GP's

[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:

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]

Originally Posted by sicksadminion

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 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.