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How to get the most out of your GP consultation

Arranging an appointment at your GP surgery can feel challenging! You may find that you have to wait for the phone to be answered or take time to send an online consultation form, only to discover that the Care Navigators aren’t able to offer you the appointment that you want, and the next available appointment slot may seem like an awfully long time away. When you arrive in the waiting room, you may see a sign telling you that you should only discuss one thing with the doctor and make another appointment if you have multiple problems and you only have a minute slot to tell your story.
 
Many patients feel hurried by this short time frame, and it can be tough for the doctor too; in this short time they have to engage with the current problem, which may be complex, deal with ongoing conditions like diabetes, offer interventions such as how to stop smoking and listen out for a hidden agenda – the reason you might have come, but haven’t felt able to raise. So, it is no surprise that in the last year many practices have increased the appointment time to fifteen minutes; this means seeing fewer people per session but allows a bit more time to deal with problems properly. A current standard day now allows for 26 appointments, which is recognised as a safer workload than previously. Having said that, our duty team will often manage more than 120 patients to ensure that those who need to be seen urgently are able to do so. Across England there were almost 39 million appointments delivered in general practice in October 2024, with an average of 1.68 million appointments being delivered per working day. This is a significant increase from the previous month when there were 1.3 million appointments per working day. 38% were booked to take place on the same day and 70% were delivered face to face. In Tavyside, we had 6,463 appointments and 5,902 answered calls. Sadly, the increase in workload has not been matched by a transfer in the proportion of funding or staff.
 
So how can you make the most of your appointment time?
 
Explain to the Care Navigator why you have phoned. This may include a bit of information about the condition you would like to discuss with the doctor. They are experienced and able to priorities your request as appropriate, particularly if your symptoms are serious. GPs are always able to see patients on the day should that be necessary. However, it may be that another member of staff is better able to deal with your needs: our mental health workers are here three days a week and have an hour to see each new patient to really give time to sort out difficulties. Likewise, the physiotherapists have 25-minute appointments to do a thorough assessment of newly presenting musculoskeletal conditions. Sometimes no appointment is required at all, and a quick administrative request can be easily sorted out by sending a message. It is important to remember that receptionists work within the parameters set out by the doctors, so it is not always possible for them to be able to give you exactly what you would like but will do their best to facilitate your appointment.
 
When you see a GP, they will start with an open question such as ‘what brings you here today?’ This is an invitation to tell your story. Evidence suggests that if you are allowed to talk uninterrupted for 90 seconds, you will be able to share the key details which will allow your doctor to make a diagnosis. This may be backed up with a few specific questions, an examination and some basic tests. Doctors are trained to listen out for ‘red flags’ that may indicate that you have a serious underlying problem, for example; if you say you’ve had unexplained weight loss or a new breast lump, expect further detailed questioning and urgent referral for investigations and a specialist opinion. Other diagnoses are made by recognising a pattern of typical symptoms that suggest a particular cause and then confirming the diagnosis with examination and tests. Don’t feel you need to be to be too clever. Some people will Google their symptoms, find a diagnosis and then mould their story to fit it but the ‘best historians’ just tell their symptoms as they are. However, if there is something specific that you are worried about then it’s fine to ask; ‘I’ve had tingling in my right hand and pain in my neck for the past week since I got back from a cycling holiday’, this may say a trapped nerve to the GP but if you are worried you may have multiple sclerosis, you should say, so this worry can be specifically dealt with. And don’t leave the most important thing until last as it will almost certainly be worthy of more than the minute of time that might be left at the end of the consultation!
 
When it comes to the examination, you need to be prepared to show the body part that you are concerned about. Nail varnish makes it impossible to examine for a possible fungal infection. It is time consuming to remove skinny jeans and high boots in order to have a rash on your calf checked out. It’s understandable for teenage girls with facial acne to wear makeup, however this needs to be wiped off before the appointment if severity of the condition is to be assessed appropriately. If you would like a chaperone for your examination then that can easily be accommodated. All GP surgeries offer chaperones, so if you would like someone with you for an intimate examination, you can just ask. Don’t feel you need to apologise; you may feel embarrassed, but your GP won’t. The most important thing is to be clear and open about your concerns so they can assess appropriately. If you prefer to bring someone with you for support or another pair of ears that is fine too. But don’t let them talk over you or interrupt. It is your story.
 
Bringing additional observations with you can also be helpful. You may have a blood pressure machine at home which have been using on a weekly basis and a record of these results is really useful. Likewise peak flow measurements, weight changes, blood sugars, the date of your last period or a list of allergies can also add valuable information if they relate to the problem you want to discuss. If you think you might have a urine infection, bringing a sample in a sample pot means it can be tested on the spot and a diagnosis and treatment plan offered straight away, with time left over for a medication review and a relaxed chat about your family. You’ll be in and out within fifteen minutes – sometimes that’s all it takes!
 
One final thing; please be understanding if your doctor is running late. Almost certainly this will be due to something beyond their control; there might have been a medical emergency, or an earlier patient may have been recently bereaved, or been told they have cancer. On those occasions it is important that a bit more time is spent helping them through a life changing moment.

Dr Harriet Doyle
Senior Partner
Tavyside Health Centre

How to get the most out of your GP consultation Read More »

Shared Care Agreements

A shared care agreement is a formal arrangement where responsibility for a patient’s medication is shared between a specialist consultant and a GP.

Share care agreements are used for specialist medications examples include disease modifying drugs, some hormone therapies, and ADHD medications.

Tavyside Health Centre considers all shared care requests from locally commissioned NHS providers.

Tavyside Health Centre will no longer be entering into new shared care agreements with private and independent providers.

What this means for patients:

Existing agreements: Patients currently under private shared care arrangements will continue to receive care as per their existing agreement until further notice

New requests: We will no longer accept new requests from private or independent providers for shared care agreements. Patients seeking such arrangements will need to explore alternative options and may wish to consider:

· Fully private treatment through their specialist

· Discussing NHS referral options with their GP

This decision has been made to ensure equitable access to services and to maintain high standards of prescribing safety and monitoring for our patients, it is in line with the guidance from NHS Devon and the BMA. Mixed funding (Private and NHS) Shared Care requests – One Devon

Shared Care Agreements Read More »

Menopause Lifestyle

As one of the menopause leads in my practice I naturally have a lot of discussions about Hormone Replacement Therapy (HRT)  but there are many of us who are unable to take HRT or who’s symptoms aren’t fully controlled by it. Just as important as medication is looking at what symptoms can be reduced by lifestyle and environment changes. To be honest a lot of the lifestyle advice is the same as we discuss with our patients all the time – eat a healthy diet, do more exercise, don’t smoke and drink less. I worry that the repetition of this advice decreases it’s impact, but there are specific reasons in menopause why it’s so important to focus on this.  

Activity and Exercise  

For me the most important message I can communicate is how important activity and exercise is in perimenopause and post menopause life. Increasing physical activity, and for those who can, adding in moderate and vigorous activity like running, has a direct impact on menopause symptoms. It reduces hot flushes and temperature intolerance, probably because a lot of the physiological changes the body makes to cope with being hot and sweaty during exercise then help us to regulate temperature control at other times. Increasing activity, especially outdoors, decreases stress and improves cognitive function and brain fog. The link between exercise and the brain is becoming increasingly understood with increasing evidence all the time. All of these improvements can then add together to improve sleep, so important as one of the tortures of menopause is insomnia.  

As well as a direct impact on symptoms increasing activity has a huge effect on post menopausal health. It has a huge positive benefit to the risk of heart attack and strokes that increases markedly post menopause. It limits the loss of bone density and the change of developing osteoporosis. It helps maintain muscle mass allowing us to be active longer and prevent falls and musculoskeletal pain. It is a powerful tool to prevent weight gain and especially fat placement around the middle which is more dangerous for our health.  

Smoking and vaping 

Smoking and vaping makes hot flushes worse, make sleeping, anxiety and cognitive function  deteriorate and moods swings increase. We all know how damaging smoking is to the body generally, damaging our lungs and cardiovascular system and adding to thinning of the bones (vaping seems to be as bad for bones as cigarettes are), but quitting at any time of life can be positive.  

Alcohol and caffeine 

 Alcohol and caffeine make hot flushes worse at the time of drinking and for some hours after, again compounding a lot of the other symptoms of menopause. Alcohol and caffeine also have a direct impact on the brain increasing anxiety, mood swings and brain fog independent of the insomnia.  

Diet 

Eating large meals late, especially high sugar or spicy meals can have a huge impact on flushes and sleep during the night. Avoiding high sugar or ultra processed foods and eating more whole foods can decrease menopause symptoms, be a part of losing or controlling weight and improving our health as we age. Foods containing phytoestrogens, for example lentils and chick peas, can improve menopause symptoms.  

Environment 

I think any menopausal woman knows the importance of a cool environment, light clothing that can be altered quickly when hot flushes occur, and cool calming sleep environments. One area of life we have less control over is our working environment but menopausal women are entitled to work in a place that allows them to feel well and this is supported in law.  

Stress and mental wellbeing 

This is a more difficult thing to tackle. Menopause tends to hit just at the point of life where work can be stressful, family commitments can include caring for both children and elderly relatives, and the pressures of life at present are intense. Menopausal symptoms are compounded by stress, and feeling unwell then decreases wellbeing – a vicious circle. It’s important to prioritise wellbeing for yourself and not just care for others.  

Useful Links: 

https://www.cuh.nhs.uk/patient-information/menopause-a-healthy-lifestyle-guide/ 

https://www.talkworks.dpt.nhs.uk/workshops/talkworks-for-menopause 

https://www.menopausematters.co.uk/ 

https://rockmymenopause.com/resources/ 

https://www.acas.org.uk/menopause-at-work 

Menopause Lifestyle Read More »

Autumn Vaccinations

Covid Vaccination

 

As we move into autumn, protection from any earlier COVID-19 vaccination you may have had will be starting to wane. For those who are more likely to become seriously ill from COVID-19, the NHS offers a free vaccine in the autumn, previously known as the ‘Autumn Booster’.

Eligible groups this autumn

The eligibility is the same across the 4 nations of the UK (England, Scotland, Wales and Northern Ireland).

The vaccine should usually be offered no earlier than around 6 months after the last vaccine dose. If you are eligible, you can get protection from an autumn COVID-19 vaccination even if you have not taken up a COVID-19 vaccine offer in the past.

Further information on eligibilities can be found here – Who’s eligible for the 2024 COVID-19 vaccine, or ‘Autumn Booster’? – UK Health Security Agency (blog.gov.uk)

The Covid-19 Vaccination Programme is due to commence on 1st October 2024, however, at the time of writing this, we have no delivery dates and therefore will not begin to invite patients until we can confirm delivery dates with the NHS supply team.

Flu Vaccination

Flu vaccination remains a critically important public health intervention to reduce morbidity and mortality in those most at risk including older people, pregnant women and those in clinical risk groups. It helps the health and social care system manage winter pressures by helping to reduce demand for GP consultations and likelihood of hospitalisation. 

Eligibility

Eligibility for flu vaccination is based on the advice and recommendations of the Joint Committee on Vaccination and Immunisation (JCVI). This includes a vaccination programme for children based on JCVI’s 2012 recommendation, using live attenuated influenza vaccine (LAIV) which provides individual protection to the child and reduces transmission in the wider population.

The following groups are to be offered flu vaccination in line with the announced and authorised cohorts (see timings section):

From 1 September 2024:
  • pregnant women
  • all children aged 2 or 3 years on 31 August 2024
  • primary school aged children (from Reception to Year 6)
  • secondary school aged children (from Year 7 to Year 11)
  • all children in clinical risk groups aged from 6 months to less than 18 years
From October 2024, exact start date to be confirmed by NHS England in due course:
  • those aged 65 years and over
  • those aged 18 years to under 65 years in clinical risk groups (as defined by the Green Book, Influenza Chapter 19)
  • those in long-stay residential care homes
  • carers in receipt of carer’s allowance, or those who are the main carer of an elderly or disabled person
  • close contacts of immunocompromised individuals
  • frontline workers in a social care setting without an employer led occupational health scheme including those working for a registered residential care or nursing home, registered domiciliary care providers, voluntary managed hospice providers and those that are employed by those who receive direct payments (personal budgets) or Personal Health budgets, such as Personal Assistants

Pneumococcal vaccine

The pneumococcal vaccine helps protect against serious illnesses like pneumonia and meningitis. It’s recommended for people at higher risk of these illnesses, such as babies and adults aged 65 and over.

The Pneumonia Vaccine for most patients over the age of 65 is a one-off vaccine and we will offer this alongside the flu and covid vaccines. 

Autumn Vaccinations Read More »

RSV Vaccine

RSV is an infectious disease of the airways and lungs. RSV infection often causes symptoms similar to a cold, including:

  • cough
  • sore throat
  • sneezing
  • a runny or blocked nose

It can also make you become wheezy or short of breath and lead to pneumonia and other life-threatening conditions. There is no specific treatment, and most infections will get better by themselves. Every year thousands of older adults need hospital care for RSV, and some of them will die. RSV can be more severe in people with medical conditions such as heart or lung disease or a weakened immune system.

RSV infection is common in young children but is most serious for small babies and for older people.

Eligibility for the RSV vaccination

Everyone turning 75 years old on or after the 1 September 2024 will be offered a single dose of RSV vaccine. This is because older adults are more at risk of serious complications from RSV. You can still get the vaccine up to the day before you turn 80.

For the first year of the programme, the vaccine will also be offered to those who are already aged 75 to 79 years on 1 September 2024 as part of a catch up programme.

If you are not yet 75 the NHS will invite you for vaccination once you turn 75.

Having the RSV vaccine at the same time as other vaccines

Shingles and pneumococcal vaccines

You may be offered your shingles or pneumococcal vaccine at the same time as the RSV vaccine, it is safe to do so and reduces the number of appointments you will need to get protected from these diseases.

Flu and COVID-19 vaccines

RSV isn’t normally arranged to be given at the same appointment as your COVID-19 or flu vaccines.

In certain clinical circumstances, your doctor or nurse can safely offer them at the same time.

Your guide to the RSV vaccine for older adults – GOV.UK (www.gov.uk)

RSV Vaccine Read More »

BMA Collective Action

Following the recent BMA ballot which you may have heard about in the press, we are writing to explain what this means for you and the future of General Practice. 

GPs have for years been doing work that is not funded and not contracted due to gaps in commissioned services and pressures in secondary care services; they have been doing so out of concern for their patients and to ensure that you continue to receive the care you deserve. However, with chronic underfunding and increased demand it is no longer sustainable for GPs to continue working in this way. 

Since 2015 we have seen 1600 Practices close or merge, there are 6 million more registered patients and 2000 fewer full time equivalent GPs across the country. Our funding levels are significantly lower than 2018 levels. This means we will be focussing on the safety and stability of our service going forwards.

Collective action is about working legitimately within our contracts. You may have heard this referred to in the press as industrial action; this is factually incorrect.  We will not be doing anything that compromises your safety, and we will not currently be going on strike.

We hope you understand that we are taking this action to ensure that general practice locally, in Devon and across England is there for our patients in years to come, and hope for your forbearance. 

BMA Collective Action Read More »