UKC

I've had a pain in my shoulder for about a week and painkillers are not shifting it so I went to the docs to make an appointment. In short the earliest appointment is two weeks time. What gives? At one time you could often see your doc the same day or the next day.

Do you have to be dying to see the dr within a couple of days?

In reply to FesteringSore:

I needed a medical certificate for some races I'm doing here in France so went to my GP this morning. Its a 30 minute drive away, and I mistakenly offered to take my elderly neighbours who needed to go too.

They were waiting two hours to be seen and spent 45 minutes in the consultation! Here every hypochondriac and their poodle comes for a natter and gets as much stuff prescribed as possible.

I only wanted the form, I'm in perfect health. She insisted she write me a prescription for Arnica (FFS?) to help with inflammation after long runs! Well its free so I took it to shut them up. I think my GP is a closet homeopath so I hope I never get a proper illness.

When I was in the UK though, seeing the Dr meant turning up and waiting your turn. Appointments weren't really possible but then if you're pretty ill I guess you don't want to wait anyway.

In reply to FesteringSore:

I've found the usual arrangement is:

- If you have something urgent, ring at 8.30 (or whenever they open) and you'll get seen the same day.
- For everything else, wait 2 weeks. Can sometimes haggle for 1 week.

It doesn't seem too bad a system... it can't be easy to balance everyone's needs and the demand with the time the doctors work.

In reply to yorkshireman:


Coincidentally I'm going in the morning, Me and Little Ent nead a med-certificate to join the local climbing club, I already have one for racing but that won't do for climbing I reckon if we're there for 10 to 9 we'll be out by 10 past 9 - it will cost us 23€ mind.

E

In reply to FesteringSore:

Don't suppose for a minute the GP will be able to do anything about it. It'll either resolve itself in that time or you'll need to pay for physio or massage. Mechanical injury is not very susceptible to medicine.

In reply to FesteringSore:

No .you don't have to be dying.

Move to the Highlands

See the doctor today. Breast augmentation tomorrow.

Anyone who has moved to provincial Scotland will tell you how quick the wheels turn in the health service up here.


Obviously down to the population density ,and the fact that those nice people at Westminster look after us so well.

Evening.

In reply to psaunders:


We try to do that but can never get through.

In reply to digby:


I'm going to book an osteopath that Mrs Sore uses.

In reply to yorkshireman:



I've heard it said here that there's a similar problem with old folks making Drs appointments because they're lonely.

In reply to FesteringSore:

dont bother going to Drs with any pain, theyll just suggest painkillers and rest.
Anything they can possibly prescribe something for they will, they never actually 'do' anything to help, if you are lucky or persistent enough they may refer you to a physio, which will then take a few months probably

- disgruntled

In reply to FesteringSore:

I know a medical student doing placement and this does indeed happen; she had a patient the other day who just broke down in front of her. I think GPs are told to ask open questions because for a lot of old people they've few else to open up to.

In reply to FesteringSore:

I cut my leg yesterday whilst out running. I then ran / waded through several flooded fields full of various types of animal shit. I was a bit concerned about tetanus so I called the GP, and 30 minutes later they'd given me a jab.

In reply to jack89:

How desperately sad.

In reply to FesteringSore:

the reason you can't get booked at the doctors is because of people like me.
I just need a referral for a MRI scan by recommendation from the hospital but no the doc want to see me in person for this. too much red tape bullsh*t for my liking

In reply to FesteringSore:

When I worked in London we used to have an office GP every week (a proper qualified one, not just the fire warden doubling up) and so you could book weeks in advance for stuff like referrals for physio, medical forms etc.

Using my real GP was a pain simply because you run the gauntlet of trying to get through on the phone each morning, then have to give up and go to work.

In reply to Turdus torquatus:

nonsense, dirty water and animal shit is good for you, ask any farmer

I also think that one of the reasons(possibly the main reason) why A & E departments are so hard pressed is that people go there with ailments that should be assessed by a GP. However, because they can't get to see their GP they go to A & E thus taking up resources that are really there for emergencies.

In reply to FesteringSore:

If I needed to see a GP I could see ours (or rather, 1 of 4) by 9:00 tomorrow, whether urgent or not.

And I could be referred to the hospital for radiography by 10:00 if it was considered necessary (not even life threatening) as was demonstrated before Christmas when I bruised my elbow.

I don't know why they make it look so easy. Maybe you all need to move to Cardiff?

In reply to Ban1:



I don't understand. Why can't the hospital refer for an MRI? Presumably thats where the MRI would be performed anyway.

In reply to Rob Exile Ward:


Exactly, don't know why it is that hard. Maybe you have a GP surgery in Wales which actually still has GPs working in it...

There are quite a lot with fewer than they should and some with none at all.

In reply to FesteringSore:
It's a nightmare here. If you Have a medical issue that's fairly urgent but usually no hope of an appointment the same day or even the same week due to the telephones being engaged for half an hour every morning. Only to get through and all the appointments are taken, unless you want to see the useless dr. You only see him if your desperate and think your arm may fall off or your eye will explode from conjunctivitis. He has misdiagnosed me a couple of times so I avoid him. I've even had to go to a & e for treatment for tonsillitis once because I couldn't even get an appointment with the useless dr one Monday morning. A & e was packed that morning, full of others who couldn't get gp appointment. Felt pretty awful that I was at a & e and not a gp for that but I was starting to lose balance and couldn't get an appointment for a week. Definitely think the booking system needs changing

In reply to FesteringSore:


Over here I pay $70.00 to see the quack. They could try that in the UK, see how it clears the waiting room.

In reply to FesteringSore:

Tell me about it! Two weeks minimum for a doc at my place. I either avoid or wait until AnE is needed.

In reply to stroppygob:

Quickly.

In reply to RockAngel:

Definitely think the booking system needs changing


Everyone seems agreed on that.

So how would you change it?

In reply to stroppygob:

Be honest here - you pay $70 of which medicare then refunds you x and your health insure refunds you y leaving you out of pocket by a lot less than $70.

LD

In reply to Lurking Dave:


True, but I still have to pay $70.00 up front. Not all quacks bulk bill.

In reply to Lurking Dave:

The point he's making though is that paying for an appointment would significantly reduce the demand for appointment's.

Standard consultation time longer.
More issues dealt with in single consultation.
Less likely to present with spurious complaints - encourages self care and other health care providers such as Pharmacy.
Encourages more telephone consultations to sort out crap like referral for MRI scan as mentioned above.
More appointments in surgery rather than driving/travelling to unnecessary home visits.
Encourages better concordance and compliancy.
Less DNAs.
More competition between GP surgeries.

Of course, some obvious disadvantages, like getting people to attend follow up appointments, access for poor etc.

In the UK it can be so hard, or it costs, to access other avenues that in the end the local GP is the first (only) point of call, resulting in many unnecessary appointments.
I'm sure things could be better up there but they sure could be a lot worse.
Most people I know who need GP access most often - children and elderly - find that access is generally good.
The ones I find that can't are the middle class commuters hence the squeals on the front page of the Daily Mail from time to time.

In reply to Ban1:

Odd that. I work in a hospital and our hospital doctors can refer patients for MRI scans, or any kind of scan for that matter.

Although it doesnt surprise me about the ridiculous level of bureaucracy you've experienced.

In reply to Thickhead:


An appointment fee was introduced in Germany a few years ago for exactly this reason. It didn´t work and was abandoned.

In reply to jimtitt:

There's a lot of countries that do charge though...

And didn't Germany have some stupid system where you paid 10euros a quarter, no matter how many times you went?

There's no easy answer but it seems to come down to a choice between 1) having difficult access but "free" appointments or 2) easy access but having to pay.

No system I've come across seems to be perfect, anywhere in the world.

In reply to stroppygob:


Pretty much the same here - I'll be paying 23€ this morning for 10 minutes. I'll get 70% of it back next month but the point is, the type of person who goes into the doctors surgery with a broken finger nail is usually the type of person who can't be arsed paying 23€ and going through all the paperwork.

Does wonders for the waiting room

E

In reply to psaunders:





Except who's to know what's urgent? Is "urgent" a nasty fever, temperature and sore throat, which will keep you away from work, but is most likely a virus that will resolve without intervention? But then again, it could be a strep sore throat in need of antibiotics. Or is "urgent" that painless mass that you noticed a few weeks ago, dismissed, but is still there getting bigger (and which is actually a cancer or lymphoma), but since you've tolerated it so far, how could it be urgent? Or how about that 40yr old with chest pain.. ..with radiation of the pain down the left arm, and general malaise, which is actually oesophagitis with oesophageal spasm, but a 40yr old with an acute MI, presenting relatively quietly is not at all uncommon. Or what about the depressed individual with suicidal ideation who lacks insight, and can't make themselves admit that symptom on the phone and who with in 2wks may act impulsively to end their lives.

The idea of accurately triaging these kinds of problems over the phone, often by an aggressive receptionist or if you're lucky a nurse, or just by the patient on the internet, is just a nonsense. There are all sorts of mole-hills turned into mountains by patients, yet there are also serious problems identified by patients which come with contextually less associated symptoms because patients are more savvy and alert, but which makes it difficult to identify the seriousness especially via phone contact.

Also, there is a loss of contact with a specific GP which loses continuity of care, relativisation / perspective of presentation in the context of existing knowledge of patients, all further compromised as so many opt for emergency appointments, and time for regular appointments gets longer and longer.

The problem is that the loss of community, dissipation of families for work, increased work force mobility, and a burgeoning of work/stress induced psychological and psychiatric illness all mean that GPs are a 1st port of call for the expression of social and psychological pressure, taking its toll on the more vulnerable, but this has significantly increased patient demand on GPs, and along with numerous clinical expectations for management of specific diseases, and screening has all resulted in a significant increase in GP workload.

As a doctor who has tried to use the service, mostly for my young sprog, but also for myself, it seems to have become highly dysfunctional and insensitive to the actuality of patient problems (which really need a decent GP contact to be identified). I went to GP with sick sprog some of which were sat on by the GPs, others were highly over-reactive, none seemed comfortable with managing sick young sprogs (3 different practices). Also, got mis-diagnosed by GPs as asthma, and medicated unnecessarily, and only after a sh1t storm from me did I manage to get a referral to paeds which resulted in identification of bronchiectasis and a chronic infection that required 3months Ab, but which cleared after 1wk (having had a wet cough bounced by many GPs for 1.5yrs. Thankfully, all is good now, and he is running around without breathlessness or cough, but I fear what would be happening to kids whose parents who don't know when something's amiss in management.

So, I have a pretty jaundiced view of GPractice, much of which is circumstantial and not their fault, created by unhelpful government, but hasn't been helped by opting out of out of hours services. I don't know what the solutions are, but I don't think it is a good system as it stands, and I dread to think what the next change will result in as a result of the consequences of the new NHS bill.

In reply to contrariousjim:

Not sure what relevance your son's bronchiectasis has to GP access though? Which is what I thought this was about. GP training is a different issue.

As regards OOH, I do OOH, 1:10 weekends and nights. I don't know 9/10s of the patients (i.e not mine) any better than Joe Bloggs from Timbuktu. I get called, on average, twice, and get paid very well for the privilege. It strikes me that a centrally funded cooperative of GPs would be more cost effective. Quite how big that cooperative should be, serving how many patients, is more up for debate. But surely its better paying a GP to actually see patients when working than trawling crap on the Internet (like UKC) to pass the time away. There is only a certain amount of journal reading one can do.

There has been a huge shift in the last 20years or so from providing acute care, when things go wrong, to chronic and preventive management, hence the advent of QoF ("performance" related pay). If GPs are to be expected to provide a quality daytime service Monday to Friday then they have to be rested at night's and weekends, the same as junior doctors and consultants protected under hospital HSE and EWTD etc.

Either that, or we need more GPs, but where are they going to come from? Current take up in the speciality is low, morale is rock bottom, there is an ageing GP population approaching retirement and as you and I both know, training needs to be longer. Not a good combination really.

In reply to FesteringSore:

In short, not enough doctors and too many sickies. If I need an emergency appointment and they literally can't fit me in, I wait until they close and then call the CHOC (only applicable in Cumbria as it's their On-Call but I'm sure other counties do something similar). You end up sitting around all night waiting for them to call you back and arrange your appointment, but you get seen that night. It's generally a very good service.

In reply to Thickhead:


10appts reduced by at least half by better management earlier. Reduced workload, more efficient performance based on definitive management earlier.


Of course.. ..or go the other way.. ..only get called for *your* patients, even less often than you currently do and do the work without additional pay as part of your normal contract.


Well we're having that debate here. And there are few who think the weekend status quo is reasonable or sustainable and moves are afoot to make a plan for a 7day service. We also agree about opting out of the EWTD, because, while the sentiment is agreed with, it's too much a blunt intrument that, as you indicate, does not take into account the intensity of work load. Why has there been an 81% increase in 90yr olds taken by ambulance to A+E. Why are a 1/3 of cancers in 13-24yr olds being diagnosed in A+E and almost a quarter overall? Preventing disease is all very agreeable, but do we really need GPs doing that? And surely, it should not at the expense of poorer acute management of disease.


Well I think it is clear that more GPs are needed.. ..or at least people covering that work. I agree about longer training being needed because a greater knowledge base helps with getting the correct, efficient and definitive management earlier. I think annual secondments both ways would be a good start to develop a permanent training culture and increase the knowledge base. However, I think that GP should on paper have never been as attractive a prospect, especially in terms of pay and work life balance.. ..in which case why isn't GP attractive.. ..my view is that it isn't culturally attractive, it's fairly obvious that like in many clinical disciplines we've become more technical, and less professional. Its not just GP either.. ..A+E are having similar problems.. ..there are currently no middle graders here, only consultants, GP trainees and FY2s!

In reply to yorkshireman:

Arnica gets used in herbal doses (as a tinture or cream) as well as in homeopathic doses (as tablets), and there's some chance it has an effect in one of those.......

In reply to FesteringSore:

I agree. During my wife's pregnancy, there were routine, scheduled GP appointments required at specific points.

Wouldn't it be sensible to be able to book these in advance, instead of the ridiculous system our surgery has that means you have to phone up on the Monday of the week you need the appointment to try and book one? Caused merry hell with her being at work and arranging customer meetings that need to be booked weeks in advance.

In reply to LastBoyScout:


I've just registered, and managed to book an appointment online - admittedly for 2 weeks time, but with the GP I wanted, and at a time when I'll have no kids in tow and don't have work meetings booked - much easier than trying to achieve the same by phoning up!

In reply to FesteringSore:

I got an appointment regarding my shoulder and it took 1 week. The doctor just told me to take co codamol. I told him I was hoping for a referral and he said he'd give me one. Nothing yet though...

In reply to FesteringSore:

General practice in the UK is in dire straits. That's why I'm over here in Australia. It's much better here, though sadly it is not reproducible in England due to a serious lack of cash.

The general publics impression of GP life is that its a cushy number with generous remuneration. However in reality income has been falling foe

In reply to FesteringSore:

Sorry phone problem... Falling for years while workload increases. Most GPS now work a 10-12 hour day with no real breaks. The actual number of consultations has doubled in the past 10 years, although the population hasn't. However everyone is getting older and GPS have to do more preventative work than they ever did before. This was a result of a new contract. This has led to peopleliving longer, therefore needing more monitoring and more preventative care and more consultations. GP numbers haven't really increased, and that' why you can't get an appointment. Sadly there is so little cash in the system investigations such as CT take weeks, which can increase workload too. I' afrid the main problem is expectation of care is way beyond what the NHS can achieve, and this expectation is not only from patients, but more importantly coming from politicians. I think you either have to accept care is going to be less than ideal given funding
constraints, or you have to look at alternate models, and lose the almost religious attachment to the NHS.

The strange thing is that on the rare occasions that I do visit the surgery, not necessarily for an appointment, there are never more than about six people waiting and some of those, I suspect, are seeing a practice nurse rather than a GP.

I do think that part of the problem is people wanting to see the GP for no particular reason. I have spoken to somebody in the local patients group and she confirmed that some elderly people go just for a "chat" because they're lonely. Then there are those who don't bother turning up.

Sadly I think there IS a need to charge people for an appointment and perhaps they should be charged, say, £10 but any follow ups for the same illness would be free. Exceptions could be made for GENUINE hardship cases.

In reply to Carolyn:


Well she gave me the woo tablet ones then which is worrying. She seemed more concerned that I stock up my medicine cabinet so it could go on the same prescription and therefore mostly get refunded.

The lack of OTC meds here is annoying - I just stopped into a pharmacy in Paris just now for some eye drops as they're a bit dry as I had an early start this morning to get the train up. In the UK you could pick up some Optrex or some such from any Sainsburys, petrol station or corner shop - here I had to ask the counter staff in the chemist and answer a load of questions, and got presented with some obscure stuff.

In reply to Thickhead:

It operates now as: everyone rings up 8-8.30am to try and get an appointment in the next 2 days. Once all those appointments are booked you then have to try ringing the following morning in the vain hope you get through and can make an appointment for your day off. It doesn't work and there are still no appointments so you have to wait til the next morning to try to ring again. This time you get through and are offered an appointment but it's when your at work. You take it and need to rearrange work so you can go to the dr. Wasted 3 days just trying to get an appointment, then either have to take time off work or rearrange shifts so you can sit in the waiting room for an hour or so before seeing the dr.

Appointments need to be able to be booked at more than 2 days ahead so you can see the right dr at a convenient time. Not waste over an hour and a half trying to ring up and get nowhere, each call going through so you pay for it, not just the busy signal & then having to take time off work.

In reply to RockAngel:






That's great, don't think you could disagree with that.

However, how is that going to be achieved in a system with too few GPs and too high a demand for service?

Taking time off work to see a GP is perfectly reasonable. Most people appreciate they have to do that to see a dentist, what's the difference?

In reply to FesteringSore:

I waited over a week for a telephone appointment in the past :-P

In reply to Thickhead:




Like plane tickets? Unpopular slots, like 3pm on Wednesday, are free. Popular slots like 8am on Monday, you pay for. Say first two appointments a year freely bookable online up to two weeks in advance to avoid the need to repeatedly rearrange work. After that you need to ring (to avoid hypochondriacs clogging things up).

In reply to contrariousjim:




What, work 365days a year 24hours a day? Unlikely you'll get many agreeing to that.

Providing OOH is part of my "normal" contract, for which I could negotiate a better deal due to the demand for OOH care (i.e more hours worked, more pay earned - realistically this is the way the world goes round - GPs are only human and will not go back to a system of working for "free").

GPs here are contracted to provide OOH care as part of their central contract/funding. They can then, and do, charge a levy to the patient for call outs (you pay to see a GP in the daytime, you pay more at night). Its cheaper to call a GP than an ambulance, which costs the patient also.

I work in a GP practice with 10 GPs therefore work 1:10.

The MOH and local Governments are looking at OOH GP care though, as a large proportion of patients who are seen by a GP OOH during the night end up in hospital anyway so work is duplicated, which is expensive.


Preventing disease is all very agreeable, but do we really need GPs doing that? And surely, it should not at the expense of poorer acute management of disease.

Possibly, but any health system I've worked in the consensus seems to be prevention is better than cure.

Keeping patients out of hospital takes time and energy and if a GP is exhausted from long hours and unsustainable workload then they are much more likely to refer to hospital.

Hence there is a choice between resting OOH and being energised for the daytime, providing better care and keeping patient's out of hospital, or working both and providing a less than satisfactory service as a consequence.



I don't know why morale is so low.

Constant long hours and increasing demand for service, going home exhausted after your children have gone to bed and turning on the news to find yet another report about how bad a person you are and how you're not doing enough work, difficulty finding replacement GPs for those leaving/retiring/maternity leading to increasing workload and demand. Constant threat of litigation - continuing rise of MPS fees, continuing increase in cost of living and decrease in take home pay. Increasing waiting times at secondary care level impacting on the work a GP does - perception that as a patient you get a quicker scan if you pitch up at ED (which is true). Closure of services (community hospitals, xray departments etc) resulting in more difficulty accessing care and less job satisfaction as less able to deal with simple things at GP level (e.g simple fractures having to attend ED as local MIU closed). GPs completing their training seem to take up short term locum positions rather than partnerships - better pay and better work-life balance - putting additional strain on existing partners and also creating resentment - having to pay someone more than you earn to do less work. Rubbish intermediary care services working Mon-Fri 9-5 making it difficult to keep patients at home who need social care.

I've been out of the NHS for 10months now and really cannot see me going back into it. I haven't regretted my move for 1 second. Go back to the UK possibly in the future, but no way would I go back to being a GP in the present climate. I would rather stack shelves in Tesco.

In reply to FesteringSore:

My local surgery used to have the reception run by the Spanish Inquisition. You'd be asked if it was an emergency (obviously not, or I'd be down to A&E), but you had to say yes. Then you had to go along and sit and wait for ages (a 'drop-in surgery').

So it was a complete surprise to me when I rang recently and asked for an appointment that day, and was given an appointment without any questions, only a couple of hours later. When I got to the surgery, no sooner had I sat down than I was called in for the appointment. Incredible.

And the same thing happened a week later when the problem hadn't cleared up as we'd hoped. My GP even had time to chat about our upcoming skiing trips...

In reply to rwong9:


Unless the waiting list for investigations is constantly growing, then there really should little excuse for delays; it's merely a pipelined system. If there are waiting lists that are static, then the backlog should be removed by bringing in more resources short term to process the backlog, reducing the delay to administrative and analysis periods.

The present system for seeing consultants is stupid. You see your GP. Your GP suspects some problem, and refers you to a consultant. But, before you can get any useful diagnostic tests done, you first have to see the consultant, who essentially 'kicks your tyres' and says "oh yes, there does seem to be something wrong, let's get some diagnostics done". If the GP could refer you for sensible diagnostics, the consultant would have diagnostic information to hand on the first appointment, thus cutting their appointment load by up to 50%.

It does depend on the GP making a good initial stab at a diagnosis (to the extent of identifying a number of candidates), but, really, that's what a GP is supposed to do; be a front-line generalist who knows enough to route patients to the appropriate consultant.

In reply to captain paranoia:

Would generally make sense, however a good referral letter from GP to consultant should result in consultant ordering appropriate tests, or tests that he/she would like, in time for consult.

The problem of a GP organising a CT scan is that 1) the perception is they would overuse the service increasing demand and 2) said consultant may have preferred, for example, an MRI scan hence duplicating time and costs.

These days, consultants often don't see referral letters until the day of the appointment.

In reply to MG:



That would be one way of doing it. I guess the problem would be the administrative headache this would create.

In reply to Thickhead:

When you only work part time, had 2 days off during the week, then still have to take time off for the appointment, it's a joke! I've had to go through that rigmarole just to get a review and ok from the dr so I could get back to exercising after a back injury that didn't require me taking time off from work, until I had no choice in the matter so I lost a mornings money for taking time off work, work had to scramble to get cover for my morning. It's now cost me in phone calls and lost wages. They won't open their appointment booking system so I can make an appointment where it's not inconvenient to me for minor reviews like that! Meanwhile, when I've needed an urgent appointment due to tonsillitis affecting my balance, I can't get one and have no other choice but to use a & e just to get a prescription for antibiotics. Maybe there needs to be a triage nurse who is the receptionist who can say what urgency your appointment is and can book you in accordingly, rather than allowing all the people who don't need an urgent appointment take them like they do when booking you into a & e. Meanwhile, I see the practise nurse every 3 months for a b12 shot and always manage to make my next appointment while in the old one.

In reply to RockAngel:

That is a joke.

In reply to RockAngel:
until I had no choice in the matter so I lost a mornings money for taking time off work, work had to scramble to get cover for my morning. It's now cost me in phone calls and lost wages. They won't open their appointment booking system so I can make an appointment where it's not inconvenient to me for minor reviews like that!

Why did you lose a morning pay?

Surely an employer should have a legal duty to allow you to attend a Drs appointment. Especially with regards to a back injury which could be made worse by continuing to work.

More than meets the eye here.

Meanwhile, when I've needed an urgent appointment due to tonsillitis affecting my balance, I can't get one and have no other choice but to use a & e just to get a prescription for antibiotics. Maybe there needs to be a triage nurse who is the receptionist who can say what urgency your appointment is and can book you in accordingly, rather than allowing all the people who don't need an urgent appointment take them like they do when booking you into a & e. Meanwhile, I see the practise nurse every 3 months for a b12 shot and always manage to make my next appointment while in the old one.

I guess it comes down to supply and demand. Once appointments are taken what happens? GP time is a finite resource at the end of the day.

Did you really need to attend ED? GP OOH? Walk in/urgent care centre? Maybe you did, depending on your local provisions.

Or maybe you should consider changing GP practice, see if its any better elsewhere.

In reply to Thickhead:
Not with a zero hours contract!
I've just had a couple of days off, I feel obligated to be working when I'm at work not getting paid to go waste a morning at the dr. Days off= time to go to dr, work scheduled=work.
I'd taken a small fall on kinder scout, minor damage to back & sciatica. Almost gone with careful exercise. So no, that's all that was going on. I also arrange my dentist appointments and any other appointment for my days off.

In reply to Thickhead:


Not to mention the two tier service provision.

I have got to say my GP practice is very good, admittedly it is rare that I visit, but when I do, I have never had a problem getting an appointment either that day or the next and they open until 8 pm a couple of nights a week, which obviously helps a lot of people who have limited flexibility around work. Unfortunately I have some professional experience with GPs, I found a decent proportion of them to be difficult and inflexible.

In reply to The New NickB:



Work needs to be more flexible. Ironically the one least flexible is the NHS itself!

To have the ability to register with a GP in your work locality rather than home would be advantageous too.

For some reason the NHS is hung up on Geographical distribution.

Unfortunately I have some professional experience with GPs, I found a decent proportion of them to be difficult and inflexible.

To be fair you get that with any professionals. I can say much the same about Council management.

In reply to The New NickB:


The service is the same, just when you get it varies. Surely better than the current system that, in many cases, seems frustrating for everyone? Can you imagine if airlines or trains required you to phone between 8.00 and 8.01 to get a ticket, if you were lucky enough to get through?

In reply to Thickhead:


Much higher with GPs I am afraid, reinforced by the fact that they generally get away with it.

In reply to MG:


I agree this system, which my GP doesn't operate, isnt good, but I don't think yours is n improvement.

In reply to The New NickB:

Then we'll have to agree to disagree as our anecdotal experiences are very different.

And you're lucky with your personal GP that they have enough staff to work into the evenings - as mentioned above many GP surgeries are under staffed, and some not even staffed at all!

In reply to Thickhead:

I am not sure how it can be a GP surgery if It isn't staffed at all.

My surgery can support evening appointments because it was sufficient patients to do so, the staff do not work extra hours, just different hours.

In reply to The New NickB:



Usually if the last remaining GP calls time and there is no one to step up then the onus falls to the LHB, or PCO, to take over the practice and stop gap with locums as much and as far as possible until more permanent staff become available. Which may include being contracted to another GP surgery which could use it as a "branch" surgery.

I know of at least 3 surgeries in North Wales in the past 12months that have been left without a GP.

It can still be a GP surgery if all the allied health professionals can provide their services e.g midwifery, nursing etc.

In reply to The New NickB:


But the core hours still have to be covered, 8-6.30, so any additional opening is extra staffing as you have to staff the core hours and then some.

In reply to Thickhead:

I suspect it is difficult in areas with lower population density, but generally larger practices are better in terms of service efficiency, service and patient outcomes, so a balance needs to be made between the size of a practice and how local it can be to everyone.

I still think in terms of the old PCTs and SHAs, because my direct involvement with health ended a couple of years ago, but I tend to think permanent employed staff GPs rather than the traditional set up is a good thing.

I agree there are, or at least were as I am a couple of years out of date, significant aspects of the GP contracts which discourage efficiency and flexibility.

In reply to Thickhead:


No. Provide a 365days/year 24/7 service. And there won't be an option.. ..contracts will be negotiated to make it so, and management here are already asking us to make plans. Radiology already is running a 7day/week service. Looks like clinics will be become 7day/week, and consistent hospital staffing ratios through thoughout the week is that basic that is being suggested. However, coming back to your 365days a year 24hrs a day comment.. ..again, that ignores intensity of work. No one wants someone on their feet, lacking sleep etc. However, when SHOs covering surgery wards or medical wards, before the even more ridiculous implementation of MMC and MTAS, it was pretty obvious then that on-call cover with 3-4 handovers/day, covering large geographical areas of the hospital, and hundreds of patients along with an unhealthy dose of hospital shirkers who were happy to pass on their undone duties to on-call staff and walk staight out on the dot of 5, were obviously dangerous and problematic. We worked out that there were 3 house officers / ward, and that moving to a residency in which those 3 house officers must between them provide cover for the 32 patients on the ward 24/7 between them would mean that you could have 1 doing day shift, 1 floating / education / break and 1 doing night shift, but helping during the day. Nominally that would be totally EWTD un-compliant, but your responsibilities begin and end with your patients, you know them all, the night shifts would be far less intense because you'd be covering only your ward and might have on avg 3 people get sick during the night, as opposed to covering the entire surgical/medical floor, between two shifts, and get ridiculous hand-overs that you had no option but to try to prioritise despite your own personal ignorance of the patients and who really might be a priority etc etc. Furthermore, it would inject a greater deal of ownership of patients and sense of responsibility for them. There would be a small core team always totally in-touch with the patients on the ward, acting as a core for the extended team. Nominally total EWTD fail, but in terms of intensity of work, ethical responsibility, safe practice.. ..its a no-brainer.


Its not working for free. Its working at lower intensity more often to provide a more knowledgeable safer service where the contract is between you and your patients and not a service that is dependent on the time of day a patient gets sick.


It'd be more sense to charge for missed appointments, inappropriate call outs, rather than penalising patients for when they get sick or as a function of their ignorance of your professional discipline.


Hospitals are dangerous places for patients to be.. ..especially for the elderly, and those susceptible to infection. It should not be accepted as a status quo that patients are liable to be sent, so lets send them anyway.



Well its political isn't it. Its about politicians saying we've reduced cancer mortality by X etc. Alcohol, cigarettes, obesity, exercise etc all become targets for health promotion, but that doesn't need to be done by GPs. There needs to be a debate about whether extending life expectancy is such a good idea, when it isn't concomittant with better health. People aren't sufficiently functional with their greater longeavity, nor is there the will, to extend working life significantly. So where will the money come from to fund what is already materialising as a problem in health and social care in the elderly, with emerging problems with dementia, not to mention macular degeneration, osteoarthritis, and all of the common chronic health issues that we see. Many aspects of screening and other required health checks really do not need to be provided by GPs, either organisationally, or hands on, its not what a GP necessarily needs to be doing. My personal view is the need for GPs to focus on a reactive acute disease and the mod to severe chronic disease end of the spectrum. Educational and screening aspects do not need to be the focus of GP work.

In reply to contrariousjim:

So I should work 365days a year?

In reply to Thickhead:


That won't pay you 150,000 or whatever the going UKC rate is for GP's...

Do we have any incentives now? In the US the medstudents get loan repayment help to enter priority areas..

So my missus is probably going to finish with $250,000 of debt, if she works in key areas (I think that's GP, family, Gyn + others) in rural areas (indian reservations or areas like Maine) for something like 6 years her debts are wiped out....

Its a pretty big incentive...

In reply to Thickhead:


No, but on call is neither working nor not. Which reminds me.. ..having been doing a PhD for the last three years and witnessing the culture in science, which is admittedly very variable, everyone is in and working on the weekend, and the hours aren't remotely EWTD compliant even though the contracted hours are nominally 8.30 till 5. PhDs and post docs and good number of the PIs all work long days here, and do so incessantly with far less re numeration than doctors. So it's rather naive to assume that working hard, or long hours is the preserve of frankly well paid doctors.

In reply to contrariousjim:

So I should be on call 365 days a year?

In reply to IainRUK:


LOL. Yeah... 58000 last year I worked in Wales. Full time.

From that I needed to pay MPS 6000, GMC 400, maintain a car and mobile phone and pay for my own CPD.

I got paid more as a junior Dr...






They've talked about it. Possible golden hello or handcuffs or settling student loan but nothing yet.

Can you imagine it? The Daily Mail would have a stroke...

"GPs, who had a record breaking pay rise negotiated under the Labour Government (10+years ago) now have to be bribed to turn up to work."

We had a chat about this at lunchtime. Even if they offered to clear my mortgage I wouldn't go back.

In reply to Thickhead:



... and student loan.

In reply to Thickhead:


In reply to Thickhead:


They must of disliked you! That's below the bottom end of sampled salaried GP work:
http://www.gponline.com/News/article/1117274/Salaried-GP-income-increases-5...
And, yeh, you have to pay indemnity, but you get one of the best pension deals available for any employee, an avg 40 days holiday including public holidays, as well as additional leave for professional and study requirements.

Mate of mine, 35, is earning £110,000 salary as a rural GP including contracted on-call commitment, and that's before additional locums, which he can fit in along with family commitments. As you said above, you can work alot less, or earn alot more just doing locums.


Not sure where you're working. But a doctor friend in Sydney is involved with medical training and GP structure.. ..and they're looking to move to emulate the UK model! I've told her its a disaster and to resist.. ..but it seems she has a fight.

In reply to contrariousjim:
I was a full time GP partner... Probably cared too much about trying to provide a decent service working for a shit LHB (check out Betsi Cadwaladr on Google - you will get the general gist), rather than making mega sums.

F*ck the NHS pension, if I had to work until 68+ to be able to claim it the chances are I would be dead anyway. A bird in the hand is worth two in the bush and all that.

Annual leave was relatively generous at 6weeks plus study leave. However, being self employed its fairly arbitrary anyway.

The temptation to move to New Zealand became too great...

Work 4days a week plus 1:10 on call.
Earn £72000pa.
MPS 1/10th of cost in UK.
Medical Council fees paid for.
Car provided for on calls therefore only need 1 car in family.
5weeks annual leave plus study leave.
10days public hols per yr.
Get to run at lunchtimes instead of scoff a sandwich over paperwork.
Home by 6pm everyday, even when on call.
GPs generally well respected in community at large.
Finance towards cost and travel for CPD.

They realise there is a problem recruiting NZ trained Drs to be GPs so they go for the next best thing rather than the cheapest.
I am involved with a recruitment agency so part of my work in future will be to poach UK trained/based Drs. Something tells me that won't be difficult...

Oh yeah, and its summer now too

'Stralians do some odd things sometimes. You get used to that here.

In reply to yorkshireman:


I thought Arnica cream/oil was supposed to be a reasonably effective treatment for mild inflammation, it's the homeopathic arnica tablets that are just overpriced sweeties?

jk

In reply to Thickhead:


I wonder why MPS is 1/10th?! Insurance reflecting insurance costs or just blatant profiteering. I'm pretty sure its the former, which also reflects the general view in which GPs are held by the public.. ..you take too many british GPs across, and your MPS costs will align with the UKs, and neither will the "respect" continue.

Hunt's new contract for GPs looks like it will seriously reduced the paper work, switching back to trusting in "responsibility", over check box checking. Remember, you don't exist in a bubble, and with figures like you quote.. ..I'm sure if this kind of thing continues you'll be contributing to growing inequality in NZ.. ..planning that second home by the beach yet? What goes around comes around.. ..it won't last.. ..and you're almost certainly contributing to a problem while providing a solution to another one.


Almost a 1/3 of my year went abroad at the MMC/MTAS onset, and about 1/4 of my year haven't returned, though many are in Ireland and love it (much harder work ethic there, much more over time, but better renumeration, though that has been cut post financial crisis and is under media scrutiny), elsewhere in Europe, some even did the exams to go to the US, but most went your way, so you're probably right. All a bit of a kick in the teeth for people like my dad who come from the vocational/professional attitude toward patient care, who worked totally on-call (outwith the main 2wk break) pretty much until he was 50 and that was in A+E along with 1/6 nights and weekends on the shop floor. More staff made that much better over the last 15yrs, but people like my old man, can understand the demand for wages, but not the ethical abandonment that is seeing the technification and guideline punting taking over from what was a professional vocational attitude. Both didn't have to happen synchronously and doctors have themselves to blame for the fact it has.

In reply to FesteringSore:

Well, the reason you can't get an appointment for ages is cos the appointments are taken. The reason for that is that other people have got in ahead of you. That isn't the fault of doctors.

In reply to contrariousjim:


ACC and the relatively low risk of litigation.

Its very hard to sue anyone here. That's why you don't get High Street lawyers advertising "where there's blame claim" and "no win no fee." For example, you don't actually need car insurance and if you're injured in a car accident you cannot sue for injuries.

British trained GPs are respected here. If you a New Zealand trained GP your qualifications aren't recognised to work as a GP in the UK. If you stay beyond 2years then return you have to re-train at least to some extent. Make of that what you want.

My first home is by the beach so don't need another one (still have home in Wales so technically do have "two homes").

In reply to contrariousjim:

. All a bit of a kick in the teeth for people like my dad who come from the vocational/professional attitude toward patient care, who worked totally on-call (outwith the main 2wk break) pretty much until he was 50 and that was in A+E along with 1/6 nights and weekends on the shop floor.

People just aren't prepared to live like that anymore, across all professions.

Leaving school at 18, 5/6yrs at med school, straight into post grad training after house jobs working 100+ hrs per week, then working like that for 30+ yrs just wouldn't encourage recruitment or retention of adequate numbers of staff.

Drs (and most people in general) want more from life now, be it proper quality family time, sport, music or whatever.

Whether on call is work or not it is a breach of liberty and there has to be some recompense for that.

In reply to Thickhead:



Why the appeal that medicine should be like other professions or simply other careers. There's your recruitment problem right there! What is there to be inspired by? Real responsibility is simply not tightly contained within a discrete shift because ethical care for other people simply cannot be switched on and off.. ..if it's there. Other devices need to take over to satisfy the conscience: trust in the system, trust in your colleagues, trust in the knowledge base of those involved, which have all been fundamentally eroded. The expectation of bright children to work in a historically respected career has resulted in square pegs being driven into round holes. A function of modern individualism that can so easily see the self, and it's liberty being so undermined by the uncontained demands that a specific knowledge creates along with the unbounded domains of a sick patients in need of care whose disease does not respect your individual agenda and who will try to die, bit by bit, irrespective of your tea break, shift end, hand over, etc. it's no wonder recruitment is bad! What's to inspire them? A workforce who are utterly uninspiring! Opting out whenever possible, and despite the onlooking public. A technified industrial worker, stripped by themselves of their own responsibility and ethic? It was the very fact of the evidence of that responsibility that inspired me, jumping in a car and driving into the dept to help.. ..help the patient, help teach, support, and be the team. Taking that care to fight the more political dynamics of import, noxious managers, health boards, and even inviting a hand bagging from Maggie in the process. Tell me what's to inspire people if the perks have become most important, and no one can talk about their "profession" without a red face?

In reply to contrariousjim:

I guess what has changed since I naively completed a university application form at the age of 17 is that I have realised there is much more to life than work.

We're only here for a short time, some shorter than others, and I'm not prepared to miss things like my child being born, my child growing up, for the sake of work.

If you feel different then that's your choice. Maybe one day you'll have your way in the health service.

In the meantime I will continue what I'm doing, which by my general reputation amongst patients and peers seems to be more than adequate.

In reply to Thickhead:


It isn't a black and white choice. It *was* ridiculous what many doctors were being expected to work.. ..but that did not mean that systemic undermining of responsibility given your knowledge and that determining relationship at the centre of medicine should be undermined at the hands of a technocratic change, and personal rights. It's just gone too much in that direction. No one would expect you to miss your child being born, but as for not spending as much time as you might want with your kids.. ..again.. ..wake up.. doctors are far from unique, and there are many in many careers that have that issue.

Enjoy NZ, take care not to take the UK there with you. Remember too that NZ is >3yrs behind the UK in terms of ageing population, those beyond working wage. That kind of demographic issue will make a massive difference to economic necessities, and as a result how much work you will experience in the future. Point being.. ..don't blame everything on people working in the system (politicians to shop floor doctors), and think about how much is actually the determinants of economic circumstance. NZ is much more dependent on labour for its export economy.. ..age will have a bigger effect in NZ when it bites. So don't count your chickens before they hatch.. ..and a question.. ..*if* things get bad in NZ will you stay and help, or will you find somewhere else that suits you?

In reply to contrariousjim:

No one would expect you to miss your child being born, but as for not spending as much time as you might want with your kids.. ..again.. ..wake up.. doctors are far from unique, and there are many in many careers that have that issue.


Absolutely, which is why I'm extremely grateful to have been in the position to do something about it. I've never claimed otherwise.



I've no real intention of doing that other than encouraging a few Drs who may express an interest in coming to work here.


NZ is much more dependent on labour for its export economy.. ..age will have a bigger effect in NZ when it bites. So don't count your chickens before they hatch.. ..and a question.. ..*if* things get bad in NZ will you stay and help, or will you find somewhere else that suits you?


It's a big "if" and depends on various other factors. No I cannot see us living anywhere other than UK or NZ.

We haven't committed to long term in NZ yet (can't really without a residence visa).

What I have committed to is never working as a GP in the NHS again.

In reply to stroppygob:


This makes me think of the Irish proverb... 'Death is the poor man's doctor'

In reply to Thickhead:


Shame.. ..when there are those who can see the problems, and when its the politically minded gong seekers who end up choosing the change they want.