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?

 

  1. 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.

 

  1. 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.

 

  1. 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?

 

  1. 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?”

 

  1. 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.

 

  1. 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:

http://www.ganfyd.org/index.php?title=Get_a_note_from_your_doctor

  • 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 … )

 

  1. 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.

 

  1. 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

 

  1. 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.

 

  1. 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

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70 thoughts on “10 insider tips I bet you don’t know about your GP

  1. Jon – Interesting perspective to be a better informed Patient. I think section 8 is really powerful personally. I think the way you present the self employed aspect is really good in parts but feel like it is complex for people to get their heads round. Must have been quite hard to write this and be happy that other Doctors would be in agreement with your thoughts I bet

    Liked by 1 person

  2. Excellent piece. One small thing is that I like it when patients produce a list. The list shows me that the patient has sat and thought about what they want to cover, and gets their entire agenda out at the start. It allows me to much better organise the consultation, which sometimes will involve deferring some items for another day. I find the worst thing is when I’ve spent 10 minutes on fairly minor things and they then mention something that really can’t wait. With a list I can help to prioritise.

    Liked by 1 person

    1. The other advantage of a list… Is I write a list, but I only expect one thing to be focused on in 10 minutes. I feel the list may help show the wider issue and what I think is the issue, but being realistic, I hope there’s on,y 1 or 2 somethings that may be giving these symptoms, and surely more info is better.

      I totally agree a big list of things that can’t be done within 10 minutes… Even just to read the list… Is not helpful for anyone.

      I appreciate the business side of info. I didn’t know that.

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    2. Great stuff Jon. I do actually find lists handy and have looked at asking 100 patients for this in advance with good effect; http://docrick.co.uk/consultations/pre-consultation-questions/

      I have a website http://www.docrick.co.uk with hints on including negotiating the list:
      http://docrick.co.uk/consultations/negotiating-the-list/

      I have also put a link to your work on the shared information site on the DocRick community under fourteen fish. This is a free to access shared site. https://www.fourteenfish.com/communityresource/view/837880

      I paraphrased your top ten as Doctors want to give more time, prioritise what you ask for, don’t be late, say what is on your mind early, GPs are specialist generalists, GPs are self employed and neutral, GPs want the best for you if they say no, Diagnosis takes time, GPs are busy all day, trust the receptionist. Hope that is Ok as a summary to link people to you
      We will circulate your top ten site at our practice. well done and thanks
      Mark Rickenbach

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      1. Thanks Mark – I think the list thing is interesting and I am inclined to agree that it can be helpful – putting something out like you have bout how to use a list is really helpful.

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  3. This was an excellent and informative read. Thank you. My son is a GP and I am well aware of most of it. Anything that can relieve the stress doctors are under is important and most patients would be grateful for these useful tips and be pleased to help. It would be great if they were printed out and left on surgery waiting room seats.

    Liked by 1 person

  4. So well written this should be part of the infromation given to new patients, when reg, I was a receptionist for almost 24 years, as much as I loved it and miss it, it’s a very difficult job, some people are so disrespectful of the gps it they are running late ect, but only to the reception staff, they are almost always fine when they get in with the gp, this has to go on the NHS web site and printed for surgery.

    Liked by 1 person

  5. Brilliant summary- thank you! I’ll be sharing this on. (Am a GP locum, was a partner for many years.) One thing I’d ideally like you to add, which is that the yearly ‘amount per patient’ is not a GP partner’s personal pay but is the amount allocated for the care of that patient in total- nursing, locum or salaried GP’s pay, admin… If questioned I usually tell people that it’s ‘the amount we have to spend on everyone looking after you, including ourselves; There are a few GP partners who end up paying themselves less than any of their staff’.

    Liked by 1 person

  6. As an ex ED staff nurse and now a patient with chronic problems I can see from both sides how the system is running – there is still much to do I agree that all patients should receive a condensed copy of your article – it is my view that patients need educating how and when to use which service without this nothing will change

    This is simply my own opinion I enjoyed your article makes complete sense to me

    Liked by 1 person

  7. Very interesting read. However the payment per patient is not the only funding for general practice and I think it is important for people to know this and the resulting pressure to achieve targets and the impact on the GPs employees.

    Liked by 1 person

    1. Could easily write a whole blog of it’s own about how GP is funded, I had to decide who much to put it/how much detail to discuss. I may be wrong but I think the values I quote are inclusive of QOF. I chose not to delve into the complexities of targets this time!

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  8. Wonderful article. My husband was a GP for over forty years so I know wher you are coming from. I am a member of my local surgery PPG and would love to see this article posted in the health centre. Is there any possibility of having a printed copy and your permission to use it. Please and thank you

    Liked by 1 person

  9. I thought this was excellent, may we please reproduce it in our surgery? I really enjoy what we GP’s do, it is challenging, rewarding and fun, that is when it isn’t exhausting, overwhelming or scary.

    Liked by 1 person

  10. As a GP I think you’ve provided patients with a really clear and concise uunderstanding of the way we work. It would be great if this could be published and promoted in the media, rather than a lot of the inaccurate and misleading information that’s out there.

    Liked by 1 person

  11. I agree with most of your points, many of them apply to hospital registrars and consultants as well. The one point that I do not agree with is ‘Many people think that being a GP is the hardest job a doctor can do’. I am not aware that other medical professionals or the public think this and it is not fair to communicate this statement to the public. When I was at medical school and as a junior doctor and now a consultant, the hardest job then and now is being a medical registrar hence doctors are switching from hospital medicine to GP and other specialities which do not require one to be a medical registrar . Sometimes the stress of being the person responsible for all medical inpatients/A&E medical patients and medical referrals is unbearable and I have the utmost respect for these people

    Liked by 1 person

      1. Medical SpR training ranges from 4 to 6 years which is a significant amount of time. Then there is the pleasure of being a hospital consultant; doing resident oncalls,post take ward rounds and sometimes clerking in A and E/MAU ie the constant pressure does not stop when you become a consultant. On a separate note there is also the significant difference in pay between a hospital consultant and a GP partner-both very qualified but why the £35,000 plus pay difference-I understand that a GP practice is like a business and there are other costs which come with GP but I’m sure the pay discrepancy is a contributing factor why there is a shortage of hospital consultants

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      2. Few points:
        1) It’s not a competition between GPs and consultants to see who works the hardest or gets paid the least. Now, more than ever, we should be working together and supporting each other.
        2) I have never been a medical registrar so cannot comment other than I know they work very hard in a difficult and stressful environment. I don’t know if you have worked as a GP or not, but I know that GPs work very hard in a difficult and stressful environment.
        3) I used the word “many”, not “most”. I think that is factually accurate and don’t intend to change the blog on this point.
        4) Consultant numbers have increased overall (significantly) while GPs are leaving faster than they can be replaced. https://www.nuffieldtrust.org.uk/resource/the-nhs-workforce-in-numbers#4-how-are-shortages-affecting-staff-delivering-care-close-to-patients-homes
        5) The blog is intended to highlight some things about GPs that people do not realise. One of those things is the societal perception that GPs are less valuable and less important than their hospital consultant specialist colleagues. It concerns me to then see the suggestion that doctors in training are moving to be a GP for an easier-ride. This assertion only serves to reinforce the incorrect perception that being a GP is a lesser calling. Personally I would be concerned about any GP registrar who had switched from another speciality for these reasons.
        6) My quick google search suggested that the average GP salary was not out of kilter with consultant pay.
        7) Let’s not argue. 😊

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  12. Being an NHS employee I found this extremely informative and well written in language all can relate too, I was surprised at the allocated amount of money per patient was still so low when all aspects of health care costs have risen so dramatically over the last few years. Education concerning NHS services does help those who use it to choose more wisely I think, breaking down their perceived knowledge of costs and availability of services into reality is essential to enable compliance and reduce waste.

    Liked by 1 person

  13. A GP is also not a mind reader! Frequently hospital Consultants make plans for treatment, then change the plans, then add in other specialaties etc but never copy the poor GP into what’s going on, so when you attend the GP they haven’t a clue what’s been happening at the hospital. I take copies of letters / emails from our hospital specialists to give to the GP just so he knows what’s happening and can know the whole picture before deciding what help is needed.

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  14. Sadly our surgery were not proactive with my husband! It would not have changed the diagnosis, but at least he could have been treated sooner! We have been waiting over 8 weeks for “fast track” lung cancer that has been changed via biopsy to bowel cancer. With secondaries in lung and liver. Original ct done privately because a chest X-ray wasn’t offered, the colonoscopy was ” normal”. But the dr left it there! Not asking him to come back, despite a massive weight loss, rough/hoarse voice, lethargy, constant diarrhoea ? Needless to say we feel completely let down by NHS.

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  15. Equally applies to practice nurses. So many patients come for one reason and then add ‘whilst I am here can you…’ be aware of timings. We are allocated a time for the purpose of the appointment. 10 mins for taking bloods doesn’t always allow for other things if you are dehydrated and difficult to bleed (just an example)

    Liked by 1 person

  16. I have the pleasure of working with GP teams to help them look at the processes which are in place to support the practice in making best use of it’s time and precious staff resources. Your article really made me smile as often we talk about the balance between what we would like to deliver, what we can deliver and the patients expectations and needs.
    The more we can appreciate everyone’s perspective from both sides of the desk the more we can deliver a service which meets the needs and expectation for staff and patients.
    Great article thank you.

    Liked by 1 person

  17. Have you GPs even considered how rude it is to put up signs in surgery waiting rooms saying how many people haven’t attended their appointments? Think about WHO is actually in the waiting room – yes, people who turn up for their appointments and then have to wait over an hour to be seen or more. I’m not exaggerating.

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  18. I’m aVet and often surprised how the two medical approaches differ. There is much to learn from each other but the Doctors seem reluctant to talk.

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  19. Point 4 Your Doctor is not Telepathic really hit home with me and is something I used to say to my Grandma often. She would see the Doctor, be prescribed a new tablet, try it for a couple of days and give up because of an unexpected outcome or side effect. I would always say to her, the Doctor has given you that to help you and if you don’t go back and tell them it isn’t working, they will assume everything is fine and it has worked!

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  20. As a hospital generalist (medicine for older people and general internal medicine), I get to experience both sides of the specialist/generalist thing – what people don’t always understand is a more general doctor is often very useful for the diagnosis and to steer which specialist to go to (if a person who is breathless due to respiratory disease is referred to a cardiologist, time is often lost on the wrong investigations). I also get patients coming in to clinic and trying to denigrate GPs – I look to explain that all senior doctors have a similar amount of knowledge, but it’s a question of breadth vs depth. That often seems to be helpful (and I haven’t had any disgruntled GP colleagues chatting to me about it;-)

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  21. Thank you, Jon, this was really interesting. I’d be really grateful for a bit more info so I understand how private referrals from GPs work? The issue has rarely come up for me, but one particular GP always begins his appointments by asking me if I have private insurance. His office is full of branded freebies from the local private hospital too, which makes me wonder if he thinks that is genuinely the best (fastest?) solution for my problem or whether it is financially motivated?

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    1. Hi, I’m not sure what’s going on there. There is no mechanism in the usual way a GP get paid for them to benefit from a private or NHS referral (unless they are leasing out a room for the service they are referring to, or providing part of the service they are referring to, in which case they should be declaring that conflict of interest). One would hope they have confidence in the quality of their local NHS hospital services …

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  22. Dr Griffiths

    What an amazing article! Last year I started working for a GP Practice in the North West – I’m thinking how I could use this information in our Practice.

    Very clear – information, advice and guidance.

    PS. You’re also an amazing GP, who helped me through a very difficult period of my life. Thank you.

    Liked by 1 person

  23. Excellent article. Should be available in all surgeries. I think it would be a good idea for patients to know cost of surgery each time they are treated – we generally lose sight of the real benefits of the NHS because it’s free at point of delivery – perhaps the public would be more appreciative when they realise how many thousands of £’s some treatments cost – saving lives without judgement.

    Liked by 1 person

  24. I’m a Business Manager in a busy 12k patient Practice and wish more people were aware of this. It’s a very well written, informative article and I’d like to link it to our website and share with our PPG

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  25. I would really love to know the background to referrals, especially where menopause is concerned. So many women are telling us that GP’s are refusing to refer them to a menopause specialist consultant. No reason is given. This is either because a) there are cost implications to the surgery for referrals or b) the GP is of the opinion that as menopause is a natural transition, women should just ‘get on with it’. This latter comment is very common. I’d appreciate your comments on referrals. Many thanks.

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    1. Re referrals: The GPs don’t pay for the cost of the referral, but the NHS does via budgets held at the CCG. All doctors have a duty to use resources appropriately. There is a clear direction of travel at the moment to try to do more at a community/primary care/GP level and less at a secondary care/hospital/specialist level. This means discouraging unnecessary referrals, while still, of course, encouraging good quality care and referral on when appropriate. I can’t comment on the ‘refusing to refer’ statement without knowing individual backgrounds and stories, but I would not expect GPs to ‘refuse’ unless:
      a) they felt there was no need to refer
      b) there was no service to refer to
      Let us not fall into the trap of thinking that only specialists are able to properly manage conditions. I would hope and expect that the majority of women do not need a specialist to help them with their menopause, and that their GP should be able to help. There may be an argument that GPs need better educating to address this need? For my views on the Generalist/Specialist debate, watch my TEDx Talk: https://youtu.be/-BfcvI49GCw

      Like

  26. Just one point on patient timekeeping; some leeway please for dementia? Getting my late mother ready for a trip to GP could take 5 minutes, or take 40 minutes, depending on her behaviour that day. To get her there 12 minutes late only to be told the appointment is forfeited seems a bit harsh?

    Like

    1. It is likely she would be seen. The point is made so that people understand that we are onto the next patient by then, that the slot has come and gone. I know other doctors have made a comparison with the train (it won’t wait for you). At the end of the day, GPs realise the difficulties we all have, and most will take this into consideration. This post is trying to make sure everyone understands the difficulties GPs also have! The fact remains that seeing someone 12 mins late means that everyone following will be seen late…

      Like

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