Grumble Thread

[Serial_Apologist]

A dispiriting (and worrying) demonstration this morning of the dire state of health services locally. An unsatisfactory dental check-up reinforced that I just have to put up with the ongoing problems I have with two molars, until such time as extraction becomes the inevitable outcome - probably as an emergency. The practice has insufficient dentists, and many of them only stay for a short time and then move into private practice or to other countries. Not good for someone such as myself who needs continuity. In the 6 months prior to the first lockdown I'd needed 3 repairs, so now I try and avoid chewing on that side - which has brought back the painful jaw joint problems that had been sorted 3 years ago... In the course of the general external check of the face and neck area the dentist asked about what she referred to as a lesion, but which I have assumed to be a wart(one of the stalked variety) and told me I should get a GP to look at it straightaway. So called by the surgery on the way home to be told that sorry they had no appointments that day. I said I wasn't expecting that (appointments have always been weeks away, as I've never managed to get into the urgent/emergency category) but wanted to book one, to be told that they don't do that. All appointments are same day booked by phone, which in practice means sitting on hold from 8am until you get through to be told there are no more appointments that day, at a likely cost of several pounds in my case, as I don't have an inclusive tariff. They brought that system in last year to deal with excessive levels of abuse and antisocial behaviour to surgery staff, but I had assumed that they would have gone back to something more like the original system by now. There have always been problems at that surgery as they have had too few GPs for at least 8 years and have not, for some reason, thought seriously and with effect about alternatives such as Nurse Practitioners and more nurse led activity to help to fill the gaps.
Going private isn't an option for the dentist as there are none locally taking on new patients, and changing GP surgeries isn't an option as all 3 surgeries closed their lists to new patients some years ago due to numbers. If I was on the other side of the railway at the bottom of my garden I could go to the nearby village surgery, one of a group of 3 serving local villages, a couple of miles away where, although they do now have problems with GP shortage (all 3 retired the same year ) a much more intelligent and agile practice management means they continue to provide a good service - including bookable appointments.
I can't book a 6 month dentist checkup either - I have to wait until the 6 months is up and then phone to arrange - so another 2 months wait on top of the 6 months already gone probably.
And idiot management people moan about "inappropriate use of A&E".
Now I need to get out into the garden and think about something less depressing.

We commisserated on my similar behalf a few months back, and I managed to get a fairly quick appointment with my (private) dentist, who extracted the problematic tooth, and I've been OK on that front since, so I do hope some solution comes your way ere too long. Having a private dentist has not proved much more costly than an NHS one, and this is in London, so maybe if you presented your obvious woes to a local one near you I'm sure they'd manage to squeeze you in in short time. In the meantime my remedy was Paracetamol, having found Ibuprofen useless when it came to pains in the mouth - as opposed to other parts of the anatomy!

[Dave2002]

We commisserated on my similar behalf a few months back, and I managed to get a fairly quick appointment with my (private) dentist, who extracted the problematic tooth, and I've been OK on that front since, so I do hope some solution comes your way ere too long. Having a private dentist has not proved much more costly than an NHS one, and this is in London, so maybe if you presented your obvious woes to a local one near you I'm sure they'd manage to squeeze you in in short time. In the meantime my remedy was Paracetamol, having found Ibuprofen useless when it came to pains in the mouth - as opposed to other parts of the anatomy!

I received a notification of an appointment several weeks ago, and thought that the appointment would actually get one problem fixed. No - when I attended it seemed to be just a triage - to see whether there was any treatment needed. So now I have another appointment booked for May. I am now seriously wondering whether to go and seek help from a private dentist.

In the past I had a dentist who gradually moved many of her patients over to private treatment. I don't think it was much more expensive than the equivalent NHS treatment. I probably misunderstood the nature of NHS and Private services in the past. I (almost certainly mistakenly) believed that NHS treatment was on a fixed tariff of charges, but I think the only fixed thing is what the NHS will actually pay to each dentist for carrying out specific dental operations. The actual charge is still determined by the dental practice. I have had similar incorrect views on GP services. GPs operate as private businesses, but they receive funding for treatment they are able to provide. The degree of funding they obtain is a factor in determining the quality of service. For GPs I think a significant factor of how much funding they get from national income sources is how many patients they have registered.

Re temporary measures, although aspirin is generally not a favoured drug for most problems, I think it may still be useful for easing some tooth pain, particularly if placed close to the area where the problems seem to emanate. Doesn't taste nice, but might work. Soluble is better.

[Serial_Apologist]

I received a notification of an appointment several weeks ago, and thought that the appointment would actually get one problem fixed. No - when I attended it seemed to be just a triage - to see whether there was any treatment needed. So now I have another appointment booked for May. I am now seriously wondering whether to go and seek help from a private dentist.

In the past I had a dentist who gradually moved many of her patients over to private treatment. I don't think it was much more expensive than the equivalent NHS treatment. I probably misunderstood the nature of NHS and Private services in the past. I (almost certainly mistakenly) believed that NHS treatment was on a fixed tariff of charges, but I think the only fixed thing is what the NHS will actually pay to each dentist for carrying out specific dental operations. The actual charge is still determined by the dental practice. I have had similar incorrect views on GP services. GPs operate as private businesses, but they receive funding for treatment they are able to provide. The degree of funding they obtain is a factor in determining the quality of service. For GPs I think a significant factor of how much funding they get from national income sources is how many patients they have registered.

Re temporary measures, although aspirin is generally not a favoured drug for most problems, I think it may still be useful for easing some tooth pain, particularly if placed close to the area where the problems seem to emanate. Doesn't taste nice, but might work. Soluble is better.

Good old fashioned cloves, as found in your spice rack (possibly) are also a good remedy for immediate easing of dental-related pain.

[oddoneout]

Progress of sorts has been made on the GP appointment front. After several false starts(the options menu didn't do what it was meant to) I managed to join the queue at No 20 at 8-40. 50 mins later I got through to a receptionist and as expected there were no appointments left. I explained about it being the dentist who wanted me to make the appt and that she would be expecting me to confirm I had done so, at which point I was offered a slot with the Nurse Practitioner on Wednesday morning. I have no idea why that option couldn't be/wasn't offered when I called in to the surgery on Monday and gave the same explanation, which would have saved me the wasted 90 minutes trapped with the telephone and the call charges which will be well over £10.

CS - the current arrangement is due to covid fallout so the contract issues don't apply I imagine. As to what happens when 'normal' working is ever resumed I don't know. The excessive waits have been the norm for years, and if there are not the GPs to fill the slots it's difficult to see what can be done. I found out this morning during a chat at the library that the GP who was in charge has retired and the person who has taken over the role is my own GP who is part-time. There are 8 GPs listed of which I know 5 are PT, the other 3 are new names to me so I don't know if they are PT or FT. The last CQC report was 2016, graded Good, reviewed 2019 and evidently not considered as need another inspection.

[oddoneout]

Good old fashioned cloves, as found in your spice rack (possibly) are also a good remedy for immediate easing of dental-related pain.

That takes me back! I worked for a dentist for a year in the early 70s and clove oil was one of the substances occasionally used for treatment especially where a tooth had infection. My father was not impressed with the rather casual approach we seemed to have to handling it as it was something that he (a research chemist) only used in a fume cupboard. The temporary (sometimes lasting a very long time though) filling material kalzinol also used as a liner under amalgam fillings contained clove oil, and I loved the smell of it.

[Serial_Apologist]

Progress of sorts has been made on the GP appointment front. After several false starts(the options menu didn't do what it was meant to) I managed to join the queue at No 20 at 8-40. 50 mins later I got through to a receptionist and as expected there were no appointments left. I explained about it being the dentist who wanted me to make the appt and that she would be expecting me to confirm I had done so, at which point I was offered a slot with the Nurse Practitioner on Wednesday morning. I have no idea why that option couldn't be/wasn't offered when I called in to the surgery on Monday and gave the same explanation, which would have saved me the wasted 90 minutes trapped with the telephone and the call charges which will be well over £10.

At least you were offered an appointment with a nurse - at my surgery you have to go through a doctor first. However at least if we phone in and are put on hold it's a free phone call. Or are you using a mobile?

CS - the current arrangement is due to covid fallout so the contract issues don't apply I imagine. As to what happens when 'normal' working is ever resumed I don't know. The excessive waits have been the norm for years, and if there are not the GPs to fill the slots it's difficult to see what can be done. I found out this morning during a chat at the library that the GP who was in charge has retired and the person who has taken over the role is my own GP who is part-time. There are 8 GPs listed of which I know 5 are PT, the other 3 are new names to me so I don't know if they are PT or FT. The last CQC report was 2016, graded Good, reviewed 2019 and evidently not considered as need another inspection.

A few years ago I went to see my regular doctor designate, only to be informed he had transferred to Cornwall two years previously! Can anyone remember a time when one would receive a formal letter from surgery in the event of a doctor leaving or retiring? Or is that too far back in the mists of time?

[Cockney Sparrow]

CS - the current arrangement is due to covid fallout so the contract issues don't apply I imagine. As to what happens when 'normal' working is ever resumed I don't know. The excessive waits have been the norm for years, and if there are not the GPs to fill the slots it's difficult to see what can be done. I found out this morning during a chat at the library that the GP who was in charge has retired and the person who has taken over the role is my own GP who is part-time. There are 8 GPs listed of which I know 5 are PT, the other 3 are new names to me so I don't know if they are PT or FT. The last CQC report was 2016, graded Good, reviewed 2019 and evidently not considered as need another inspection.

Glad you can get into the surgery. Depending on the experience and confidence of the nurse, you may find she calls in a GP to take a look.

I have to say, you are more accepting of the situation than I would be. In circumstances where budgets are set to be strained beyond breaking point there can be no justification for making patients spend such amounts callling, only to find you cannot even obtain an appointment. My feeling/hunch, from reading the press etc, is that the GP contract remains largely the same, except that there are some specific programs for delivery of certain add-ons (as desired by government) that were put back to accommodate the booster programme.

The system you describe discriminates against whole sectors of their patients on their access to care and is patently unfair even if it were not open to legal challenge. If I felt I might end up the worse for using the surgery complaints system (they all have to have one) then I would think this is just the sort of matter I would expect a letter to my MP to result in challenge of the situation.......

[oddoneout]

At least you were offered an appointment with a nurse - at my surgery you have to go through a doctor first. However at least if we phone in and are put on hold it's a free phone call. Or are you using a mobile?
The surgery is getting better at sorting out whether it is necessary to see the GP first - the reluctance to delegate was from the doctor side I found out when I queried why I had to see the GP first then make an appointment to see nurse or equivalent for tests to be done then another appointment to see the GP for the results. Re phone it's landline and it's a standard geographic call, same with dentist, and with other local surgeries.
A few years ago I went to see my regular doctor designate, only to be informed he had transferred to Cornwall two years previously! Can anyone remember a time when one would receive a formal letter from surgery in the event of a doctor leaving or retiring? Or is that too far back in the mists of time?

I think the answer to that is yes, unless presumably the surgery is being closed as a result of the retirement in which case some form of notification will be required. I remember being laughed at when I asked to see my GP about 12 years ago, having not needed to do so for a good few years, as they said "Oh he retired 3 years ago".
Apologies, the quotes and replies have got muddled but I don't want to fiddle and lose what I've written, so hope it can be deciphered!

[oddoneout]

Glad you can get into the surgery. Depending on the experience and confidence of the nurse, you may find she calls in a GP to take a look.

I have to say, you are more accepting of the situation than I would be. In circumstances where budgets are set to be strained beyond breaking point there can be no justification for making patients spend such amounts callling, only to find you cannot even obtain an appointment. My feeling/hunch, from reading the press etc, is that the GP contract remains largely the same, except that there are some specific programs for delivery of certain add-ons (as desired by government) that were put back to accommodate the booster programme.

The system you describe discriminates against whole sectors of their patients on their access to care and is patently unfair even if it were not open to legal challenge. If I felt I might end up the worse for using the surgery complaints system (they all have to have one) then I would think this is just the sort of matter I would expect a letter to my MP to result in challenge of the situation.......

There comes a point where you have to accept. I have over the years queried and challenged what happens at the surgery, with some useful discussions with the practice manager which have explained the background to some of the issues. A fundamental and very longstanding issue is not being able to recruit GPs, even before the recent wave of problems, something which other surgeries in the area also face. As large housing developments have gone up, patient numbers have increased and so have the pressures. It would seem that a quiet town with good schools, low crime etc is just as unattractive as an inner city sink estate - perhaps more so in some cases - not enough challenge/career progression opportunities?
There were certain things the P Manager was not aware of, especially with regard to the appointment system, until I raised them and asked him how I was supposed to proceed. There were a couple of occasions when I got the line that all surgeries had whatever problem I had raised and I was able to provide evidence that other surgeries had found ways of dealing with, for instance time for staff training that didn't involve early closing on Wednesday. It is time for another letter to the MP though; it is some years since the last exchange which provided evidence he used at some committee or other.
So I have a choice of working with, as best I can, the current set-up or doing without a doctor. Today's experience has given me an idea of what I would need to do as and when I next need an appointment, but I can always hope that by that time something approaching what passes for normal service (ie bookable appointments even if several weeks wait)has been resumed.

[alywin]

As far as I can see, most, if not all, GPs seem to be "part-time" only. Partly because they seem to be required to do a day of CPD each week, but also sometimes because they hold other posts apart from being simply a GP. It doesn't necessarily mean that they are all parents with children, fitting in work round school hours and other requirements, as some people seem to suggest.

[oddoneout]

As far as I can see, most, if not all, GPs seem to be "part-time" only. Partly because they seem to be required to do a day of CPD each week, but also sometimes because they hold other posts apart from being simply a GP. It doesn't necessarily mean that they are all parents with children, fitting in work round school hours and other requirements, as some people seem to suggest.

Does it really matter why they are part-time? If it means that expensively trained(for individual and state) personnel are still in the system who would otherwise not be that has to be considered a benefit of flexible working. If there are enough PT staff to make up the FTE needed to cover the work that is what matters - and that is the problem at my surgery with recruitment difficulties.

[gradus]

If we phone the GP we are asked to describe symptoms to a receptionist who passes the info to the GP who in turn phones back later and if appropriate asks you to attend the surgery. Sounds cumbersome but actually works quite well in practice. It's a two doctor practice but fortunately never takes too long to get through by phone.

[Dave2002]

If we phone the GP we are asked to describe symptoms to a receptionist who passes the info to the GP who in turn phones back later and if appropriate asks you to attend the surgery. Sounds cumbersome but actually works quite well in practice. It's a two doctor practice but fortunately never takes too long to get through by phone.

Here the procedure seems to be:

1. Phone the surgery - talk to a receptionist.
2. If appropriate - book a telephone appointment with a GP.
3. In the telephone appointment the GP may ask for a face to face consultation.
4. The face to face consultation may result in further treatment/investigation, such as a hospital referral.

Overall it's not too bad, and really can get things moving quite quickly - typically within a week or two (any emergencies get dealt with much quicker), though some logistic things don't seem so well worked out.
Some referrals may be to places which are many miles away, and even for slightly nearer ones nurses and other medics may ask "Why have you come here? There's another unit where I often work which has spare capacity, and it's much closer to you."

[Bryn]

Here the procedure seems to be:

1. Phone the surgery - talk to a receptionist.
2. If appropriate - book a telephone appointment with a GP.
3. In the telephone appointment the GP may ask for a face to face consultation.
4. The face to face consultation may result in further treatment/investigation, such as a hospital referral.

Overall it's not too bad, and really can get things moving quite quickly - typically within a week or two (any emergencies get dealt with much quicker), though some logistic things don't seem so well worked out.
Some referrals may be to places which are many miles away, and even for slightly nearer ones nurses and other medics may ask "Why have you come here? There's another unit where I often work which has spare capacity, and it's much closer to you."

My recent experience of the system is similar, except that twice in the last five instances, I have been offered an appointment not with one of the practice's GPs but at the local "Urgent Care Centre". The examinations there were, to put it mildly, cursory. However, my most recent attempt to get a diagnosis of the problems I was experiencing resulted in a swift call from a locum at the practice who asked me to attend within the hour. She carried out a thorough examination, diagnosed the problem and prescribed medication which has, so far, proved effective. She also made a point of advising that she would telephone three weeks hence to check on efficacy and any side effects of the medication. So, a somewhat variable level of consultation, with a locum having offered the most thorough service. I do hope she joins the practice on a permanent basis.

[Nick Armstrong]

The fad for fading music in while the presenter is still speaking seems to have spread to COTW