# Not happy with service provided by GP practice



## truthseeker (22 Nov 2011)

Just reminded of this from another thread here about GPs.

Im not happy with the service from my GPs practice. I like the GP on a personal level, but over a few years, and increasingly in the past 2 years I have become unhappy with aspects of the service. The reason I hadnt changed GP in the past was mostly because Ive had the same GP for 20 odd years and it seemed like a lot of hassle to change. A recent nasty experience with the practice has persuaded me that I should change.

But Id like peoples opinions, perhaps Im being unreasonable in my expectations?

There are 2 GPs in the practice, Im not confident of one of them due to more than one misdiagnosis, therefore I always only use the other, meaning I can really only see a GP half of the time.

One GP costs a tenner more than the other for no reason I can see. Unfortunately its the one I prefer who is more expensive!

One GP refuses to accept medical card holders or indeed to sign up to any scheme (like combined care for pregnant women) at all - in other words, private patients only, at a tenner a pop more than the other GP. I just feel, for a caring profession, that this is a bit money grabbery and it doesnt sit well with me. 

There is absolutely no service offered outside of a straightforward appointment, ie, if you phone afterwards with a query about your appointment, with a query about instructions given, with an update such as your condition has worsened - the receptionists will not entertain you at all. To the point of rudeness actually. They behave as though they are the gatekeepers to Valhalla. I know that this is coming from their employers so they are not directly to blame, but I object to paying for a 20 minute appointment at 10am and then having a simple question at 1pm and an absolute refusal for it to be dealt with. I have on occasion had to pay for a second appointment to ask a question regarding the first!! The only way to speak to or get a message to the doctor is to pay for an appointment. If you leave a message you never ever get a call back.

One GP refuses to computerise the system, meaning you can never have a receipt re-issued which is annoying if you lose one.

Sometimes they dont write things in the notes and if, god forbid, you end up back because of some issue to do with an earlier appointment and you happen not to see the same person (a locum covers holidays for example), there is confusion because nothing was written up.

If you have to make a return visit with the same complaint in a matter of days, you are charged full whack again.

The locum GP (and the locum receptionist for that matter) always behave in a totally different way and offer help beyond what is normally available leading me to believe that the practice is actually not helpful compared to others - of course, Ive no experience of other practices so dont really know!

So I suppose the question here is this - is the above a normal way for most GP practices to behave?


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## micmclo (22 Nov 2011)

Don't you know?
Some doctors have a God complex 

Just on the medical cards, it's their choice realy. If they have a good reputation and enough private patients then they don't need the extra workload. Nothing uncaring about it.
Maybe they've had bad experiences with many locals with medical cards or possibly have hassle getting paid by the department.

People often don't respect what they get for free so maybe they stopped dealing with medical cards due to timewasters. And while you are not a timewaster, if they take your call they'll take fifty more during the day from everyone else
It's a business and a business decision was made, nothing to do with money grubbing


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## horusd (22 Nov 2011)

Sorry truthseeker, nothing to add to your comment, but the secretaries acting'... as though they are the gatekeepers to Valhalla.' is brilliant.


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## Purple (22 Nov 2011)

Like any business (and it is a business) there are different practices offering different levels of care at different price points.
Just because you pay at the higher end of the scale it doesn’t mean that you’ll get high-end service. Shop around; ask friends and family to recommend a GP and move.

On the issue of medical card patients not all GP’s can get a medial card list. Most of them would like them but it’s a closed shop. The average payment per patient consult per GMS patient is €65 whereas the average charge for a private patient is €50. That’s another bug-bear of mine; why is the state paying a 30% premium to doctors who have a guaranteed income?


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## truthseeker (22 Nov 2011)

micmclo said:


> It's a business and a business decision was made, nothing to do with money grubbing


 
Yes, I appreciate its a business decision, but it irks me nonetheless.



Purple said:


> On the issue of medical card patients not all GP’s can get a medial card list. Most of them would like them but it’s a closed shop. The average payment per patient consult per GMS patient is €65 whereas the average charge for a private patient is €50.


 
What do you mean by this Purple? Whats a closed shop mean? 

As a patient of the practice I can ask for an appointment with either doc, but one doesnt accept medical cards - so in reality just one of them deals with any medical card patients. Would the medical card list not apply to the practice as opposed to the individual doctors in the practice? The locum who covers holidays accepts any patient of either GP, medical card or not.

On the rest of it - yes, Ive spoken to family and friends (some of which are with the same practice and are also considering a move), and will definitely be moving. It can be difficult to find a practice open to new patients actually - never realised that before.


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## Firefly (22 Nov 2011)

Purple said:


> That’s another bug-bear of mine; why is the state paying a 30% premium to doctors who have a guaranteed income?



I can never figure this out...surely with such a guaranteed income it should cost the government 30% *less*?


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## Sunny (22 Nov 2011)

Purple said:


> On the issue of medical card patients not all GP’s can get a medial card list. Most of them would like them but it’s a closed shop. The average payment per patient consult per GMS patient is €65 whereas the average charge for a private patient is €50. That’s another bug-bear of mine; why is the state paying a 30% premium to doctors who have a guaranteed income?


 
I did not know that. Surely there are large savings right there.


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## Purple (22 Nov 2011)

truthseeker said:


> What do you mean by this Purple? Whats a closed shop mean?



Only vocationally trained GP's ca have a medical card list. The number of doctors that can be vocationally trained is restricted.
Many GP’s have the required experience (time spent working in various sectors of medicine etc) but didn’t do so under the umbrella of the vocational training scheme and so can’t get a medical card list.
If one doctor in a practice has a GMS list then all of the doctors in that practice can see patients from that one doctors list. In fact the GMS doctor may never see their own patients. They still get paid for them though, still get the pension, still get the grants for equipment and still get their receptionist, secretary and practice nurse paid for by the state (if they have enough patients on their list). It’s all those extras that make up the €65 average. GP’s saying that they “only” get X per patient is like Gardai quoting their basic pay and leaving off the allowances and extras they get. 

The IMF boys are not happy with this set-up and have insisted that it be changed. 
The more competition the better in my view. A cut of 20% for all services that the state pays for would not go amiss. That includes all the prenatal care etc that is covered for all patients, medical card or not.  

My wife disagrees with me on this (obviously ) but while it would impact severely on our household income I still think it is the right thing to do (a bit like taxing the children’s allowance and introducing property tax).


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## micmclo (22 Nov 2011)

Sunny said:


> I did not know that. Surely there are large savings right there.



I seem to remember Mary Harney tried to make savings but a huge fuss was kicked up and I don't think anything was done in the end

Minister for Health must be the toughest job in the country, all you do is face down vested interests. Sometimes you win and sometimes you lose


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## vandriver (22 Nov 2011)

Do you have any link to back up your claim that it costs e65 per visit on average for medical card patients?


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## truthseeker (22 Nov 2011)

Purple, thank you for that most informative post.


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## ajapale (22 Nov 2011)

Purple said:


> The more competition the better in my view.



Im not so sure about this! There are a lot of factors which influence your initial and subsequent choice of GP and am willing to bet that price is way down the list of those factors.


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## Purple (23 Nov 2011)

ajapale said:


> Im not so sure about this! There are a lot of factors which influence your initial and subsequent choice of GP and am willing to bet that price is way down the list of those factors.



There are other forms of competition besides price competition.
Service providers should compete on service, competence, price, facilities and ease of access (location, opening hours, parking etc).  
Doctors are no different from any other service provider in this regard. The patient (their customer) should also feel that they are valued, that the doctor knows that they have chosen to spend their money with him or her. I always find it strange that so many people thank their doctor after a consultation but so few doctors than their patient for the custom.
At the end of the day you are buying something from them. They should be grateful for that.


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## Purple (23 Nov 2011)

vandriver said:


> Do you have any link to back up your claim that it costs e65 per visit on average for medical card patients?


.[broken link removed] 
They give a figure of €64 in 2008.


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## Protocol (23 Nov 2011)

[broken link removed]

Link to HSE PCRS document on payments to doctors.


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## Vanilla (23 Nov 2011)

Wouldn't mind a bit of competition in our area. Our GP moved and his patient files were left with another GP in the town. There are only two GP practices now left in the town. I didn't want to go to the GP that the files were moved to and tried to move to the other GP with my family- but we were told there was a 'waiting list' !


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## Firefly (23 Nov 2011)

Purple said:


> ...still get the pension, still get the grants for equipment and still get their receptionist, secretary and practice nurse paid for by the state (if they have enough patients on their list).



I didn't know these things were paid for by the state...that's a complete joke. A good friend of mine is a GP and I always wondered how he could afford a practice nurse and a receptionist. Next time he complains about medical card patients wasting his time by coming in every day I'll ask him how his pension is doing! 

This needs an overhaul. Something simple like going to the dole office for a GP voucher if you need to see a doctor. The doctor then gets refunded after the visit by the state for an agreed amount. No pension, no practice nurse or any of the other benefits...


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## Complainer (24 Nov 2011)

vandriver said:


> Do you have any link to back up your claim that it costs e65 per visit on average for medical card patients?



I'm pretty sure that the capitation fee mentioned in [broken link removed] is a fixed annual fee per patient, not a fee per visit.


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## Purple (24 Nov 2011)

Complainer said:


> I'm pretty sure that the capitation fee mentioned in [broken link removed] is a fixed annual fee per patient, not a fee per visit.



Now if I wasn't on Complainers "Ignore" list then he would have seen the link I posted.


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## johnwilliams (25 Nov 2011)

can a doctor (a) who has a patient with a medical card stop another doctor (b) from taking on said patient, a neighbour of mine wanted to change to a different doctor  ,but new doctor was not able to take neighbour on, no reason given ,a lot of people have been leaving doctor (a) for other doctors lately ,and think doctor (a) may have put a stop to it. doctor (a) is not as good as the other doctors in the area


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## Sunny (29 Nov 2011)

Well now I have heard it all......

http://www.independent.ie/national-news/gp-told-mum-to-hand-over-ring-before-son-seen-2947868.html


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## Ceist Beag (29 Nov 2011)

That story is from 2006 - why is suddenly deemed newsworthy now? And why is James Reilly mentioned in the first sentence? Oh wait, James Reilly has just come out with a pre budget statement so lets try and dig up something, anything, negative even if it isn't really related to him! The GP in question isn't even named in the article! Outstanding journalism Eilish O'Regan!


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## Sunny (29 Nov 2011)

Ceist Beag said:


> That story is from 2006 - why is suddenly deemed newsworthy now? And why is James Reilly mentioned in the first sentence? Oh wait, James Reilly has just come out with a pre budget statement so lets try and dig up something, anything, negative even if it isn't really related to him! The GP in question isn't even named in the article! Outstanding journalism Eilish O'Regan!


 
I don't really care about the James O'Reilly angle (though I am from North County Dublin and I know all about James). I just find it amazing that a doctor would take jewellery from a woman to pay for treating her sick son.


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## Ceist Beag (29 Nov 2011)

Agreed Sunny - I just find it a bit strange that the story is 5 years old and is only hitting the newspapers now.


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## One (29 Nov 2011)

To answer the original question, I would have changed GP a long time ago. I have been misdiagnosed several times. Recently when I was in a lot of pain with a trapped nerve I was charged €50 for a 10-15 minute session of being told how to sit straight. Another physiotherapist charged me €50 for putting an ice pack on my back. If you don't think you are being properly treated and it is easy to move GP, then move.


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## truthseeker (13 Dec 2011)

Just an update on this. Its not so easy to get a new GP and it appears you have to resort to 'playing the game' to do so.

I phoned the first recommended place - not open for new patients.

I phoned the next recommended place - a VERY snotty receptionist asked me why I needed a new GP, had I recently moved? I (honestly) said that I was unhappy with the service with my old GP. I was then subjected to a slightly bizarre monologue detailing that in order to be 'allowed' become a patient of the practice, that I would have to be interviewed by the doctor, and that if he felt that I wasnt a 'problem' (yes this is the word used), then I would be allowed to be a patient. I was a bit confused by the whole thing so I said 'eh, I dont really understand, what kind of a problem are you talking about' and she said that they have to be careful of people and that you cant just ring up and get an appointment without being screened first. There was a strong indication that not being happy with a previous GP is not a clever thing to tell a potential new GP. At this point I politely declined being interviewed to pay someone for a service and hung up.

Then I phoned the next recommended place - rather than have an ordeal similar to previous I just said that I needed a new GP as I no longer lived near my old one and was given an appointment immediately.

But I get the impression that you cant say you are not happy with the service from an existing practice without being labelled a looney with issues - its ridiculous, its a business right? Youre not happy with the service you take your business elsewhere!!! Except, as Ive just found - its not that easy.


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## Complainer (13 Dec 2011)

truthseeker said:


> I phoned the next recommended place - a VERY snotty receptionist asked me why I needed a new GP, had I recently moved? I (honestly) said that I was unhappy with the service with my old GP. I was then subjected to a slightly bizarre monologue detailing that in order to be 'allowed' become a patient of the practice, that I would have to be interviewed by the doctor, and that if he felt that I wasnt a 'problem' (yes this is the word used), then I would be allowed to be a patient. I was a bit confused by the whole thing so I said 'eh, I dont really understand, what kind of a problem are you talking about' and she said that they have to be careful of people and that you cant just ring up and get an appointment without being screened first. There was a strong indication that not being happy with a previous GP is not a clever thing to tell a potential new GP. At this point I politely declined being interviewed to pay someone for a service and hung up.


This is a bizarre way for them to be treating potential customers. I'll keep your experience in mind the next time I hear the GPs club whinging on the news about reduced fees. I'd be sorely tempted to lie in those circumstance.

I saw ads for a new GP service around Sandyford (I think) offering a flat fee for the year - about €130 for an adult - with unlimited visits. Interesting business model - not a million miles away from the fixed fee they get for medical card patients.


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## annR (16 Dec 2011)

My experience with GP practices is that you are not really treated as a paying customer. . . .secretaries are as rude as hell sometimes . . .we put up with it all but if a situation arises where you are very ill and anxious, the rudeness and bad service can become so stressful.
This is why I moved, got a recommendation from a friend, made an appointment, never looked back, didn't have any problem.


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