Surgery notes
with Dr Graham Easton

20 August 2007

Getting to see your GP

When you’re feeling ill the last thing you need is hassle trying to see a doctor, but that's exactly what many NHS patients say it feels like.

Here are the top three niggles I keep hearing from friends, family and patients, and my thoughts from the other side of the receptionist's desk.

What’s the point of appointment times if I'm always kept waiting?

Fair point. Basically, it depends on how long (or short) you've got before the next patient's appointment is due.

The average appointment slot in general practice is ten minutes - not long when you consider it can take an older person several minutes to get undressed and dressed again. Some people need less than this (a repeat prescription for the contraceptive pill, for example) but many take longer.

If someone’s really sick, or has unusually complicated problems, I can't just boot them out when their ten minutes is up. So, inevitably, surgeries can start to run late.

Some doctors - including me - choose to have a proportion of 15-minute slots so waiting isn't automatically built into the system. I find it works well.

Patients can judge how long they need pretty accurately

But because there's no limit to the number of people who ask to see a doctor each day, there's a limit to how long GPs can spend with each one. The longer I take over a consultation, the fewer patients I can see in a day, and the longer the rest have to wait to get an appointment.

People who bring long lists of problems can really slow things down for everybody. If you're someone who hoards medical problems, or if you have lots of symptoms you think are relevant, scribble them all down on a piece of paper.

Then - and this is key - hand the list to your GP at the start of the consultation. You can both decide what your priorities are and how much, realistically, can be achieved in ten minutes.

If you know you need longer than ten minutes, it’s sometimes possible to book a double appointment. Research suggests patients can judge how long they need pretty accurately.

If you can't turn up for your appointment, then please let the surgery know - preferably giving plenty of notice. Even if it's last minute it helps, because your GP can get on with some paperwork or see the next patient.

People who don't turn up for appointments cost the NHS about £162m a year.

Many patients bring information they've printed off from websites, or newspaper cuttings, to discuss with their GP. That's fine by me. But don’t expect your GP to read every line during your consultation, and don't be surprised if your doctor, who's medically qualified and knows your personal history, doesn’t agree with what a journalist has written for a general audience.

When I try to book ahead, why am I told to ring back on the day?

Practices have to meet government targets when it comes to patient access: all patients should be able to see a health professional (for example, a nurse or doctor) within 24 hours of ringing, and they should be able to see a doctor within 48 hours.

To meet these targets many practices keep some appointments that can only be booked on the day patients ring. This obviously reduces the number of slots that can be booked in advance - and also means when you call back you have to spend ages listening to an engaged tone as everyone scrambles for the 'book on the day' appointments.

Most surgeries have a GP dealing with queries on the phone or even by email

Most practices will give you a shorter 'emergency' slot if your problem is something a doctor really needs to assess that day.

Some practices offer quick access by having a walk-in clinic every morning, although be prepared to wait in the waiting room instead of on the phone, and don't forget most surgeries have a GP dealing with queries on the phone or even by email. Ask if this is an option at your surgery.

You could also ring NHS Direct for advice, although you may well be told to see your GP.

You have to be at death's door before a GP will do a home visit

If you’re really at death’s door, most GPs would recommend calling an ambulance. But it's true, gone are the days when your family doctor would pop in to see little Jimmy’s painful ear on his way home from surgery. Now, home visits are reserved for the genuinely housebound.

Why this apparent heartlessness? Well, a home visit - even a 'quick' one' - takes considerably longer than a surgery consultation. As a general rule, I'd allow 30 minutes for a visit (in a fairly compact list area) during which time I could have seen three or four patients in the surgery.

And these visits are often done in poorly lit, cluttered rooms without all the equipment or computer notes doctors like for an optimum consultation. So, unless it's absolutely medically necessary, you’re usually much better off coming to the surgery.

Time pressure, more patients and the 48-hour target mean home visits are based on medical necessity, not social preference. Childcare difficulties, lack of transport, running out of your medication, bad weather or something good on TV aren't good enough reasons for a home visit.

Check with surgery staff exactly what the rules are about appointments and home visits in your surgery, so you get the best care and your GP can see as many patients as possible.

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