Doctors: Diagnosis By Phone

[buggie]

.... sorry spadetownboy, first sentence was in reply to you - rest of post was just me rambling!!

[Boris Karloff]

Yeah - but can you blame patients/parents going to A & E when they are being provided with a 'service' like this from Melbourne Grove Concordia? They ONLY offer you a phone appointment with a nurse?! I know one of the nurses there and they have been put under massive pressure from management to implement this dodgy system, with loads of complaints. As a result they raised it themselves with Tessa Jowell, the PCT (who regulate practices and gave Concordia the tender) and the Patient Forum - but no one has doen anything! Incredible.

When General Practices are run by private companies - such as Melbourne Grove Medical Practice run by Concordia - profits and governmenet targets will come first. Full stop. Anything else is of secondary importance.

What amazes me though is that no one on this forum has suggested a simple solution - CHANGE GP! CHANGE GP!! That's what I did. The Gardens or Nunhead Grove both in East Dulwich are great practices where you get to see a GP (great GPs too) without any of this telephone/seeing a nurse stuff - God knows what important medical things these people are missing by operating this way.

You are not bound to your GP - you can move and because of the way GPs are operating now, under government initiatives, most GP practices have 'open' lists - they want patients to join their list. So if you are apathetic and stay with a practice that you are complaining about, then don't complain. or MOVE!!!

[Cassius]

Changing GP is NOT always the way for everyone. I have back problems which are dealt with by a particular doctor at Melbourne Grove by dry needling which had done me more good than any other technique - not many GP's offer this.

Also I have build up a rapport over many years with the staff there - especially a couple of the nurses and one or two of the GP's - why should I have to go through all the hassle of finding another surgery (especially one that offers good times for those of us who work AND is right next to the train station).

I don't like the new regime, and it is VERY new - but as I am lucky enough to only need to use the doctor infrequently at the moment I am prepared to put up with it for now.

[Boris Karloff]

I do take your point Cassius, and I can see that if you have a very long relationship with a particular GP/GPs, or maybe with lifelong illnesses etc, then changing GP is not an option. I suppose I was think ing that it's not so much of a big deal to change GP if someone has barely seen the GP they are registered with.

... either way, as a more regular attender, I'd be interested to hear about your experiences of the new telephone appointment system at Melbourne Grove, because I guess the final answer will come from whether they are able to continue providing you with the service you are used to?

[Cassius]

As you say Boris - we are all entitled to vote with our feet. I will give the new regime a chance before I make judgment.

[bignumber5]

It's a rant-y one, so advanced warning:

do the gp,s still not come in ,in the evenings to take all the primary care stuff in minors and paeds?

Not exactly voluntary, tho. PCT funded it may be, but there's more primary care work to be done than that covers. And half the time the shifts are unfilled, so A&E regs (trust budget) cover.

Interesting point about culture of service use/abuse: worked in NZ for a while, and there emergency care is free, gp care costs you. Yet people still went to their gp. And if they did come to A&E with primary care issues, it was to ask a) do i need to see one of your doctors, or should i see my gp? or b) i've got a gp appointment booked for the end of the week, am i safe to wait that long, could i have some advice about painkillers to keep me going until then etc. And if you gave them advice, confirmed that they were safe to wait for their gp etc, the response was "thank you nurse, that's great, sorry to have troubled you."

The situation here is that to refer someone from A&E back to their GP is refusing them treatment, I know my rights etc. Despite the fact that the legislation exists to do so: the 2003 DOH document on "Streaming" (new-speak for "triage") states that there are 5 areas that the streaming nurses may allocate patients to: resuscitation, major treatment, minor treatment, Primary Care and Self Care. these last 2 are rarely used, for 2 reasons. As already alluded to, the British public "know their rights" and and go ballistic, and that health professionals in this country are scared of complaint/legal action and are covering their own arses. Bringing GP cover into the dept was supposed to encourage triage/streaming nurses to use the primary care area by bringing it on site, so you wouldn't be "sending people away."

A&E is fast becoming overwhelmed because triage nursing has become largely about defensive practice. Many moons ago, when I was new to the dept that I was in, I triaged someone away and one of my colleagues felt the need to quietly let me know that "we don't really do that here, I mean, you're accountable for anything that happens to that person now, aren't you?". Big debate ensued.

The culture of service use/entitlement in this country is, to my mind, a major factor in UK healthcare. Clinicians have a butt-load of responsibilities but no rights, patients have rights but no responsibilities. If patients had the responsibility to use the service appropriately, as directed by the professionals working within the system, and triage nurses were supported in their allocation, A&E waiting time headlines would be a thing of the past, and primary care would be forced to admit that it's current service is hopelessly inadequate. A&E has been overhauled in the last 10 years, and is now quicker and easier than a GP. That doesn't mean that it should be first port of call for everything - GPs must follow suit in becoming more accessible. In NZ, the Emergency Dept was quicker, easier, and cheaper (ie. free) but people didn't turn up in the middle of the night, pissed, with a cough that they'd had for 2 weeks, just because they could spare the time to wait for a couple of hours just then and that was more convenient - they wouldn't dream of doing that, because it was the wrong place to be, and that would be incorrect use of the service.

The NHS is on it's arse for a number of reasons - and I think opinion will always remain divided on how to right them: more money, centralise vs foundation trusts, privatise and so on. But the system is set up for use in one way, and is used in another. Either the system needs to change to accomodate the use, or the use needs to change to fit the design of the system. Otherwise it's square-peg-round-hole, changing the hammer wont help.

[Mrs P]

Just been reading through this thread and glad that it did eventually get pointed out the melbourne grove surgery has been taken over by a private company - in my opinion this makes it very different to your normal GP surgery (which I will admit may not be perfect but I think this due to a mismatch between the patient's expectations (e.g. I pay my taxes/your salary and I'm not feeling very well and want to be seen now and no i can't come tomorrow because i'm playing tennis (sorry, very stereotypical)) versus the reality of the system (e.g. this patient is more ill and takes priority right now))

I am a doctor and I have worked in A+E, GP, hospital and now in the primary care trust (statutory body responsible for delivering health care and health improvements to their local area) - but not, I hastily point out OUR local PCT, so it's not my fault concordia got the bid.

As such I totally believe in the aims of the NHS and fully support it although it is less than perfect to be a patient in and a nightmare to work in. My husband has private health insurance through his work which I could also have but I refuse on principle - I don't think that I should work on providing a healthcare system if I don't have any interest in assuring its quality because I am safe in the knowlege that I can go somewhere else if I get ill - it's a conflict of interests like a private company running a GP service. I also do not believe that the internal markets work within the NHS as health is not a commodity - it is a right.

I agree with previous clinicians' (!) comments about the difficulty of diagnosing over the phone and would not like to do this myself. I do think this is an efficiency (aka money saving) drive.

I would also like to point out that GPs (or any doctors) earning ?100 000 is not that common and usually involves being a partner in the surgery or a consultant which requires huge monetary investment on your part and years of work after years of medical school and training. No one goes into medicine for the money - ask any junior doctor - basic salary ?22000 after 6 years of medical school and untold student debt.

I am a patient at melbourne grove and being generally fit and well have thankfully not had to use the system very often. When I have it is been dissappointing at best and my latest experience, coupled with the fact it has been taken over by a private firm, a move which i personally object to, has convinced me to move. It is a business: it hit where it hurts!

[bignumber5]

Well said, Mrs P!

[Boris Karloff]

Couldn't agree more, Mrs P - shame you're not in charge of Southwark PCT - a bit of common sense is just what they need - it's a travesty that they gave the tender for melbourne grove to Concordia.

I also thoroughly agree that Concordia Melbourne grove is just a business, so people should do what they do with any other business they don't like .......... take their custom elsewhere.

Check these out:

http://www.southwarknews.co.uk/00,news,8709,440,00.htm

http://nhsblogdoc.blogspot.com/2008/02/something-is-rotten-in-state-of-denmark.html

Sad really

[Cassius]

Well finally had to make the call for an appointment - to be treated by the receptionist as if I was a semi-criminal at least. When I pointed out that I might be in a meeting or not at my desk when I was called back I was roundly rebuked, and told I would have to call again if that happened. After being at this practice for over 20 years since the heyday of Dr Grant, I could cry at the treatment I now have to put up with in order to get an appointment with my doctor. I KNOW what is wrong with me and I even know which doctor I should see about it, but that is no longer good enough. In fact because I got a bit stressed and upset on the phone I expect that my message won't even be passed on.

[bawdy-nan]

That's awful Cassius. Is it worth making a complaint - to them or to the PCT? I know that doesn't help you inthe first instance.

It sounds as though they are really getting it wrong there.

[cathg]

definitely seem to be teething troubles to say the least. i rang to make an appointment for my daughter, had a prompt consultation with a doctor and was given an appointment for an hour later. I then realised i couldn't get her there due to work so I rang back to rearrange the appointment for later in the day and was told I would have to have another phone consultation before new appointment could be made. Eventually common sense prevailed and I was given a new time without speaking to the doctor again, but the system clearly has some glitches in it at the moment.

[first mate]

I too have just asked for an appointment and was amazed to be asked by the recepetionist what was wrong with me and then to be told I would be telephoned later by a doctor, who would assess if I needed to be seen. I have been with Melbourne surgery for many years and have to say that this seems an absolutely loony system. If I see a doctor I wnat to see them face to face not to discuss symptoms overthe phone. Not wanting to sound paranoid but I think there is a huge confidentiality issue here. I suppose that next they'll be outsourcing consultations to call centres or doing them over Skype. The doctor /patient relationship has to invovle physical proximity, surely. Many people find it hard to discuss ailments and a valuable part of the assessment processs involves the doctor being able to look at you and to examine you.

If this continues I'll be voting with my feet.

The recptionist told me that this system was being "trialled" elsewhere, couldn't be more specific though, and that the sytem had proved popular and succesful. Does anyone have evidence of this?

[Cassius]

Well -I've got my appointment however it would have been a very different matter if my symptoms were, shall we say, of an intimate problem - what is one to do then? Not everyone is in their own office or can just pick up their mobile and find somewhere private to talk.

[first mate]

Cassius,

Glad you've got your appointment, but glad you also emphasised the point about confidentiality re intimate problems etc.. What are you supposed to say over the phone if you've got say: erectile dysfunction; bowel problems; post natal depression; bad skin......?! The list goes on and on. Even if you can find a quiet space to have the phone call it still doesn't feel comfortable or right to have to discuss very private matters in this way.

In addition, when the receptionist asks, as she did me, "what's the matter with you", one is inclined to say that's between me and the doc, or words to that effect. A receptionist subjected to constant rebuffs, however gentle, is going to get p***** off pretty quickly, and that doesn't help either. Still say it's a truly loony system and could only have been invented by an organisation intent on saving pennies where it can.

[bawdy-nan]

It does sound pretty hopeless. I'm not against being able to speak to a doctor on the phone. I've done this a couple of times and its been very helpful. Once when I had a sick child, didn't wnat to drag them in but wasn't sure it warranted a home appointment - I really wanted some advice and an idea of when to make an appointment if things didn't get better. When I've done this with NHS direct its been pretty hopeless and I've pretty much always been refered to casualty. Once, to my horror, they sent an ambulance even though I insisted we didn't need one, could get to casualty easily and I was very clear it wasn't a life or death situation (my baby had bronchiolitis).

Another time I'd been to the GP with a fever and bad cough. We'd agreed to postpne anti-biotics in case it wasn't necessary. After a few days it was getting worse and worse as was my fever - I was able to speak to a GP and arrange a prescription to be collected.

From my perspective this worked really well and saved mine and the doctor's time.

On the other hand its sometimes totaly inappropriate and the approach you describe sounds wrong and not at all patient friendly. It surely favours those who can make a strong case for why they need to be seen. I'm sure some people must just get fobbed off and those with things difficult to describe or that they keep putting of will fall through the crack.

[first mate]

BN,

Agree with you that if you have a specific and clear cut acute illness then the phone approach can work, after all we have NHS direct as an example of consultation by phone. Also, guess we would all feel quite happy to discuss pretty much anything to do with our children over the phone, somehow it doesn't feel intrusive or threatening in the same way.

They might consider offering phone consultations for those who feel they can work with that system, but ultimately let the patient decide whether they need to see a doctor or not. I don't think that there are many who want to waste the doctor's time with petty stuff...though there will always be a few. Perhaps they need to think this this new system through a bit more. Wonder if anyone from the surgery reads this?

[glau]

Silly question really... but having been with mgmp for 18 years now as a family, we finally are also considering to move - but if we move to a different practice, will our notes follow us? The practice saw us through the birth of the children, some chronic or ongoing health stuff and only the idea of having to start all over again is holding me back.

Has anyone actually changed gps?

[ratty]

Yep - your notes go to the main office (Waterloo) and then get sent on to the new surgery. Actually this may have changed now but they definitely move with you!

[lajburns]

Hello,

I'm writing an article about this for the South London Press and I'd be really keen to hear about people's experiences with this pilot scheme.

And any other issues in the East Dulwich area for that matter!

My number is 0208 710 6437 and my email address is [email protected]

Cheers,

Lindsay, SLP reporter

[glau]

Thanks "ratty", might take the plunge. Any recommendations for GP 'best practice'?

[Michael Palaeologus]

The Gardens Surgery is very good in my experience.

[Peckhamgatecrasher]

I second The Gardens.

[CamberwellOz]

I have been on hold with Melbourne Grove for 10 minutes and now the phone just rings out..... APPARENTLY they are open to 7.00pm but it seems that 17.45 is a much better time to ignore my calls. (6)

[CamberwellOz]

Right... the lady said they are going to call me back tomorrow morning at 9.14am??? Errrr....

I would like a good GP to move to please. Any recommendations?