GP's

[Mike]

I live in the South West (Bristol area). I have just been excluded from my GP's surgery for seemingly having the temerity to criticise the poor service they are delivering. I am not happy. I would like to test the water for a more effective patient led NHS GP service.

Am I alone, or has anyone else encountered any of the following:

Overbearing "senior" partners who think (wrongly) that they know everything (shades of Sir Lancelot from the Doctor in the House series) and who treat patients like cattle.

Inability to book appontments by telephone (let alone on line!) requiring personal attendance at the surgery (only to be told, you can book by phone you know....grrrr!)

Inadequate (or non existent) complaints service.

A lack of attendance by the partners and a reliance on locum staff.

Support staff who think they are medically qualified and question simple requests for treatment (Eg 'flu jabs for at risk kids)

Other parts of the NHS (eg child cardiac care) seem to have come into the 21st Century.

Why are these people (GP's) still allowed to live in the past and behave like Victorian patrons?


(Thanks NHS Sucks for the chance to air this rant!)

[craigwalsh]

Hi, Mike --

Welcome to this new forum, and thank you for your rant. I don't know if you felt better after you posted it: I know that simply posting my own rant made me feel much better.

Have you actually been barred from your GP's surgery? Wow, they must really think you're a bad boy! Your description of your GP's surgery sounded a lot like my own. The redeeming factor at my surgery is that the folks there are generally quite friendly. They try (in their own way, and subject to the numerous constraints imposed upon them by the NHS system) to be helpful.

And, like yourself, I've found an over-dependence on locum staff, and even young registrars. I've usually found that the locums and registrars are more helpful --- and less cynical --- than the senior doctors.

When you say that there's an "Inadequate (or non existent) complaints service" have you tried the complaints procedure at your local Primary Care Trust?

I haven't had the most wonderful experience with my complaint to my own PCT (Worcester), and am now at the stage of taking my complaint to the next level --- the Healthcare Commission. But it might be worth your putting your complaint in writing and submitting it as a formal complaint.

I had a quick look on Google and found this webpage (http://www.ubht.nhs.uk/involving_people/getting_it_right_together.htm) for your area. This may only be for complaints against your local hospital, but I'm sure the PALS folks there will be able to point you in the right direction.

While looking at this United Bristol Healthcare NHS website, I found a page (http://www.ubht.nhs.uk/involving_people/Getting%20involved/getting_involved.htm) that's called "Patient's Voice." It says, "How to have your say at your local hospital, GP surgery or community health service. Click on Patient's Voice. (http://nww.nhs.uk/patientsvoice/at_hospital.asp)" But when I clicked on the link for the Patient's Voice, I got a DNS error: Page Not Found.

It made me smile. Just shows what the NHS thinks of the patients' voice. :mad:

I hope you'll post more messages about your encounters with the NHS, particularly if you file a formal complaint with them.

Again, welcome to the NHS Sucks forum.

[Mike]

Hi Craig,

Thanks for your response.

I regard the senior partners of the practice as buffoons, and told them so.

Because, they say, of my obvious lack trust in their abilities (none actually) I was invited to depart. Clearly they suffer from charisma and sense of humour bypass (a double proceedure available under BUPA only and only to members of the medical profession). As I would only use them for repeat prescriptions and the most minor of matters - certainly not any surgical proceedures- I find this a bit of an damned imposition and will not accept their high handed, dog in the manger attitiude.

I have used the PALS service before at Warrington General when my mother died. They were pretty hopeless.

I am going to use the NHS complaints service. I have e mailed for an advice as to how to proceed, but guess what? no reply as yet.

Thanks for the links, those that work- (I had the same problem as you -lol!)

Mike

[craigwalsh]

Hi, Mike ---

I can imagine that the senior GP's didn't like being called "buffoons." :p

I don't think the senior GP at my local surgery is a buffoon (fortunately), but he's certainly infused with a sense of self-importance. I suspect that he would view any complaint filed as unwarranted. And there's always this irrational fear that the doctors or nurses will somehow blot your copybook with some hidden code that will tell all future GP's "Troublemaker! Watch out!!"

In my own chart I've seen the notation, "Many complaint." That's if you can read it:

http://www.aquarena-springs.com/images/many-complaint.gif

What a shame that you didn't have great joy with the PALS in the past. I must confess I haven't been overly impressed either.

[mark1baker]

Craig

"Many complaints" would usually mean "lots of symptoms" in a medical record.

MIke: I have no way of knowing whether you have any resonable cause for dissatisaction, but most people, myself included, would think it rude to call people buffoons.

Mark

[craigwalsh]

Hi, Mark ---

Yes, I see what you mean about "many complaint" also meaning "many symptoms." And I'm even willing to give 'em the benefit of the doubt. But in its context in my chart, it meant "complaint" (as in my grumbling about the treatment I'd received) as opposed to "symptoms."

The full context:

http://www.aquarena-springs.com/images/mulira1.gif

At the time my only medical symptom/complaint was that my back hurt like heck. Small wonder. I'd fractured it a few days earlier and this was not correctly diagnosed despite an initial 13 hours in A&E, complete with x-rays and CAT scans, and two further A&E visits.

And you're absolutely right about being rude.

I occasionally watch Airline on television, and enjoy seeing how easyJet personnel deal with upset customers. In general eayJet seems to treat passengers as an annoyance --- sometimes an unbearable annoyance. The staff seem happy when all the passengers have left. The youthful airline supervisors forget that the passengers are the folks who pay the light bills and salaries.

(Perhaps I'm being unfair on easyJet. I've never flown with them. After watching the TV programme, my wife has said she'll divorce me if I ever book a flight on easyJet.)

I have found, in life, that when people are upset, in pain, under stress, etc. they sometimes can forget civil niceties and can be rude. Very rude. I agree that they shouldn't be rude --- but it just happens. And I've watched easyJet personnel say, "I'm not going to speak with you if you speak to me like that." Almost invariably that takes the discussion to the next higher level on the Stress-O-Meter.

A long time ago, when I was in university, I worked for an airline in Hawaii during my summer holidays. I found I could calm down an upset customer by speaking in a low, reassuring voice. Calling the customer by name as often as possible. (It's hard to yell at someone who is calling you by name.) And even if the airline did nothing wrong, I'd apologise profusely for the fact that the customer was upset, had been inconvenienced, etc.

Once a customer (patient?) is calm, it's a lot easier to find a solution to the problem. It didn't work all of the time, of course. Nothing ever does. But it worked most of the time, and I had a much more enjoyable work day --- rather than being yelled at from one moment to the next.

Based upon my experience with the NHS, many of the staff are shell-shocked, and just don't have any patience when an upset patient raises his or her voice, or is rude.

I think this sign --- photographed by me in the GP Out-Of-Hours suite at the Worcester Royal Hospital --- should face in both directions:

http://www.walsh.li/images/violence-against-staff.jpg

[Mike]

Thanks to all who have responded.

I had a good laugh about the Many Complaints thing (it appeals to my sense of humour anyway).

I did not mean to be rude when calling the senior partners at my GP practice Buffoons, just accurate. What I feel (very strongly) accords with the dictionary definition. When I am intentionally rude (rare) I often resort to the odd adjective, which might offend some of a more nervous disposition. Those to whom my ire it is directed, are left in no doubt about my intentions.

For the record I had hoped that the "Wisheart" debacle at Bristol Children's Hospital might have rid the Health Service once and for all of the high handed attitudes so often prevailant up to that time among some consultants ( "I have spoken so it is so. Don't interrupt you are only a patient or patient's carer"). I was it seems, quite wrong. There are still those whose ego's are so large that they (wrongly) consider themselves superior, certainly to mere lowly patients like me.

If the Consultants can change, then why can't the rest of them . There is, in my experience, little or no edge with nursing staff as they consider themselves more on the level with the patient (consumer).

The problem seems to be national. GP's - buffoons and non buffoons alike, are making themselves totally irrelevent. NHS Direct effectively undermines the surgeries as being more responsive and generally better so why should the public put up with at best a second class service. Useless appointment handling, impersonal service, too many locums replacing partners who are absent for one reason or another. I would like to strengthen the old fashioned "Dr Finlay" style service, not see it undermined.

Are these GP's sleep walking into oblivion? Do they not realise what they are doing - or have done? Am I alone in this rant?

OO! I feel so much better.

Mike

[craigwalsh]

Useless appointment handling, impersonal service, too many locums replacing partners who are absent

Sounds like you've been to my GP's surgery. :)

When I had a general grumble (not a formal complaint) with the senior doctor at my surgery, he agreed with everything I said. He seemed to be powerless to change anything. Even the simple change of having schedules agreed two months in advance (instead of a few weeks in advance) so that appointments could be booked sensibly into the future. I guess if you give up on on easy changes, it's simple to give up on making any real improvements.

What did the senior GP blame? Who or what did he see as being responsible?

Women doctors! :eek:

His view was that more and more GP's are now women, and that all women want is to "have a 9-5 job, and then go home to their family." And, as a result, the GP system --- at least in the eyes of the senior physician at my surgery --- is doomed.

With an "enlightened" approach like that, what hope is there?

I just read an interesting article about Inadequate Pain Management in the UK -- Can We Do Better? (http://www.paincare.org/about/message.php?id=208) by Cathy Stannard and Martin Johnson. They conducted a survey in late 2001 - early 2002 among 569 GP's throughout the UK. A surprising 88.6% responded. Each GP had an average of 187 patients with CNMP (chronic non-malignant pain). Optimal pain control was estimated to occur in less than half of the patients (46%).

The authors say, "The most important finding from this survey is that most GPs feel that the management of chronic pain is unsuccessful in over half of the patients who seek help. Very importantly, although most GPs found specialist hospital pain services useful, a relatively small proportion of interviewees expressed a desire for improved access to such services."

"Efficacy of the available pharmacotherapies was a prominent concern, expressed by 60% of GPs, although notably only 10% of patients were treated with strong opioid analgesics. . . . When asked for a more personal perspective GPs commented on the difficulties of 'managing distressed patients with poor coping strategies.' They described 'feelings of helplessness' and commented that patients with chronic pain generated a significant workload."

Hmmm. Now let me see if I have this right? GPs don't think analgesics are strong enough, yet only 10% treat patients with the stronger medications that are available --- the opioids. GPs think patients with chronic pain take up too much of the GPs workload, yet only 14% refer patients to a pain management clinic. "Nearly all GPs (96%) thought that chronic pain treatment could be improved in their locality," but they seemed (at least in my opinion) to understand that the improvement could start in their own surgeries.

In my trawl through Google, I found the website of The British Pain Society (http://www.britishpainsociety.org/patient_home.htm). From there I downloaded (http://www.britishpainsociety.org/opioids_doc_info_for_patients_2004.pdf) a brochure, in PDF format, about treating patients with opioids. My own GPs (two of them) had written prescriptions for strong opioids (pills and a patch) without even providing me with basic information about likely side effects, etc. For example, they didn't mention constipation --- yet the brochure says "Many people are constipated when taking opioids. If you do become constipated, it is important that it is treated quickly. Your doctor will advise you about this, and will prescribe some laxatives for you." I became constipated for the first time in my life, and let me tell you --- severe back pain, constipation, and the drowsy/confused nature of opioid medication isn't any fun.

Why didn't my GP give me a copy of the British Pain Society brochure? Do you suppose my GP has even heard of the Society?

I stopped all of my pain medication on Monday of this week. I've had a strange week, with lots of what can only be called withdrawal symptoms (hot and cold flashes, sleeplessness, pain in my elbows and knees, etc.). I wasn't told I was becoming a junkie.

My pain has also increased quite a bit, but at least I'm not drowsy and confused. Now if only I could be generally pain-free, but yet generally awake and functional.

All of this has, of course, reduced what little confidence I already had in my GP. And that's a pretty sad state of affairs.

Sorry, I guess I have "many complaint."

[Mike]

As this argument develops it seems to me that general practice has become the Cinderella service of the NHS and that GP's have basically given up the ghost. There seems to be no or inadequate front line service. New Labour has won a decisive victory by simply cooking the books and diverting a relative pittance into the pockets of the senior partners and is saving millions, billions even at the expense of the "ill" populace.

I hope I am wrong but initially I thought that GP's had sleepwalked into a government trap to pay off the older existing GP's with the large salary etc. and practice payments for a truly second class service (limited hours, locums etc., etc.).

As a matter interest, are there any doctors, GP or otherwise reading this who actually care about front line service of the NHS? Is everthing now going to NHS Direct (interesting that recently the public were asked to contact NHS Direct if they feared Polonium poisoning - and not their GP's).(:eek:)

I cannot believe that the Hypocratic Oath takers have been hijacked en masse by Tony & Gordon & their odious crew.

[Mike]

Well I agree. Women Doctors? They are at the root of all evil aren't they?

Sounds like you've been to my GP's surgery. :)

When I had a general grumble (not a formal complaint) with the senior doctor at my surgery, he agreed with everything I said. He seemed to be powerless to change anything. Even the simple change of having schedules agreed two months in advance (instead of a few weeks in advance) so that appointments could be booked sensibly into the future. I guess if you give up on on easy changes, it's simple to give up on making any real improvements.

What did the senior GP blame? Who or what did he see as being responsible?

Women doctors! :eek:

His view was that more and more GP's are now women, and that all women want is to "have a 9-5 job, and then go home to their family." And, as a result, the GP system --- at least in the eyes of the senior physician at my surgery --- is doomed.

With an "enlightened" approach like that, what hope is there?

I just read an interesting article about Inadequate Pain Management in the UK -- Can We Do Better? (http://www.paincare.org/about/message.php?id=208) by Cathy Stannard and Martin Johnson. They conducted a survey in late 2001 - early 2002 among 569 GP's throughout the UK. A surprising 88.6% responded. Each GP had an average of 187 patients with CNMP (chronic non-malignant pain). Optimal pain control was estimated to occur in less than half of the patients (46%).

The authors say, "The most important finding from this survey is that most GPs feel that the management of chronic pain is unsuccessful in over half of the patients who seek help. Very importantly, although most GPs found specialist hospital pain services useful, a relatively small proportion of interviewees expressed a desire for improved access to such services."

"Efficacy of the available pharmacotherapies was a prominent concern, expressed by 60% of GPs, although notably only 10% of patients were treated with strong opioid analgesics. . . . When asked for a more personal perspective GPs commented on the difficulties of 'managing distressed patients with poor coping strategies.' They described 'feelings of helplessness' and commented that patients with chronic pain generated a significant workload."

Hmmm. Now let me see if I have this right? GPs don't think analgesics are strong enough, yet only 10% treat patients with the stronger medications that are available --- the opioids. GPs think patients with chronic pain take up too much of the GPs workload, yet only 14% refer patients to a pain management clinic. "Nearly all GPs (96%) thought that chronic pain treatment could be improved in their locality," but they seemed (at least in my opinion) to understand that the improvement could start in their own surgeries.

In my trawl through Google, I found the website of The British Pain Society (http://www.britishpainsociety.org/patient_home.htm). From there I downloaded (http://www.britishpainsociety.org/opioids_doc_info_for_patients_2004.pdf) a brochure, in PDF format, about treating patients with opioids. My own GPs (two of them) had written prescriptions for strong opioids (pills and a patch) without even providing me with basic information about likely side effects, etc. For example, they didn't mention constipation --- yet the brochure says "Many people are constipated when taking opioids. If you do become constipated, it is important that it is treated quickly. Your doctor will advise you about this, and will prescribe some laxatives for you." I became constipated for the first time in my life, and let me tell you --- severe back pain, constipation, and the drowsy/confused nature of opioid medication isn't any fun.

Why didn't my GP give me a copy of the British Pain Society brochure? Do you suppose my GP has even heard of the Society?

I stopped all of my pain medication on Monday of this week. I've had a strange week, with lots of what can only be called withdrawal symptoms (hot and cold flashes, sleeplessness, pain in my elbows and knees, etc.). I wasn't told I was becoming a junkie.

My pain has also increased quite a bit, but at least I'm not drowsy and confused. Now if only I could be generally pain-free, but yet generally awake and functional.

All of this has, of course, reduced what little confidence I already had in my GP. And that's a pretty sad state of affairs.

Sorry, I guess I have "many complaint."

[Elen]

Gosh, I don't know where to start... Hmm... A little background about me: former NHS GP receptionist (not a dragon, very pleasant, but will not tolerate being sworn at or threatened with physical violence), now working away from patients in the pathology lab of my local hospital and applying for medical school... with the hope of becoming a GP.

GPs actually have to give good reasons to remove patients from their list - this ranges from abuse (verbal or physical) to a breakdown of the doctor-patient relationship (which is probably what was thought in your case, Mike).

Complaints - these should first be directed to the practice manager and if the response is inadequate, you can complain to the local PCT. It pays to know the complaints manager at the PCT and have their email address - my local PCT is dreadful, but the complaints manager is always prompt if you email.

NHS Direct causes far more problems than it solves. I have seen it create hysteria in a new mother about her baby because they didn't have the background information on the patient (and the fact she'd been seen 5 times during the previous week). Their usual response is "see your GP in 4 hours". This is also the response of the local Minor Injury Unit, which will only see patients with minor injuries if they're limping into the hospital with their leg half off, and only on Tuesdays.

Pay and working conditions - the hours worked by GPs and cover provided by out-of-hours services was in the nationally negotiated nGMS contract. To be honest, patients would not be happy with GP surgeries if they were open 24/7. In fact, the more you give the less respect you get. I once offered a patient an appointment at 9.30am one morning and she said "haven't you got anything sooner". It was 9am that same day.


Mike - you said: "are there any doctors, GP or otherwise reading this who actually care about front line service of the NHS?"

I would say without hesitation that the vast majority of GPs in this country care deeply about front line NHS services and about the patients they serve. They have to battle every day against a tide of ridiculous government-set targets that have no relationship to whether a patient feels they're getting a good service or not; they take time away from seeing patients; they put a neverending series of hoops in front of GPs who just want to make a referral to a consultant... and so on.

In fact the whole referral to secondary care is a complete sham. If the referral actually gets to the hospital (it's intercepted by a PCT panel who decides if it's worthy or not - also how patronising is that to a trained doctor to have his/her medical competence questioned like that??), the consultant will often write back saying "can't treat" or "won't treat" or "you should refer to x", rather than getting off their backsides and actually doing something.

An awful lot of doctors don't like the way they have to work within the NHS. It's not surprising that patients feel the NHS sucks. But there is no justification ever for abuse towards staff who are only there to help. After all, I can't tell you to bugger off if I'm sick of your pointing at me threatening me with physical violence. I have to stand there and use all my training to try to diffuse the situation, offer you a choice, try to resolve the problem. This relationship works both ways. Patients and healthcare professionals alike should remember that.

[craigwalsh]

Hi, Elen ---

First of all, welcome to this new forum. I'm delighted you took the time to register, and I found your postings very thought-provoking. I look forward to reading more. It's very interesting, at least to me, to see the NHS from the other side of the desk.

You indicate:
This relationship works both ways. Patients and healthcare professionals alike should remember that.
From my own experience, the folks who forget this truism most often are those who work for the NHS. If you have a spare moment, and are so inclined, please read my saga of what should have been a simple visit to the GP out-of-hours service, by pre-arranged appointment. It's posted at: http://www.sucks.org.uk/?p=12

I was in tremendous pain, but I was still polite. After I'd waited 45 minutes past my scheduled appointment time, I just couldn't sit in the plastic waiting room chairs any longer (I'd fractured my back a few months earlier, and they were unbearably uncomfortable). The "Sister" was offensive, aggressive, and kept interrupting me. When I politely pointed out the sign posted on my side of the counter should face both ways --- which, I believe, is your point --- she called security:

http://www.walsh.li/images/violence-against-staff.jpg

I've read the rent-a-cop reports (obtained by me under the Data Protection Act) and they make me sound awful: a real threat to the security of the hospital. They made a big deal out of the fact that I walk with a cane. They didn't mention that I'm a 57 year old retired company executive recovering from a fractured back, and that threatening anyone --- much less NHS staff --- is just not my style.

I also obtained a copy of the security video footage. I'm shown sitting at the front of the hospital in a wheelchair (my wife found this for me in the reception area) while the rent-a-cops are in the parking lot having a cigarette break. The camera operator even zoomed in on them enjoying their break. If I was such a threat they had a strange way of "protecting" the hospital and its staff.

Initially the Acute Hospital Trust tried to shuffle me off to Catalyst --- the mysterious company that owns the hospital and provides all of the services (like cleaning, catering, security, etc.). I had to speak to the jurisdictional officer at the Health Ombudsman in London to convince the Trust that my complaint should be handled within the NHS complaints procedure. I took my time and wrote a factual complaint, which the Chief Executive, John Rostill, proceeded to misplace. This only came to light about two months later when I started to gently nag for the response.

You also write:

GPs actually have to give good reasons to remove patients from their list - this ranges from abuse (verbal or physical) to a breakdown of the doctor-patient relationship.

I have recently been removed from my GP's list --- after 17 years. I received a letter from the PCT advising me I had to find a different surgery, and telling me that "no correspondence would be entered into." I was not given a reason for my being removed, but it was right after my letter to the surgery of December 1. My letter, and their stuffy response, are elsewhere on this forum:

http://www.sucks.org.uk/forum//showthread.php?t=14

I checked, and I have more formal (university) education than my GP. Not that this makes a difference, but who does he think he is telling me this is "not a debating society?" Doesn't he want patients to take an interest in the management of their own medical condition? I guess not.

What he really wants is to shift patients: eight minutes each. Tops. Gotta move. Waiting room full. A couple of words scrawled in the notes, and the file tossed in a plastic bin until the next time. "Next!" In my 17 years at the same GP's surgery, I have only eight pages of handwritten notes --- and two of these were written by the nurse when I first registered, and are almost two decades out-of-date.

It's easy to write a prescription (in my case for Class A narcotics). The doctor can hand the patient a prescription, spewed from the computer printer, and say, "Here now, off you go. This will fix it." Leave out the part about addiction, constipation, etc.

And the sheer arrogance of the "no correspondence" comment! This sums up the NHS. They've lost sight of the fact that the patients are really the "customers." Instead we're viewed by many (but not all) NHS professionals as generally a pain in the proverbial. Wouldn't the NHS be a lot better without the pesky patients?

Based upon my recent experiences, the NHS is broken --- beyond all likely repair. It's really a shame.

[Elen]

Thank you for welcoming to the forum.

The problem is patients aren't "customers". I don't know about you, but I can't just say to my GP "I'm going to find some other doctor who's actually going to listen to me" as easily as I can stubbornly refuse to shop in M&S if I receive bad customer service. There is no patient choice. Private healthcare, where you pay to be seen, should not rely on a GP's referral. If I want to see an endocrinologist and I'm happy to pay £120, why shouldn't I be able to make an appointment? After all, I'm paying him to see me.

You should be able to find the reason for your removal from the practice list - the GP has to cite the reason in his letter to the PCT. Of course your local PCT could be run by a bunch of wallies (which wouldn't surprise me - my local one is), but this information can't be withheld as far as I know.

Your experience at the hospital I can't comment on, only to say that the reaction of calling security seems an overreaction under the circumstances.

The medical notes request under the DPA - this now includes computer-held records. You can be charged up to £50 for copies of paper records and up to £10 for computer records (at least that's what it was 6 months ago before I left general practice).


Doesn't he want patients to take an interest in the management of their own medical condition? I guess not.

No, in general, doctors absolutely loathe patients taking a real and in-depth interest in their own health. This, in my opinion, is a rather silly attitude to take and possibly yet another reason why patients turn up at A&E with bruised legs, grazed knees and minor self-limiting illnesses.

[craigwalsh]

The problem is patients aren't "customers".
Oh you're so right. But the patients really are the customers --- who do they think pays for the NHS anyway?

I know about the old chestnut that doctors and nurses pay taxes as well, and they certainly do. But I submit there are many more patients who pay (in aggregate) the bulk of the tab for running the NHS. And without patients, there would be little point in having an NHS. But this simple fact is lost on many folks who work in the NHS --- who, at least in my experience, view patients as an irritation. Whingers.

Private healthcare, where you pay to be seen, should not rely on a GP's referral.

I have discovered that it doesn't. Yes, I still get a GP referral letter when needed (using a private GP at the Cromwell if I must) --- but only because my insurer, BUPA, requires this. I have discovered that most specialists don't much care about the referral letter. I almost have the feeling that they view this letter with a bit of contempt.

I have taken to checking the box on the BUPA hospital form (you have to fill this out each time you want to see a consultant) telling them that I don't want the consultant to send a letter to my GP. (Not, of course, that I have a GP --- having been kicked out of the door.) I figure that I'm a better custodian, and guaridan, of my medical records than my GP. I can always bring them a letter myself if I think it would be helpful for them to have it in my chart. A chart they never have the time to read anyway.

I'm going through the Data Protection bit with the practice manager (a nice guy) at my former GP's office. He somehow didn't understand that a data protection request also included information held about me on their computer.

[sicksadminion]

NHS Direct causes far more problems than it solves. I have seen it create hysteria in a new mother about her baby because they didn't have the background information on the patient (and the fact she'd been seen 5 times during the previous week). Their usual response is "see your GP in 4 hours"

Oh dear, someone else complaining about something they have no facts about.

Firstly - we have no background on *any* patient, it's up to the patient (or the person caring for the patient) to give a reasonably accurate history. We're not psychic!

Secondly - There's no such thing as a 'usual response'. There are many dispositions in use, ranging from '999 immediately' to 'Contact pharmacist'

It's really, really easy to find out how the service works. Ask before slagging us off. We're all working for the NHS, trying to help people, yet I hear criticism from everyone from GP receptionists (who also cause a LOT of problems, I'll expand on that if you want me to) to tabloid papers. It's not a great job, people are far more abusive over the phone than they would be in person, the hours are bad and the pay (when it arrives, which is not often) is mediocre.


We're only trying to help, trying to do our jobs as best we can. If it wasn't for us then GPs, A&E depts and OOH services would have a lot of slack to pick up.

[Elen]

Oh dear, someone else complaining about something they have no facts about.

Firstly - we have no background on *any* patient, it's up to the patient (or the person caring for the patient) to give a reasonably accurate history. We're not psychic!

Secondly - There's no such thing as a 'usual response'. There are many dispositions in use, ranging from '999 immediately' to 'Contact pharmacist'

It's really, really easy to find out how the service works. Ask before slagging us off. We're all working for the NHS, trying to help people, yet I hear criticism from everyone from GP receptionists (who also cause a LOT of problems, I'll expand on that if you want me to) to tabloid papers. It's not a great job, people are far more abusive over the phone than they would be in person, the hours are bad and the pay (when it arrives, which is not often) is mediocre.


We're only trying to help, trying to do our jobs as best we can. If it wasn't for us then GPs, A&E depts and OOH services would have a lot of slack to pick up.

No, you see this is the whole point: patients are becoming less and less responsible for their own healthcare. This is really very bad. The more the NHS offers, the more is expected of all who work in healthcare, the less the patient thinks they have to do. For example: their repeat medication being ordered on time is their responsibility and yet we frequently had patients telling us they were going to die because they had to wait 24 hours for medication they should have ordered a week before.

Whilst I have no experience of working for NHS Direct, I have wide experience of its effects. I have seen it whip a poor mother up into an unnecessary frenzy over her child. I have heard countless patients told by NHS Direct to see their GP in a specific (often unnecessarily stupid) number of hours. I realise it's driven by a series of questions you have to ask, because I rang NHS Direct once. I was very happy with the service I received and found it to be reassuring. My experience as a patient was good. My experience of its effects on patients I have had to deal with at work, is not.

Finally, I hope you've had a front desk job in healthcare so you know what you're talking about when you say patients are far more abusive over the phone than in person. Because in my experience that's a load of rubbish. Abuse in person is very common in general practice and extremely frightening for reception staff. We're here to provide a service and I suppose I am lucky that I only had to dial 999 on one occasion in 5 years, but there were many days when I felt threatened by patients. Over the phone you are at a distance - whilst in your experience it may be more common than abuse in person, it is not nearly so threatening and you certainly couldn't convince me you felt your safety under threat by an abusive phone call.

[sicksadminion]

See, you keep going on about this 'young mother whipped into a frenzy' because she was given info that did not take her previous 5 visits into account. If she had given this information, then the advice would've been tailored accordingly. It's not our fault that some patients are lazy and have an inflated sense of entitlement. Your point about them not picking up repeat RXs backs mine up. We can't physically see them, we have no access to medical records (because it's supposed to be a confidential service) so we don't know if they're telling the truth or giving us the whole picture.

With regard to timed dispositions - this is based on the urgency of the case. It's not unrealistic for someone to see a GP if they're sick, but the system can make it impossible. I speak to people every DAY that have been told "You can't see the GP till next week", when they have an urgent health problem. We cannot say "Oh well then, you'll have to wait". We have a duty of care to them, and have to advise them what the most appropriate action is.

Oh and what you also should remember is, PATIENTS LIE. A lot of them have figured out that if they go to A&E/GP/OOH service/dial 999 and claim that NHS Direct advised them to do it, it'll get them off the hook. But the point is, if sick people could access their GP when they needed them, they wouldn't have to lie, scheme and abuse the system.

BTW - I've worked in retail, in a busy regional hospital, and at NHSD. This is by far the worst job for abuse, threats and intimidation. At least hospitals have security - we don't. See how working on a deserted industrial estate finishing at 2am suits you. Just because patients are on the phone it doesn't mean they can't get to you some other way, it can be terrifying.


Oh and while my experience with GP receptionists has been mostly good, some of my patients cannot say the same thing:


Boy with head trauma, blurred vision, dizziness -told by receptionist to call NHS Direct as surgery was closing in 2 hours time
Young lady with petechial haemhorraging on legs, stiff neck, photophobia - told by receptionist to go home and call NHSD or return to the surgery at 9am the next day, because "Doctor has just come out of a meeting and needs time to relax." Said receptionist did not even consult a nurse or doctor. Young lady is admitted to hospital later that day with meningococcal septicaemia. Mum did not call NHSD as she'd already been given the brush-off at the surgery and didn't want to bother anyone.
The grandson of a 93 year old woman, calling me in tears because his gran died in the street of a heart attack. He wanted to know what he could do about his 7 year old daughter who was with the old lady when she died, and could not stop screaming. Refused GP appt. by receptionist on the grounds that it was 'not life-threatening' and could wait until the next day.



Like I said earlier, we ALL work for the NHS, we're ALL trying to help patients. What good does it do to waste energy slagging off our colleagues when we're already under so much pressure from the outside? There's no way I'd say to a patient "Don't bother with your doctor, he's rubbish" or "Hospitals don't know what they're doing", so why do you, and people like you think you have the right to do that to us?

[sicksadminion]

you certainly couldn't convince me you felt your safety under threat by an abusive phone call.

They know which building we're in, it's easy enough to find the address of your nearest site online. We've had two instances of break-ins where intruders waited in the toilets and attempted to assault nurses. We've gone off shift to find cars vandalised and threats on the windscreen. I've been followed home twice. We're all issued with personal alarms as standard. I'm working until 2 or 3am on a (by that time) deserted industrial estate, in the middle of nowhere, with no security staff.

Please don't tell me I have no right to feel threatened.

[craigwalsh]

Hi, sicksadminion ---

First of all, welcome to the forum. We're glad you took the time to register --- and after reading your first postings, I'm especially glad that you're here. Lots of food for thought.
It's not a great job, people are far more abusive over the phone than they would be in person, the hours are bad and the pay (when it arrives, which is not often) is mediocre.
Wow --- how depressing. You say the pay "when it arrives" is mediocre. I assume the NHS pays you in a timely fashion, per your employment contract. I hope they're getting that right.
some patients are lazy and have an inflated sense of entitlement
Double Wow! I don't think of myself (for example) as lazy, but I certainly have a "sense of entitlement." I know that NHS services are free to all, and not linked to the taxes paid by an individual, or not paid. Having said that, my wife an I have paid over £4 million in taxes in the past 20 years. I believe we've done our share of helping to fund the NHS. We've had BUPA coverage all that time, and still have BUPA insurance, so we take ourselves out of the NHS system whenever we can.

With my recent bout of Sleepless Leg Syndrome (Ekbom Syndrome) I had occasion to call NHS Direct. I was told someone would call me back, which they did. I'd read everything I could about Sleepless Leg Syndrome on the internet, including the scientific journals at Google Scholar. The nurse at NHS Direct was generally unfriendly and unhelpful.

BUPA has a similar 24/7 service. When I called the BUPA number, I was put right through to a nurse. She seemed to have all the time in the world, and was reassuring and friendly. She was quite "motherly," which is what I think most people want when they're feeling poorly.

I accept that BUPA probably pays its staff much more than NHS Direct. And I hope that BUPA doesn't put its staff in some "deserted industrial estate."
Oh and what you also should remember is, PATIENTS LIE.
Triple Wow! When I read that I realised that you need to get out of there --- run to the nearest exit. The NHS has made you cynical and unhappy. Please, for your own sake, find a job that makes you happy. Where you feel that you're being paid what you're worth. Where you're not having to carry a personal attack alarm, or deal with people over the telephone who you frankly don't like.

In my career I've had to fire some people who've worked for me. (Not until we'd exhausted every possible effort to try to make things work.) I have a standard speech: "We want you to be happy." I'd explain how the current job was obviously not making my soon-to-be former colleague happy, but that they seemed to be afraid to quit and find another job.

I've actually had people come back --- six months, a year, two later --- to tell me that I was right. (I always love to hear that I'm right.) They come back to say that I gave them the push that they needed, and that they have found a job that makes them happy. And that it's wonderful.

You just don't sound happy to me. And I want you to be happy.

[sicksadminion]

You're right, I'm not happy. Few of us are. We spent a year not knowing from one week to the next whether we'd still be employed in the previous month, or if we'd be closed down altogether. We were promised financial remuneration after being on the wrong grade since 2004 - but had to wait 18 months and when it arrived it was wrong. We rarely get paid correctly - whether that means on time or the right amount, and no-one wants to do anything about it. Unison are no help, some of us don't even know what our monthly wage is supposed to be as it's never the same twice. Because of the financial position this puts many of us in we can't afford to find other employment, vicious circle and all that.

Now, about the 'lazy and entitlement-complexed patients'. I did say *some*, and I do stand by that. You have to remember that not everyone is like you. I mean people who call 999 for toothache because 'I pay taxes', or people who turn up at A&E for sore throats, or who call us at midnight on a sunday demanding dental care immediately. We have callers who lie all the time, some of our callers have ASBOs for abusing the service, see here (http://www.google.co.uk/search?q=nhs+direct%2Basbo) You're right, I am cynical, I have to be. When you have a 42 year old woman calling and pretending to be a little girl of 12 who's been repeatedly raped by her dad, says she's pregnant and has concealed it, and claims she's bleeding and in pain, you get upset and then find out it's a hoax and she does it all the time, how would you feel? This is by no means a rare occurrence. People also lie about the urgency of their symptoms, are advised to see someone urgently, and then we get the blame because we have to be cautious.

I never let any of this affect my work, I never take these things out on the callers, but maybe the nurse you spoke to had simply had enough? It's no excuse, but job insecurity, stress over targets, bad working conditions etc. are bound to take their toll. I doubt very much that your lovely BUPA nurse has to deal with these things daily. She probably doesn't deal with 80 callers in a shift, isn't under pressure to meet certain figures. She won't have endured a recruitment freeze, with half the necessary amount of staff working double their contracted hours.

Most of the nurses I work with are amazing, but they're only human. The wall of our call-centre is plastered with Thank You cards and letters - that's what keeps me going.

I believe in the NHS, it's necessary, and not everyone can afford private care. I want to uphold it's principles, but some people make it seem like a daunting task. The majority of my callers are sad, desperate, ill, and it's a joy to help them, but you have to have some cynicism to survive. If you don't toughen up just a little then you'd cry yourself to sleep at night because of the horror of it all. Wouldn't you be upset if everywhere you turned you were being criticised? We work very hard, but we're a scapegoat for the ills of the entire NHS simply for doing our jobs.

[craigwalsh]

Good grief --- it's not a pretty picture from the other side of the fence. My heart really bleeds for you.

One of the websites you pointed me to (a BBC website) has this snippet:


In Essex, a 38-year-old woman was banned from abusing the emergency services, after she called 999 38 times in nine months. A court heard she pretended to be unconscious and swore at ambulance crews who went to treat her, forcing them to take a police escort. A similar case in Hove, Sussex saw a woman banned from dialing 999 after she made hundreds of hoax calls and also rang the NHS Direct advice line more than 240 times.


Now I'm not a bleeding heart liberal --- more a George Bush-esque Republican Conservative. But in these brief stories it sounds like the people need help --- as in treatment or counseling. Instead, in caring Britain, they're slapped with an ASBO. That'll teach 'em.

Of course, just reading these few sentences I have no way of knowing if the two cases, both in Sussex (hmmm . . . . ), are just nasty people out to be nasty. I believe that there are, in fact, people out there who are just plain bad. Or whether these people have more serious mental illnesses, for which the solution is treatment, not an ASBO.

If these folks do have a mental problem, will an ASBO really stop them from doing something that is compulsive?

You're right about the nice BUPA lady. She is dealing with a more rarefied group of callers: a smaller number, quite possibly better educated, older, and I would guess more "polite." She's more Waitrose, whereas you're stuck in Asda.

Why don't you find the nearest BUPA call center and drop off your C.V.? Maybe you can become happy again.

Life is far too short to have the bosses at the NHS make you miserable.

[sicksadminion]

I think I'm too much of a socialist (but only with a small 's' ) to work at our local BUPA hospital!) I felt really upset last year when I had to use a private hospital, I've been brainwashed :D

With regards to the ASBO thing- a *lot* of consultation happens first. There are meetings between all parties involved, interim measures are taken, and it is an extreme last resort. These callers need serious help, but to use your supermarket analogy - mental health services in the UK are currently like Netto or Lidl. Makes me horribly sad sometimes. Even a hardened cynic (!) can't help but be affected. I have a long car ride home at night, I've often spent it in tears.

This is partly why situations like yours happen (awful btw). The services that should be looking after regular patients have to mop up the overspill from a failing mental health system. It's particularly bad OOH. You just can't contact anyone. Services are stretched, tempers fray, and everyone loses.

Here's to the New Year, hopefully a change in administration, and improved access for all! (Ever the optimist!)

[Elen]

Oh and what you also should remember is, PATIENTS LIE.

Please don't patronise me. I've been working in the NHS a long time and am well aware of this fact. I'm only sorry you take criticism of your service so badly. We should all try to improve the service we provide.

I had no idea working for NHS Direct was so dangerous. Try locking up in the evening by yourself in an area where your patients live and working where they 100% know where you work. I really fail to see how working for NHS Direct is any more dangerous than any other part of the health service, but if it's a threat to your safety/life, I'd be inclined to take it up with your manager.

The GP receptionist cases you cite don't surprise me - a lot of them act like mini doctors, thinking they know best. But a lot of them aren't like that. The majority of our patients were very happy with our service (80% rating reception very good or excellent in the patient questionnaire). There are always ways of trying to improve the advice we offer. Sometimes the tough call comes right at the end of a hectic week and it's difficult to think very clearly. But whenever I was in doubt over anything I would always put the patient in for an emergency appointment. If it was someone who was complaining of something more serious I would always suggest calling 999 if their condition were to deteriorate before the doctor could visit. Having said all that, patients lie to other healthcare workers about the way they've been treated by their surgery. They make so much crap up, it's unbelievable.


But the point is, if sick people could access their GP when they needed them, they wouldn't have to lie, scheme and abuse the system.

Yeah, right. Some patients can't be bothered to even ring or turn up at their GP to see if there's an appointment, just go straight to A&E and lie about not being able to get an appointment. It's truly unbelievable. We always had on the day appointments available and yet every week without fail we would receive a phone call from MIU from a nurse shouting at us for not offering a patient a reasonable appointment. Time and again I had to politely inform them that the patient hadn't even attempted to ring and if they had would have been offered one of eight routine appointments that day.


I love working in the NHS. You have to be able to deal with all the problems the patients throw at you during the day and be able to leave it behind when you leave the surgery/hospital. You have to be able to laugh about some truly awful stuff in order to keep your sanity. The NHS has made me a little cynical, but I still believe in the service and its continual improvement.

[Elen]

There's no way I'd say to a patient "Don't bother with your doctor, he's rubbish" or "Hospitals don't know what they're doing", so why do you, and people like you think you have the right to do that to us?

I have never told a patient to not phone NHS Direct because I believe it's crap (which I don't, even in the slightest, I've just had a few problems with the effects it has caused on some of the patients). In fact I've never had to tell a patient to ring you at all because our surgery actually provides a good enough service. I would never make allegations about the competency of another NHS organisation because that is extremely unprofessional. How dare you suggest that I would.

[gp2]

Post Shipman and Dame Janet's inquiry I would imagine that prescribing strong opioids for chronic non-malignant pain has reduced.
the withdrawal symptoms that you experienced were physiological, and did not mean that you were becoming a junkie.

[craigwalsh]

I would imagine that prescribing strong opioids for chronic non-malignant pain has reduced.

I keep meaning to go to Boots to return (for destruction) alll of the strong opioids that were prescribed for my chronic, non-malignant pain.

Here's Exhibit A, the little scrap of paper given to me by Dr. J. J. Lee at BUPA South Bank in Worcester:

http://www.walsh.li/images/dr-lee.gif


Dr. Lee didn't want to write the prescriptions --- he wanted me to go back to my GP. His explanation (excuse?) was that a private prescription would cost more than an NHS prescription. When you're experiencing the level of pain I've experienced, saving a few pounds is the least of my worries.

My GP prescribed the Durogesic DTrans patches (fentanyl) -- 50 mcg/hr. This caused all sorts of problems, so I was then put on BuTrans 10 mcg/hr (buprenorphine) patches plus eight 50mg Tramadol a day --- plus eight Paracetamol (prescribed) for good measure.

If this is a reduction in the prescribing of strong opioids for chronic non-malignant pain, what were they doing before? :eek:

[gp2]

the GP is on a loser here. where there are difficulties with pain control and a private doctor suggesting unspecified doses of opiates, if things go badly the GP takes the heat. if things go well the private doctor takes the credit.
I should have said that the proportion of GPs prescribing strong opiates will have reduced, not the amounts which are titrated according to response.

[craigwalsh]

The GP is on a loser here.

Yes, you're right. But only because the GP didn't take the time to talk to me. He just wrote the prescription, didn't even discuss side effects or the possibility of addiction, and sent me on my way. Within a week I was in A&E.

It's curious. I requested, and received, all of my notes (under the Data Protection Act) from my GP's surgery. The notes of this fateful September 15 consultation are missing. There's a stamp on the notes for the date and the word "Comp," which I'm guessing might mean "computer." But as I filed a Data Protection Act disclosure requst, did the practice manager not think that included computer records?

All the GP has to do is talk to his or her patient. Sadly, doesn't happen. And that's why the GP is on a loser.

[Elen]

But as I filed a Data Protection Act disclosure requst, did the practice manager not think that included computer records?

If you asked for copies of your notes under the DPA, this should now include both paper and electronic records, especially as many doctors now only write the date and one word in the paper records.

sicksadminion - I recently found out NHS Direct employees are paid at a rate of £8/hour and up to £12/hour at weekends. This is significantly better than a lot of NHS jobs, including mine... not that I'm bitter and twisted of course. ;)

[gp2]

Did the private GP discuss the side-effects of the medications he was recommending?
Since OOH services now record telephone conversations it has become obvious that some patients are obviously untruthful when they later complain.

[zippyRN]

reading this thread (and others)

my initial response is what cereal packet did some of the posters sudden acquire a medical degree from ...

if you go into any healthcare setting and demand treatment, threatening staff if you don't get what you want right now, it's unsuprising the service may suggest that if you are that unhappy you seek your care elsewhere...

people seem to think they are 'customers' of health care , not you are not you are patients ...

it is an accepted fact which i am not going to try anddipute that there are some within healthcare who do not measure up... but to be insulted , threatened or treated like an idiot becasue you do not do what a patient or their friend / relative wants , rather than what is appropriate / clinically indicated is a very quick route to an irretreviable breakdown i nthe relationship between the health professional and thepatient.

[zippyRN]

My GP prescribed the Durogesic DTrans patches (fentanyl) -- 50 mcg/hr. This caused all sorts of problems, so I was then put on BuTrans 10 mcg/hr (buprenorphine) patches plus eight 50mg Tramadol a day --- plus eight Paracetamol (prescribed) for good measure.


If this is a reduction in the prescribing of strong opioids for chronic non-malignant pain, what were they doing before? :eek:


never heard of the WHO analgesic ladder?

paracetamol has synergistic properties in conjunction with opiate and opioid drugs

tramadol has both opioid and none opioid pin releving properties ...

[craigwalsh]

Did the private GP discuss the side-effects of the medications he was recommending?


The private pain specialist did not discuss the side effects of the medication he suggested. He also did not write the prescription, saying it would be much "better" (for whom?) for me to get the prescriptions from my GP. And my GP also did not discuss side effects. I have read the little leaflets that came with the medication --- and you don't always get these. The leaflets seem fairly generic, and spell out virtually every complication known to man. It's hard, as a mere patient, to make much sense out of all of this.

Since OOH services now record telephone conversations it has become obvious that some patients are obviously untruthful when they later complain.


The head of the Worcester OOH said that he thought my problems with the OOH came from the fact that they didn't properly triage me when I made my initial telephone call. Of course, he came to this conclusion without actually listening to the recording. I asked if the calls were recorded and he said they were. I asked for a copy so we could all hear (rather than speculate) on how well the call was handled. I am still waiting. The latest excuse I received was that the recording had been "archived." Where? To the moon?

It's fine to record telephone calls, but if the recordings cannot be easily (and quickly) retrieved it doesn't make tremendous sense.

[gp2]

"It's fine to record telephone calls, but if the recordings cannot be easily (and quickly) retrieved it doesn't make tremendous sense."

You must be naive to believe that.

[jenny]

"people seem to think they are 'customers' of health care , not you are not you are patients ... "

Breathtaking arrogance. "YOU" might be a patient one day - oh dear, poor you if you get treated with that kind of contempt.....

[zippyRN]

"people seem to think they are 'customers' of health care , not you are not you are patients ... "

Breathtaking arrogance. "YOU" might be a patient one day - oh dear, poor you if you get treated with that kind of contempt.....


professional relationships rely on the client of the professional being willing to take the advice of the professional ( with second opinions if necessary) however it;s not like choosing a new kitchen whenere you can ultimately decide what you want ...

[jenny]

Ultimately the decision rests with the consumer - the patient. Whether the person providing the service is paid for by the state (the NHS) or by the patient (privately) the ultimate decision is made by the consumer of the treatment. Professional relationships rely on mutual trust and respect - that goes both ways. The patient can definitely decide what they don't want - and should do, in my opinion.

The last time I came across a rather ridiculous stereotypical consultant who prefixed his monologue "with all due respect, the patient cannot necessarily make the decision about the treatment" I walked out of the consulting room. As it happened, I had read most of the papers that had been written on the subject, so I was very well informed. I decided the best thing to do was to make a consultation with the person who had written most of the papers - bingo! A true professional, involving the patient in the decision-making process all along the way.

[craigwalsh]

Jenny, I think your comments are spot on.

I developed restless leg syndrome (http://www.rls.org) after I fractured my back. It's known to be caused, among other things, by back injuries and opioid withdrawal. And I'd done both.

There is often a long delay in making a correct diagnosis of RLS, and it has this silly sounding name. I was one of the lucky ones. I'd read an article about RLS and the fact that most doctors didn't know much about it --- or how to treat it. I went to the RLS website (http://www.rls.org) and read all about it. The symptoms described on the RLS forum by many people who suffer from RLS were, in most cases, exactly what I was experiencing.

I printed off a couple of research papers (one from the Mayo Clinic) and went to see my former GP. He wouldn't even look at what I'd brought with me. He dismissed it as "internet junk." Instead, he prescribed an addictive sleeping pill instead of the medication I'd requested (ropinirole (http://en.wikipedia.org/wiki/Ropinirole)).

His sleeping pills did nothing. When I called the surgery again I was told that only a neurologist could prescribe ropinirole. So I called all over the country trying to find a neurologist who could see me (essentially) immediately. I found a great one at the Cromwell Hospital in London, a 250 mile round trip from my home. But it didn't matter --- I couldn't stand another sleepless night.

I've been on ropinirole for a couple of years now. No side effects. And no RLS symptoms. If I am late in taking my nightly tablet I can start to feel the RLS "pain," and it goes away once the tablet takes hold.

ZippyRN says that medical care is "not like choosing a new kitchen whenere you can ultimately decide what you want ..." I absolutely agree that it is not as insignificant as selecting a new kitchen. But I am the only person (and the right person) to ultimately decide what I want.