/ Health

Are some GPs failing patients?

Cartoon of doctor running

In our undercover investigation of GP practices, we found wide differences in the quality of consultations. We also found that many GPs are not acting on patient feedback. How does your GP treat you?

We sent trained undercover fieldworkers into 30 GP practices across England to assess the consultations given to patients, and found huge variability in diagnosis.

Our expert panel – including three GPs – rated 12 of the visits poor, while 14 were good and four were satisfactory. Consultation times varied greatly, taking anywhere from three to 20 minutes for the same patients with exactly the same symptoms. There was also a significant correlation between the quality and the length of the appointment, with all 12 ‘poor’ consultations lasting eight minutes or less.

Hasty healthcare

We’d all probably agree that GPs work hard to do the best for their patients, but it’s worrying that people with the same symptoms could have such a different experience when they visit their doctor. You can see an example of this in our undercover video footage:

http://www.youtube.com/watch?v=yrwIIq6AyI0&feature=youtu.be

This is something I’ve experienced myself. Sometimes I feel like I’ve had a great consultation and other times I can see that my GP is so rushed that she just needs to move on to the next patient.

When I spent a day with a GP, it was interesting to see how just one patient, who needed emergency admission to hospital, threw the whole day out, leaving other patients with long waiting times.

Voice of the patients

In a separate survey we asked GPs how they use feedback from their patients. We found that half of GPs don’t review patient feedback from the national patient survey and a quarter don’t discuss patient feedback at staff meetings. Worryingly, two in five said they don’t change policies and procedures based on the feedback they receive.

Hopefully the changes taking place in the NHS, with new regulators and patient groups being set up, will ensure that patients’ voices are being heard and, most importantly, acted on.

Does our research fit with your own experience? Are GPs at fault, or is the system failing? Could GPs improve by simply listening more closely to their patients?

Comments
Profile photo of jimbo123
Member

trying to get to talk to the pope is easier

Member
Dr S says:
25 April 2013

Thank you Which for your article which, as a practicing GP and GP trainer, I think is a fair and balanced assessment. The answer is clearly Yes!
I agree that patients are generally good at assessing the quality of consultations. One current mechanism for driving quality is supposed to be patient choice ie theoretically as patients move from weaker practices to practices perceived as ‘good’ these will gain income and be able to grow. This market is supposed to drive poor performers out of business. What is striking however is how few practices have gone out of business despite 10 years or more of this market operation. Even though patients increasingly are exercising choice; as your work shows this market is failing but no one seems to have picked up on why.
One factor is the relative under supply of GPs which limits choice but this is hardly likely to change in the financial circumstances but there is another.
What happens is that in areas of wide variation in GP quality, high need patients in poor practices experience poor service and so switch practices. Low need patients don’t use the practice much and so don’t switch practices so often. Consequently the popular practices gain significant increases in workload but only see an average increase in income as capitation fees are based on average need. As a result popular practices experience a level of demand disproportionate to income. Poorer quality practices suffer some drop in income but a bigger drop in workload as high need patients leave and so actually become more profitable per patient! If you look at QoF data on a local geographical basis you will sometimes find very wide variations in the more demanding diagnosis types such as depression / learning disability /dementia between some neighboring practices, which is consistent with this hypothesis. There is an urgent need to calculate GP budgets on the basis of actual need rather than on the current mix of historical precedent and a formula that only works reliably for much larger populations and which take little account of demands actually faced by practices. (It may surprise people to learn that a practice will be paid exactly the same amount to care for a 30 year old fit businessman who never sees his GP as a 30 year old man who suffered meningitis with permanent brain damage at the age of 2 and is now bed bound needing 24hr nursing care in the community.. and a lot of GP attention.)
The market then might start working in favour of both patients and the sort of doctors they prefer to see.

Profile photo of wavechange
Member

GP practices are often criticised because of difficulty in making appointments, yet these practices are still accepting new patients. Something is clearly wrong for this to be permitted.

Profile photo of katejo
Member

My current GP practice has a strict catchment area. Does this mean that the practice is not allowed to reject new patients provided that they live within the area concerned ? Where else would they go ?

Profile photo of jimbo123
Member

why is it when i get what they say is a emergency appointment is there only ever me there

Profile photo of moudi
Member

Would it better if we all had vouchers to buy appointments with the GP and Practice of choice?
The NHS will remain a conveyer-belt system especially as public spending is being capped or cut.
Where is the choice when people are lying on trollies waiting for beds?

On the other hand, when my son sprained his wrist whilst on holiday in Florida, the bill for seeing a doctor (for no more than four minutes), having a bandage and a prescription for Brufen resulted in a bill for $1800.

Wander how it is done in Germany or France! Do they have better service and more choice?

Profile photo of Menz
Member

I recently visited my local GP as i was suffering from severe depression. during my appointment I told him that I had recently found it hard to even get myself out of bed, and had spent the previous weekend laid in bed and thinking of ways in which I could commit suicide, I was so low!
The doctors response was that he “didn’t like to give out tablets, so just go home and try to cheer up”!
At the time, I was so low that I didn’t want to ask for a second opinion or make a complaint, and so I just left it at that. It wasn’t until a few months later that I decided to make a complaint to the Practice Manager, and had a 10 minute conversation with him on the telephone. During this conversation, he denied that I had ever had an appointment with the doctor in question, and told me that he would write to me within 10 days to let me know the next steps in the complaint procedure. That was roughly 4 months ago and was the last I heard from him!
I recently went into the surgery to pick up an official complaints form, but have not bothered to fill it in, as I have lost all faith in the surgery and its staff!

Profile photo of Figgerty
Member

I hope you are feeling improved by now and in better shape to meet the challenges of each day. If you are still very depressed, get an emergency appointment with another GP in the practice and ask to be referred to a councillor or therapist. He may suggest other treatment, but telling you to ‘go home and cheer up’ is just not acceptable treatment.

I hope you completed the complaints form as only by complaining can you register your dissatisfaction with the surgery. Also take a copy of the complaints form before you hand it in, as they may ‘lose’ it.

You can also access your surgery on NHS Choices and detail your unhappiness on your treatment by the Doctor and the Practice Manager. The Practice Manager should reply to your comment. Other patients are able to see your review and prospective patients often check this website when they are looking for a new GP.

I wish you good health and good luck.

Profile photo of Figgerty
Member

I now have to wait three and a half weeks for a routine appointment at my GP’s surgery. The extended wait is because two of the GP’s are on maternity leave. Terrific to have women GP’s but their family life impacts strongly on their patients waiting times. The two male GP’s are not very popular, one barely gives you the time of day and the other is very jovial – opposites indeed. I try and avoid both but may have to see them if our 5/6 women GP’s continue to be so fertile.

Still, things could be worse, see this article on a grandmother’s quest to see her medical records:

http://www.bbc.co.uk/news/uk-england-beds-bucks-herts-22057826

Profile photo of jimbo123
Member

i have just read about prince phillip who just nipped in to a HARLEY St clinic to get a quick opp yet i at 56 have been told by 3 NHS quacks that know one is prepard to opperate on me at 56 years old so go home and die well thanks allot what does that tell you???

Profile photo of julieshrive
Member

My new GP who I haven’t chosen[ NHS Constitution] has been ignoring the need to transfer hospital appts to research hospital as moved 100 miles away as so bad where was in London ie: not referring on advice of surgeon / specialist . Thinks physios & Nurses can treat what GPs can’t??!!
The GPs were written to in January .He is believing mad diagnosis from the top of their heads when have had 5/6 acute incidents of excrutiating pain & near paralysis & knows my chronic uti medication can resolve . They are all ignoring the disability found in relation to- spina bifida occulta .The time before last it was pyuria at 80 & Urgent Care refusing to test.This is exactly what happened before cardiac arrest when going in weekly with classic symptons & evidence.They had been recording as mental to cover up negligence now they can ignore. Does Government or Law want to know .They collude by allowing no hippocratic oath .

Member
Ghulam says:
18 July 2014

My Gp Surgery is a Nurse Surgery!
You call in the morning for an emergency appointment without knowing you are expecting to see a nurse.They have one or two nurses and they are specialist in all fields. You tell them you want to see a doctor not a nurse than receptionist will try to convince you if not she will force you to see her specialist nurse instead of a GP. It happened to me three time in a row I’m sick of it now because nurse will tell you she’s a nurse and can’t help much & it’s extremely hard that they refer you for any thing to consultant.
This surgery is called Medici Medical practice on Windsor street Luton at LU1 Post code.

Profile photo of nessa
Member

I have been visiting my go for over 3 years with respiratory problems at night
As my chest Always sounds clear and I have no lymph nodes I have been sent any with more pills for anxiety , none have made any difference and the symptoms are getting worse. As time goes on my mental health is declining and I need help from theatre mental health team . I do not get better in any way because by this time I have done loads of research online and I know I have lung cancer with cushions syndrome . I told my doctor this and she said as I’d had a clear X ray I was totally wrong. My symptoms have got worse and last time I went to see go u felt ridiculed . I am extremely ill bit different one feel I can go to age . Can my doctor be named as indirectly she has killed me and I have 3 daughters and a grandchild
Will I get in trouble if I name doctors involved?

Profile photo of moudi
Member

You should feel happy the X ray and examination were clear, but you are clearly worried by the symptoms you have. I think you can ask your GP for a second opinion or a referral to the chest physician: see this paragraph from NHS choices web site.

‘ You can ask your GP or another healthcare professional for a second or further opinion (an opinion about your health condition from a different doctor).

Although you do not have a legal right to a second opinion, a healthcare professional will rarely refuse to refer you for one’

If you can afford it, you can ask for a private chest specialist referral (GP needs to refer you) but I have no idea how much this consultation would cost.