GP appointments.

Dr Mark Porter today’s Times.

Can’t get an appointment with your GP? I have a few tips
As many patients struggle to get past telephone consultations and online requests, Dr Mark explains why it’s so hard to get seen by a doctor and the best course of action to take when you become ill

Dr Mark Porter
Monday November 13 2023, 5.00pm, The Times
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Arecent survey of older people’s experiences accessing GP surgeries had me squirming in my seat this morning. And this quote from the director of the campaign group Silver Voices, who commissioned the survey, was the trigger for my discomfort: “The family doctor is becoming an elusive species, with many hoops to be negotiated before an audience is finally granted to the patient.”

Three quarters of the 1,200 people surveyed said they found it difficult to get a face-to-face appointment with their GP, with most being offered telephone consultations instead. Faced with hurdles such as holding while waiting for their call to be answered or being asked to submit their request online, many gave up and sought alternatives: one in five said they had resorted to their local emergency department, while one in three said they had booked to see a private GP. So what has gone wrong?

I do not, and you certainly don’t, need a survey to know that it is difficult to get an appointment with a GP. My practice has historically had one of the highest patient satisfaction scores in England, and we pride ourselves on seeing all urgent cases the same day, but we are slipping. We can still cope, just about, with urgent requests, but over the past few years waits for routine appointments have gone from a few days to a few weeks.

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I can’t speak for every practice, but our biggest problem has been demand. I don’t want to bombard you with data but it is important for perspective. Suffice to say that GPs are not being intentionally elusive (well, the vast majority anyway), rather they are drowning under an ever increasing workload. Before Covid, GP surgeries in England completed about 25 million appointments every month. In September this year that figure had risen to 31 million (32.6 million with Covid vaccines).

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And, contrary to what you may read or experience, most appointments are still face to face (71 per cent in September). GPs deal with about half of all appointments and nurses about a quarter, the rest being with healthcare assistants, counsellors, paramedics, pharmacists and other members of the team. And four out of ten consultations are completed on the day that the patient requested one.

As timely appointments become harder to get, people will inevitably look elsewhere, but GPs still see about 20 per cent more people in a month than emergency departments (EDs) in England see in a year. However, it doesn’t take much to overwhelm local hospitals, and that alters perception too. Think of patient demand as water, GP surgeries as a bath and EDs as the bathroom floor. We do about 360 million consultations a year while EDs do about 25 million. So when the bath overflows even a tiny bit it floods the floor.

There is no single reason behind the recent rise in demand. However, factors include record waiting lists at hospitals, meaning people can’t get the operation or treatment they need so depend more on their GP to keep them going, and the challenges of an ageing population with multiple issues that require constant input (about half of the hundreds of blood tests we do every week are for monitoring long-term conditions).

At my surgery we have tried all sorts of things to make it easier for patients to book in. Most appointments are made on the phone, but you can book routine ones online or using the NHS app, or walk in and do it in person. Nearly all urgent requests require a telephone consultation first to assess what needs to be done and when. And non-urgent requests can benefit from this triage.

Take a 40-year-old woman who over the past six months has felt run-down and more breathless when she exercises. Questioning during a triage phone call reveals that she has very heavy periods and is a vegetarian. She needs to be seen, but it would be a more efficient use of everyone’s time if she had a blood test to check for anaemia first so she can be seen with the result and everything completed in one face-to-face GP appointment.

All of which is great in theory but of little consolation if you are No 10 in the queue waiting for someone to answer (see below). Our record for one day is more than 800 calls to reception at a branch of our practice that has more than 6,000 patients. I know it’s frustrating, but when we open another line or employ another receptionist, as we have done, we get even more calls.

Meanwhile, “out the back”, a typical day for me starts at 7.30am and finishes at 6.30pm with brief breaks for a pee, a quick coffee, lunch at my desk and a home visit or two. Be reassured I am not hiding in my room reading a book or scrolling through my phone. I am not after your sympathy, just some understanding that your difficulties are not solely because doctors are an elusive species. They are a dwindling one, but that’s a subject for another day.

The GP’s guide to getting help
Booking systems vary across practices, so it is hard to generalise, but these tips may help to ease the booking process at surgeries that use a mixed system like mine:

• If you want a routine appointment — for a problem such as a longstanding arthritic knee, or to discuss HRT — do try to use the NHS app or online booking system if your surgery has one
• Alternatively try calling outside the busiest periods (8am to 10am and 2pm to 3pm at my practice). Waits will typically be two weeks or more
• If you feel your problem is urgent don’t feel fobbed off with a call back from a GP. It’s typically the fastest way to access care, and I often tell people to come straight in once I have triaged their request
• If it is very urgent — such as chest pain or a suspected stroke — don’t call your GP. Dial 999
• No matter how ill or angry you are, please don’t take it out on the receptionist. They are under a lot of pressure, and being polite is more likely to get you what you want
• Last, if offered an appointment please turn up —one in ten people didn’t in September — or call to cancel so we can offer it to someone else

If folk would only embrace technology and use it, they would find it so much easier than it was before the internet came along, and the thing which I think causes the most problems with using technology, is by using smart phones, and to put it in a nutshell, when you used to fill in a paper form, the form would be normally on A4 sized paper, and I noticed that forms which older folk or disabled folk would be required to fill in, would be printed on much larger forms, so that folk could see what they were doing, and it has gone from that, to folk of all ages and disabilities, being asked to fill in forms on a phone, the size of an old post card, and that I think is the problem, if older folk invested in a desktop sized system, and that could be a laptop computer, connected to a large monitor, along with a full sized keyboard and mouse, that is so much easier to use, than a mobile phone, when accessing online services.

I have difficulty getting a GP appointment.

I do not derive one iota of help from Dr Mark Porter's tips.

Looks like we live in totally different worlds.

Tommy I used to access such stuff on my desktop, but it is no longer possible.

Ena

My local doctors is Bryn Cross Surgery.
If I submit an ask my GP request before 8.30 AM I am usually seen on the same day.

Sixty years ago, I had a GP at Bryn Cross.

His name was Scott Manderson.

You did not make appointments. He was too mean to employ a receptionist: you just went and sat in the waiting room. Next.....Next.... Next.... Until your turn came around. Of course there was the occasional violence as people tried queue jumping. He was good at doing domiciliary visits .

His son Marcus was a successful London based barrister. Unfortunately Mrs Scott Manderson caused the doctor a few problems often involving C&A.

TTS how many people can afford money to pay for broadband/laptops/smart phones etc to keep up with modern technology My house phone costs 24pence to connect plus 16pence per minute to be put on hold with stupid music .with connection times anything from a few minutes to over a hourSo just to say hello would cost 40pence and if your on hold could cost pounds

PeterP

Yoo have said yourself that you use your mobile for phone calls, just like I do, I wouldn't dream of using my landline to make a phone call.

As regards the computer equipment you mention, yes, there would be an outlay, but a decent laptop, 24-inch monitor and a separate full sized keyboard and mouse set, could be got for under £500, which is less than the cost of a decent smartphone, and as regards broadband, you are looking at just under £20 a month, because they are phasing out ordinary phone lines, so only the Fibre system is available, which can also be used for streaming, even if you don't subscribe to a streaming service like Netflix, there is the BBC iPlayer ITVx etc

The point is that to enjoy internet surfing, you need a full sized monitor, keyboard and mouse even if you have a touch screen monitor, you will find it easier if you also have a keyboard and mouse.

Tommy,

I got an NHS text to inform me I could no longer access my GP's practice by 'Systemonline', which was the browser/url way of doing such comms from desktop computer.

Contacting the link in the text, I then spent the best part of an hour navigating the flow of pages and instructions to put NHS app onto my device. The service located my systemonline account, accepted my username and password, and correctly identified my GP.

And terminated with a message that my registration could not complete because either I had changed GP, or my name or address.

Done none of those, and been with this GP for almost thirty years, so I wrote a letter to GP's practice manager. She phoned me back and said the NHS app codes for the practice are wrong, and I would need to bring my device into the practice for them to complete the set up procedure.

When I mentioned desktop, she laughed. No I can't bring in a desktop: not even a laptop. Has to be an iPhone or an Android phone NHS App!

I can do this, but arthritic fingers and eyes not what they used to be, makes it far more difficult than using my large hi-res monitor and full size keyboard.

How many people have £500 spare and £20 a month rental This is why a lot of people are going to food banks because they are struggling to feed themselves and don't have money to throw at modern technology

Ena

In my doctors, and I was in there on an appointment less than two weeks ago, from opening in new premises in 2006, they used an appointment system, connected to a large TV monitor in a top corner of the waiting room, and when it was your turn, your name flashed up on the screen, overriding the medical information videos being shown on the TV, and that system was used for years and then an automatic check in system was put in, you inputted your name and D.O.B. on a touch screen, and it confirmed your appointment and listed you as waiting to be seen, and that system worked fine until 'lockdown' and since 2020 the TV monitor as never been switch on, you book in to the receptionist, and when it is your turn the doctor or nurse walks down to the waiting room and shouts your name out, so that is progress for you.

PeterP

The point I am making is that if older people or people with impaired vision could actually see clearly on a full sized monitor, what was on the internet, then it would drastically improve the experience of those people, they would enjoy using the internet, instead of expecting them to fill in forms on something the same size as a post card, which they struggle to do, and as regards the cost, the start off with a laptop, you can get a reasonable one for £200 and then add a full size monitor, and you can pick a keyboard and mouse set from Asda for £20 in fact you can pick up a 24 inch monitor from Argos for less than £130, so you could get full system, based on a laptop for less than £400

Bout time these arsehole primma Donna doctors (loosely speaking) and their Adolf receptionists were sacked...what a load 'O' Bollocks.

all caused by an unsympathetic government who drliberately flooded the system & created this backlog . some on here who support the tory party may well have £ 500 to spare . unlike the rest of us .

Tory,s...me Arse..Thankyou.

wise up cycler .