Imagine you are an 85 year old lady, walking slowly with arthritis, who takes 5 minutes to undress, and is embarrassed about slight incontinence as well as loneliness/depression and 4 other problems/diseases. You have 10 minutes to communicate with your GP effectively, and he is a locum that you have never met, and who himself will be unlikely to see you again. Of course you would like “continuity of care” …
The GP has to “put the patient at the centre of his concern”, and this is difficult if he wishes to remain sane. Over-demand, under-capacity, under-funding and over expectation are all in play… Being honest about the state’s ability might not be what doctors wish to talk about.. A republican would say “go privately” son…
Primary care is under pressure, but these rules will help you to make the system more efficient — for you and your doctor
General practice has had a kicking in the quest for a scapegoat to shoulder the blame for the pressures that over-extend so many parts of the NHS. As a GP I have a vested interest, but as your correspondent I feel duty bound to point out that primary care is looking just as shaky as some emergency departments. It is busy everywhere, as you will no doubt have discovered if you have tried to make an appointment with your GP.
Although we are widely rumoured to spend our afternoons on golf courses discussing how to invest our hugely inflated salaries, most GPs have their noses pressed to the grindstone for 10-12 hours a day. The latest performance statistics reflect this; nine out of ten NHS contacts take place in primary care with practices in England alone offering 100 million more appointments a year than they did in the mid-Nineties (300 million versus 200 million).
We may be working harder, but we are not keeping up. It is often far too difficult to get an appointment, and when you finally do get one, you have just ten minutes to share your concerns, for the doctor or nurse to question and examine you and for a suitable plan to be devised and explained. This may be enough if you have a simple problem such as an ingrowing toenail, but impossible if a GP is trying to manage someone who appears depressed.
Doctors are campaigning for longer consultations, but offering fewer, longer slots will just exacerbate waiting times. And we loathe the long waits as much as you do. Who wants frustrated clients?
It is not all doom and gloom. We can make the system operate more efficiently for everyone if we all work together. Here are ten insider tips on how to get the best out of your GP’s surgery.
1 Do you actually need an appointment? A number of clinical commissioning groups are asking GPs not to prescribe treatments that are available over the counter for minor conditions such as thrush, headlice or hayfever. Patients are directed instead to a pharmacist for advice and to pay for their medication. It is primarily a cost-saving measure, but also frees valuable appointments. Go to your local emergency department if you have something that is obviously better treated by them, such as a suspected fracture or other injury (Thursday evenings and nights tend to be quietest; mornings, particularly Mondays, busiest). However, don’t abuse the department just because the lights are always on.
2 If you do need a GP appointment, try to avoid calling at the busiest times (before 10.30am, particularly on Mondays). The exceptions are if you have an urgent problem, when the receptionist may be able to add you to the end of a morning surgery, or if you think you need a home visit (the more warning doctors get, the easier it is to plan). The quietest time to call is generally between 2pm and 6pm or use the online booking service.
3 Ask for a home visit only if you or the person you are calling about is truly housebound. My practice covers 200 square miles and I can easily see five patients in the surgery in the time it can take to make one home visit.
4 Plan ahead, particularly if your problem is routine, such as a blood pressure check or a smear. Be flexible.
5 It should always be possible to be seen quickly if your problem is urgent, but it may take some negotiation. It is hard to generalise because different practices have different policies, but the first person you need to convince is the receptionist. Don’t be put out if they ask for further details — they are just trying to prioritise. If you are not happy with their response, then ask for a practice nurse or GP to call you back (many practices have a duty doctor or nurse specifically to do this). Be polite, but assertive. And try to stay calm. GP staff are often stressed too, and although you may feel under the weather and upset, getting angry rarely helps.
6 The NHS is your service. You pay for it and depend upon it, so treat it with respect. If you have an appointment you can’t make, phone and cancel in a timely manner so that it can be offered to someone else (there are 30 million no-shows annually). And never say something is urgent if it is not: it weakens trust and ruins the system for everyone.
7 A lot of time, for doctors and patients, is taken up with repeat prescribing because guidance suggests we should only give a month’s worth of medication on each prescription. However, there are simple ways to make this less onerous for everyone, so ask your surgery about repeat prescribing initiatives such as online ordering, or arrange for your local pharmacy to hold a year’s worth of signed prescriptions for you.
8 When you see the doctor or nurse, be clear about what is concerning you and express it succinctly. Tell them if you think you know the diagnosis; at best you may be right, at worst it allows them to allay your fears. And wear something appropriate because consultation time is too valuable to spend time stripping off layers.
9 Be realistic. I don’t rigidly enforce the one-condition, one-appointment rule, but equally expecting me to tackle five separate issues in ten minutes is unreasonable. By all means mention a number of problems at the outset, but expect your GP to prioritise. You may need to come back to discuss the rest.
10 Finally, if you don’t rate the service offered by your current surgery and you have a choice in your area (not everyone does), then vote with your feet and try another practice.
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