GPs in Bradford district - your feedback answered

Key themes of feedback

• Many patients have told Healthwatch it’s been “impossible” to get an appointment, or that they’ve been stuck in endless phone queues when trying to secure an appointment.
• Some patients have reported experiencing rudeness from both receptionists and clinical staff, even suggesting that this would put them off seeking treatment.
• Many people have told us they wish they could have a named GP who they always see, who knows them and their history. They say they feel that in the current system they are “pushed from pillar to post” and that it’s inefficient and stressful to have to repeat their stories to different medical professionals.
• When getting in touch with their practice, some patients have reported experiencing confusion over who they’re dealing with, especially over the phone. Some are confused about the range of roles that now exist at their practice, such as nurse practitioner, physician associate, physiotherapist, pharmacist and “care navigator”.
• We’ve heard mixed feedback about the use of new technology and remote appointments in GP practices. Some people said they were treated very quickly and effectively with remote appointments, on the phone or using video technology. We’ve also had feedback – including from practice staff – that older people, those lacking in confidence using the internet, people in rural areas and with poor internet connections plus those with learning disabilities and visual impairments, have been or could be disadvantaged by the use of technology.
• We have also received lots of positive feedback, particularly at the height of the COVID pandemic from people who were made to feel safe in practices, had good experiences of accessing care and reported excellent service from staff who went above and beyond to support their patients.

Dr Azam, GP partner at Park Grange Medical Centre in inner-city Bradford, discusses the increase in demand for services at his practice - demand which can be exacerbated by people presenting with issues that could be dealt with by self-care or a pharmacy.

He asks patients to "trust the signposting process" carried out by reception staff, and explains how even if you don't see your named GP, they will be aware of what is going on with your health - and will seek to provide continuity of care in cases where it's particularly important, such as patients with long-term conditions like diabetes or asthma.

Dr Azam highlights the range of work a GP carries out aside from seeing patients, and explains how his practice works to serve the needs of its predominantly South Asian community.

Dr Rayment explains how her rural practice in Burley-in-Wharfedale needs to expand to be able to meet the needs of a growing population and accommodate new staff and the doctors of the future.

She discusses the need to book well in advance for routine appointments, the different ways of contacting her practice and explains why some patients may be asked to have some initial investigations before they are given an appointment to see a GP.

Dr Rayment also discusses the range of professionals available in the practice to support patients in different ways, including local mental health support, and an initiative to support people with chronic lung conditions in an area with a high elderly population.

Dr Rayment discusses the perils of communication breakdowns between patients and staff, and how receptionists are now an "integral part of the practice team" and patients' care, rather than someone "who finds you an appointment".

She discusses how primary care is now "so much more complicated" than it was 20 years ago and now, most days, staff feel like they're "fighting fire".

She says primary care and general practice has changed as a result of Government policy, a shortage of GPs - and that she feels "nobody told the patient" that the current way of working is the "new normal" for practices.

Many patients have told Healthwatch it’s been “impossible” to get an appointment, or that they’ve been stuck in endless phone queues when trying to secure an appointment.

• Have not been able to book a doctors appointment for a long time now. I am 72 years old
• Can’t get to speak with a doctor for weeks on end.
• Since COVID it is so hard to see a doctor.
• It has been two weeks I have been trying to call the clinic to arrange a smear. Each time I call I am waiting in a queue of more than 15, after waiting and getting to number one I am told ‘we are unable to take your call at present’
• Trying to get answered via the telephone is near impossible, and when you finally manage to speak to someone, they ask you in-depth questions about why you are ringing, you have to explain nearly everything with regards to your Illness, or what is wrong with you
• How lucky we are to have such a wonderful GP practice. Phones are answered quickly and following an explanation of my issue to the receptionist I'm booked in for a telephone consultation with the relevant person that day.
• If you want to contact the surgery, you have to listen to a long spiel first, then you will get asked to tell the receptionist what's wrong.
• You have to keep ringing at 8.30 till phone line free, takes at least 20 mins to get through
• On hold for over an hour
• A long wait for the receptionist..up to 20 minutes, usually
• It’s an answering machine always, never a person; you either have to wait when you are 47 in queue or they will hold your place and call you back. This can sometimes take hours
• Average 1hr sometimes will get cut off and start again. Very unreasonable.
• Unable to get through for 3 weeks. Couldn’t get through one day my son was poorly despite trying 113 times.
• Receptionist asked me what my issue is, the whole process now is far worse than before pandemic it’s virtually impossible to see a GP
• It seems as though you are now vetted as to whether you can have a telephone or face-to-face appointment. Unfortunately if you get a telephone appointment  but then actually need to see the doctor you can't till the following  day. So it all takes longer.
• Pre-pandemic the phone was answered, no holding or call-back service. Appointments were not always available that day but were not a two-week minimum wait
• Assessed by receptionist who are usually good. Before COVID it was much better as when you called you always got to speak to a person not have to listen to a five-minute-long message.
• Staff answering phone always polite, but rarely able to help immediately. Can't get through at all in the mornings, because call queuing system overloaded.
• It is a total lottery to get through for an urgent appointment on the phone

Some patients have reported experiencing rudeness from both receptionists and clinical staff, even suggesting that this would put them off seeking treatment.

• Trying to get answered via the telephone is near impossible, and when you finally manage to speak to someone, they ask you in-depth questions about why you are ringing, you have to explain nearly everything with regards to your Illness, or what is wrong with you.
• 45-minute queue to speak to a receptionist who decided if you get a call back. Not always at a convenient time.
• Unhelpful and unsympathetic treatment of the reception staff…
• Almost impossible to get an appointment; receptionist's sole aim seemed to be to prevent patients seeing a doctor.
• Receptionists are extremely rude, patronising and don’t even try to help. They show no care or compassion whatsoever
• Getting an appointment is almost impossible for the same week or the following week, the reception staff are extremely rude and can be very blunt with you.
• Communication skills are lacking and can make a patient feel uncomfortable. When you ring your GP surgery it would be nice to speak to a receptionist with a kind heart.
• We were made to feel that we were somehow to blame for not understanding the bureaucracy and complexity of the NHS…
• Most receptionists are helpful. Before COVID it was easier to get an appointment. Now it is a telephone appointment first and then when necessary, an actual appointment.
• The receptionist wants to know what's wrong and she decides if you need to see a doctor.
• Speak to non medical receptionist who messages GP about my enquiry and asks for call back. GP decides how to respond.
• Unfortunately some of the receptionists at my surgery are quite rude
• Receptionist are very pleasant, but you don't want to talk to a faceless stranger about your sometimes quite personal and intimate problems.
• I spoke with the receptionist and mentioned why I was requesting a GP appointment. I think it is a good way to find out where/what/which clinician I should see or speak with
• Receptionist. Very unhelpful.. they give out health advice when they shouldn't.
• Always helpful, friendly and courteous
• It feels a rushed conversation by the receptionist and almost like they are half listening wanting to get onto the next call
• There should be another level of skill, training and experience after the receptionist with who a worried patient can have a proper, private conversation.

Many people have told us they wish they could have a named GP who they always see, who knows their history etc. They say they feel that in the current system they are “pushed from pillar to post” and that it’s inefficient and stressful to have to repeat their stories to different clinicians.

• Rang surgery requesting a call from the GP who was dealing with my problem. A GP rang back, unhelpful, said he would contact my GP and ask her to ring me (works part time). That was three months ago, no response. There is no continuity of care. Have not rung them again, there are too many hurdles to jump through.

• I never get to see the same doctor, and at 75 years old I think it is important that I have consistency of care in my treatment. At my age I really don’t have the confidence in accessing a GP or other medical professional via Zoom or other technology methods.
• Phone by GP but then had to have scans and then was told to phone up and make follow up with same GP however when rang back was told not possible to make appt for that GP as she didn’t have bookable appts so had to have phone appt with another GP and start from scratch explaining everything again
• Service now is terrible. You don’t get to see a GP you are triaged by someone who doesn’t know you then a GP will call no face to face now.  You should be able to see the GP that you are registered with if at all available.
• Poorer; less responsive; harder to get an answer to phone; can’t see same GP therefore healthcare less good and safe; condition not managed well
• Had phone appointments. No good as a replacement. Too many different GPs so no continuity. I think service for people with disabilities is poor
• (There should be a) dedicated GP per person/family, relationship & community focused practice, re-establish the practice as a friendly and welcoming place. Technology is welcome, but not at the expense of the humanity of care and connection.
• Less reliance on modern technology as not equal accessibility to all. Named GP for every patient registered so you can forge a relationship and have some accountability. It’s passing from pillar to post each time you ring or need help for an ongoing condition that really irks and wastes time repeating what has happened to different health care professionals.
• More continuity of care would I think reduce the call on services, when I first saw a GP when I was very ill with COVID she was caring and supportive. I had the good fortune to speak to the same GP the second time and therefore she knew what was wrong and it reduced the time needed on the phone with her.

When getting in touch with their practice, some patients have reported experiencing confusion over who they’re dealing with, especially over the phone eg is someone a nurse practitioner, doctor etc.

• I used online reporting and was phoned by a nurse practitioner who didn’t identify herself as such and later a receptionist referred to her as doctor.
• I've had appts with GP or practice nurse depending on what I need.  Also had medication review with a pharmacist on the phone which was really helpful and saved me time.
• Nurse Practicioner, Practice Nurse… understood their role and how they could help me
• I’ve seen GP’s, practice nurse and the phlebotomist. Both F2F and phone, except phlebotomist
• Sometimes just identified themselves as "clinician", sometimes there was an actual doctor. With actual doctors, while they could and did prescribe, I didn't think they were any more intuitive or more able to understand my issue than the "clinicians".
• More receptionists, more qualified people answering the phone, more face-to-face appointments with actual real live doctors. Less under qualified staff given fancy titles to do the work of doctors
• I really wish for consistency, i.e. seeing the same Dr. and if I need to see , in an emergency,  a different doctor that they would check my notes first

We’ve heard mixed feedback about the use of new technology and remote appointments in GP practices. Some people said they were treated very quickly and effectively with remote appointments, on the phone or using video technology. We’ve also had feedback – including from practice staff – that older people, those lacking in confidence using the internet, people in rural areas and with poor internet connections plus those with learning disabilities and visual impairments, have been or could be disadvantaged by the use of technology.

• This new alternative method of communicating with the surgery (online) is great if like me you are tech-savvy, and have un-interrupted access to the internet; however ours is a small rural village and has generally an ageing population, who are often set in their ‘old’ ways and don’t take well to change.
• For me the best thing is being able to use the e-consult service which means explaining things in writing without being tongue tied and struggling to say what the problem is.
• I have used the e-consult twice now for my daughter. Twice I have used this service, both times I have had to call the surgery two days after as no GP called me in the timescale given. I think it’s an excellent idea for non-emergencies but only if it works.
• The main problem is that the local practice is always reviewing the way that patients can contact them eg times of day e portals etc, which is understandable, but is confusing for service users.
• I find the phone call appointments much easier to fit in to life and work
• I prefer the mixed options, I mostly do not need to see a GP in person and if there are digital options to get things like a prescription then I'd prefer to use it.  It was clear to me though that when I was offered the face-to-face appointment with the GP I was really very ill. As it happens I'd been vomiting for 10 hours by the time I had that conversation so I was not surprised
• I spoke to a doctor by phone but it took three different call-back appointments before they eventually diagnosed the problem
• Any kind of appointment is better than none at all. But some things can’t be diagnosed in a phone call.
• I hate the idea, I was supposed to register on line as a new patient but failed at the video stage, in the end I sent a letter to the Practice Manager with all my details and eventually was registered.
• I'm not happy with video link
• The video call was fine it was to check that I was injecting my insulin OK. At our practice they have not resumed the ability to book online appointments. So you have to phone from 8 am and then wait in a queue.
• Definitely not, want face to face you can’t hide your emotions/fears face to face
• Nearly all consultations are done over the phone which is sometimes ridiculous as the doctor cannot see what your ailment is
• Would not work for my husband who doesn’t use technology. Wouldn’t work at all in our area as internet isn’t strong enough to stream and the one call I do make using such is forever hanging there………and dropping out.
• I think it is discriminatory for some people who can’t use internet
• No use for measuring things like breathing rate, pulse, BP etc. But bless her, the GP tried. Was more helpful when I needed a video appointment for the doctor to examine my son's eczema. She could see clearly enough on the video to prescribe then.
• Not used video but I'd be fine with it. Saves time
• I was referred to an app after being assessed as pre diabetic. It was rubbish and was a paid service. Nurse had no idea and was going through motions.