As a former GP principal, I am all too aware of the challenges GP practices face meeting patient demand for care. Adding to this, practices have been forced to rethink how they deliver care during the Covid-19 pandemic. There has been a drive to innovative ways of working, including increased use of telephone triage, email encounters and digital video consultations. This is appropriate for many encounters and shows that general practice is evolving to the needs of patients. Practices and primary care networks have also adapted protocols and systems to provide safe face-to-face care and there are many good examples of this.
However, in my role as an out-of-hours GP, I continue to encounter patients who report that their practice is closed or that phones are not answered when they try to call. On other occasions when patients manage to speak to their practice, they are advised to contact 111 for a face-to-face review.
Discussions with colleagues working in urgent care and casualty departments reveal that they also have encountered this. As a consequence, far more patients are being seen in settings where they are not best managed. These patients need either ongoing care from a GP or specific referrals which are not done in the out of hours or emergency setting. This results in a delay in care that has the potential to compromise patient well being including worsening of chronic mental health problems and delayed suspected cancer referrals.
I recall seeing a 65-year-old patient with rectal bleeding who his GP managed on the telephone initially as suffering from haemorrhoids, then on a subsequent occasion when the bleeding persisted was told to call 111. When I examined him , I felt a rectal mass. The patient journey would have been more agreeable and safer if his GP had seen and examined him in the first place. This would have happened last year and I would argue should continue to happen.
There is also an opportunity cost – the time out-of-hours providers and hospital spend dealing with these patients could have been more effectively spent managing patients with more acute problems, including Covid.
I appreciate that we are working in unprecedented times. Things have not been helped by the fact that general practice seems to have been overlooked by the Government in delivering the response to the pandemic. I feel we could have been asked to play a far more active role in local Covid management, which is a shame. Additionally, as if often the case in general practice, there is great variation between practices and networks. I would argue that there will be no better time than present for greater collaboration and shared learning.
Finally, I hope that my colleague do not mind if I ask them to consider that if I can see patients, why can’t they?
Dr Milan Dagli is an out-of-hours GP in Middlesex
READERS' COMMENTS [23]
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What a load of sanctimonious nonsense. I’ve worked out of hours shifts where patients have told me they couldn’t get appointments to see their GP, not realising that I was their GP, and had empty appointments on my practice list that same day. This author is out of touch with the reality on the ground – we are flat out, working non-stop. But sure, fling muck from your ivory tower, Dr Dagli. Make sure more of us feel completely undervalued so that we too leave due to burnout and stress, and you will get even busier. This sort of tripe is not helpful. I guess the clue is “former GP principal” because you’re clearly out of touch with the real world. And yes, I’ve been seeing patients morning and afternoon today, as well as fielding triage calls, phone consultations and myriad requests, med revs, path results and paperwork. Grow up and stop flinging mud.
It’s a tricky line, trying to avoid face to face contact Vs deliver good care.
But having picked up covid on a home visit, it’s great to be back at work and “immune”.
In 2 months time with widely vaccinated staff, there will be no stress getting back to normal. We’re nearly through it!
Sigh…..
There are pockets of less than ideal practice in all walks of life and it is certainly not confined to in-hours general practice.
This blog just feeds into the right winged media narrative that we are all workshy, greedy and lazy.
Considering the vast majority of us are working our butt off with the covid vaccine activity, this article is not helping and I can’t help wondering about its purpose.
OOH GPs do a great job on the whole, but so do we.
Totally agree Shaba! Can’t understand any professional slagging off any part of a grossly under resourced and underfunded service trying it’s best to deal with all manner of expectations/demands!
The issue is that the author is right- patients aren’t getting to see their GP FTF when they should. Because we are too busy ringing back all the worried well or twenty somethings with splinters. Let’s look at the model and say it’s not fit for practice. ‘We’re too busy’ is no excuse for the substandard care patients are getting. Look at your call list today. Did half of them really need that appointment? Why are we working in such a ridiculous system which is a free for all for those who shout loudest. Charge a small fee and watch the dross disappear. Or Cathy on as we are and have the seventy somethings die from their missed cancers. Your call. I know what I would favour.
Why is the OP working in out of hours instead of daytime GP practice? Perhaps answering that might give the OP some insight to :”Finally, I hope that my colleague do not mind if I ask them to consider that if I can see patients, why can’t they?”.
Worrying symptom, believing what patients tell you…….
ha ha exactly. my mum says the same as do many purely because they can only book a callback. we all agree its unsatisfactory. that’s covid but its not the same as not being able to talk to ur gp
Unfortunately patients always say this during covid or not. I am a GP who has been working hard in practice throughout the pandemic and I’ve still had patients say I thought you were shut.
I think this post was quite inappropriate in a time when we’re all working as hard as we can. I see patients I need to see everyday as well as my full telephone appointment list. My Fast track referrals have been the same over this pandemic period as the same period last year.
Yes, you will always get some Gps that aren’t as good as others. But think, maybe that GP was on there own in clinic maybe due to sickness of colleagues, already with extras and patients to see and maybe it was right at the end of the day the call came in (given that you are 111) and sometimes unfortunately patients are directed to 111 as the GP simply does not have the capacity. Granted it was not ideal in this situation, but think before you mouth off about your fellow colleagues.
Lol @ ScottishGP, but I agree. Remember Gregory House, MD – Everybody lies…
As a full time GP who also does OOH patients most definitely do lie. Have seen my practice patients do this and this includes lying they couldn’t get an appointment when they actually had been seen that day. 111 is unable to tell anybody that this is not an emergency and send them back to their practice and in doing so stoke demand. Along with moving up from routine urgent and very urgent. Sickest OOH patient I dealt with was marked routine. (child with urospesis). But locally OOH we are the same as daytime in ringing first and seeing those that need examining.
And the hourly rate for OOH work is?
I recognise truth in all these comments. Patients do sometimes tell lies in order to access treatment but I also recognise from previously being in practice how difficult it can be for a patient to get an appointment, and how stressful it is for a receptionist to deal with patients asking for help when all the staff are fully booked.
My own anecdote. Relative contacted me as they thought that they had shingles. Saw photo and it was indeed shingles with lesions near the eye. Told them to contact GP and get a course of acyclovir. They contacted GP but no “slots” free and were told to contact 111, who predictably told them to go to A+E. Turned up at A+E and was treated but told off by Nurse for coming to A+E with an infectious disease!
Of course I could say that when I was a GP I would see as many “extras” as were needed, and I did, but I also recognise that I had to retire before the age of 60 because I couldn’t cope with the workload in a job that I loved. So there needs to be limits on workload but we cannot limit demand, and at this time there is a shortage of doctors, nurses, and other staff skilled to work in primary care.
Pitting doctor against doctor in arguments like this feeds into the drip of the Daily Mail propaganda that it is the fault of the lazy doctors and not an NHS that overpromises and is underfunded.
GPs are working hard, but in the middle of winter, with a Cover crisis, and with GPs trying to mop up the postponed work from the previous lockdown, I think that there is a capacity issue.
@ Shaba Nabi “blog just feeds into the right winged media narrative” – indeed and a shorter version of this article by the same author appeared in the Telegraph in August.
I agree with much of what the comments say. Everyone is entitled to their own opinion but this article reinforces the view that GPs are work-shy etc when that simply isn’t true. The author does not mention the fact that a lot of work has been shifted our way eg 111 talk before you walk, the poorly resourced covid vaccine programme etc and we have all the usual winter pressures plus covid etc with no proper support.
Telephone consultations actually take up much more time and we are bringing in patients for face to face reviews. As someone has pointed out, patients are always saying they can’t get appts, covid or not and I don’t think they will ever be happy to be honest. The expectation and demand to be contacted immediately and seen etc is so high that I think going forward things need to change.
Ofcourse we are not a homogeneous bunch and the threshold for seeing patients will differ a bit but I think pointing the finger and using phrases such as “ Finally, I hope that my colleague do not mind if I ask them to consider that if I can see patients, why can’t they?” is actually poor form all round and a bit of a kick in the teeth. Thanks for nothing!
Just a reminder: people complained about not being able to see their GP even before Covid.
F2F GP appointments are triaged first. Some are seen face to face, but not all. Remind me what happens in OOH? Oh yes – every contact is triaged first, and some are seen face to face (but not all).
I suspect the author of the post might not understand the irony.
So the author has seen one example of poor practice and made a sweeping generalisation about what this says about general practice? I could definitely write similar articles about something out of hours once did, or A+E, or any other medical team. But that’s not really helpful or fair is it?
It’s an uncomfortable fact that the media, RCGP and gmc forget; patients are known to LIE to get what they want.
What load of rubbish from a self claimed messiah. Like many of my hard working GP colleagues mentioned earlier, this particular doctor needs to have an sight of what the GP community is doing and how they are supporting their patients during an unrelenting COVID pandemic. Slagging the fellow GP community based on what some patients told him is really a bad sign of a deranged mind. I am sorry to be harsh. I am also one of the GP principals who like many of us have not taken any time off throughout the pandemic to help patients in the best way we could. we have telephone triage; face to face review, QOF work, day to day management of running the surgery, attending meetings after meeting to plan to face the ever changing demands and advices from the government every day.
It would be lot easier and comfortable to do OOHrs sessions alone without any of the associated perils of General Practice. But that might be the reason for him to be an escapist and do the easy bit, relinquishing his job as principal. Like some one said earlier grow up man.
The author is correct- there are some GP’s who are using covid as an excuse not to see patients. But when the majority have been risking their lives and sanity to provide care including all necessary face to face contacts, in the face of significant public vitriol, I don’t think this article is helpful.
Sorry, writer, but as both a GP partner and OOH GP, I can assure you that patients lie, just like they always have when it comes to using OOH and ED. Lazy writing, shame on Pulse for publishing this tat.
David Rose – “So there needs to be limits on workload but we cannot limit demand” – Why can’t we limit demand?
Anbakan Krishnamurthy – Deranged? Or part of the lefty do-gooder, bleeding heart, virtue-signalling, happy-to-work-to-death-for-peanuts serfdom bunch? Maybe that is what your definition of deranged is 🙂
Group hug.
All together now, Cardies;
“The patient’s fibbing , Lord. Kumbayah.
The patient’s fibbing Lord, Kumbayah.
The patient’s fibbing Lord, Kumbayah.
Oh Lord, Kumbayah”
Apologies to Joan Bayez.