GP’s under pressure

I want to turn my attention this month to the subject of GP’s. Recently they have been having a really tough time. NHS reorganisation coupled with increased workload and reduced time for patient care are forcing many doctors to leave general practice early. Internal and external pressure, as well as our increasing “tick box” and blame culture have slowly built up to a point where for many GP’s it’s all become too much. Certainly the non face to face patient care needs to be substantially reduced to give more time to actually treat patients. As it is we are lucky to get ten minutes, and very usually the average time is about seven minutes. Since 2008 an additional 40 million patient consultations per year have added to the workload of GP’s. Patient demand for GP services in England continues to grow with an estimated 372 million patient consultations per year, sharing just under 10,000 surgeries. That’s a huge amount of people needing these services. Added to this the population is ageing and growing and of course in some ways it is more unhealthy.

I am writing this article coincidentally on the day that junior doctors are on strike. Watching the usual political debate it is still evident that these doctors are not striking for money, and have not left patients to die, their colleagues and consultants have taken over. They are striking to put a marker in the sand that the hours they work will not keep increasing, if they back down now who knows where this will lead. Also the chronic under staffing with doctors stressed to the maximum means that more hours with the same number of GP’s could put patient lives at risk. However there is something more insidious going on here, behind every amazing NHS hospital are staff who are unappreciated and morale is low. Overworked, understaffed with cuts round every corner, there is little to hold them up except if they dig deep enough their initial desire to help people.

It is all too easy to GP bash, I hear it a lot of this in my clinics, and I remind people that things are not like “the old days” sadly. I’m lucky I have a fabulous GP who understands me, gives me time, doesn’t mind me making suggestions and works with my particular beliefs about nutrition. I believe that the relationship you have with your GP is one of the most important, he or she is your first response unit to getting better and getting the right help.

With appointments feeling rushed many people come away feeling not heard or dismissed or talk about GP’s becoming nothing more than prescription writers, however I think that is unfair. If you want to see your GP, you have to be prepared and cannot as lovely as it would be to indulge in niceties and go in “for a bit of a chat”. Ten minutes is not much – these are precious moments to explain what’s going on, get checked and get treatment.

So if you wish to get the best out of your GP try these few rules:

1. It’s far better to turn up to the surgery and get an appointment than calling. Many phone systems only take so many calls and may be up against hundreds trying to get through. I’ve tried this, and turning up first thing I’ve never had more than a few people in front of me, on the phone I have no idea, and the whole redial thing just makes me more frustrated. If you think about it sensibly Mondays and Fridays will be most busiest, Mondays people may have struggled through the weekend having been ill and Fridays people panic because they can’t wait until Monday. Mid week is best.

2. Getting to the point and not rambling will save you a lot of time. Your GP is not a counsellor and only wants to hear the facts. So keep it brief, stick to the point and tell the truth. Don’t leave the most important symptom until you are waiting to go out of the door. If I go to the GP I don’t store everything up for one hit, but go for each individual event. Last time I went I timed myself especially for this article, it took me four minutes to say good morning, what was happening, a brief history of the issue and then the GP gave me seven or eight minutes of their expertise. In fact we had officially two minutes to spare, so then I said how grateful I was and asked after his family.
3. Go with a full bladder and don’t drink caffeine before your appointment. If you are asked to give a urine test it will be easier and if you are having your blood pressure checked or even an ECG, caffeine might affect the result.

4. Don’t go to the doctor with a cold or flu virus unless your symptoms are worrying you. There is nothing they can do and you won’t be given antibiotics unless you have a bacterial infection. Don’t go either if you have dental issues, or you are a bit lonely and want a chat.

5. To Google or not? Some GP’s welcome this and some don’t. It could save time but try not to go in and tell the GP you have diagnosed your condition, that’s their job and you might be treading on toes. Some general information might help speed the process so that you know what to ask. If you have questions and feel you might forget write them down or take a partner or friend with you if you need support.

6. Don’t be shy about what’s wrong as you really haven’t got time to be shy. I work and write a lot on embarrassing bowel issues especially diarrhoea. The GP has heard and seen it all before so don’t exclude a symptom that might be really important.

7. It’s important to talk about one symptom at a time unless they are two small symptoms. This can get complicated eg if you have undiagnosed coeliac disease or hypothyroidism you might have many symptoms. But if your eye hurts and your little toe they are probably separate conditions to be discussed at different appointments.

8. Don’t be afraid to push, but do it in a nice way, talk quietly and be firm. If you are new to a practice and the GP doesn’t know you that well, and you feel a gut instinct that something is really wrong, speak up. It is hard for them to distinguish what level your pain is compared to someone else’s particularly if they don’t know you. If I turn up at my GP’s, they know I’m not normally there, so something is clearly not right.

9. I think making people feel appreciated helps, a card, a bottle of wine at Christmas will no doubt make you unforgettable and perhaps when things are really tough you might get a better response from the tired GP when he knows he is appreciated.

10. If you don’t like your GP for some reason, ask the surgery if you can see another doctor. Often surgeries now will give you a choice. If you don’t want to talk to a man about female health issues tell the surgery you are uncomfortable they will understand.

We have to accept that the days of surgeries feeling homely and social niceties have possibly gone as there just is no time any more. No doctor I have spoken to thinks that ten minutes is long enough. In the “good old days” appointments were still about ten minutes but the doctors were far more lucky to run over time as they essentially had far fewer people to deal with and far less administration. In that ten minute slot they have to greet you, establish a rapport, find out what’s wrong, do an examination, order tests and write prescriptions, in addition they may need to be admitting the patient to hospital. These are all important decisions. On top of this they are dealing with abusive and aggressive patients, getting approached in supermarkets by irate patients demanding to know why they can’t get an appointment.

Obviously I work entirely differently to a GP but my hour long plus consultations feel like such a luxury, giving the patient ample time to talk and tell their story. However this is a private service and people’s expectations are high as they should be. Often I hear people saying my GP never told me that – this is usually about nutrition. That is not the GP’s fault as they have not had the training and have not got time to start looking at food diaries and giving out flimsy nutrition advice.If you are lucky you might get referred to a dietician if funding is available. I simply adore my GP and whether you like it or not this could be one of the most important relationships you have in your life, trust me when you are really ill, they are lifesavers (literally).

If you would like to contact Kate for a consultation please contact 01323 737814/310532