GP refuse to refer and have a policy not to see under 16's

GPs are private businesses, and more or less do whatever they feel like. It is about time we had a National Health Service that is truly national and accountable.  My own view is we need a tax-funded insurance system and a mixture of publicly-owned and private providers that the >patient< can choose, not be at the mercy of bureaucratic commissioners.

Many years ago I had a job opposite Guy's. I needed a routine blood test, and was told to go to my local hospital - which meant taking a morning off work. I asked the GP if I could go to Guy's in my lunch break ... no, the GP Commissioning Group (or whatever it was called back then) had a "contract" with the local NHS Trust.

Personally, I would like to see health centres that provide access to the full range of primary care, including minor treatment, pathology, OT, physiotherapy, counselling ...  and patients can go wherever is convenient. In 1948 it made sense to be "registered" with a local GP ... now we have computer systems, it should be possible to go to any provider and for them to access your basic NHS record.

My local GP practice has four doctors, three nurses, and >twelve< admin and clerical staff. It still takes two weeks to get a routine appointment, if you can get through on the phone to book one.

in my view the solution is just to remove GPs all together. For routeen things like vacination and routeen tests pharmacys could do it fine. We can move the diagnostic / referal function directly into hospitals with dedicated diagnostic wards. Then we only really need peripetetic GPs to do house calls.

No.

Peter said:

in my view the solution is just to remove GPs all together. For routeen things like vacination and routeen tests pharmacys could do it fine. We can move the diagnostic / referal function directly into hospitals with dedicated diagnostic wards. Then we only really need peripetetic GPs to do house calls.

No, I must disagree to that. Hospitals are not autism friendly, for one they all smell of ammonia cleaner, echo with noise, and have fluorescent lighting. Even before you get to the fact you are almost always seen by a total stranger at a hospital, you also more likely to catch something in a hospital that serves the whole area than just your local town and villages too. Then there's also the issue of travel to and from a big hospital.

Fortunately logistical and common sense prevail and we will have GP's for a while yet. The nice thing about GP's is you usually can change them if you aren't happy with the one you have. Our nearest next GP surgery is 5 miles away and the nearest hospital is 20 miles, we are in a rural area not a city. Usually there are options if you don't like your current GP if you know where to look.

You might not like GPs but you can't say the whole system should change to your liking when others rely on it for better or for worse as it is. What GP's need is better funding and patient accuntability, it's not revolutionary, one would only take a pen tick from a government worth a damn, and the other you can get by going over their heads to ombudsman services, PALS, commission groups, or getting a letter to their regional managers, you just have to find out how to demand better from your GP in the chain of command.

No.

Peter said:

in my view the solution is just to remove GPs all together. For routeen things like vacination and routeen tests pharmacys could do it fine. We can move the diagnostic / referal function directly into hospitals with dedicated diagnostic wards. Then we only really need peripetetic GPs to do house calls.

No, I must disagree to that. Hospitals are not autism friendly, for one they all smell of ammonia cleaner, echo with noise, and have fluorescent lighting. Even before you get to the fact you are almost always seen by a total stranger at a hospital, you also more likely to catch something in a hospital that serves the whole area than just your local town and villages too. Then there's also the issue of travel to and from a big hospital.

Fortunately logistical and common sense prevail and we will have GP's for a while yet. The nice thing about GP's is you usually can change them if you aren't happy with the one you have. Our nearest next GP surgery is 5 miles away and the nearest hospital is 20 miles, we are in a rural area not a city. Usually there are options if you don't like your current GP if you know where to look.

You might not like GPs but you can't say the whole system should change to your liking when others rely on it for better or for worse as it is. What GP's need is better funding and patient accuntability, it's not revolutionary, one would only take a pen tick from a government worth a damn, and the other you can get by going over their heads to ombudsman services, PALS, commission groups, or getting a letter to their regional managers, you just have to find out how to demand better from your GP in the chain of command.

TBH I'm not going to get into this further I have an important phone call to make before 10 and stuff that needs doing before I have to away from keyboard for a while. So I'll just say goodnight Peter.

not all autistic people have noise senstivity. Those who do can get reasonable adjustments. Like being seen in an exam room at a hospital rather than in a cubical, and not being asked to wait in a waiting room. Belive me my experence of the GP is not atypical it is the norm for a city practice (which is the vast majority of practices) Being put off by busy GPs is not an autism spicific thing.

Peter said:

Far better to walk into a noisy clinic, tough it out for a bit,

For you maybe, but you are not everyone else. I for the most part don't have very high support needs on a good day but any day I have a health issue worrying me isn't a good day anyway, I get told I have a high tolerance for things but that's only because I'm not a 6 year old banging his head into a wall stereotype people think of when they hear the word autistic, even I couldn't cope with that, it's a privilege to be someone that can handle a noisy clinic and "tough it out".  A lot of autistic people can't. Would you really just say pooh to people like me and let us have meltdowns and run out before we get seen just to have our health issues get put off longer and suffer more? If so that is quite selfish.
If you need it a certain way because you are one autistic person with unique needs you should advocate for that for yourself. You are supposed to be able to do that, and health care practitioners should be autism sensitive anyway. It sounds like you have problems not addressed through the correct channels with your specific GP practice that you are blowing up as if it is a problem (and an unfixable one) for everyone.

In practice I never see the same GP twice and I almost never get a choice on which GP I see if I want an apointment I have to take what I can get time wise. In fact I strugel to get a face to face apointment they'd rather do teliphone interviews and leave administering tests to nurses. The notion asking to changed to another GP in the same practice is just a fantasy in a busy city practice. You never have just one GP. And half the time when you see them they will just try to make excuses not to refer you because they know the waitinglist for everything is huge and they maybe don't see you as a priority case (and therefor not even worth trying to get on the list).

They'll just keep kicking the can down the road with endless follow up apointments rather than refer you, efectivly hoping you'll go away. Far better to walk into a noisy clinic, tough it out for a bit, be seen by a specialist who actually knows what an urgent case in his specialism looks like, and come out knowing your case has been properly triaged.

For those who truly can't stand hospital there are home visits ... but guess what after the visit if you need anything more complex than antibiotics guess where you're getting refered anyway ... hospital.

Like any other large bureaucracy, the NHS is essentially unaccountable. An extreme example is the Letby case, where clinicians and managers were more concerned about "reputational damage" than the possibility that babies were being killed. Look at the recent report that said that many maternity units were dangerous, not because of a deranged killer, but because they were understaffed, underfunded, and badly managed. The structure of the NHS means that it is possible to bounce blame between commissioning groups, provider Trusts, individual clinicians, and the Government for not providing enough money.

Talking about autism specifically, despite Winterbourne View and several other major investigations, residents in long-stay institutions are still being abused, the Government still has not amended the Mental Capacity Act and the Mental Health Act, or brought in effective inspection. Care staff are paid less than supermarket shelf-stackers ... you will not recruit and retain good staff if you do not provide adequate pay and conditions.

Taking your point about smells and fluorescent lighting ... it ought to be the case that the NHS was leading the way in designing accessible facilities, but again it is about cutting corners to save money. Or plain stupidity, like the architects who decided to put the ophthalmology clinic - which needed dark rooms to examine patients - in the part of the building with windows and the dermatology clinic in the windowless area. Some architects and planners are not the sharpest tools in the toolbox.

PALS are not independent, they cannot investigate complaints or advocate for patients. If you get an apology, there is no independent check that any lessons will be learned or changes made ... in effect, each GP practice, Trust board or whatever mark their own homework.