One in four evening and weekend GP appointments in CCG trials unused

tom73

Veteran
Location
Yorkshire
Of course pharmacists don't all want to do it. The current setup to be a IP doesn't fit in with lifestyle, business or work patterns so isn't as crazy an idea as it sounds. But what happens is the NHS has a great idea, the big companies say this is great. Then this great idea depends on a pharmacist or someone else having had some training to allow them to do it. Then very few pharmacists have the training and it falls flat on its face, usually with some bureaucracy, some risk and paperwork averse behaviours from pharmacists and haggling about pennies for payments/free. It's the same whether it be NUMSAS, flu vaccinations, SCR, various PGDs and on and on. I find it hard to see community pharmacists surviving long term without a lot more of them prescribing.
Totally true so much good stuff just die's a death or get's diluted to point of being pointless. The idea of adding it fully or partly to pre reg training I don't think is a crazy one and has merit and worth looking into. As is adding it to other HCP's training. I agree community pharmacists need to adapt or die it's the harsh reality of the changing market and it's need's.
 

tom73

Veteran
Location
Yorkshire
It depends on your opinion. Critics could for example say that you live in a CCG with one of the worst records for appointments after 6pm and at weekends and that the two aren't completely unlinked. Others would say that plans to get rid of the drop-in centre in town and minor injuries located at another location and move it all to the far north of the city is a seriously dumbass idea. Other CCGs would you say lucky bleeders, how did you manage to hang onto yours for so long?
Yes it can be seen like that. A fundamental shift need's to happen in public attitudes and not seeing the 1st port of call being a GP or A&E. The increasing want for everything to be instant is not helping either. Only need to watch the many fly on wall GP and hospital stuff to see that many don't see a problem in wasting time. Our walk in centre closed as it had no effect on lowering A&E numbers. The place was right it was well reported but still massive under use. Our CCG is not helping with it's new idea of a out of hours come watered down 111. CQC are close to calling time on it. It closers at 2pm weekend's and bank holiday's. Week day's hour's are not much better either. The GP group that run's it however well they have done well from it.
 

mjr

Comfy armchair to one person & a plank to the next
[QUOTE 5398244, member: 76"]
The patient with a mental health issue would be sat in front of a GP with a special knowledge or and interest in, say, dermatology. This would mean that a further appointment is needed. Meanwhile in the next door consulting room would be an itchy patient, explaining their symptoms to a GP with a Special Interest in Mental Health conditions. One simple question asked and that situation is resolved, and each patient would have been in front of the appropriate doctor!

This could be explained better I agree, but there is a very good reason for the question.[/QUOTE]
Saints preserve us from GPs with special interests. They don't have time to follow the latest treatments and after all the G is for General. My worst treatment misadventures originate from GPs with special interests who felt they could treat me in primary care (avoiding paying for me to go to hospital? Hopefully not. Let's hope it's arrogance not penny-pinching) in direct violation of NICE Clinical Guidance.

I would probably try to avoid a GP with a special interest in CV issues, in the hope of cautious treatment and better chance of a prompt referral to specialist clinic if needed. I couldn't do that if a receptionist is directing me to someone who doesn't know my decades of treatment history rather than my GP of record.
 

tom73

Veteran
Location
Yorkshire
You have clearly had a bad experience of a GP stepping out of line and thinking they can best treat you but clinical best practice is often the same HCP with extra training dealing with most of the patients with a given clinical need.

"Special interests" It's more a case of extra training in a given area. Often minor surgery e.g ingrowing toe nail or a vasectomy are carried out by one or two GP's within a practice or women's productive health such as fitting a coil and implant. The whole point that it's better to have one or two with an interest and had extra training treating parents with that clinical need. They then can and do stay up date as they are one's that use the skills every day instead of say a GP giving a steroid injection directly into a joint who last did one 3 years ago. Sure the G is for general but they can't be expected to know and treat everything that they see. It's sound clinical practice to refer on to a different GP if they know more about a given area of treatment. In fact for some treatment's you have to have extra training and show your up to date and fit to practice in order to do them.
 
They don't have time to follow the latest treatments and after all the G is for General
All GP's have to show continuous development now and are continually competency assessed. Which doesn't mean to say they're all good or you won't have a personal bad experience but it's at least a big step up from qualifying and never needing to update again.
 

tom73

Veteran
Location
Yorkshire
Indeed they do as do all doctor's If they wish to hold a certificate to practice and legally work as one. Being registered with the GMC mean's little with out it. Any HCP that want's to hold onto a registration find's the time to stay up to date and maintain the evidence to prove it. Can't move in our house for article's and journal's you need a bag just to carry around Mrs 73's practice portfolio.
 

mjr

Comfy armchair to one person & a plank to the next
[QUOTE 5398606, member: 76"]Yep, I think your experience of one person really does mean that everyone else should not try and see a GP who may have an increased knowledge of, or special interest in a certain branch of medicine. After all, it is must better to see someone who has not budged from his consulting room for 30 years, but who hasn't got you better in decades, rather than someone who spends time in their specialist area, with specialist clinicians seeing how things are developing and may have a clever new idea..[/QUOTE]
I'm far from the only person to suffer this sort of experience, but I am not going to share the medical histories of some relatives (my illness is hereditary) and friends in a public forum - I hope you can understand why.

Even with me, it's not merely experience of one person - it's happened twice with different GPs in different places. I made the mistake of letting the aggressive reception-controller at the second practice allocate me to another GP with an interest before I contacted a health charity, found the NICE papers and directly challenged the GP but they basically said they knew better. It was only when I had an urgent appointment for yet another side-effect while that GP was away that a locum actually obeyed the Clinical Guidance and I got the hospital treatment I needed.

I'm not sure what the last bit means, because I'm arguing in favour of treatment for serious illnesses being done by people who spend their time in their specialist area, rather than GPs with interests.

As for "hasn't got you better in decades" - my underlying illness is currently incurable, so there's no chance of that (which is a real mindbender when you realise it - and part of the specialist care is dealing with the mental health consequences of that). It can be benign with good treatment, but it can be both hellish and life-shortening if mistreated, worse than untreated and that's where people get taken by GPs with special interests who think the NICE guidance to refer to specialist care doesn't apply to them.
 

tom73

Veteran
Location
Yorkshire
@User76 It's true when done right and based on sound clinical evidence moving services is in everyone interest and i'm not one for keeping things just because it's alway's been like that.

Our cardiology dept is one of the best luckily it was till he was killed lead by one of the top cardiologist's. So we wanted for nothing and treatment's you normal only find in large teaching hospital's he worked to bring them to our hospital. The dept even lead the county on some new treatment's and is still held in high regard. Not bad for district general.

Our CCG has decided to close our dedicated stroke unit and move to another local hospital even though the hospital has no cardiology ward in fact out of all the DGH in the area ours is the only one that has. They then followed that up my saying out of hour's paediatric and children's surgery will be moving too. Even though we have a leading SCBU , the area's paediatric intrusive care retrieval and transport service is ran from it and the only DGH in the area to have a paediatric Resus bed in A&E one of a very few in country. So some time's you do have question just what is going on?
 

mjr

Comfy armchair to one person & a plank to the next
[QUOTE 5398733, member: 76"]Your third little paragraph is a problem for the NHS though. The NHS has often suggested this very thing, and the public won't go for it. These specialist areas of health should be dealt with regionally, but honestly the public won't stomach it. Bristol has a Heart Centre at the BRI and a Cardiology Dept in Southmead because they are different Trusts, that's mad, they are less than 5 miles away from each other! But you tell the people of North Bristol that their CCG wants to move the service to the BRI to make it make more sense and watch the fireworks! [...] All specialities would like to centralise, but the uproar is too great and it can't be done. Look what happens when a small community hospital is closed down![/quote]
I share your bafflement at the opposition to specialist centres, but I should have been given the option to choose and book a specialist hospital clinic many many years ago, so I'm not sure that it's the patients who are opposing it as much as the GPs and other so-called community leaders.

But there should still be a place for small community hospitals to deliver some services. Not all in-patient care is specialist, is it? And it does rather seem that once such sites are abandoned by the NHS, we very rarely see them return to a town again.
[QUOTE 5398733, member: 76"]The bit in bold though, and this is not supposed to spark a big row with you as it comes up a lot so don't jump down my throat about it, but I don't understand why people on here write this sort of stuff. It is an anonymous forum, [...] [/QUOTE]
No it isn't, especially not for anyone who uses the same username on other sites (heck, my username here was made LESS anonymous because some people deliberately (IMO) repeatedly misspelled my old one in very poor trolling), or most who have attended a forum ride or event, or some who have corresponded with others - and none of us are safe from the admins and possibly the moderators and Google (which this site uses)... which reminds me I should poke the GDPR non-compliance again when I get a round tuit.
 

screenman

Legendary Member
Popped into the doctors this afternoon to get hooked up for online, I was told that I am already registered, so why was I told last week I was not. Also that I do not qualify for a flu jab.
 
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vickster

Legendary Member
Popped into the doctors thisafternnon to get hooked up for online, I was told that I am already registered, so why was I told last week I was not. Also that I do not qualify for a flu jab.
Are you in a qualifying group? If not, then it makes sense you don't qualify. Asda do for £7 iirc (my GP practice charges a tenner for comparison)

Have you got the online access sorted now, makes life so much easier for regular or non emergency appointments
 

screenman

Legendary Member
Are you in a qualifying group? If not, then it makes sense you don't qualify. Asda do for £7 iirc (my GP practice charges a tenner for comparison)

Have you got the online access sorted now, makes life so much easier for regular or non emergency appointments
To be honest I was already going to go to a chemst for the flu jab, it was only the receptionist who suggested that I have it done at the doctors when I popped in there yesterday, the nurse was the person who said I do not qualify, they did not offer me an option to pay otherwise I would have done so.

Just checked online and there are no appointments released or words to that effect.
 
OP
marinyork

marinyork

Resting in suspended Animation
Location
Logopolis
To be honest I was already going to go to a chemst for the flu jab, it was only the receptionist who suggested that I have it done at the doctors when I popped in there yesterday, the nurse was the person who said I do not qualify, they did not offer me an option to pay otherwise I would have done so.

Just checked online and there are no appointments released or words to that effect.
Just ring up some 100 hour pharmacies and ask. £7-£11.50. Ask them specifically when pharmacists trained to give the jab are on duty and tell them your age (different jabs this year for different ages, if you're under 65 then that vaccine is pretty widespread).

You might be able to get the flu jab as late as 11pm or midnight.
 
OP
marinyork

marinyork

Resting in suspended Animation
Location
Logopolis
Work has been underway for years on a general flu vaccine that would last five years. Not yet here. Some people think never.

Some people are aware of the strains. A lot of stories in the daily mail this year about strains which is bumping up peoples' worry. A quite typical conversation this year is I want the four strain one and I'm willing to pay for it and we can't do that for some patients.
 

classic33

Legendary Member
With an underlying condition, epilepsy, that comes first, for me. It rules out painkillers, locals and antibiotics due to interactions with the anti-epileptic medication. Ended up back in A&E more than once, before they believed me.

I lost the best GP I've had. He left some six years ago. I'd trust him more than some of the specialists I've been under. He took an active part in trying to control the epilepsy. And if he wanted to see me, he made the appointment then I was informed.

At present, if something similar arises, it's now too specialist for those at the surgery. Blood tests to check the medication levels are now done on at the local hospital. Results being sent back to the surgery. Getting to see someone to see what those results are, and what action should be taken is now not medically urgent. If I'm lucky, I may get in to get given those results.

If it requires passing onto a specialist, it requires another appointment. Those appointments are nigh on impossible to get. So any tests done upto that point are now too far out of date and usless.

There may have been two or three appointments kept, which includes those at the local hospital by this point. All of which are now rendered useless, requiring repeating.

I've had early morning Saturday appointments, which were simply to be passed along the system. But they're no longer done.
 
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