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 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 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." 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.

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."

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:



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:



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:

[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!

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? 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. From there I downloaded 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).()

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?

Originally Posted by craigwalsh

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!

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? 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. From there I downloaded 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."