Columnist Dr Katie Musgrave considers whether the crisis in general practice is down to the fact that too many patients present with trivial concerns
It has gradually dawned on me that at least half of what I do is totally and utterly pointless. Sometimes it’s actually downright ridiculous, and I’m left wondering if it would make any difference if I wasn’t there.
Is it just me, or does the frequency of trivial consultations seem to be increasing exponentially? Is it the switch to remote consultation, or perhaps a post-pandemic reaction?
Take the patient who called up last month complaining that they felt hot in the sun.
Or the one who wanted to discuss why they felt faint if they missed lunch.
Or the one who’d had a rash, which had disappeared, but they were worried it could come back.
Or the child who was unwell with a fever, but the parent wasn’t sure if it might be serious, because they hadn’t picked them up yet from nursery.
I could go on for a long time. I spend an awful lot of time talking to people about ridiculous things. I had better not though, as someone might report me for insensitivity to the GMC.
But then again, the GMC frequently appears to target well-meaning doctors caught up in a dystopian nightmare. Still, sometimes I think it wouldn’t really matter if the GMC came after me, as half of what I do is totally pointless, and it would make practically no difference if I didn’t do it. Ironically enough, if I was suspended by the GMC, I might actually find myself doing something more useful with my time.
Was it better before Covid? Did people contact us about less trivial matters? Granted, we still had our ‘regulars’, but at least I felt I might do something vaguely useful, such as check a blood pressure and notice a mole. I also got to know patients personally, who might open up about their underlying issues.
Not now. I just trawl through an endless stream of inane phone calls, feeling like I’m missing the crux of the matter, but lacking the time to bring in the people who really need to see me. Some GPs say a bulletproof triage method is the answer. But having worked within such a system, it struck me as simply another way of sifting through a depressing mountain of dross.
But it’s got me thinking, is the crisis in GP numbers actually a confected nonsense? If half of what I do (and I’m pretty sure it is) is totally pointless, then surely a mildly concerted effort to incentivise patients to consider whether a GP appointment is truly needed might make a huge difference?
This winter is almost certainly going to be another shocker: with chaotic, dangerous and undignified scenes unfolding in emergency departments. I hope neither I nor any of my loved ones need urgent care.
If we could solve the GP crisis, might we also significantly improve the situation in out-of-hours care and emergency departments? And then little old ladies might not be left for 10 hours waiting for ambulances, and they might not be transported to hospital on bin lids, and all manner of atrocities might be avoided.
Still, I better not think too hard about that. Because this patient is worried about why their hair is greying more at the front – and they really need my full time and attention.
Dr Katie Musgrave is a GP in Devon and quality improvement fellow for the South West
We don’t get any of those kind of consults. There aren’t enough GPs.
Careful what you say….there are a lot of prying eyes on this website with a low threshold to refer you for offending anyone. It’s the woke culture.
You will find that prior to Covid and the initiation of telephone triage only that your reception staff filtered out most of this crap
Total triage by non GPs is one partial solution
Perhaps an AI computer could do this Or whilst programming one perhaps some ANPs
Then charge patients for the triage and ambulances and charge for Aand E if not an accident or emergency
We just need another 80 hospitals ( to include the RAAC infested ones) and the whole system might work with just a few thousand more nurses 🙂
Just think really warm weather or very cold weather reduces GP consultations by a lot so clearly some patients are choosing to misuse the service
I fully agree with the article- there are plenty of GPs to go around but we’re drowning in complaints and life related issues that we have medicalised as “illnesses”. Short sighted GMC advice on kindness and craven NHSE complaints procedures make things so much worse. Our GPs are truly scared of offending anyone. Charging to see GPs in France / Ireland / New Zealand cuts up to three quarters of consultations. We have over 5 million patients signed off work long term! We, the GMC and the NHS are making the nation sick, and we seem blind to it.
As I sit here this evening going through letters this can apply to most of the e-consults to action.
Part of the need is for someone who will get it right to help educate (by which I mean not just telling or teaching, but also coaching people or parents on their decisions) patients as to what is normal, or acceptable, and what to do about minor ailments that are not.
Grandmothers and grandfathers, and other respected community members, used to perform this function, and got it right some of the time. The next generation of grandparents seems to be wholly less skilled in this department, probably because of lack of suitable education themselves, but also because of the challenges brought in nby social media, fake science, and ‘marketting’ which is diametrically opposed to minimising intervention and natural healing.
Patients/parents need to be coached by doctors (or respected practice nurses or Receptionists, in manageing and deciding on level of management of, both minor and possibly major, symptoms and conditions.
The nonsense spouted by various government bodies is tending to undermine authority, both of what they say, and also of what doctors say.
Had British cuture developed differently, yes, we could be managing now with far fewer GPs; and this is still a possibility for the future;
But at present, there is no way this situation could be reached in less than a generation – so at least 30 years now, and a lot is down to cultural changes towards individual self-centred capitalism, and away from respect, and honour for others
I love the ‘trivial’ as it can get sorted quickly – 10 hours of complex presentations will have me retire in a week
PS ‘’trivial’ headache, a bit of a stiff neck and a funny purple rash, can you turn the light off please. Don’t want to bother the GP.
The dross is rising because the access threshold is too low. It started with NHS Direct. Remote consulting (of whatever species) is adding to that. I’m for a Back To Basics approach. All F2F. No phone calls. Zero tolerance for late attendance. In return you’ll actually sit in the same room and have your problems actually managed instead pseudo-managed. Am I the only one who thinks the one-problem rule is utter bullshit? How have we come to this? Fighting the patient again. Making enemies of our own people.
@drno. The one problem rule is a defence mechanism to atleast try and stick to the BS 10 minute consultation which give the complexity of what we now see should be assigned to the dustbin. Given free at the point of use, patients are happy to sit around for 45 minutes talking about all their woes we can do little for. I’m a doctor, not a social worker counsellor or friend. I also find there are a lot on “non consultations” eg patients being seen multiple times by both GPs and noctors with no clear plan or conclusion wasting appointments. The only solution to this mess is to charge for access on a time basis. Only then will patients take responsibility and we will have the time to manage patients properly. And no before the cardigans get going, it will not result in diagnostic delays and poor health but will get rid of the dross.
Could not agree more. The ability to self care has seemingly gone out of the window and everyone seems desperate for a medical diagnosis to explain why the don’t feel 100% every day of their lives.
I have not come across these sort of consults very often. Those sound more like the consults I get from friends in the pub. We do get what we know are minor problems coming forward from people who are rightly worried for someone with no medical knowledge and advising and reassuring them is part of the job.
Perhaps a small fee to book an appointment would help patients think clearly about whether they actually need an appointment?
Meanwhile huge amounts of GP time wasted on fatuous tick-box nonsense, sadly much of it originating with well meaning but clueless colleagues.
Then the hospital dumping, the time spent trying to get past the barriers to referral, the fatuous pharmacy advise about trivia.
Telephone consultation, nice because you get to go home on time, but often simply generate more appointments and more work because the problem was not dealt with.
And PCNs, wonderful opportunities to be generously paid for sitting about drinking coffee rather than seeing patients. Similarly Appraisals.
So yes, enough GPs, too much useless activity.
“How can you say to your brother, `Let me take the speck out of your eye,’ when all the time there is a plank in your own eye?”
The vast majority of trivial nonsense I see is iatrogenic.
EG Patients who have been told they need medical input for their borderline BP or their prediabetes or their PSA result. Or patients whose pointless routine blood tests have thrown up abnormalities of unknown significance
Consults about nothing are on the rise. Consults about excessive adiposity related problems are already making about half of workload.
Think about £50 per consult should fix the demand. The trivia will just disperse, as will the adipose, who having spent cash on advise to avoid take aways, will take away the message that taking health for granted is just too expensive.
Bottom line – NHS corrupts people into learnt state of helpless obesity (that can only be helped by prescribed drugs of cause)
We are training GPs and associated healthcare workers for a world that has been disappearing for the last 20 years. We are in a world of electric cars driven by computers and we are exhausted because we are still driving horse drawn vehicles.
A political commitment to address demand and a significant health and food educational investment at school etc. is the only way to resolve this issue without creating even further health inequality. I don’t see this coming anytime soon. If we have enough now then we had too many in 2015 which given our increased population living with frailty and other morbidities is probably not correct, lifestyle sadly does not have 100% causality.
thyrotoxicosis, insulinoma, stage 2 syphilis. Yes I have been under supervision and criticised by the GMC for over-referring and over- investigating, but I try to come to a case with all options open to eliminate the serious. Research in India showed that the less well off used medical services more often than those that could afford it: Punters cannot tell whether some symptom is serious or not, that is why they come to us, Dr google is not up to the job to rule out conditions by taking a history.
“Meanwhile huge amounts of GP time wasted on fatuous tick-box nonsense, sadly much of it originating with well meaning but clueless colleagues.
Then the hospital dumping, the time spent trying to get past the barriers to referral, the fatuous pharmacy advise about trivia.
Telephone consultation, nice because you get to go home on time, but often simply generate more appointments and more work because the problem was not dealt with.
And PCNs, wonderful opportunities to be generously paid for sitting about drinking coffee rather than seeing patients. Similarly Appraisals.”
Absolutely. THIS is the BS we should be pushing back at, rather than alienating/blaming patients. So much of this conversation generates anti-patient vibes/attitudes. Such a pity.
Completely agree with the article and with comments pointing out why so many people dont seem able to deal with so much stuff themselves. To the folk saying ‘i don’t see any of this stuff in my practice’ ..well you make me chuckle. That too is a genuine primary care ‘thing’ ..you might not be dealing with this dross fella but someone in your practice is.
None of this makes me at all interested in returning to GP in a practice. What a complete nightmare it all is.
The patients can only do what these small groups of the same recycled patient avoiding inept GPs who circulate within the overpaid CCG/ICB /PCN boards and sometimes LMCs direct.
The same GPs who complain about the current NHS are the same names appearing on the highly paid board lists decades ago when these policies, tick boxing and decline started and now they blame others for their past incompetence.
Patients can be educated about better use of the NHS service that now exists and there are a minority who overuse this service but it is not the patients to blame but this group of GPs who have led the NHS alongside their failing NHSE compatriots into the abyss.
Thanks Katie. Let me know if you want my number and I have a brilliant UC recommendation for you if you’re happy with digital.
The problem is with the slick urban wooly cardie GP diversity. They are too “individualist” to agree on anything. Just reading “I don’t get that kind of patient 🤔” makes me want to hoot. Really? Well, they have found their victim in your receptionist, PM, other woman or are good and quick to complain or you don’t work anywhere near where they live. If we stood up a bit more often for each other strike would be an option, telling people to not come in with grey hair at the front would be, GMC and NHSE wouldn’t roll over us and the threat of a referral wouldn’t work. We are like a bunch of school kids siding with the bully when there’s no common enemy – the strays – but not with the one talking sense.