/ 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

I am fortunate not to have had a problem with our GP service for many years. When the children were young we had a poor and abrupt response from one of the senior partners when he did not feel our child was ill enough to see him. I went back home and wrote him a letter (my wife insisted it should be polite in tone) explaining how bad we were treated..

A couple of days later, during the Christmas holiday, he personally, dropped a very nice apology letter in our letter box. He asked us to call to see him if we were not happy with his explanation and apology.

We never had any problem since..I recommend approaching or writing to the doctor or nurse who you feel has let you down first. It should work, and if it does not then you have the option to go further up the line!.

My G.P. surgery has a Patient Participation Group but it is very difficult to get patients to join the group so if patients have questions about how their Practice is being run, they have only to either join the Group, or talk to a member or speak to their doctor. However few take the trouble preferring to just moan to their friends!

if my practice had something like this, i would be willing to join (provided that any meetings were at a time when I could attend without taking time off work)

In the past thirty years or so I have had been with GPs I would rate as very poor, fantastic, adequate and very good (my current GP). In each case my view has matched very well with the opinions of others who have used the same GP/practice and I chose my current practice as a result of recommendations from friends and neighbours. The practice is run very efficiently and I have been equally happy when I have had to see another GP.

The very poor GP gave potentially dangerous advice and I regret not having reported her. She also failed to report a problem with a recently introduced drug via the yellow card system.

My fantastic GP would see me any day without an appointment providing that I was prepared to wait until the end of his surgery. The majority of his patients were students so I doubt if he had to do any house visits. He was genuinely interested, well informed and up-to-date with the options for treatment of asthma and other conditions I suffered from. I once met him in the local Tesco and he asked me about something I had consulted him about earlier in the year. The PCT announced its intention to close the one-man practice and despite a campaign by patients the practice did close.

I advise anyone who has a choice of local GPs to ask friends for their views. There may be useful reviews of the practice on the NHS Choices website:
http://www.nhs.uk/Pages/HomePage.aspx

My only gripe with my GP service is the length of time I have to wait to see my own GP – about two and a half weeks, Most of the GP’s in the practice work part time and they do not advertise the shifts they work, I like to see my own GP as I have built a good relationship with her over the last four years. For a non urgent appointment, with another Doctor, I usually wait about ten days.

I feel that I get a very good service with my GP, she listens to me and is proactive in sending me for blood tests and in one case to see a consultant. She is now going on maternity leave, so I shall have to see someone else in the next nine months.

We have to wait 3 – 5 weeks to see our doctor of choice. It has always been this way. Why can’t they make an effort to reduce this ridiculous waiting time?

They then wonder why they have so many missed appointments!!!

Dr C Fleming says:
5 April 2013

No,Alfa,it has not always been this way! See my post of 23rd March!! Blame the (now abolished) PCT bureaucrats for enforcing this system!!!

Kajka says:
17 March 2013

I had a problem with GP few years back since then Im trying not to go there at all and rather found homeopath/naturopath.
I was with children who had streptococcus A. I had angry throat, couldnt eat I was in great pain and weatk. In practice i visiting its hard to get appointment with the same GP. So first one just looked at me and gave me antibiotic without any tests just by look. Once i finished them (still not be able to eat properly cos of pain) next day i had to go back as it was worst then before i started to take antibiotics. GP laughed in my face and send me home that it will takes time for antibiotics to start working. Thats was saturday. On Monday I went again. Another GP again just prescribed me antibiotics again no tests or check. One week later I was lucky finally. When I went in following Monday, angry and tired, I luckily got appointment with a GP who cared. I came in, she looked at me and without me talking to much she asked me if i had any test done when i told her that i just keep getting antibiotics, she start with test and check me properly. She again gave me antibiotics and when i kept asking and crying to do something so i can eat to get pain away she suggested to get echinacea drops. Those drops made wonder!!! Unfortunately GP got sacked few months later because she was suggesting as well medicine like this. 3 months later I had horrible reaction to antibiotics. My hands and legs especially the joins got swollen and hurt badly and I needed my partner to look after me (dress and feed me). When i went to GP practice, another GP said its just reaction to antibiotics, Just by look at me and gave me strong painkillers which were useless. Didnt work just made me .sick.m I stopped them I had some herbal cream for and that cream did wonder. Once i put it on half hour later it was hurting less, two hours later no swelling eased. Since this I had similar experience with my son so I just go there when i need blood test which now is useless as they dont do whole tests.

Why can’t we choose which doctor to see within a practice? Okay, it would mean long waiting times for the best doctors, but it would be possible for them to reserve time for emergency appointments.
I expect you could change once, and you would be allocated to the either least popular doctor, but you couldn’t change again.
I’m with a good practice,but I feel that my doctor dislikes me. Honestly, I’m not paranoid. I don’t think everybody hates me. Perhaps he just dislikes old women – he wouldn’t be alone in that – or it might be a successful ploy to deter me from seeing him when I am ill.
It does work but what will I do when I suspect I am dangerouldy ill?

You would have to ask the practice to get an answer to your question. My GP only works two days a week, so if I need an urgent appointment it might have to be with another doctor. When I ask for an appointment they offer me a choice of seeing my own doctor or any doctor.

Michael says:
17 March 2013

GPs are behaving like solicitors, no one to answer for a poor services, need a better regulator immidatly to deal with them.

par ailleurs says:
18 March 2013

I suppose it’s in the nature of any profession that it will contain good, bad and indifferent practitioners.It’s just unfortunate that a bad GP will have potentially devastating effects on your health.
I make a point (being thankfully free of any chronic problems) only to see a doctor if something is clearly wrong and shows no sign of righting itself or not responding to over-the-counter remedies, or homoeopathy/basic herbal treatment. This has always stood me in good stead over the years and the GP knows that if I turn up then I’m not wasting his time and takes me seriously. It also means that I only ever take medicines if really needed and haven’t yet joined the army of pill poppers who can end up on long term medication and having to take pills to obviate the side effects of the the originals and so on into an ever increasing circle if very unlucky. This has become a widespread problem, particularly in the elderly.
It is possible to chose which GP to see at my practice if the appointment is relatively non urgent. Waiting times for the appointment are also acceptable and flexible. I count myself lucky to live in a semi-rural, relatively prosperous area where there isn’t a huge amount of social problems which must make some GPs’ lives intolerable.
The point made by Michael is a valid one. Complaining about poor service, let alone malpractice, is tortuous and difficult and will be beset with many obstacles on the way. I’m lucky enough never to have had the need to complain but have heard of others who faced nearly insurmountable difficulties from medics who rapidly close ranks.
Finally though I think that many of us complain too much about GPs’ services. Theirs must be a difficult and often thankless job. Whatever their faults I’m still very glad that they’re available.

Dr C says:
18 March 2013

I hope this article opens up a debate with the public and profession on variable quality in primary care.
I would like to make some points.

1.All GP’s are experiencing demand going through the roof and even using new technology such as telephone/skype/e mail will not be enough for a service that is free at the point of contact, an ageing population and with more care being shifted from hospital to community.
2.No doctor, having fought through to some of the most contested training places in the UK and the ensuing further demands, sets out to be a bad doctor.Lets look at the factors which allow it to happen and take steps to prevent it…

tristan says:
18 March 2013

I’ve had very variable experiences.
On the low end – a Doctor who just didn’t care and treated you like you were an inferior being. He did have a fancy desk though. (his reception staff were not at all surprised if you asked to see someone else – unfortunately it was so common, the other doctor’s had no free appointments).

On the better end, I now have a GP who is very thorough and will spend as much time as she thinks she needs to – the downside is that she is always running late…

Jan Bryan says:
18 March 2013

My GP’s are a Group Practice and cover everything from Baby Care to Hearing Aids. They also offer Welfare Benefits Advice. I have been with this Practice since I was born in 1955 and have seen Doctors come and go. Some were average but the majority were and are brilliant.They run a brilliant system. If you need to see a Doctor urgently, you ring after 8.30am and will book you in for later that morning. You have to ring a few times to get through, but if you cant, you ring after 9.30am and make an appointment for later that week. The waiting times have reduced drastically and the longest I have had to wait is 30 mins. My Docs are caring, professional and willing to go out on a limb for you. However, I have heard horror stories from some of my friends who live in different Boroughs. I witnessed one Doctor tell my friend to leave as her time was up. She has a number of very serious illnesses and she was not being cared for properly, so much so that I wrote to her GP and threatened her with the GMC. She pulled her socks up a bit after that and takes my friend much more seriously now. Her care is still not what it should be but she can get in to see the GP much earlier (she sometimes had to wait 3 weeks). She then spoke to her Pharmacist, who is brilliant, and asked him if could recommend another GP. He told her to stay where she was as the others in her area were worse. Scary!!!

This is an important study – I think the focus of this conversation needs to shift away from GP’s to a more meaningful debate about the system within which they work. The 10 minute consultation has not changed for decades …and yet the demands placed upon the GP within that 10 minutes have soared. The system has been shaped – by politicians – in such a way that if GP’s (and other health care professionals) do not perform like monkeys and fill in all the tick boxes then they don’t get paid. It is this single factor that has deprived the health service of the care/compassion that people once valued. Health Care Professionals do not need to be trained to be compassionate – I have never heard anything so absurd!…it reflects the profound ignorance of people making these statements. They have created a system that does not allow health professionals the time and freedom to be the caring professional they would so like to be. It takes time to sit and listen quietly and calmly …to allow the patient to talk freely…to ask questions …to think …to make shared decisions….all of this takes time, which is now given over to filling in templates and asking targeted questions to meet targets. There is strong evidence now that the Quality Outcomes framework has done very little to mprove health outcomes…yet it remains in place. Beyond that, regrettably government, media and the fragmentation of society have resulted in a culture of learnt helplessness – so the system becomes swamped by demand for trivial minor illnesses. In days gone by it would be nconoceivable, to see someone with a sore throat in a surgery – many people now demand to be seen within a few hours of the onset of the slightest symptom. So…is it any wonder that it is hard to find a GP who stays in practice for very long? They trained to care for people and to be able to make a significant difference to their lives – the current system pushes them far away from that. More and more GP’ s are opting to become sessional locums because it offers them a way put of the system whilst allowing them to practice as doctors. And it is going to get worse…now GP’s are being asked to manage primary care budgets and commissioning – even less time to focus on care and being caring. RIchard Lloyd’s comment in the article – that the new changes will offer an opportunity for patients to be heard – is odd: we already know and have known for ages what patients want – continuity of care and prompt access to care when they need it. You can have all the feedback in the world but if the system cannot respond to it then why bother. I stress that it is the system NOT just the GP’s that need to respond. The truth is that the until people are given the truth about the NHS and its limitations then things can but get worse – patients will not understand why their GP asks them irrelevant questions and has no time to listen to them and so make correct diagnoses and treatment choices. It is time for honesty and transparency from government about the limits of the NHS and a realisation/acceptance that current system and proposed changes are seriously flawed, time for a new sense of responsibility and confidence in self care from users, and aowerfulshift away from medicalisation and over treatment. Then…you will see all those “bad” GP’s become the people they really are – caring and compassionate.

Dr C says:
19 March 2013

Well said JM.
Tick box and targets make some people feel safer.You can point the finger of blame more effectively.You can measure it and also reward/ punish.
But as we have seen with mid staffs it can produce awful cultures where the result is an opposite of what it is meant to achieve ..ie better patient care.
There is a major crisis brewing in primary care.I gather that less young doctors are choosing it as a career route.

Lesley Beale says:
4 April 2013

Well said JM! If there were only more people like you!

Thanks for all the comments. You might be interested n our separate survey of patients. We uncovered a widespread reluctance to complain. More than half who said they had experienced a problem with a GP in the last 12 months told us they didn’t complain. And of these, more than a quarter thought complaining could lead to worse service or treatment, and just over half thought nothing would be done. What do you think about that? Do you complain?

I have complained and been deregistered twice this year realiseing LA/ PCT have taken over the directing via contracts & as a result having to move out of London, after paying £300 to a Surgeon expert in Harley Street who wrote to GP & Specialist to refer to him on NHS as very complicated [ Insurance companies regard as long standing NHS Low Priority??]This was to Specialist who said not his remit the complications of my disability the NHS ignores . They pretended then returned to specialist who said complications were not his remit Using invented incorreect letter from a PA said would be wasting tax payers money as had all tests done .He contracted in Specialist NHS had also done this regarding haematuria the year of my cardiac arrest never having been referred . The Surgery before had been writing hallicinating dillusionary on weekly visits with classic heart symptons & evidence . And I had someone legally qualified meeting same problems them as they were refusing to let me get a second opinioneven privately
This time had pyuria count of 80 I was a begging at the A&E s they transferred to Urgent Care not testing for sepsis to Arabic Dr saying her hands were tied When raised this with Harmoni the Irish Clinical Manager maladministrated the issues. Issues such as negligent online medical records. The latest ones have been writing ranting when explaining about history & emergency symptons . If hadn’t self medicated [ told not to] could have been fatal.
I have been silenced on these panels & Link . If you complain they maladministrate deliberately .As for GMC & Medical Ombudsman & Dept Health Care QC They have a lot to answer for & have allowed no hippocratic oaths? I wonder why?

The Government are blinkered & need to restructure back to amore ethical system . No care in the Community by lay people offering swimming is not it.In my Borough Islington no etthical decent Dr could operate on its dangerous policies so it buys in the not fully qualified operating unreasonably under their direction .

After making positive comments about my own GP practice, near the top of this page,I might soon be making a complaint.

I phoned today to book in for my annual medication review and to have blood test repeated after being on a different medication for a couple of months. The first appointments that reception could offer were in 3 weeks (20 days to be exact). Tomorrow morning I will ring to say that I need a repeat prescription and cannot wait until I have seen my GP.

I’m not ill, but I have never waited three weeks to see a GP in my life. I look back fondly to the time when I could be seen any weekday at the end of morning surgery. The PCT closed down that practice because it was ‘outdated and inefficient’. 🙂

Are there any rules about the maximum delay between booking a non-urgent appointment and being seen?

Last April I requested a repeat prescription by post. The slip was returned to me and someone had written on it “No repeat until after review” or similar. I went in to complain and was told that this should not have been sent to me at all. they did me a repeat prescription and made an appointment for my review approx 5 weeks later as it was non urgent.

I had a problem when ringing the surgery to make an appointment phone ringing and not getting through to speak to a receptionist and when I finally got through being offered an appointment with my doctor in two and a half to three weeks. When I complained about this, I was told I could use an online Patient Access to book my own appointment. I have done this for about a year and it has worked very well. By doing the booking myself, I can see how few appointments are available and the few shifts worked each week by all but two of the Doctors.

Should I complain because there is not a roster online or in the surgery, showing the shifts worked by all the doctors.

Dr C says:
20 March 2013

Do your practices offer telephone consultations?
Could the problem have been dealt with in this way rather than face to face??

No, I have to see my own Doctor every three months for blood test results and medication review. Booking my own appointments works very well as I do not have to wait ages to speak to a receptionist. The problem is the few appointments available for my own Doctor because she works part time. She is going on maternity leave shortly so I will use the opportunity to try out other doctors. There are two male doctors and the other six are female, only the male doctors work full time and I don’t really like either of them. My previous doctor retired four years ago, he had been my doctor for nearly twenty five years. He worked full time, gave all the time necessary to his patients and because of this, his appointments always overran. His long time patients did not mind this as we realised that we may have needed that extra time on our next appointment.

It is good having so many female doctors in the practice but it means most work part time due to family commitments.

Dr C says:
21 March 2013

Sorry Figgerty,
But i am intrigued that they need to see you physically every time…medication reviews can be done electronically on the computer and blood forms pre printed…

That is what I thought in the beginning but my Doctor and my previous one were adamant that I need to be seen every three months, I have a serious condition which was diagnosed in 2008 and I need to be monitored closely, that includes talking about how I am coping mentally with the condition as well as changing medication as necessary.

I only hear of telephone consultations when a patient is requesting a home visit or when someone has a query about medication. Maybe other consultations take place by phone but I am not aware of them.

Until recently my surgery claimed to offer an online booking system. However, whenever I logged on, I got a message which said “No appointments available. Please contact the surgery”. I only once managed to book one in this way and eventually gave up.

Jayne says:
28 March 2013

It’s a very easy appointment for the GP, a lot of them do all the time.

Why are we having to wait up to three weeks to see our own GP?

In my practice there are two men GP’s who work a full week and seven/eight women GP’s who only work part time, one of them works one day a week. I realise that it is due to maternity leave and other family commitments that the women are unable to work more shifts but this leaves us patients at a disadvantage if we wish to see our own woman GP each time. It is a catch 22 situation, have a much better woman GP and wait up to three weeks to see her or have either a flippant or brusque male GP and be seen in about a week. For routine appointments, I choose to wait for the woman GP. but if I need an urgent appointment, then I will see any GP, even a man!

Alec wood says:
22 March 2013

Our practice is involved in a project run by NHS Wirral and Chester University to set up a weblog and facebook page for Practice Patient Groups to facilitate dicussion and feedback of views and comments to the practice management team. Our blog is at http://ppgegp.wordpress.com/ and the results of the latest patient survey and the practice management team’s response and Action Plan can be found on the BLOG page. There is a link on our HOME page to our Facebook Page. This is a new initiative in its infancy but the idea is that through Facebook “likes” copied automatically to “friends and friends of friends” each Practice will eventually attract a large patient following reaching and listening to patients that it would not normally be in contact with.

Fed up says:
22 March 2013

At our 2 man practice one of the Drs is constantly going on Sabaticles or holidays thus leaving , ok the much better of the 2 GP’s, to cope on his own. He is the much preferred GP anyway due to his pleasant and caring manner and therefore his workload is huge at the best of times. The crunch has obviously come and sadly he is now leaving, I wonder why?? And 2 part timers are coming instead, I wonder if they know what is in store for them!
There should be a limited amount of time that any one GP can take off in any one year thus keeping continuity for patients and a balanced work load for the partners, even if it is the senior partner.
This guy seems oblivious to the feeling in the town towards his easy come easy go attitude and the reassure it put on everyone else in the surgery. IF people did wite comments about the running of the practice I doubt he would see it as caused by him. We are now moving practice as we are unsure what the future holds and like many others refuse to see the only now remaining full timer, due to his appalling patient skills, that is if he is even there!

Many are being forced to work 2 surgeries by corporate LA directing them . Does LG Ombudsman want to know Just had the overall Manager with brain fog .Uncouth was the word. Employing GPs without a hippocratic oath says it all .