What is going on at your surgery

New ways of working for GP surgeries

Almost certainly, your surgery will be operating very differently this winter, according to The King’s Fund (KF) medical charity, They have just carried out a survey, and say GPs are “hedged around with ‘national guidance’ rules” and regulations.

If you don’t like the new system, don’t blame your GP. GPs have to abide by these rules (even if they don’t agree) – but there is nothing that says you have to. So if you are not getting what you think you should from your surgery, – now is the time to get active.

There are some benefits: before, we had the ridiculous referral system, where the rules said if you needed to see a consultant again, if the last appointment was two years previous, etc., you had to see your GP for another time-wasting appointment to ask for another referral. No longer – at my surgery now it’s one quick phone call and it’s done!.

However, in some cases the KF highlights that GPs had been advised to suspend routine referrals to secondary care. I found the way round that was to find my own Consultant (more on that later), phone their Secretary to find out if they were doing appointments, then phone my surgery and request a referral to X. For me, this worked every time; I suspect my GP was only too happy not to have to waste time going through the system, and was happy for me to do the leg work

Telephone consultations

At our local surgery the procedure now seems to be

Phone Receptionist to say what you need
If you need to speak to a doctor, you are told they will phone you
When your GP phones, if you need to see them face-to-face your GP arranges the time and date during the call
You then go to the surgery and wait outside to be called in.
If you are out when GP telephones, it might be best if you call back and remind Reception that you are expecting a call. GPs are often over-worked, and your call may get forgotten.

Routine follow-ups

If your routine care for long-term conditions has been paused during the pandemic, it should have been restarted, If it hasn’t, then phone your GP. Have details of what the appointment is for, whom you need to see, and stress that it is urgent.

If your appointment is for routine tests, in some instances hospitals are asking GPs to order and manage tests I have been having a District Nurse come and give me blood tests at home, rather than have a trek in to hospital, so have been very happy!
Covid-19 itself is certainly causing additional workload, from patients requesting exemption from mask-wearing, wanting notes for employers or schools or being concerned about their ability to get a test, to the need for cleaning and additional PPE for appointments.
GPs are also increasingly seeing the longer-term effects of Covid-19, caring for those discharged from hospital and those who had milder illness but who are experiencing the complex symptoms of ‘long-Covid’. If you are experiencing symptoms, have a look around on this website, as many symptoms are the same as long-term side effects from cancer drugs. (aftrcancers.com)
The wider fall out of the pandemic, the social, economic and psychological effects are causing people to seek help from their general practice. The KF say GPs have reported an increase in the proportion of each day’s consultations that involve mental health problems.
On top of all of this GPs need to implement the largest flu vaccination campaign in history, with social distancing measures also meaning the process takes much longer than usual. The KF say they have spoken to countless GPs, practice staff and volunteers who are spending their autumn weekends standing in car parks to make sure their patients receive vaccines.

What’s to come

You would think the Tick Box merchants would leave surgeries to get on with it, but it seems Administration bods can’t stop interfering. The KF say Primary care network (PCN) contract requirements were delayed until October but will now restart, together with new targets for practices to gain access to Investment and Innovation Funding.

Care Quality Commission inspections resume in October and PCNs need to move rapidly to spend the additional money for new roles that is attached to the contract, which has been very difficult during the pandemic.

No-one knows how many GPs will still be working come the winter, but with growing demand, an ever-diminishing GP workforce and difficulties in recruiting, inducting and supporting new staff, it is going to be a tough winter for general practice.

Finding your own consultant

If you find your GP can’t/doesn’t want to make an appointment, my unofficial way is to phone the Consultant myself. During Lockdown their Secretaries have been very helpful; sometimes making an appointment directly with me, and sometimes asking me to phone my GP and say I have cleared it with them, and can they send a referral.

If it is to see a new consultant I ask friends if they can recommend a good one

And/or I look up my local hospital website for their consultants. Google around and think a bit – I like anyone who has done training/work abroad – who has been involved in research for my particular type of illness – and apart from the notorious Ian Paterson who is now in jail, if they also work at local private hospitals as this usually means they are well regarded. You can look for someone who is young/old, female/male, family person etc. It’s all there, and Googling around I usually get a feel for what someone is going to be like.

Once I have a name, I find phoning Secretaries and asking “does so-and-so deal with my particular type of xxx can be very productive. Secretaries can be extremely helpful, and when I have explained what is wrong, once or twice they have even said “you need to go to ~X – they deal with this particular problem”.

Now you have a name you go back to your GP and request a referral. And I also phone the Secretary back, say a referral is on its way, and see if they can pencil me in for an early appointment. Now this often happens. But for how long I don’t know – so get in there quick!

This takes time, but if you don’t help yourself, you don’t get. And we are going to need to be a lot more pro-active if we want the best healthcare.

And if you still need help. go to the Categories on the left and look up Getting an Appointment.

If you want to comment on your surgery contact your local Healthwatch and/or Clinical Commissioning Group.

And – and this has proven itself time and time again, after the appointment send a quick email to thank the consultant for seeing you and/or thank the secretary for arranging it. During lockdown the brownie points I picked up doing this proved invaluable.