Having raised the issue of GP appointments with the Secretary of State and Simon Stevens, Chief Executive of NHS England I was pleased to learn that NHS England has directed GPs to ensure that they are offering fact to face appointments:
Dear colleagues
UPDATED STANDARD OPERATING PROCEDURE (SOP) TO SUPPORT RESTORATION OF GENERAL PRACTICE SERVICES
Guidance on the phased easing of Covid-19 restrictions continues to be issued by government, in line with the Coronavirus roadmap out of lockdown, with services following and adapting accordingly.
As such, ahead of government rules on social distancing changing from 17 May, we would like to draw your attention to the Standard Operating Procedure which will be published shortly, and which will update and replace previous guidance.
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- Half of all general practice appointments during the pandemic have been delivered in person, GP practices must all ensure they are offering face to face appointments. As the chair of the Royal College of GPs has said âonce we get out of the pandemic and things return to a more normal way of living and working, we donât want to see general practice become a totally, or even mostly, remote serviceâ, so while the expanded use of video, online and telephone consultations can be maintained where patients find benefit from them, this should be done alongside a clear offer of appointments in person.
- Patients and clinicians have a choice of consultation mode. Patientsâ input into this choice should be sought and practices should respect preferences for face to face care unless there are good clinical reasons to the contrary, for example the presence of COVID symptoms. If proceeding remotely, the clinician should be confident that it will not have a negative impact on their ability to carry out the consultation effectively. The RCGP has published guidance on âRemote versus face-to-face: which to use and when?â. We are asking CCGs to prioritise support to practices who are reporting very low levels of face to face appointments.
- All practice receptions should be open to patients, adhering to social distancing and IPC guidance. This is important for ensuring that patients who do not have easy access to phones or other devices are not disadvantaged in their ability to access care. Receptions will not yet feel like they did prepandemic â for example where space is very constrained patients may be asked to queue outside. Individuals with COVID-19 symptoms or who meet criteria for self-isolation should continue to follow public health guidance. Posters providing information about the symptoms of coronavirus and to direct patients that have symptoms or a positive test result in the last 10 days not to enter the building are available on the Public Health England Campaign Resources Centre website.
- Patients should be treated consistently regardless of mode of access. Ideally, a patient attending the practice reception should be triaged on the same basis as they would be via phone or via an online consultation system.
- Practices should continue to engage with their practice population regarding access models and should actively adapt their processes as appropriate in response to feedback.
Thank you for your continued hard work and for your ongoing commitment to continuing to deliver the highest quality general practice services.
Dr Nikki Kanani, Medical Director for Primary Care
Ed Waller, Director of Primary Care
May 14, 2021
6 months ago my GP surgery adopted a darwinian approach to appointments i.e first come first served from 8am for appointments that day and only that day â you just have to keep phoning everyday
I believe this new approach was to help them state that no one waits more than âa-dayâ when the appointment is actually booked
Iâve seen this approach in hospitals to reduce waiting times in-house they start the clock when you talk to the reception not when youâre actually been seen by a doctor?
May 14, 2021
If anybody doubts what has been going on at Wokingham Medical Centre -get hold of Wokingham Today this week – local newspaper. A 2 page report on the shambolic goings-on.
May 15, 2021
Yes, a brand new surgery that cost a mint but provides a service that in no way compares to the one it replaced by combining two former GP practices – most especially the Rectory Road one.
May 15, 2021
Copeland area of Cumbria has the same problem . Built a shiny new ‘health centre’ combining 2 health centres. The result, phone on the day for an appointment, HA no chance! When they eventually agreed to offer advance appointments again, expect to wait 3 weeks+, not the previous 2 weeks.
The covid business took them to an even lower level of idiocy.
Getting an appointment – the receptionist have you phoned 111? Yes, they told me to get an appointment with my GP. Disgruntled murmurings the other of the phone, wants to know in gory detail the medical problem!! – telephone assessment occurs, need to see the GP – receptionist even more disgruntled says you can only have the appointment providing you wear a face nappy, medical exceptions ignored, you must wear a face nappy “to protect the staff”!! See the GP, he says if the mask is uncomfortable, please take it off.
Would not accept hard copy repeat prescriptions. Had to be done via a specific phone no, which is only open for a couple of hours 3 days a week. Extraordinary difficult to get through and when you do, the multiple options are whispered, with no opportunity to re-listen the menu, which is useless for those hard of hearing. Yet 3 miles down the road at a completely different practice they accept hard copy prescriptions!
May 15, 2021
Fred, its not just confined to the Medical Centre, many of our friends at a number of other local Practices say it’s exactly the same for them at their’s.
May 14, 2021
Many thanks for the update, and for pushing that issue to a better conclusion.
Now we just have to wait for GP’s to get their online systems working properly, and improve telephone access – Even before CV online booking were impossible to achieve.
May 14, 2021
This whole affair is hugely frustrating.
The government asks us to guarantee 24/48 hours and GPs get hammered because appointments are mainly released 8am on the day to attain 24/48hrs. Advice then is to release them throughout the day to avoid forcing patients to call at 8am except that this only achieves patients calling multiple times and getting frustrated why they cant have one that is being released later.
The Government asks GP surgeries to keep patients safe during a pandemic by offering telephone, video and econsultations first and only provide face to face when clinically required. And now GP surgeries are being being accused of being closed and refusing access, despite us dealing with unprecedented demand during this last year. Up 20%z
The Government contractually requires GP surgeries to widen its staffing to include Clinical Pharmacists, Advanced Nurse Practitioners, Clinical Paramedics, and Mental Health Workers. And now GP surgeries are being accused of rationing GP appointments and âfobbingâ patients off to other clinicians. This despite a shortage of GPs and the need for those other roles.
The Government demands that GP Surgeries offer choice yet demand that the same GPs follow evidence-based methods that look at clinical need. Do we give patients what they want or do we give them what they need based on their condition? They are not always the same thing. People should have a choice of hotel not a choice of fire engine.
The NHS is free at the point of need NOT free at the point of want and whilst choice is important, we need to be clear about what choice about. A patient might want a face to face appointment to discuss a possible referral that could be managed via telephone, but this same face to face appointment might be better served being used for a more vulnerable patient. After all, GPs can only see one patient at a time and can only see so many patients per day and remain SAFE.
Finite resources that provide free unlimited care means GP surgeries have to make choices. Each GP surgery makes different choices based on the staff it has available and the patients it looks after. Patients have choice to move GP surgeries if the one they are at does not cater for their wants.
Ultimately, this all erodes trust in GPs and removes confidence that practice surgeries put patients first.
130k people dead in the UK and 3.3million dead worldwide and climbing. Maybe there is some forgiveness for Gp surgeries trying to do the right thing by improving access to telephone and econsultations to reduce risk and preserve face to face appointments for those that really needed them.
An anecdote for everything no doubt, but this type of issue is exactly why clinicians are leaving General Practice and finding other careers or retiring.
Who could blame them?
May 15, 2021
It is clear from your comments that you are either a GP or have direct involvement with a practice. It is fine for you to complain about the problems you face from government dictates, however you seem to miss the point that your purpose is to serve the needs of your patients. If you are unable to do this effectively it is for one or more of the following reasons: You have taken on too many patients, have insufficient staff, or are an inefficient practice. You should look to your organisation to solve this matter not try to blame the government.
May 15, 2021
Are you suggesting that clinicians never leave General Practice for more money/few hours/less criticism or oversight? Retiring? well yes why not after most GPs are paid ÂŁ80k or ÂŁ100k + and can ‘retire ‘ on handsome income or part-time working as most females now do.
May 15, 2021
Samuel, âPatients have choice to move GP surgeries if the one they are at does not cater for their wants.â
This isnât strictly true, the best surgeries are full and unless youâre already on the list and are putting a new family member on you havenât got a chance especially if it is a clinic near your workplace rather than your home.
What happens to people whose local GPs have all centred in one building all offering the same level of service? Where is the choice then?
Iâm personally happy with my surgery but I know a lot of people that arenât and I tell them to move and try to help them so I know this is a big problem.
May 15, 2021
Understood – I take your points Samuel — Far too much government interference.
If GP surgeries were more independent they would be able to offer services that were needed and wanted… I’ve long been suggesting a better way to organise surgeries would be to make them a one stop, quick shop, for all ailments, that encompassed alternative therapies, including Chinese, Osteopath and other specialist massage treatments, Podiatrists, and even dentists. There are so many things that do not get better with NHS treatment – other solutions are ignored far too often.
My solution would of course require a GP to initially diagnose the problem and send the patient on to the correct specialist.
The NHS has to reform to stop it being so bureaucratic – It has created a box ticking empire for itself.
May 15, 2021
Samuel
Thank you for taking the time to explain the situation from the position of the clinicians. Your comment really opened my eyes to the issues.
Do you feel the government is trying to close down sole practitioner surgeries and are, in effect, creating almost small cottage hospitals?
Are some practices taking on too many patients for the number of GPS and clinicians?
May 15, 2021
Samuel, I have some sympathy for your profession as it is under considerable pressure.
On the other hand, there are plenty of other professionals and tradespeople etc who have been under considerable pressure, not just during the pandemic but because of economic cyclic ups and downs – naturally, they are not considered as either ‘angels’ nor are their occupations treated as a national religion.
It isn’t that easy to simply change practices, even if you live in an urban area with more than one GP surgery – as you say, doctors are leaving the profession, or are increasingly working part-time, so patient lists become full. But there is frequently bad management at practices – why, for instance, do so many only have one telephone number for access? Why not have one line to make appointments, and another for general enquiries? Why not have facilities to take messages, so that if necessary patients can have their calls returned with relevant information where required?
May 15, 2021
Could it be due to the GPs not being NHS employees rather NHS funded….they are after all private companies
May 15, 2021
hit nail on head.
May 15, 2021
Samual
Frustrating certainly, perhaps the problem or the thinking, relates to the fact that General Practices get paid for the number of people listed on their books, and bears no relation to: visits, appointments, referrals, treatments undertaken, successful outcomes, or anything else come to that matter.
Not sure how we change that for the better and still keep it free at the point of use, perhaps you could give us some of your idea’s for improvement to customer/patient service.
May 14, 2021
In the 1980’s, my family were patients at a busy local GP multi-partner practice in suburban London.
Other than in an emergency, we could always choose which doctor we preferred to consult, we could speak to a receptionist and explain that either we needed to see a doctor quickly, or that we were happy to wait for 2-3 days for attention, and a small number of appointments were held back each day precisely so that patients requiring urgent care could be dealt with promptly.
I wonder what went wrong…..
May 15, 2021
What went wrong was government interference. As always.
May 15, 2021
@Mark B; Indeed, because govts in the last 30-40 years have always tried to micro-manage the NHS into some sort of medical service run on faux market economy lines, thus the NHS sees many of the problems that dog the US health care system, rather than allowing the NHS to run their own hospitals, out-patients and GP surgeries etc. from top to bottom as public services, or if one want to disguise taxation as ‘choice’, the mixed funding system as found in say Germany – were govt mandates the purchase of health insurance, unless specifically exempt, but also mandates the maximum a private insurance can charge whilst also stopping pre-existing conditions being excluded.
May 15, 2021
The problem occurred when Blair changed the principle and purpose of health care to that of ‘production based’! You can’t treat people like a piece on a production assembly line! Blithering moron he b**ge**d up the whole system, reduced beds capacity and encouraged ‘bed managers’ in conjunction with open door immigration “to rub the noses of the right in it”. The NHS has become a ridiculously top heavy management and bureaucratic mess and failing far too many patients, who are treated like cattle. Discharging a patient the same or the following day after major surgery is the recipe for disaster, evidenced by the number of patients who have had to be readmitted. And the subsequent governments are just as moronic for continuing this stupid, dangerous and failed model of arrogance, ignorance and stupidity!
May 15, 2021
@J Bush; Problems within the NHS started long before Tony Blair became PM before he was even leader of his party, NHS Trusts were created in 1990, the start of the top heavy management you cite. I’m not saying Blair didn’t make things worse, but then he was trying -for electability- to be more Thatcherite than the Tories had been on many policies for the last 18 or so years before.
If you run what is always going to be a reactionary, unpredictable, health service [1] using business accounting methods, worse the free market, were the bottom line of a spread sheet is all that matters come judgement day (such as Estimates day) now that is “stupidity” beatified, heck NHS Trust even have to pay NNDR, thus further draining money away from the front line, what Cabinet or Dept. minister allowed that oversight through?!
[1] in fact any such service, police, Fire & Rescue etc.
May 14, 2021
Our GP practice is as secure as Fort Knox.
The staff carpark is virtually empty. My wife tried to secure an appointment for swallowing difficulties but was told it was non urgent. We eventually got to see the practice nurse who referred her straight to hospital.
People are dying whilst highly paid doctors sit at home.
It’s a scandalous situation
May 15, 2021
To people who do not care – and who do not have to care – whether someone might be seriously ill, nothing is urgent.
May 14, 2021
All I would ask is that the GPs and Nursing Staff be allowed to make judgements on the pace and degree of returning to the norm layed out by the CEO of the NHS. They are bright people, they know the local situation, trust their talents in this area.
I would also look at saturation vaccination in all those areas where the Indian Variant is manifesting itself, plus ceasing all flights from the sub continent until herd immunity is achieved in the UK.
May 14, 2021
Lots of ‘should’ instead of ‘must’. So they have been allowed a getout.
May 14, 2021
Some GP are very diligent and some are just appalling, âdirectingâ them from on high will make almost zero difference. The problem is the system of remuneration which encourages rationing and delay. The blame lies with people like Blair, Hunt, Hancock, Simon Stevens over many years … one law graduate and three PPEs all Oxon. and all essentially Socialist dopes. The NHS is a religion and an appalling system of healthcare. It kills hundreds of thousands and fails millions. 5 million waiting for procedures and millions more other medical care.
May 15, 2021
@LL; Indeed, just remember though, all GPs work within your beloved Private sector, merely being contracted to the NHS, they run their own surgeries and hours as they see fit. The people you claim are “Socialist dopes” are nothing of the sort, well at least not Socialists, ask ex Leader of the Labour party, or the General Secretary of Unite the Union…
The NHS doesn’t ‘kill hundreds of thousands and fails millions’, the system does (but then the same happens in the USA too [1]), and it always will where ‘budgetary considerations’ (or profit) are placed higher than medical need.
[1] you should check the level of claims for medical malpractice, and the level of non diagnosis, in the USA
May 15, 2021
It is always America that is compared to the NHS.
As you do here Jerry.
What about countries in Europe or Far East or Australasia that have systems rated higher than the UK.
Wht not copy the best in the world?
May 15, 2021
The truth obviously stings you Peter2….
May 15, 2021
What a strange reply Jerry.
I repeat…Why not copy the best in the world.
May 16, 2021
@Peter2; “Why not copy the best in the world.”
That would subjective judgement.
May 14, 2021
Are we to be punished because of the lack of team spirit in areas of low vaccine uptake ?
I’m sure local lockdowns will be a political hot potato for ..um.. reasons we aren’t even allowed to discuss.
Why don’t we just board everything up and stitch masks to our faces permanently ?
We are now openly ignoring Boris.
May 15, 2021
âWhy donât we just board everything up and stitch masks to our faces permanently ?â
Donât give them ideas..
May 14, 2021
I rang the Doctors’ Surgery this morning at 8am. They were ‘engaged’ for the first 25 mins. or so. When I did get through, I was 10th in the queue. I held on until about half an hour later when, I was first in the queue. Wonderful, I thought, only to have them hang up and of course, the phone went dead! What a shambles! I could say a lot more here about my experiences with Doctors/Hospitals etc. but what’s the point! I ended up walking to the surgery and posting them my problem and details in their prescription box.
May 15, 2021
Free at the point of non delivery, waiting list and rationing. The envy of no one sensible.
The only person I know who has died of Covid was given it in hospital after being admitted for a minor stroke. He was then dumped into a care home untested to infect others, then returned to hospital & finally tested but died the next day. Well done the wonderful NHS! No treatment at all from them would have served him better.
May 14, 2021
The Conspiracy Theorists will say that there is no intention of returning to how it was and tele appts are here to stay .
May 15, 2021
or rather the opinion of the man ‘on the Clapham Omnibus’?
May 14, 2021
I now know why the system is so chaotic
The Home Office revealed today that 199 illegal immigrants were intercepted making the channel crossing in nine boats on Thursday
Does anybody in government care ???
May 14, 2021
That will be the same Home Office that got the EU migration numbers wrong by how many millions?
May 14, 2021
I wonder if they got their vaccines on arrival?
May 15, 2021
Over 2000 arrived in just two days last week on the small Island of Lampedusa.
May 15, 2021
I read about that L/L and I wondered how many would be on their way to our shores.
May 15, 2021
No, they don’t. That is why nothing is being done about it.
This has gone on for months. We don’t know who these people are where they come from, what the state of their health is, etc.
The Politicians wring their hands, and blather on about âdiversityâ, while doing nothing. I was hopeful, when they put a Border Patrol ship out there, but it is just being used to pick people up and bring them to shore.
I didn’t vote last time, after a lifetime of voting. It seems pointless. Every time we complain, we get a lecture on âracismâ. We are just supposed to put up and shut up.
May 14, 2021
I like the having the opportunity to have a remote video GP consultation, this along with Patient Access on line service for prescriptions is a good way of dealing with routine medical needs.
I accept there are those who need a face to face appointment. However a growing number of us enjoy remote access for a whole range of services inc Doctors video call that I have experienced myself and I loved it,so I don’t want this to stop but accept it can complement face to face. In fact I hoped it would become the normal practice because IT technology is the future.
Don’t throw the baby out with the bath water -(don’t reject new technology that’s just started)
Those few individuals who don’t like the NHS can always go private.
reply If you read what I wrote you can see I proposed patient choice. You of course have to disagree with anything here.
May 15, 2021
Yes, of course new technology should be used – where possible. It is good that you have both the equipment and the know-how to access remote video GP consultation, David, but many people have neither, especially the very elderly – and if you are hearing/vision impaired, or in acute pain, there are further difficulties of fumbling with pressing the right key in the right place at the right moment.
A friend of mine is extremely ill and wheelchair bound because of frequent recent cancellations of an operation she needs to have on a regular basis. She was informed this week, after the latest cancellation at 24hrs notice, that prescription for vital anti-infection medication would be sent from the hospital to her GP surgery. It took 11 calls to get through to a receptionist, to discover that the hospital’s email had not been sent….she was then informed that there was no GP on duty that day, so the prescription could not be issued anyway.
May 15, 2021
IT diagnosis is the way forward, after all who gets to see a GP promptly, efficiently, without bias, and non-judgemental? Keep one back for problem diagnosis and referral?
May 15, 2021
Sir JR I read again what you have written in your topic for today.
You are correct so I need to apologise for my mistake in that I carried out speed reading.
However I donât always disagree with your topics of the day, so in that respect I do not disagree with everything here.
May 15, 2021
My mother and three of my aunties donât own, nor will never own, a mobile phone, theyâre sticking with the old fashioned landline analogue telephone â what help is all your IT and video calling when a high percentage of the elderly donât use smart phones ? Lowest common denominator
May 14, 2021
You are number 272 in the queue. No joke that by the way.
My brother has a similar one trying to get through. He managed to drive over 100 miles before he got through.
Same thing at hospitals. The administrators have taken over and are employing lots of administrators because more administrators is good.
The NHS is self destructing in the same way that the BBC is on the verge of bankruptcy.
May 15, 2021
If senior administrators employ people to whom they can delegate their actual work, then they can be paid the top whack for a very easy life.
You get the same in government with ministers.
May 15, 2021
and with Union leaders.
May 14, 2021
Net immigration of 300k a year. We should be awash with medical staff seeing as that was the reason for allowing it.
May 15, 2021
I’ve had one illness during this COVID crisis. Despite my giving NHS 111 a good steer as to what was wrong – I’m a graduate of the Wikipedia School of Medicine – I was told to isolate until I had a COVID test and then see a pharmacist. He then failed to adequately diagnose the problem, despite being able to see me face-to-face. I was told to contact my GP, who would have been my first port-of-call before the COVID crisis. She was able to make the correct diagnosis, on the basis of seeing a texted photo. Prescribed an anti-viral, I was told NOT to visit the pharmacy to collect it, because I was contagious. So I’ll give the NHS 3 out of 10. And wonder how many people are going to die as a result of late diagnosis of treatable problems. The GPs must get back to work.
May 15, 2021
Like plenty of shops, why couldn’t GPs just erect plastic screens between the doctor and patient, and if the wearing of masks is so beneficial why couldnât that suffice during a doctorâs appointment ? and carry-on as normal
May 15, 2021
Letter in today’s Daily Telegraph:
SIR â My husband was requested to see his GP at 3.15pm. He duly presented himself at the surgery. At 3.10pm I received a phone call for him from his GP. I explained he was at the surgery.
After my husband had waited nearly half an hour, the GP appeared, came over and explained that it was a phone call appointment. My husband then said: âWell, as Iâm here, letâs talk about whatever you want to see me about. There is no one else here in the waiting room. You can sit two metres away.â
The GP replied: âI canât do that. Go home and I will phone you.â
If that isnât the world gone mad, what is?
Janet Bates
Stock Green, Worcestershire”
May 15, 2021
Brian
Very similar happened to my wife at the Wokingham Medical Centre last year before covid, an absolute farce.
May 15, 2021
This is going to be like putting the genie back in the bottle. There are some things you just donât want to talk about online. Minor issues I have no problem with a secure video chat with a GP but other, personal, embarrassing or really worrying issues no people donât want to discuss it first with a triage receptionist with no clinical knowledge, and you know they gossip about things locally with their friends – donât tell me they donât because I people disciplined for this very act.
Good luck in changing this no face to face appointments, it was like the warnings in 2004 when Labour changed the GP contract and were confident theyâd cover on-call on rota as we had previously (if your area does really well done because its a postcode lottery and donât expect it to last) – pwha that was knocked off immediately at a reduction of ÂŁ6000 pa in GP allowance which was quickly made up again with extra payments for blood tests and taking weights etc.
May 15, 2021
Under government direction, slots are for 10 minutes. I don’t know if it is also govt direction but my GP surgery only allows for one item to be discussed, so if I have a couple of items, I, untrained, have to decide which is most urgent and make separate appointments for each. Where’s the sense in that? – a waste of doctor’s time and mine having to travel to the nearest town, park at extortionate rates (because the doctors car park is full with staff cars) walk about half a mile from the town centre to the surgery, when it could be done in a couple of minutes. I asked the surgery about this and they said to ask for a double slot. That’s a joke, it usually takes two or three days to get one slot and even if it worked why book the doctor for 20 minutes when the whole lot could probably be done in the first ten. Utter madness.