KS

We have had our advice and guidance requests take over 8 months to get a response. In one instance the patient had died waiting (with the guidance that eventually came back saying they didn't need to see a specialist for the thing that they died from).

BREAKING: “I can sit here and confidently tell you, it is worse” A jobbing GP.

@parthaskar @Parody_RCGP Half of these people have no clue how inundated we already are .. just today 2ww rejected .. ‘yes we know your patient has documented weight loss, anaemia and high platelets but can you check an LDH and re refer after that ’ 🤷🏻‍♀️

I’ve been doing this GP malarkey for nearly 20y now. It struck me today that the only way I can carry on practising the way I used to is if I do it at my own personal expense. It never used to be like this - there was enough time in the day for bereavement visits, wellbeing checks, proactive care, time with colleagues to discuss patients & build relationships. General practice today is decision making at the same speed as a shoot-em-up game. Today was just me for 55 same day requests for appointments, clinical supervision of three members of staff, medical student education, paramedic education and all routine needs for a population of 1250 patients. We’re fortunate to have personal lists - though the new contract doesn’t value the continuity at all - and that matters to me deeply. Leaving work at 7, I decided to pop in to a patient of mine that I’ve known for 14y. In their 80s, they’ve just had joint replacement surgery and are having a bit of a wobble. We had a chat, they felt better, we have a plan & I’ll check in next week. This is the kind of GP I want to be. My day would have been less frantic, I’d have eaten/urinated at a sensible time, and I’d would have been less snappy with the children whom I saw briefly before bed if there hadn’t been so much nonsense crowding my day: 25 mins on hold trying to get through to a specialist (and failing), an insurance company slyly demanding a conversation with me about a non-urgent issue because it saves them money, dealing with consequences of private tests not requested by me but with the inevitable ‘see your GP’ as disposition, missing discharge medication, delayed follow-up, inappropriate ‘GP to’ as the heart failure team have a waiting list - and much more. Commissioning gaps, poor clinical pathway planning, govt targets on access over quality, media perpetuation of entitlement over responsibility and disproportionate investment & expansion of specialists over general practice have caused this. This is not ‘part time’ GP working - as a partner that’s never a thing. This is expectations from everywhere without resourcing to match. We want to deliver the things we did 20y ago - that’s why we went into this. If you want your family doctor back then you need to support us - because we want to be that too. I’m a GP, but also a Mum, wife and daughter of aged parents. I can’t do this at my own expense any more, and nor should I have to. Arguments of laziness and greed always abound, but really what we need is a properly resourced service. Please stand with us - a fight is coming.

In 1 week, it will be national policy to bounce 1/4 of GP referrals.

@wesstreeting Has it ever occurred to you both that the reason we are more likely to be referred could be due to racism at the GMC? That you have both discounted the loyal service many of us have given to the #NHS ? Both Labour & Tories have plundered other nations to recruit doctors & nurses

This is a huge concern for every single GP I meet and speak to. It should be a huge concern for every patient too @HealthwatchE @NVTweeting @jacoblant

Being a GP is now a never ending game of apologising that other services no longer offer care, explaining tests and treatments done by others, and late nights researching how to manage conditions previously handled by specialists. (Whilst being chastised for all NHS ills)

6300 Neighbourhood Health Centres already in walking distance of 90% of the population Cost to bring hospital to community just 1.5% of NHS budget £50 per patient per year Yet @wesstreeting doesn’t want to do it instead it’s 43 centres rather than investing in GP practices

2/2 However amongst all the excess verbiage. around page 5O one clause is quite clear. GPs are contractually required to refer patients for other NHS services as required . Paragraph 8.1.3 b refers. So you'll have to remove that from the contract but god help the patients.

@DrSteveTaylor During my 29 years as a Consultant I vetted all referrals to my service. I estimate that I 'rejected' at most 1 referral in 100 from local GPs, and certainly nowhere near 1 in 4.

I was removed from a waiting list for a life-threatening condition despite responding to a letter asking me if I wanted to stay on the list in the affirmative. No one will do anything about it. No one has apologised. There’s no one I can complain to. NHS is broken.

@edallen41 @ElectionNight5 5 million more appts a month ccd 2019 Discharge delays Treatments in hospitals remain low particularly admitted care Problems with beds which remain occupied 93% A&E admissions remain similar A&E type 3, but type 1 static Advice sort by GPs up whilst people wait for hospitals

It changes nothing except giving us more work to do collecting useless data, making sure we are hitting a target that has no benefit for patients. england.nhs.uk/long-read/reco… 6/End

Today's adventure in being a UK GP shows why the system is creaking. Of 30 patients on my list today, 3 were GP problems; rest are waiting for definitive secondary care treatment. Manager added our actual GP work (hypertension reviews) as extras because we have no time anymore.

▶️ No answer about the fact Advice & Guidance will now be mandatory, meaning a GP won't be able to refer directly to a consultant on almost every case, and who is responsible for the care 2/3

To put that in context: a typical hospital outpatient department, with all its clinics running across multiple specialties, sees somewhere between 100 and 180 patients in a four-hour morning session. We handled 633. With a fraction of the infrastructure and at a fraction of the £

Dear NHS, Patients are not Processes. Please let us get on with the job of treating the sick, with suitable support to enable us to get on with the job of treating the sick. We have duty of care, so please give us control over how we deliver that care. Best, Iona

@AliJaneMoore The main way waiting lists are reducing is this and advice and guidance. GPs picking up the slack Admitted pathways and non-admitted barely moving New Referrals flat but Advice and Guidance up. Yet no funding for GPs

I’ve always maintained Advice & Guidance = Advice & Avoid. Neither helps the GP nor the patient when they need a F2F specialist opinion.