GP waiting times !

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Friday 16 January 2015 1.22am
I have been registered with Bermondsey & Lansdowne Medical Mission on Decima St. for years, then it merged with Artesian Health Centre, waiting times for appointments have lengthened over the years but as of this month they have gone crazy. I couldn't get *any* appointments with any doctor at either surgery when I tried several times to book via the automated phone service .. finally I got one three weeks away when I booked with a real live person.

I know this is a more widespread problem and certainly A&E problems have been in the national news this month. But I was shocked to hear that my surgery, according to the receptionist, now has over 18,000 patients on its books and has no ceiling on the numbers it will continue to register.

I looked into using other local ones, like Princess St., but I am not in their catchment area. Another one that looked very quiet and civilised when I visited the other day was the Blackfriars Medical Practice, who told me their patients might expect to wait a week for an appointment but again, sadly, I am not in their catchment area.

I am baffled as to how all the new moneyed inhabitants of this area are apparently putting up with this very poor GP service .. and why there haven't been new surgeries opening up to cater to what is an obvious need !?

Feeling a bit desperate at times, I even wondered about private options in the area, although realistically that wouldn't be affordable for me long term.

Would be interested to hear other people's views on this subject. Thanks !
Friday 16 January 2015 10.19am
I can't comment on these surgeries in particular, but appointment times are a product of supply (GPs) and demand (patient numbers x consultation frequency) - with a mix of longer, short term and 'immediate' booking slots.

As a GP, I can only tell you that this is getting increasingly difficult to manage. Many of my colleagues work 12 hour days and go in at weekends to catch up with admin work. There are a number of factors driving the problem:
1. Average consultations per year per patient have increased from 3.5 to 6 in 15 years.
2. We do far more preventive and chronic disease management work (driven by the 2004 GP contract)
3. People are (rightly) encouraged to consult earlier with a variety of symptoms in order to diagnose serious disease earlier.
4. Turnover in places like SE1 can be 30% of registered patients per year, meaning practices have to 'run to stand still' keeping up with their targets.
5. The Daily Mail et al constantly blame GPs for every failing of the NHS (for pure political gain), the result that only 3000 out of 4000 GP training places each year are filled, students don't want to train as GPs and we have a national shortage of 10,000 GPs.
6. Like other NHS staff we all feel demoralised and sick of all the reorganisation (the Landsley 'reforms' were an ideological attack on the NHS and totally unwarranted)
7. Practices have lost 17% of their funding in the past 5 years
http://www.rcgp.org.uk/news/2014/april/funding-for-general-practice-set-to-plummet-by-fifth-by-2017.aspx

It will only get worse if we go on like this. Political change is required.
Friday 16 January 2015 1.33pm
Your not missing anything at Princess Street - three or four week waits last time I tried to book (gave up and went to one of few remaining walk in clinics).

I wrote to complain (very nicely, saying I understood and would like to help if they told me who to write to), oh 18 months ago, no reply.
Friday 16 January 2015 4.20pm
ive had good experiences with the waterloo health centre. They used to have a walk in clinic 0900-1100 but got rid of it over a year ago (approx) .

I was skeptical about the replacement arrangements , which was you would phone the surgery , reception takes your details and a GP phones you back . ive only had to call them twice, both times i was called back within an hour and had the gp give me an appointment later on the same day , second time i was given telephone advice by the GP and didnt need to see anyone
Friday 16 January 2015 4.55pm
Just another example of the infrastructure in the area not being put in place to cope with the growing population due to increased development.

I have no issue with new flats and new residents moving to the area, I think it is great to see Bermondsey become a more popular place to live - but services are not being increased at the same rate as the population is increasing. Public transport is another example.

I'd guess that the ageing population is partly responsible in the increase of GP visits per person over the last 15 years?
Friday 16 January 2015 5.17pm
I agree with ninja about Waterloo. I was sceptical about the new system but it works well and I guess weeds out those who just want a warm place to sit. They also get a lot of "walk-ins" because of the transient population and that must be easier to handle with telephone booking
Saturday 17 January 2015 4.57pm
GP practices are extremely lax in not checking new patients' eligibility to access free NHS services - i.e. the only requirement is for the new patient to provide an address in the catchment area of the surgery - but they never check the residence or immigration status of the patient - as they are required to by the Department of Health Regulations.

It's therefore not surprising that there are thousands of patients on their books.

The other aspect is that GP's surgeries are run as taxpayer-funded businesses, where the GP Partners can take out profit. Despite complaining endlessly about the Coalition Government's policy on the NHS, interestingly, GPS are very happy to quietly take profit out of their surgery businesses. The more patients you register - then obviously the more funding the surgery can claim.

GPs earn at least six-figure salaries and generous final salary pensions.

Obviously, it goes without saying that they provide a vital service, but they are over-paid. I can think of far more stressful jobs in the public services where pay is nowhere near what GPs receive.

Basically - it's all down to how effective your Union representation is and how scared politicians are of them. The BMA, who represent doctors, is an organisation not to be messed with.

But don't just take it from me - Andy Burnham, Labour's Shadow Health Secretary has acknowledged publicly that the GP's contract negotiated under Blair's Government was a mistake here.
Saturday 17 January 2015 7.11pm
No connection whatsoever other than being a very satisfied customer but Blackfriars Medical Practice is first rate
Sunday 18 January 2015 10.32am
Sorry, but you are not entirely correct, and I'd like to reply to your comments one by one:
GP practices are extremely lax in not checking new patients' eligibility to access free NHS services - i.e. the only requirement is for the new patient to provide an address in the catchment area of the surgery - but they never check the residence or immigration status of the patient - as they are required to by the Department of Health Regulations.
- You are simply wrong. GP treatment is free to all those resident in the UK (i.e not just tourists). Hospitals are required to check entitlement to secondary care. Look here:
http://www.nhs.uk/chq/pages/1087.aspx?categoryid=68&subcategoryid=162
We can only check an address, anything else is discriminatory.


The other aspect is that GP's surgeries are run as taxpayer-funded businesses, where the GP Partners can take out profit. Despite complaining endlessly about the Coalition Government's policy on the NHS, interestingly, GPS are very happy to quietly take profit out of their surgery businesses. The more patients you register - then obviously the more funding the surgery can claim.
- Practices are small businesses that fund themselves by a variety of NHS and non-NHS work (medicals, insurance forms, occupational health services, travel etc). Don't blame the GPs for how the NHS was set up in 1947. The NHS services are paid for in a hugely complex mix of baseline, fees and targets that changes every year. If you don't provide the service, you don't get paid.

GPs earn at least six-figure salaries and generous final salary pensions.
- GPs have NEVER had a final salary pension. Unlike hospital staff their pension is a career average, and always has been.
- As for salaries, you need to match like for like. From the oft quoted 'six figure +' (Daily Mail etc), you can deduct: Employers and employee national insurance (28%), Medical indemnity (7-9k) and a whole raft of other compulsory professional expenses. It is true that there is a wide variation in practice earnings, but GP earnings are not in excess of hospital consultants and probably behind many similarly qualified professions (especially in London).

But don't just take it from me - Andy Burnham, Labour's Shadow Health Secretary has acknowledged publicly that the GP's contract negotiated under Blair's Government was a mistake here.
- It is true that GP income went up a lot under this contract, but so did workload. GPs as a whole massively 'over performed' on DOH expectations. Since then average GP income has declined by 30% and those who have tried to maintain incomes have had to work 12hr+ days to do so.

I'm not complaining, its a hugely rewarding, but very high demand and high risk job. However, I do think its important to put the record straight. GPs are actually the core of the NHS. It is the judgements we take about diagnosis and the daily negotiation with patients about their care that enables the NHS to provide efficient and effective care. Without GPs the system would collapse and we would end up with a US-style expensive care for a few. Some politicians and their wealthy backers and media barons would like this, so don't believe all the rubbish you read in the Daily Mail.....
Sunday 18 January 2015 10.48am
GP's are the core of the NHS ?

as a paramedic for nearly 20 years i would beg to differ

and don't get me started on 111 ;)
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