I have not really touched on my experiences with my GP. There are many reasons for that. Mainly because I don’t want to just vent or make assumptions about the current state of the NHS. However, recently I have started to think about the impact that my GP is having on my well-being. Today I want to look at some of the things I have encountered and what could be done to avoid future challenges and improve overall accessibility.
Let’s start with actually getting an appointment to see a doctor. The pandemic completely changed the way doctor’s surgeries had to operate. My local GP wouldn’t allow access to the service for anything but emergency cases. It was no longer possible to get an appointment in advance, you just had to call up on the day and hope that there was still space for you. Routine appointments (medicine reviews or checkups) were not even an option. I want to emphasise that I understand why these steps were taken. Still, I do have an issue with how accessibility is now less accessible. While the pandemic is far from over, it is at a point where the systems can be and probably should be altered. As it currently stands, the process for accessing my GP is to start calling at 8:10am (why not 8am is beyond me), and hope you manage to get through at some point. More often than not you will just get an engaged tone (my current record is 111 engaged tones). If you are lucky enough to get the prerecorded message about ill staff, welcome to the queue. If you are trying to contact them after around 9am for an appointment bad luck…
Next comes the receptionists. They are often referred to as the gatekeepers to the NHS, and with good reason. When you finally get through, you will be quizzed about your condition and asked nonsensical questions (at least from a neurodivergent perspective). My favourite question is “Is this an emergency?” Firstly, if it was an emergency I’d be calling 999, secondly what is an emergency when it comes to getting an appointment with a GP? Does my appendix have to have burst before I am allowed to get an appointment with my doctor or can I speak to them before that happens? The worst part of this is that if you aren’t sure what your condition actually is, explaining your symptoms to a receptionist can be extremely difficult. It feels like you need to know what your diagnosis is, before getting a doctor to give you a diagnosis. Regardless of how you manage to explain your condition, more often than not you’ll just be told to call NHS 111 or use the online version. This is problematic for many reasons, the main one being that the system has a habit of either telling you that you’re having a heart attack or that paracetamol will fix any other condition.
Miscommunication. This is a big one with the current setup. Depending on what the receptionist has put down in your notes can depend on how the doctor initially engages with you. I often struggle to explain how I am experiencing issues, and having to explain things twice to two different people can be frustrating and also confusing. It can mean that the information that the doctor gets is not the same as the information I gave the receptionist. While this is problematic, it is nothing compared to the issues I encounter at the appointment. My approach to appointments is to have a clear goal when I go in. This often means I have a good idea of what the issue is, and what I would like to see happen. That isn’t always feasible, especially when tests need to be run, but having an idea of what to expect can be quite helpful for me. The problem comes when the doctor takes a different route or I misinterpret what they have told me. I end up frustrated and annoyed and less likely to engage in the future, even if that means my health suffers as a result.
Finally, there are routine appointments. Even if you don’t have long-term medical conditions, it is always worth getting a check-up (the frequency is dependent on age and any conditions a person may have). Routine appointments are now almost impossible to get hold of. As I mentioned earlier, the way my GP currently works is to have on-the-day appointments. GPs are able to book appointments in advance, although that relies on you actually being able to access a GP in the first place. Even when you do manage to get a receptionist to book an advance appointment, you find yourself having to justify your reasoning and then having to wait almost a month before you can be seen. When it comes to checking on your medications or discussing concerns about long-term conditions, that is a long time to wait.
The current system does not work, especially for people who have additional needs. So what can we do about it? By we, I mean both myself and the GP surgery, because I realise that an entire system can’t be changed overnight and it also requires both parties to have realistic expectations. Let’s start with the current method of getting access to a doctor. 111 engaged dial tones only to be told that there are no further appointments is not a situation that people should encounter when trying to access routine care. Prior to the pandemic, the surgery had a drop in the system, as well as pre-booked appointments. While the system was far from ideal, it allowed people to book an appointment if it wasn’t an emergency as well as attend the surgery if it was something more immediate. This method cut down on the need to constantly press redial and also allowed people to access the service at a time that suited them (instead of having to call the surgery at 8:10am and hope that there are appointments when you finally get through) or worse, postpone seeing a doctor.
When it comes to communication issues between a doctor and myself, I would find a short summary of any interactions (especially if they take place over the phone) very useful. It is very easy for me to misunderstand the discussion and take away something completely different than was intended. A summary would allow me to be sure I am following the instructions I was given, as well as see where the GP may have misunderstood what I was trying to convey. I can get hold of my GP records, but the problem with those is that they are written in a way that is mostly for professionals, it includes many acronyms and medical jargon, not to mention that the process of gaining access is challenging at best and offputting at all other stages. Another way to improve communication is to allow extra time for appointments, as much as I try my best to get to the point, I need time to ask questions which often seem unrelated in order to be sure I fully understand our discussions, being rushed and having lots of information thrown at me is overwhelming and can be distressing. I would also like emails to be less vague or passive-aggressive. I do appreciate the emails, especially since my sleep schedule can be quite random at times, however, the tone is often very frustrating for me to read and take in. One recent email told me that I had misunderstood what action was being taken around my eating disorder, and another told me I have abnormal white blood cells, but it’s not an emergency. These two brief emails alone contain some of the main problems that I encounter with doctor/patient communication.
Small alterations to accessibility could make a huge difference in how people engage with their medical professionals. It often feels that unless you have support from a person within the medical system (eg an outreach worker or occupational therapist), you have no chance of getting anything done. This took me a long time to write because I wanted to try to see things from every angle. I didn’t want to be the person demanding special treatment. I have only just realised that asking for accessibility is not special treatment. Everyone should be able to access their GP with the same amount of ease, for some of us that might require support and we shouldn’t be afraid to ask for it.
Not Broken 