We’ve all been to the doctor, right? We know how it works; we know how to get an appointment and what to say when we go. I’m always surprised at how little people do understand about how their doctor’s surgery really works, and how to get the best out of them. Most people don’t realise that a GP runs a small business and that they get paid a set fee to provide all of your care. Do you have any idea how long your appointment slot is, or how many patients your GP will see each day? Hopefully you won’t need to visit your GP very often, but a bit of insider knowledge can help you when you do need to go! How many of these insider tips and nuggets did you already know?
- Your Doctor would like to give you more time
- Most GPs provide just 10 minutes for an appointment. Although this might not seem very long you must remember that this has increased over the past 20 years from a typical 7.5 mins per appointment, and from even shorter appointments before then. GPs can choose to offer longer appointment times, but there is a balance between length of appointment and how many appointments they make available. This is obvious when you think about it – do you offer fewer, longer slots, or more, shorter ones? What would you do? Depending upon your reason for attending, 10 minutes might be more than enough time, or woefully inadequate. Got a sore throat? You might be in and out in 5 minutes. Hearing voices and suicidal? You might be in there for half an hour, or probably longer. Your doctor will rely on a variety of problems presenting to balance these demands on their time, and hopefully will run roughly to schedule. Often they will run late.
- You can help this by understanding how long your appointment slot is (just ask when you book), and working with your doctor to get things done in the time allowed. If you already know you are going to need more than 10 mins, ask reception if you can have a longer slot. They will probably be happy to oblige.
- Your Doctor does not like lists
- Well, let me clarify this. Your Doctor would advocate you knowing what you are coming for, and if writing this down in advance will help you, then I would suggest you do so. However, bearing in mind point one above, if you only have 10 minutes and if you pull out a list of 5 problems this is pretty stressful for your GP. Were you expecting 2 minutes per problem? Be realistic. Prioritise what you want from your doctor.
- If you arrive 10 minutes late, you have missed your appointment.
- What I mean is that if you are 10 minutes late (or more), then you are not just late, but your appointment slot has come and gone. The next patient is now due. Remember that the impact of being late is not just on your doctor. They may be prepared to finish their surgery late in order to see you, but what about all the other patients who have booked in and arrived on time? If you arrive late, this is who you are causing hassle for, all the people around you in the waiting room. I guess I’m just asking you to think – is this fair?
- Your Doctor is not telepathic
- Pretty obvious, right? Yet it seems that people think their GP will know what they are worried about, which of their problems is a priority for them and what their hidden fears are. A good doctor will no doubt explore all of this with you, but you can short-cut this. Be up front about what is on your mind. If you are worried because you think your rash or lump might be cancer, then say so. If you want to exclude some rare condition because your mother had it – let the doctor know. Try not to leave your main problem until the end. You would be amazed how many people get through the whole consultation and then, at the end, say something like “While I’m here, can I mention this chest pain I’ve been getting?”
- Your Doctor is a specialist
- They have just specialized in being a generalist! Don’t make the mistake of thinking that there is a hierarchy of doctors, with GPs at the bottom and hospital consultants at the top. Your GP will have spent a minimum of 5 years in training AFTER medical school. They are experienced doctors qualified to look after you. Sometimes people think that going to A&E means you get to see a ‘proper doctor’ – remember that the junior doctor in A&E is likely significantly less experienced than your GP. Many people think that being a GP is the hardest job a doctor can do. If you are concerned that you might need to see a specialist, then talk this through with your GP – they are in a really good place to decide with you if that is what is needed, or not.
- Your Doctor is self-employed
- Did you know this? Why does it matter? GP partners own the business of the practice and are ‘independent contractors’ to the NHS. Many members of staff at the surgery, including some of the doctors, will be employed, but by the surgery not by “the NHS”,. This has a number of implications:
- Firstly, your GP receives a set amount of money per patient per year to provide all of their care. It doesn’t matter whether you see your GP every week all year, or don’t attend for 5 years; your GP gets the same amount of money for looking after you. You must not think that by seeing your GP you are ‘doing them a favour’ by bringing in money for your attendance! The amount of money your GP earns varies from practice to practice (they are all individual small businesses) but the average is around £140 per patient per year. This is really good value (less than 40p per patient per day), particularly when you consider this is the money the practice receives to provide all the services and pay all the staff including the doctors.
- Secondly, this means that your doctor’s surgery is contracted to provide certain things, and not others. It’s worth remembering this as this is why you will sometimes be asked to pay for things. In simple terms your GP is contracted to provide medical care, but not to do things outside of this such as the multitude of letters they are asked to sign. If ANYONE asks you to “get a note from your doctor”, you should really question this before heading off to the surgery. Many of these requests are unnecessary and just seek to move a perceived risk from one person to the doctor, who may not be in a position to carry that risk. Check out this website first for more info:
- The payment GPs receive is not affected directly by referrals or prescribing – the costs for this are in a separate budget. If your GP decides to prescribe an expensive medicine for you they are not paying for it themselves. People often think that GPs switch medicines to cheaper ones in order to personally benefit financially. NOT TRUE! They are doing this to help the NHS budget as a whole, which I would hope we would all be in support of.
- Because they are small businesses, they bear any increasing costs themselves. Rising indemnity fees (insurance against being sued) have to be paid by the doctor themselves. A doctor working only 2 days per week can be paying £6,000 per year on indemnity insurance. Why does this matter to you? Because if they are paying £6,000 on that they are not spending that £6,000 on another receptionist, or nurse, or another doctor. The higher the costs, the less likely the surgery is to be able to add in additional services. So, bear this in mind when you are thinking of suing your GP!
- Despite what The Sun might tell you, your doctor does not earn £700k per year (unless your GP happens to be the sole one in the country that does … )
- Your Doctor wants the best for you
- If your GP decides not to refer you on, or not to prescribe anything, or not to investigate you it is not because they are trying to be difficult or just trying to save money (don’t forget, their take home pay is not affected by these things). It’s usually because they don’t feel you need any of the above. They also understand, probably better than you, the risks associated with over referral, over treatment and over investigation. This is not a game where you need to see how much you can get from the NHS. This is about keeping you healthy, investigating when appropriate, and treating when we need to. Bearing this in mind, your GP will not mind explaining it to you – just ask. If you were hoping for an X-ray, mention this and have a grown up conversation with your doctor about the pros and cons of doing that.
- Your Doctor is not taking part in a medical drama.
- When you watch the TV, watch out for the doctors. I bet, 9 times out of 10, that they get the diagnosis right, first time. I’m afraid this is not real life. Many conditions are not at all obvious, and time is the only sensible way to start to differentiate between them. GPs often get vilified in the press for not picking up serious illness (“I attended my GP 3 times before they referred me with my cancer…”). In reality serious illness often initially presents the same as mild, self-limiting illness. A cough, for example, can be caused by many things, from a simple viral infection to lung cancer. The patient who presents to their GP with a cough that they have had for less than a week is unlikely to get a chest X-ray on the first visit, but if it has failed to settle after 3-4 weeks, then that’s a different story. Be aware of this and remember that this is complex stuff. In particular, ask about the things that you should watch for and under what circumstances you should return for review
- Your Doctor might play golf, but probably not in their lunchbreak!
- The traditional view that people have of GPs is that they see a few patients in the morning; a couple of visits, then are free until evening surgery at 5pm. Plenty of time for 18 holes in the afternoon? The traditional view is out of date. Most GPs see 18-20 patients in morning surgery, followed by visits, and then a further 18-20 patients in the afternoon. Many GPs see more than this. In addition to these face to face consultations, there will be phone calls and paperwork. Paperwork is an essential part of patient care, but takes time. It consists of looking through the results of the investigations that have been ordered, reading letters from consultants, acting upon these letters (consultants will not infrequently give actions for the GP to undertake), signing prescriptions (signing prescriptions is one of the riskiest things that GPs do – be aware of this and don’t be upset if there is a query over your medication – this might just mean that the GP is taking the trouble to check that this is safe for you and won’t kill you) and arranging the investigations and referrals from the previous surgery. The waiting room may be empty, but that doesn’t mean the GPs are all putting their feet up. That’s a lot of patients seen, and a lot of decisions made. If you are waiting for the results of an investigation, this can be stressful, and you quite rightly will want the results as soon as possible. Here are some things you should consider:
- If the test was arranged by your hospital consultant – that’s who you should go back to for the result. Ring the consultant secretary (ring the hospital switchboard and ask to be put through) and ask when the consultant is going to convey the results to you. If they try to palm you off by saying they will send the results to your GP, explain that you want the results from the specialist who arranged them who is in by far the best place to give appropriate advice.
- If your GP did arrange the test, the smart thing is to make sure you know from the outset when and how you should expect to get the results. Are they going to phone you, or do you need to call? Speaking to the receptionist if you are uncertain is the way to go – explain your problem, and ask how to proceed – they will probably be able to help you.
- Your Doctor has entrusted their reception staff with an important job
- And that job is not just to make things as difficult as possible to make an appointment! The receptionist’s main job is to deal with enquiries, book appointments and generally ensure all is running smoothly. They are not medically trained, but they will have a really good understanding of the services on offer. My advice would be to entrust them with a rough idea of the problem that you have. This way they are able to direct you to the most appropriate course of action. Don’t forget that everyone who works in the surgery is covered by the same confidentiality clauses. You can trust that the receptionist is NOT going to be talking about you to others. Increasingly doctor’s surgeries include clinics run by nurses, physios, pharmacists and more. If you ring and insist on an appointment with a doctor, without explaining that it’s because you have a bad back, you might have missed out on seeing the physio – probably a better option for you.
- If you are polite and friendly to reception, they will be polite and friendly to you. They are not trying to be obstructive, they are just doing their job – you might be anxious and stressed, but try to keep calm. The receptionist can be key in getting the right help as quickly as possible – just remember, that help might not be the GP.
So, how many of these top 10 insider knowledge facts did you know? As with all things, the more we know about how things work, the better able we are to work with the system and get what we need done. I hope these facts and tips have been interesting and helpful to you. If they have, why don’t you share them with a friend?!
If you want to watch something from Dr Jonathan about the value of the Generalist – check out his TEDx Talk online https://youtu.be/-BfcvI49GCw
Dr Jonathan Griffiths is a GP at Swanlow Surgery in Winsford. He is also Chair of NHS Vale Royal Clinical Commissioning Group.
If you have a question for Dr Jonathan, why don’t you find him on Twitter @DrJonGriffiths
Number 9, so true! My doctor rang me at 9:30pm to follow up on the wrong prescription from the chemist. I wrote a letter to the surgery, thanking him for that. It was such a minor thing but it just shocked me how late the doctor was still working.
I value the NHS, we are very lucky have it.
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Thank you for reading and taking the time to comment.
There is a lot I didn’t know, I wiĺ be much more mindful from now on. This was very helpful. Shalom.
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I am a lady aged 75 with quite a few medical problems. Before the COVID problem I was unable to make an appointment even though he said he would like to see me every month. That doctor has left the surgery about 5 months ago. Since then I haven’t been able to see or speak to one. Appointments with other departments at the doctors are made but the results are never followed through. When I ring up to query why I have not heard anything i am made to feel like I’m being unrealistic. Most of my problems have become very much worse because they have ignored things for 40 years and now I am feeling quite desperate can I refer myself to consultants . What do I do for the best. I would like my last few years without constantly worrying what will happen next. I would really appreciate your advice.
Sorry to hear that you are finding this difficult. I can’t offer medical advice obviously but I would suggest arranging a routine call with a GP at your practice and discuss your medical concerns with them. If your concerns are more about the running of the practice and access to services you may wish to ask to speak to the practice manager.
I appreciate the fact that the NHS is under pressure and that doctors have a time slot to try and stick to but wouldn’t it be more beneficial to the system patients that have visited their doctors on several occasions for the same ailment to be sent for further investigation as many patients have been prescribed medication that can be addictive if taken long term, prime example we have a patient comming in that has been sent to the physiotherapist for a back complaint to which he could not even put his hands on the patients back but the patient still hasn’t been referred for a scan of any kind. If the patient was referred they may now have the knowledge of what is causing it and how they can deal with it either with an operation of with self medicating through other methods, as With some patients if they know for definite what the problem is they find alternative ways of dealing with pain and it also rules out any underlying illness which will also relive any stress which also can contribute to them feeling worse
Excellent information and supportive of the GP’s workload and business
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Excellent written , going to upload on waiting screen in our practice .
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Amazing and so true. May we feature this and your blog on our surgery website please?
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Thanks Ruth, no problem – happy for you to feature this.
Wow, great reading. I work in a GP surgery as a medical secretary & I know this is true. Thank you for informing the public
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Thank you Sue
After working in a doctors for 17 years on front desk and office, I certainly appreciate any health care professional. I don’t mind if my doctor is running late for my appointment, as a patient may have needed reassuring or have thingsexplained to them. In an ideal world I feel everyone should experience a day in the life of a surgery and then perhaps they wouldn’t be to quick to complain.
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Thanks for reading and taking the time to comment
Came across this on a Facebook post. Really helpful and informative article. Will now share on Facebook. Thank you.
Thank you Eric
I would love to hand this out with my registration packs. Would you be happy with this?
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Yes, that’s fine Eileen. I’d appreciate a credit on it, but please feel free and go ahead.
Your leaflet “10 Insider tips I bet you don’t know about your GP” was available at our local Health Centre and I found it very interesting. I would have been more interested if you had commented on the Quality and Outcomes Framework and it’s impact on your workload and remuneration.
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Thanks for reading and commenting. I’ll give the QOF suggestion some thought.
i was wondering if there is any way of getting hold of a few leaflets on this as i would love to have them in our waiting room for patients to read
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Hi James – feel free to print out. I know other surgeries have done that.
Great article. Our GP’s would love to create a precis’d version of this for our website with a link to the full article. Is that ok?
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Hi Cheryl, yes, no problem. Thanks for reading!
I did not know that schools are not supposed to be asking for doctor’s notes. My children’s school has a statement somewhere that after so many days, a doctor’s note must be provided; perhaps someone should be fixing this problem with schools directly (I don’t know who, but not parents; schools don’t listen to parents). Also, my children’s school say that ‘a cold is not sufficient reason to take time off school’. This is clearly not true; a sniffle might be not sufficient reason, but a bad cold is a serious illness, and may need time off school, surely? This means that parents are likely to claim that ‘child has a nasty virus or something’ or else to send children into school where they infect everybody else… I wish there were better guidance on these matters (sick notes and when to keep children from school to avoid infecting other children and teachers, some of whome might be immunologically compromised) from the NHS and that schools’ compliance were rigidly enforced.
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Many thanks for the comment. Couple of things – I have blogged about some of this previously and you can read it here: https://drjongriffiths.wordpress.com/2017/09/28/the-school-told-me-to-come/
Secondly, the guidance you are looking for does exist and you can find it here: http://www.publichealth.hscni.net/sites/default/files/Guidance_on_infection_control_in%20schools_poster.pdf
My son has been set on going to medical school and getting a GP job. I am surprised that GP jobs are specialist jobs at being a generalist. I’m proud that my son wants to do the extra years after medical school to become a GP.
Thanks for this Michael. Really pleased to hear that your son wants to be a GP – best wishes for his training!
I have only flicked through your comments as it was a site that came up when I searched if only choose and book referrals were feasible, now. Whilst helpful, I feel you’re conception of patient experience and service provision may be linked to that of your experience in possibly a less populated area than some parts of the south of England. Your conception that all GPs are concerned to enable people to become well is most certainly not the experience of all patients and a concern to save money on referrals because of incentives by CCGs to restrict referrals is a more prescient experience, particularly if the impact is in respect of quality of life and not mortality. For those of us in overpopulated areas some advice on repeatedly going to the GP in pain and being refused, delayed, promised but not done referrals, having consultants write with recommendations that are not done, as well as passing blood that should have necessitated a more urgent referral and it isn’t done some useful advice would be appreciated! Funding for those with long term health problems are obviously being redistributed in some areas.
With all best wishes
Judith, it sounds as though your experiences have not been what you would have expected. I’m not in a position to say whether that is through differential investment, local guidelines/commissioning or individual decisions made by clinicians. If you have concerns about local commissioning decisions I would suggest you approach your Clinical Commissioning Group. Jon
ok some of this is just not true or is very misleading. Doctors DO in fact get paid money to stop referring people to hospitals, and you say they don’t. It’s been known and published in the news (example : https://www.theguardian.com/society/2018/feb/28/gps-offered-cash-to-refer-fewer-people-to-hospital or https://www.independent.co.uk/news/health/nhs-gp-savings-sick-patients-operations-avoid-hospital-treatment-reward-cash-a8231591.html ) so why do you say the opposite? Your GP typically DOES want to dispense with you. They refuse to provide antibiotics when there are cases when it’s warranted and the GP blames the patient for resistance as if patients are to blame for GPs over prescription.
Hi Matt, thanks for your comments. The comment in the blog is about individual referrals and the lack of association between the costs associated with referral and the GP pay – in other words the GP does not pay for the hospital activity associated with the referral. As you point out there are referral incentive schemes in place in some parts of the country, but these are looking at encouraging appropriate referral rates for the practice population as a whole, not discouraging individual referrals, and not paying GPs on the basis of specific individual patients as far as I am aware. There is a subtle difference, I would say, between population and individual health. I have not met a GP yet who would not refer when they felt this was required. With regard to GPs refusing to prescribe antibiotics when they are indicated, I must challenge that. I have also never met a GP who felt that an antibiotic was needed but who would not prescribe. For the record I will also point out that there is no referral management scheme in place where I work, these are not universal.
My husband is a retired GP. That doesn’t mean he is now a half-wit or has forgotten all he ever knew. I am a diabetic and, as I am sure you know, that means that foot issues need to be given serious attention. I had a serious foot infection and sought a GP appointment as my husband told me that he believed I needed antibiotics. I was refused a GP appointment or an appointment with the diabetic nurse. Given an appointment with a nurse who refused me antibiotics but gave me ointment and said I should come back if there was no improvement after a week. A week later no improvement, indeed worsening! Still refused a GP appointment and nurse told me to continue using ointment. As I was by now in serious pain, I walked out of the surgery and across the road to the pharmacy where I asked to see the pharmacist. The pharmacist took one look at my foot and said I definitely needed one, and possibly two courses of antibiotics. He told me to go straight back to the surgery and tell the receptionist that I needed to see a GP at once. What a transformation! Within ten minutes I was with a GP who said my foot infection was serious and immediately prescribed me antibiotics.
I later complained to the practice manager and the practice diabetic nurse. My complaint was noted and the diabetic nurse wrote to all members of the practice informing them that any diabetic patient with foot issues must be treated urgently and see a GP. Good result! However, here is a clear case of receptionists and non-specialist nurses lacking knowledge and failing to afford patients appropriate attention.
So it’s really annoying and clearly untrue to say that GPs who invest such power in their non-medical staff, allowing them to block access to the doctors, are doing the right thing. If it hadn’t been for my husband and the pharmacist, I could have lost my foot!!
Excellent article are you happy for it to be shared please?
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Thank you. No problem. Share away…
The receptionists my be bound to confidentiality but the rest of the patients on the waiting room overhearing them asking out loud of my problem is, are certainly not.
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Absolutely, and we need to ensure that we remember this. The majority of appointments being made, however, are on the phone, and that was where i was coming from when writing this.
Thank you for this insightful post. Re. point 2 : as a patient with a couple of chronic autoimmune diseases I do try to prepare a list of things that are helpful and relevant to make the most efficient use of the opportunity. I completely appreciate that patients need to book ahead for a longer time slot if they have a lot to cover, and that there is a need to prioritize. (Possibly something the admin/ reception staff should discuss with patients when taking appointments!) However, it’s also concerning and frustrating when the doctor dominates the consultation and spends the entire time talking, or jumps to conclusions before hearing all the information being offered (or worse, dismisses a factor because they’ve already made their mind up). As a result,the patient may only get a chance at the very end of the consultation to raise a significant concern. I can understand that’s stressful and frustrating for the GP, but it is also for the patient. Completely avoidable by letting the patient talk first (within reason), listening carefully and then asking questions.
I also need to add that the use of a computer throughout the consultation can be a mixed blessing. Polite patients will not interrupt or offer information while their doctor is typing. If the majority of the appointment is spent that way then the patient might not have much opportunity to raise their problem or question.
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Thanks for this. Excellent points for us GPs to bear in mind. The computer is tricky and I totally get your point. The problem is that the typing also needs doing at some point within that 10 minutes – I tend to do mine after but of course to do that and run to time I have to get you sorted even quicker than 10 mins! Your points are well made though, thank you.
I would however be interested in knowing what a patient can do if doctor is more interested in talking about himself! Lots of little anecdotes but not much in way of empathy or treatment.
I have chronic conditions and get feeling he thinks I’m there for his company . I am not!
I’ve been attending every few weeks for last year to get him to chase up appointment with cunsultant Neurologist and now I’ve given up. Always leave surgery thinking he’s going to act but never does.
Can’t change GP as no one has vacancy for new patient and I’d have to travel too far.
I’m glad you explained that doctors’ will make decisions about things like reference and prescriptions with our best interest in mind. I’ve been having stomach pain for the last month or so but have been a bit nervous about finding a doctor to discuss my symptoms with. Thanks for sharing this article and helping me feel more comfortable about finding a general health clinic and booking an appointment!
A useful insight from a GP’s perspective, its purpose to re-educate and reset patients expectations on what to expect, from their visit to their GP. But it falls short on providing a comprehensive insight to the factors that drives GPs decisions, such as how the NHS receive significant financial incentives, from pharmaceutical companies, to have certain drugs actively prescribed by GPs, such as statins. It would be useful therefore, when detailing how GPs are paid etc, to also include the financial incentives received.
I already knew most of the posted info, but how about the surgery’s where you see a different doctor every visit. There is no doctor/patient relationship anymore, something very important particularly with males who already find it difficult to go to a doctor. You can request a particular doctor on duty if your lucky enough to get through between 7-8am, but which really poorly person is able to do that. My surgery will only make same day appointments unless for treatment such as for arthritis or minor operation, for which they run clinic days.
The practice nurses that phone and are able prescribe I am no fan off. The screening of whether I was a worthwhile candidate to see a doctor!!!
Fobbed of so often with medication which turned out I did not need, nor helped with my problem.
This ridiculous system missed the cancer that was developing inside my body and was not picked up until when I went into urgent A&E care, where I discovered that it had already metastasised into my spine and the excruciating pain I was experiencing was a fractured vertebrae. My life expectancy is poor.
I don’t who came up with this stupid system, but it’s taken away any real chance if fighting this.
The old system may have left me sat in waiting room for a longer period, but the doctor knew me, knew my family and would have taken me seriously when I said “I feel really unwell”.