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Doctor's surgery

pretty useless!

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Female
Aely  Female  Hampshire
13-Oct-2020 15:34 Message #4795035
Yesterday i had a suspect "lesion" removed from my back at our local hospital. I have 3 stitches and a dressing. My daughter, who came 40 miles to return me home after the short procedure, had a peek and said it had bled (showing through but contained my the dressing)

I was firmly instructed by the hospital to ring my doctor ASAP, book a nurse appointment for 2 weeks time to have the stitches removed. I commented that I might be lucky getting one. The nurse said it MUST be done in 2 weeks. The surgery was obligated to do it. I rang my surgery. No appointments available. Ring again in a couple of days. She mentioned they were trying to get nursing staff. I said I have a more pressing problem. The dressing can be removed after 24 hours,. As it has bled and dried. As it will probably be stuck down by the dried blood that must be done carefully and it will need a cleanup. I have had 2 frozen shoulders. I can't reach the dressing. It can't stay on for 2 weeks. It has to be kept clean.

Receptionists reaction? "I'll put you down for a telephone consultation within 48 hours."

The doctors and nurses are good - problem is, getting to see them!

Nothing to do with the doctor's surgery but additional problems -
1) not allowed to have a bath until stitches are out (a light shower is ok, but I don't have a shower. Bucket and sponge will have to suffice.)

2) Supposed to apply vasolene 1 or 2 times a day for 2 - 3 weeks "to protect healing skin". I have vasolene. Can't reach back.
Female
JustLyn  Female  Cheshire
13-Oct-2020 16:44 Message #4795049
Not all nurses do dressings. I used to run a minor op clinic 2001-2004 then, when I moved to where I have just retired from they wanted "to develop the nurse team" and I was taken on to do that. That GP surgery was one of three in a health centre so it had a separate treatment room and for a long time, a specialised contraceptive clinic. It started out OK, as I had a health care assistant and a junior nurse, but gradually, even though it was agreed at my interview, my role started to change without my agreement. In addition, I had no need to do dressings or contraception for ver 10 years so I developed other skills and had my own patients, such as diabetes management which was above what most GPs are trained to do. I was booked up three weeks ahead.

But then patients, and even some GPs weirdly, do not understand skill mix. So occasionally, patients would not tell the receptionist the reason they were making an appointment, then expect me to deal with their dressings. It isn't just as easy as taking off a dressing, it is having the equipment to deal with what you might find underneath. I d know that if a dressing is left on a bit longer, it isn't usually a problem. Many hospital staff refer things to the GP that is inappropriate and assume all GP practices offer the same services, but many have been contracted out.

Some patients got quite agressive, but if I was booked ahead for 3 weeks, there were lots of patients who wanted to be squeezed in for all sorts of things, but if you are already trying to fit in your advanced bookings, there is only your toilet break left!
I started to leave the building on my unpaid lunch hour, an eleven hour stretch, or else the phone would ring in the middle of my soup and sandwich, or there would be a knock at the door with a "Can you just..."

The problem was being left as the only nurse after the junior left after 10 years and the excuse was always no money, whilst the GPs all had new big cars, I often had to buy my own equipment and pay for my own training.

AS for wound care, in the old days many problems were caused by frequent dressing changing, but when I did training after working on heart surgery, the methods had progressed to leaving dressings on for days, as although they look messy, of no infection has been introduced, you won't get one. The principle, if a dressing had to wait, was to cover it with another layer, then just bathe it off if it stuck as the running water under a shower seemed to have a therapeutic healing effect with the water gently beating down on the crusts. The trick was not to rip off any scabs as that could expose the tender healing tissue beneath.

I heard last week that the nurse that replaced me lasted 4 weeks then resigned, then they tried an agency nurse who lasted 2 weeks. It is akin to training to be a qualified teacher, have a speciality in autism or be a lead in safeguarding, but end of being your own assistant so you don't have time to do the job your trained for.

Sorry, it's a bit of a moan, but although I have had great GPs practices as a patient, as a nurse I have worked in the pits and the frustration is still with me otherwise I would not have retired. An agency offered to pay me to go back, but I couldn't face the internal politics again. My friend, my HCA, is at great risk because her GPs are not treating her diabetes properly and I feel impotent in kicking them up the behind as I know just what to do to help but cannot.
Female
JustLyn  Female  Cheshire
13-Oct-2020 16:46 Message #4795050
Ah...sorry, stitches do need to come out ideally without 2 days overdue. You could try a walk in centre, they used t do a lot of ours but 111 might check if they are making appointments instead?
Female
Aely  Female  Hampshire
13-Oct-2020 17:14 Message #4795051
I'll check back with the surgery in a couple of days re the stitches appointment - and work from there as necessary. Thanks for the advice. I think our nearest walk-in centre is in the next town.

My daughter suggested I try my niece about taking the dressing off. I had forgotten she isn't working at the moment (sadly made redundant). I gave her a ring and she came round via the chemist, bringing an anti-bacterial spray and a new tub of vasolene. She took the old dressing off, it hadn't stuck thankfully, and put a protective gauze over the top to prevent rubbing. All masked and gloved up as there have been a couple of cases of Covid at her daughter's 6th form college. She was brilliant. Luckily, unlike her parents and siblings, she lives a short drive from me, not in Canada.

Even before Covid my GP surgery had problems. They ran an emergencies only service for weeks last Autumn because of staff shortages.
Female
eurostar  Female  Merseyside
13-Oct-2020 17:27 Message #4795052
Aely do they not have a district nurse system because with the greatest imagination in the world a telephone consultation won't take stitches out or put vase line on, and you need to know what's what, good job you have family but a lot don't, this is not good it's dedpicable
Female
wonderoushen  Female  Gwynedd
13-Oct-2020 18:46 Message #4795060
I don't know about your area, but here district nurses are in short supply, sometimes theres no night cover at all and an emergency call to them can result in a 12 hour wait.

I get a bit fed up with being asked by reception staff why I want an appointment, as Lyn says often its to book you in with the right person, but at other times it feels like a return to the bad old days of the receptionist guarding the doctor from the patients. It also not nice being asked why you need an appointment when your actually at the surgery, the answer the doctors just told me to make one often dosen't seem tobe good enough for the reception staff, also theres a lack of privacy and it might be something you don't want to talk about with load of people behind you.
Female
JustLyn  Female  Cheshire
13-Oct-2020 19:53 Message #4795068
When I worked in Bolton, the district nurses were helpful and communicative. It's funny how different areas have totally different philosophies as Manchester were terrible. It wasn't that each nurse was terrible, but the system in which they worked were inflexible and even if they were visiting a patient for something else, they would never just check a blood pressure or blood sugar. Even worse were Tameside, absolutely useless. I even tried complaining to the Trust, be hey ho, it was one of those Foundation Trusts that made up their own rules. Heck, I could make this political!

Euro,

It depends what despicable, the patient not getting the care, but then the nurse might not be able to work due to health problems. Most GP's run on absolute minimum staff because they hold the funds to run the practice how they please, often on a shoestring.
Female
eurostar  Female  Merseyside
13-Oct-2020 19:59 Message #4795069
Lyn I think I have the most amazing health centre in the world, I, m coming from a practical place of aely needs stuff done which cannot be done by a phonecall, to not even be offered advice but brushed off by a receptionist is despicable, if I rang my surgery for the same I know for a fact, previous experience, they would have directed me to the right place and person, covid is being used as a generic clause, the receptionist has not been helpful at all
Female
Aely  Female  Hampshire
13-Oct-2020 20:18 Message #4795070
Must admit Euro, I wondered how they were going to remove my dressing for me over the phone! Thought I would humour them though.
If my neice hadn't been out of a job and available (although dashed off for a job interview once I was seen to) the dressing would have stayed on until Friday when my daughter is driving the 40 miles to bring my shopping.

Thank goodness I had Sepsis 5 years ago and not now!
Female
eurostar  Female  Merseyside
13-Oct-2020 20:24 Message #4795071
Lol ours have a list of alternatives, if no district nurse, or doctor, or nurse appointments available they give you the number for nearest walk in to you to make an appointment there, before covid they would make it for you but obviously busier now, good luck aely hope all heals well x
Female
JustLyn  Female  Cheshire
13-Oct-2020 20:42 Message #4795072
Receptionists is most surgeries don't have any discretion. If they are told no appointments, they have no leeway to make any decisions. They get bad tempered because they are stuck in the middle taking the flack.
Male
Pboro Trevor  Male  Cambridgeshire
14-Oct-2020 10:14 Message #4795110
Most surgeries now have a proliferation of 'Nurses' from the basic healthcare assistant, upward as they gain more qualification and on to the fully qualified nurse, and even up to a nurse practitioner who can prescribe some medicines.

It all depends on how and what level 'nurses' your surgery has managed to recruit.

Trevor
Female
JustLyn  Female  Cheshire
14-Oct-2020 11:40 Message #4795121
Most surgeries actually don't Trevor.

I have spoken on the subject at meetings throughout Manchester, including the Royal College of Nursing.

You might find a few who have a good team though, and they are often in disbelief of how some surgeries run.

I have worked in 9 GP practices, so have a broad experience from the inside out.
Female
Aely  Female  Hampshire
15-Oct-2020 14:38 Message #4795233
JustLynn, I have now been given the earliest appointment available on their books, 8.50 on the morning of Wed 28th Oct, 1 day and 18 hours late, so I hope that will be ok.

I remember when I had a lumps removed from boobs many years ago, when the nurse came round to remove the stitches they were buried because of inflammation. I finally got the last 2 stitches out myself a few weeks later. My fault, in a way. I was supposed to take it easy but I lived in an upstairs flat with a young child and a husband recovering from a brain operation so taking it easy wasn't an option! Able to be more careful this time.

Female
JustLyn  Female  Cheshire
15-Oct-2020 15:54 Message #4795243
Although leaving stitches too long causes inflammation, as along as infection is prevented, it usually just involves slightly more digging around to get them out.

I am not sure if treatment advice has changed again as it was at least 17 years since I needed to do any, but I do know late stitch removing has always been an issue where the hospital lays down expectations that can rarely me met, but I have never seen any major incident on superficial stitches remaining in too long if they are left alone.

On the other hand, my mother was left with internal stitches left in that caused issues for many years, but then that wasn't down to the GP surgery.

You may find this site reassuring.
https://woundcaresociety.org/long-leave-stitches-surgery
Female
Aely  Female  Hampshire
15-Oct-2020 17:40 Message #4795252
Thanks Lyn
Male
Brundall  Male  Lincolnshire
17-Oct-2020 16:34 Message #4795389
Best to email the Practice Manager and get them to sort it out! Start at the top not with the minions.
Female
JustLyn  Female  Cheshire
17-Oct-2020 18:33 Message #4795403
The practice manager cannot force a nurse to add in more patients than there is space for. There are many patients each day that want same day appointments but as with my surgery now, the nurse they tried that with after I left lasted only 4 weeks, then the next one 2 weeks. Now they, and the next door surgery have no nurses whatsoever, and no applicants.

I once complained, well I actually had email evidence of attitude from our practice manager and it turned out, the GPs told her I was the same grade staff as her in relation to pay.

Well run surgeries have a proper team that work together and not against each other, or with one member picking up all the slack.

Once the nurses left, the non-minions tried it on with the salaried GP and now she too has resigned. It took them 2 years to find her.
Male
AndyMacG  Male  the West Midlands
18-Oct-2020 16:17 Message #4795483
Yes Aely, i totally agree, useless is one word for them,

I have had an abscess on my neck for at least ten weeks, i have had a severn day course of antibiotics but there is still a lump on my neck which has gone down but is still there and sore to touch, Anyway i had an appointment Saturday 17th for my flu jab so when i went in for my jab i asked the Dr if he'd have a look just to confirm it was getting better and not worse, anyway, he refused saying "It was a flu clinic not a consultation" then in his next breath and after i had my flu jab he was asking me to take this urine sample collector for my annual review which isn't due until December, i refused quoting the same "i thought you said this was a flu clinic not a consultation" I could have caused a right rumpus but i just walked away.

So, what is it with Dr's these days is it part of there training now on how to be obnoxious, whats happened to the Hippocratic oath, is it still part of a Dr's remit and one last thing, where do i complain?
I have complained to the surgery but that'll fall on deaf ears as usual so is there anywhere else i can complain to?

I know Lynn is or was in the trade perhaps you can point me in the right direction or at least answer a few of my questions, please?





Andy Mac
Male
AndyMacG  Male  the West Midlands
18-Oct-2020 16:18 Message #4795484
Whoops, i meant "JustLyn" :)





Andy Mac
Female
JustLyn  Female  Cheshire
18-Oct-2020 16:44 Message #4795490
To be honest Andy, flu appointments are often only 2 minutes, even in normal conditions and you don't need the patient record open. Even just opening the record takes 30 seconds then once you have started ANY consultation you have to document whatever was said, what advice was given, and then any treatment or tests offered.

Like anything else, word gets around, and what exceptions you make for one, opens a can of worms.

It was because I wanted to give proper care to those booked in that I refused to see any extras, with the exception of people struggling to breathe in an asthma attack, or a suspected heart attack needing an ECG (which wasn't on my job description).

My manager often conflicted because the money side of general practice wants the nurse (and often the GP) to cram in as much as possible, but because managers are not clinically trained, they are often trying to make health professionals cut corners.

My manager could never grasp that piling patients in high in a flu clinic resulted in patients having an opportunity to swab bugs then complain the flu vaccination gave it to them, or complain they had waited too long in a huge queue. There was time to do nothing else.

But... when I got my way doing a 5 minute clinic, I could, if I had time, catch patients who didn't normally attend during the year for their pneumonia vaccination (which doesn't come prepared as you have to draw it up out of an ampoule, and also, produce a prescription). Also explain why the pneumo is different to the flu. I could do the odd blood pressure, prescription update, issue a bloods form, so the new GPs soon discovered my flu clinics were more production but I needed more of them.

Andy, it doesn't pay to be rude to the GP under pressure. Complaining he is asking to bring in a urine sample next time is much easier than looking at a boil on the neck. Some things are just not comparable. It's like patients complaining they can be late and still seen because the nurse or doctor is running late. One is because the patient didn't allow enough time, and the other is because the health professional has probably had to deal with an emergency so the the urine sample and the boil are in completely different consultation requirements.

The trouble is, taking more time with one patient would be at the expense of the next one and a flu clinic just doesn't have any leeway built in.

As for a recurrent or lingering boil, remembering I am not a GP.
1. Check diabetes control as poor Hba1c or raised sugars causes boils and is often a sign someone is diabetic if not already.
2. Take a swab if leaking, as the lab then identify the correct antibiotic, though boils are often staphylococcus, but treating with a guessed antibiotic is why we have MRSA and more antibiotic resistance.
(I used to give the patient the swab sometimes, and you might get one from your reception staff but you would need to use it without contaminating it.)
3. Stop any processed sugars where possible as it is sweet blood that attracts the bugs that causes the boils.

and the NHS says
https://www.nhs.uk/conditions/Boils/
Female
JustLyn  Female  Cheshire
18-Oct-2020 16:46 Message #4795491
LOL, I'm Lynne... anyway, I meant swap bugs not swab them!
Female
Minnie-the-Minx  Female  Hertfordshire
18-Oct-2020 17:11 Message #4795493
It's often difficult to get an appointment at my local surgery, but they have always fitted me in once I have explained that it is an emergency. I have never had any problems when my asthma has been bad. I have always been seen.
I had some minor surgery once and the hospital told me to change the dressings daily. However, when it came to actually doing it, not only could I not reach or see the wound properly, but I almost fainted. I rang up the surgery to ask what to do and it was end of hours for the day. The receptionist said that the nurses had gone home, but she was a trained nurse, if I could get there in the next 20 minutes, she would change the dressing for me.
I can think of numerous times where they have gone out of their way to be helpful.
Male
AndyMacG  Male  the West Midlands
18-Oct-2020 17:14 Message #4795494
Thanks Lynne for taking the time to respond and in response all i can say is it was an appointment and not a walk in, also i was early as i always try to be and there was no one else following me into clinic when i went through to the Dr's room.

Like i said, i think its healing from how it feels but being on my neck i can't see it, i just needed a little reassurance, i'm just thinking of the times, a one moment look would have saved an whole morning if i make an appointment and even then i'm not guaranteed to get to see a Dr!

Anyway, thanks again Lynne :) x





Andy Mac
Female
JustLyn  Female  Cheshire
18-Oct-2020 17:51 Message #4795500
Thanks Lynne for taking the time to respond and in response all i can say is it was an appointment and not a walk in, also i was early as i always try to be and there was no one else following me into clinic when i went through to the Dr's room.

No patient doesn't mean no work. I used to hear patients in the waiting room saying there was no one waiting, but sometimes, well, all the time, GPs and often nurses have loads of phone calls waiting to me made before they can go home.

I often found, for example, if a patient didn't turn up on time, I could do more that was needed with the present patient, only to find the late patient arrived, then I had two patients in one appointment, often where one had been asked to book a double appointment, so then the next patient would be seen 30 minutes late!

Not is all as it seems to the eye.

I remember one patient walking out on me, thinking I was doing nothing, when I was actually waiting for an ambulance with a patient having a suspected heart attack, but you can't say anything because of confidentiality.

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