in a few months- many patients will not accept to be told their heavy smoking has to stop. Or that being overweight is not helping those aching knees - etc. They will keep shopping around until they find a doctor that will tell them what they want to hear- even if it is not the best medicine.

And even if long-term, it is a disaster for humanity... I worked for Beechams in London who first made antibiotics available to the masses- and yet now, due to abuse- it could be our undoing. A friend of mine is recovering from throat cancer and has developed an infection- and they just can't find an antibiotic that he is not allergic to.