/ 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 a bit frustrated with my practice at the moment. In early January I received a summons to make an urgent appointment with my GP. I went straight to the surgery to do this and was told that there were no appointments for 2 weeks. One was made but ,when I turned up, i was seen by a different GP who had not been briefed and had not seen the letter which a consultant had sent to the practice. I had to bring my own copy in.
The practice has now told all patients that there will be NO advance appointments from April onwards. Anyone needing an appointment must ring on the day. This is completely incompatible with anyone who is working full time in central London and has to get permission from a manager for time off/arrange rota swaps at work. I can see myself turning up late due to wasting time trying to ring for an appointment. They are doing this because many people have missed appointments. It will result in patients only visiting the doctor if it is absolutely essential and symptoms may be missed as a result.

Beefy two shoes says:
22 March 2013

I belong to a surgery where you take a tag off the wall & wait to be seen
yes there are better Dr’s in the Practice & there are the “wait & see” Dr’s too
I did have a complaint with one of the Dr’s but decided to have it out with her
it happened a few years ago when my Husband’s leg was infected & she said it was ok
hence he had to have his little toe amputated & he was lucky at that as it was first thought
that he would lose his leg below the knee if it hadn’t been for me insisting that he was seen at hospital where he was kept in to have antibiotics
I have worked for GP’s & know how they work – change information on the comp for example to cover their back (not all Gp’s do this)
I think that most are overpaid as a lot of the staff do the quof stats

Dr. Norman White (retired) says:
23 March 2013

One has to start with selection of students. I am told that several universities do not routinely interview candidates. The highest attaining academic students don’t necessarily make the best doctors. I worked in GP for 36 years after training as an anaesthetist. The attitude of any doctor should be curiosity about the symptoms and relationships between life styles, work, and disease.
We are supposed to be doctors (latin for teacher) but how can we learn from patients if we don’t listen to them? “Listen to your patients, they are telling you the diagnosis” Governments must take some blame. They have killed the “family doctor” concept where GPs knew the family and had cared for patients literally from conception to grave. Medicine used to be a vocation where time was irrelevant, where we saw our patients in their environment often out of hours and had a close professional relationship and shared the responsibility closely with our specialist colleagues. Sadly, I hear from friends and relatives that their GP seems to have no grasp of basic or “fail safe” medicine and thinks that the responsibility for health lies entirely with the patient. I call it “do-it-yourself” medicine. Doctors need relieving of the burden of Government interference and bureaucracy. Doctors recruited from all over the world have varied from brilliant to criminal. Their cultural background and language has sometimes created a barrier to best practice. The NHS is really done on the cheap with impossible expectations and it has only been saved by the dedication of many of the staff, for years underpaid and exploited, who tried to maintain standards against ignorant Government interference.

Terrry H. says:
23 March 2013

I am 74. Male. No an over regular visitor to the Surgery. When I do see my GP he is very dismissive usually saying “at your age you must expect/cope with/endure……etc etc” I feel that he has no intention of treating me other than the odd prescription for infection. I would like to complain but fear even worse treatment if I were labelled “trouble maker”.

Perhaps one of the Doctors in this discussion could address this problem.

74 is not old, I would expect to live on for another twenty years if my general heath was good. Perhaps you should say this to your GP the next time he says “at your age …” and say that you want to enjoy good health with his help. Is there another GP in your practice who would respect your age and wisdom and treat the symptoms regardless of age.

I often complain about goods and services but would be reluctant to complain about a GP like you I would be afraid of worse treatment as a result. I am lucky as the only thing I have to complain about is the waiting time (2-3 weeks) for a routine appointment for my GP.

Dr C Fleming says:
23 March 2013

For many years the surgery had a “walk in and wait to be seen” system,which meant you were seen on the day you wanted to be seen,even though on busy days you might have to wait. There were no “Dragon at the gate” problems and surveys showed the patients loved this system.Those patients with major problems who wanted a long meeting could speak to the receptionist and come in at a time not during normal surgery hours. All this worked!! But…then the PCT said everybody HAD to have an apointment..and when told both patients and doctor preferred the old arrangement threatened a large financial penalty unless appointments were brought in…..patient choice was totally irrelevant!!

The service I receive from my GP is gold standard. I think that the service we receive from our GP’s is probably the central gemstone in the tiara of the NHS. GP’s, given the complexity of their demanding duties and the time spent in preparing for their role, provide us with a service of outstanding value. I can think of a number of estate agents,builders and investment specialists for whom I have no similar sentiment.

Lyn says:
26 March 2013

I have been so fortunate all my life in that I have always had superb doctors – and have needed them to be good at times. How things change. I moved a few years ago to a small town and find now that we do not have the option of booking an appointment with our GPs. We have to book a telephone consultation and only the lucky few actually get to visit the doctor in person. This can lead to serious problems for patients – I know of one who was prescribed an increased dose of medication that could have killed him.
Early last year, before the system changed, I booked an appointment after my first ever bout of Vertigo and was roundly told off for not dealing with it via a telephone consultation. This particular doctor refused to prescribe me what I eventually discovered was the standard initial dose of a medication I needed, I was therefore under-medicated for two years until I changed to a new doctor who joined the practice, when my level of medication was increased by 30% to this initial standard level which was what I needed.
Our local Health Authority announced an new initiative in January, for the over 50’s who do not currently have a heart problem, to have a health check and receive advice on how to avoid developing heart problems in later years. I have been asking about this since January and each time no-one knows anything about it until eventually the Practice Manager says that this is ‘something they are looking into but it is not yet in the pipeline’.
We have no option but to put up with this situation because this practice is the only one within a five mile radius, so what can we do?

Damien says:
27 March 2013

Is secret recording of this type legal?
If they were posing as patients and did not have the complaints they claimed then why is this not defrauding the NHS? The GP could have been seeing someone else with a genuine complaint.
Were the pretend patients registered with the GP and therefore his/her patient? If so how does this affect their medical record? If not how did they get to see the GP without further fraud?
Have the experts who viewed the recordings considered or been warned that they might be viewed as complicit in a fraudulent or misleading use of publicly funded resources and/or doctor patient confidentiality, and therefore potentially vulnerable to to investigation by the GMC?

Max Hotopf says:
29 March 2013

Why are you trying to protect what is an already very powerful profession from public scrutiny?

Damien says:
29 March 2013

But what is the answer to my questions?

damien says:
9 April 2013

So in effect are you are saying that these were not real patients and they misled the practice into believing they were temporary residents and that they had a real illness? If so then I expect the practices were paid by the NHS for these “patients”. If so the NHS unwittingly funded the research. There seem to be some real ethical issues here regardless of the worthiness or otherwise of the research. As I understand it, registered medical practitioners were involved in the design and execution of the research and would be required therefore to have sought and achieved appropriate ethical committee approval. How was this obtained and where is it published?

Thanks Joanna. Having acted as academic supervisor for students on hospital placement, I am reasonably well aware of the need for correct procedures to be followed with regard to ethics. I assume that Which? complies fully with legislation and behaves responsibly in all its investigations, but some transparency would be useful. When Damien posted his question, I tried to find the answers online and in the magazine, without success. To avoid future questions it would be useful to have information about how handles ethical issues when conducting its investigations. I am not suggesting that information about each investigation should be provided.

Another common criticism of Which? is whether sufficient product samples have been tested for conclusions to be statistically useful. On several occasions, we have been given additional information that does justify the validity of the product testing. Here again, some generic information giving more details about product testing would be useful.

You could ask a FOI of information question of LA & NHS who contracts in Doctors who have not taken hippocratical oath as their procedures are not ethical – discriminatory .These procedures concern them taking over referrals by the unqualified who have shortened the online record on remits as will have no Dr in charge . Thatchers Policies .which includes the loss of Middle management, deregulation & antibiotics have a lot to answer for.
Yet again – having relocated a month ågo –  I am having time wasted – å GP, due to discriminatory procedures emanating from online medical record which must be illegal as gives the patient no say as been trying for transferral to research hospital in Bristol/Oxford .So I am having to travel over 100miles each way to London for hospital appts then admin cancelafter checked appt brought forward [ tests] because of this.So I don’t get test results till 6 months later as suspect specialist doesn’t see till nearer appt.When borderline for a pacemaker??!!The GP says he cannot understand MRIs & wants Notes being witheld on purpose by PCT .

Surely when have fibrillation , am borderline for a pacemaker this is dangerous?
My last London Authority is witholding records again after employing policy of rotation[ derregistration] no referrals before cardiac arrest .This is main reason for the move as my temporary acute symptons are ignored till next time causing me extremw disability [ lower back near paralysis] . I have now been passed to physios who do assessments for social services saying don’t deal with the medical ???!!Disabnilitydiscrimination.?

My problem directly connects to disability found in relation to chronic utis & needs objective research which is being refused by primary care as saying not their remit yet specialist’s[ academic professor] research is spina bifida the uro & neuro though he has never admitted to this .
I have had the same blaming in every call centre due to administration with no discretion .This is dangerous especially when connects with antibiotics as without I will die & GP thinks he knows best starting at square one knowing last time had cardiac arrest dying x3. at time after weekly visits and 4/5 emergency incidents. Hiatus hernia wasn’t it ???

It is now happening again with the system pretending it is mental yet the most qualified Drs & Surgeons say my condition is very complex. l?? I don’t expect Dr to be incapable of listening or following their seniors advice …what is going on?

Max Hotopf says:
29 March 2013

I run a specialist newsletter. In January, we wrote about Trip Advisor sites which are common now in Germany, East Europe and the Nordic which allow patients to review doctors. In many cases they have hundreds of thousands of reviews! Here is a link to the article if it is of interest: https://dl.dropbox.com/u/1388801/rating%20sites.pdf

Interestingly, in Germany doctors were recently asked whether they thought such rating sites had much impact on which doctors patients chose to see (Germans have a lot more patient choice than we do in the UK). The docs thought such sites were unimportant. Patients reckoned that in two years time they would assign a value of over 8 out of ten to reviews on such sites and already assigned them a value of 4+ out of ten!

I was fascinated to see that lay patients in the UK appeared to be able to tell when they were given poor practice. This is key as academics and policymakers generally reckon that healthcare consumers do not have the knowledge to rationally assess the quality of the care they receive.

I am mainly satisfied with my GP Practice but feel there is a lot of rationing going on because of the financial situation. My local hospital operates at 95% occupancy rate which clearly leaves very little room for manoeuvre,this has occurred through continuous new build houses and no proper planning for any extra infrastructure which would include GP surgeries.This problem is probably wide spread throughout the country.Politicians are not worried as they receive excellent treatment because of their jobs in life. I feel you need to be polite but assertive with your GP and not fobbed off . I have recently had a severe back problem and was only given an Xray when I would not accept medication only as the answer. However, know this would not work for everyone.In respect of many part-time GPs feel there should be a minimum number of hours they are required to work,one day seems crazy.

Dr C Fleming says:
29 March 2013

To Paganlady…….for severe back problems a plain X-ray is often not diagnostic. If your problem persists ask your GP to arramge an MRI scan which should be more of help.

Thank you to Dr C Fleming for your advice, have asked for MRI scan but so far have met with resistance and informed to go on spinal pathway which I have refused. My reason is that I wish to have a diagnosis before seeing another person.Any advice on how to get MRI scan would be much appreciated.

Dr C Fleming says:
29 March 2013

Do you have any idea of what this pathway entails??

A classic case of millions being spent on new commissions, regulators etc. when what is really needed is more doctors. The politicians and bureaucrats always seem to do this to justify their existence. In a few years time it will probably all happen again. When will they realise that with an aging population, more illnesses being recognised and having to be diagnosed by doctors the last thing they want is more paperwork. I do have issues with my doctor but I do not blame him but the ever increasing pressure he is being put under.

For Dr Fleming It appears I would see a Specialist for backs. However, I have had plantar facitisis for two years and know this is connected to my back problem. I do not know of course whether the back problem caused the foot problem or vice versa,that is why I have requested an MRI scan. Hope this information is useful.

Dr C Fleming says:
31 March 2013

I suspect the specialist will order the MRI,so go for it!

Patricia says:
2 April 2013

I hardly ever visit my doctor because I’m afraid of being crossed off the practice.
Two doctors have already crossed me off their practice for saying what I thought.
Doctors should realise they are not always right ; I do hope they have all read the book Could it be B12 ; which actually proves how much they know about nutrition and that they can be wrong.
It is about time doctors listened more than prescribed.
Diet is important and doctors should make the effort to learn about nutrition.

Of course GPs can be wrong but it is not going to help if you antagonise them. I’ve never heard of anyone being crossed off a GPs list but if it has happened twice there must be a reason.

Apart from one GP who was fairly universally hated by her patients, I’ve always got on well with my GPs and two of the drugs I take regularly for asthma were suggested by me. They have also politely told me when I am wrong about something.

Try a double dose of humility and make another appointment in a couple of weeks. 🙂

Patricia says:
2 April 2013

Believe me I ‘m humble and I’m patient. However , I don’t need to see my doc at the moment.

Whilst as a GP I accept that this is an important survey highlighting some poor and unacceptable practice it is not truly representative of everyday General Practice. For the trained fieldworkers to go into thirty practices I assume they must have registered as temporary residents and I think this should have been made clear in the report. Temporary residents present a problem in GP because the doctor seeing them will not have normally access to previous records, particularly details of prescribed medication. You are therefore starting with a blank sheet which is time consuming and can be frustrating. The normal expectation is that you are dealing with the immediate problem and that the patients own doctor will continue to provide ongoing care.
I work in an eleven doctor practice and none of us work full time. Our female doctors have young families to care for but the reason other doctors have reduced sessions is because of the sheer pressure of workload. The commitment when you are at work is so intense that full time working is unsustainable. When I started in my practice 32 years ago I and my partners worked full time. Patients could expect to see the same doctor each time. In future this will not be possible and patients will need to adapt to developing a relationship with two or perhaps three doctors.
Although we try to provide a seamless service we have the same pressures as any other business. Doctors or their families become ill, and we have to respond to that often at short notice. We also have a problem of patients failing to attend appointments (DNAs) This consistently runs at 4% and costs us 12 hours of doctor time a month.
We have to respond to a changing demand with a large increase in elderly dependant patients, many with memory problems. This means that patients may be seen by other primary health care workers such as Community matrons and Advance Nurse Practitioners rather than GPs.
The report does not mention the NHS choices website. (http://www.nhs.uk/Pages/homepage.aspx ) This provides a method of comparing practices in an area which I found useful in advising my daughter to find a practice when she moved away. It also allows patients to record complaints (or plaudits!) anonymously with the opportunity for the practice to respond.
Finally I think it is worth pointing out that in recent years our workload has increased and our pay reduced significantly.

Dr C Fleming says:
9 April 2013

Dear Joanna…see my comment dated 23rd March. Then see how many wrote in re long waiting times for appointments! If there is one thing that maybe should come out of this……a push by Which to allow patients and doctors to decide what system best suits their particular surgery,maybe a mixed system of open attendances and appointments. In all my long medical career I have never worked out how one can be sick by appointment.

I was told that I would only be treated for pain, so proceeded with a thorough private investigation and they came up with lots of allergies and deficiencies, and reasons how this came about.
The allergies included maize, rice and soya, fructose amongst loads of other things.
If you look at all medicines prescribed,or over the counter they include these properties. My concern was that at some point I would need some kind of medication. My GP told me to source my own medicine as it was not his remit, and the Doctors to whom I saw were Quacks.
Is there a way to get the private investigations accepted by the NHS or is a complaint necessary.

Your doctor could be right, Ellen. Be very suspicious if you have been advised to take expensive supplements.

Dr C Fleming says:
16 April 2013

There are a very large number of people out there who claim to do testing for a huge variety of “problems” and come up with totally ridiculous and mainly imaginary results. They are NOT part of the NHS and their socalled findings are not part of a GP’s remit.But they do succeed in getting people to part with a lot of cash!!! It is extremely unlikely that you are allergic to such a range of disparate items. Be careful!!

Ellen

I suggest you go back to your GP. If your pain is caused by what you are eating, the problem should be investigated, rather than having you take long-term pain relief.

The solution could be to change your diet, but you do need to have professional advice and to keep a diary because food intolerances can be a challenge to identify. Once the problem has been diagnosed, an NHS dietitian can offer appropriate advice on what to eat and what to avoid while maintaining an adequate diet. Many nutritional problems are food intolerances rather than allergies, meaning that it is necessary to cut down consumption rather than totally avoid what is causing the problem.

Whatever the problem or solution, it is very unlikely to need you to spend a lot of money on dietary supplements or expensive products from health food shops.

Doctor C Flemming and Wavechange, you are right everyone should be cautious of seeking help outside the NHS, I was, and chose very carefully, but when the only treatment was large doses of steroids and huge weight gain and still had the problem of ulcerated colitis resulting in massive intolerance’s and deficiencies. I was overjoyed to have this particular problem cleared up which I had had for a number of years, yes it took three years to do it. Caused no doubt caused by loads of inflammatory pills given for other reasons.
And no the Dietitians said they could not help me.
If this is a Cure then it should be looked at. My question is still how can you get the NHS to consider the results of a reputable Medical practitioner

Ellen – The normal procedure is for a GP to refer patients to a NHS consultant specialising in the relevant area, or a private consultant if the patient is prepared to pay or has private medical insurance. In most cases the consultant will report back after tests and/or treatment and may advise on future management if appropriate. I have had numerous consultations, both NHS and private, and I have been very happy with how well my GP and the consultant have worked together.

If you are unhappy with your GP you can switch without giving any reason, but if they regard your ‘reputable medical practitioner’ as a quack, there might be a reason.

Best of luck.

Yesterday I went to my health centre to have a blood test . Even though I arrived at 8am there was already a very long queue and I had to wait a full hour . I do think that priority should be given to patients who have to get to work and those who have had to fast since the previous eve . All the other patients could come after about 10am.