From The Times Tuesday 18th June 2013
I am proud to be a GP but, along with many of my colleagues, my self-esteem has been somewhat dented over the last few months by the way we have been portrayed. Not only are GPs seemingly responsible for NHS crises ranging from teetering A&E services to burgeoning antibiotic resistance, we are also overpaid and lazy. Little wonder that our patients get so fed up when they can’t get in to see us.
This is neither the time nor the place to defend my profession but I believe, very strongly, that most GPs are hard working dedicated doctors who earn much less than the figures bandied about, and who have become a handy scapegoat for politicians facing difficult decisions. However, I hold my hands up when it comes to access – getting in to see your doctor is far harder than it should be.
Access isn’t just an issue for patients – doctors and practice staff worry about it too. No one likes working in a system where people experience lengthy waits; it creates stress and frustration on both sides. Like most surgeries we have tried a variety of different systems to improve access but no matter how you increase supply it is more than matched by demand and you end up back at square one. GP surgeries in England alone now offer 100 million more appointments than they did 20 years ago (see below), but waits remain unacceptably long in most practices.
To be candid I don’t see the situation improving anytime soon, indeed it is likely to get worse, so here is my insider’s guide to getting the most out of the current system.
• Think before you dial. If your problem is a real emergency – such as chest pain, collapse, or a suspected stroke – dial 999. If it is not an emergency, call your surgery to discuss what you need, and if you are unsure who to call dial 111.
• Avoid busy times, particularly Monday mornings. If your problem isn’t pressing, try not to call before 10.30am on any day as staff and lines are likely to be busy. However, if you are requesting a home visit – from a doctor or a district nurse – you are better off joining the morning rush as the earlier a practice knows about visits, the sooner it can allocate them. If you ring after midday the doctors may have already started their rounds.
• And only request a visit if you, or the person you are concerned about, is truly housebound. A doctor can see 4 or 5 patients in the surgery in the same time it takes to do a home visit and it is very frustrating to be called out only to find a note on the door saying “Back in 10 minutes, just taking the dog to the vet”. It happens.
• Be realistic and think ahead. People expect to have to book an appointment with their dentist or hairdresser at least a couple of weeks in advance, and GP surgeries should be no different when it comes to routine appointments for things like smears, blood pressure checks, immunisations and blood tests.
• If your problem is urgent and you feel you need to be seen quickly then that should always be possible. Systems vary but every practice I know will see urgent cases the same day, typically as “extras” added to the end of morning or evening surgery. I can’t advocate just turning up but some patients do, and they invariably get seen – eventually.
• If you are not sure that your problem warrants an urgent slot, but you can’t wait for a routine appointment the following week, ask for a doctor or nurse to return your call. Some practices have a dedicated on-call doctor / nurse who does telephone triage, while others divide the telephone workload when they finish morning surgery (around midday).
• If your query is related to a long-standing condition such as diabetes or asthma, then why not ask to speak with the nurse who you normally see in clinic (most practices now have specialist diabetes and / or asthma nurses). Or ask if you can email them?
• Don’t abuse the system. If you have an appointment and can’t make it, please phone and cancel so we can give it to someone else (at least 30 million appointments are wasted annually because of “no-shows”). And be honest about your need for an urgent appointment – every GP is used to seeing people with an “urgent” verruca, but this sort of abuse of the system makes receptionists wary, and spoils it for everyone.
• Do you actually need to see a doctor? If it is a simple problem like uncomplicated heartburn, hayfever or a cold, why not cut out the middle-man and go direct to your pharmacist? Over-the-counter medicines can be cheaper than prescription charges, and the pharmacist can always refer you if he / she is concerned.
• Ask about the most efficient way to collect repeat prescriptions. Systems vary from email ordering through to monthly pick-ups from your local pharmacy, but they are all designed to make it easier for both patient and doctor.
• Be assertive but polite. Working on reception is a tough job for which the staff rarely get any thanks, but often plenty of abuse. They are there to help you so give them a chance. But if you not happy with the service you are being offered, then stand your ground – the squeaky wheel gets the grease.
• And when you do eventually see the doctor, be succinct as time is not on your side. Have your symptoms clear in your mind and share any concerns you may have (lots of people Google their symptoms in advance and part of our job is to reassure them that it is not as serious as they suspect – hopefully!). Oh, and please wear something sensible that will allow easy access if you need to be examined.
• Finally, if you don’t like the level of service offered by your surgery, and you have a choice of going to another (and not everyone does) then vote with your feet.
• Although GP practices are often thought of as being on the periphery of an NHS that is mostly hospital based, the reverse is true – 9 out of 10 of all NHS contacts take place in primary care
• GP surgeries in England alone now offer around 300 million appointments a year, up from just over 200 million in 1993, and the figure looks set to rise to closer to half a billion over the next 20 years
• There are more GPs today than there has ever been – currently around 31,000 registered in England, operating out of 8,000 practices.