"GP reception lets the rest of the system down."

About: London The Royal London Hospital / Trauma and orthopaedics

(as a service user),

I am being treated for sciatica (which has been escalating for over three months) and am prescribed a number of pain medications that have little or no effect.

I had an evening appointment for an MRI scan in an apparently private E15 clinic is moved forward and processed efficiently, for which I am grateful. I am in quite a lot of pain in any position and am particularly unable to lie down, though unfortunately I must to undergo the MRI scan. When I emerge from the scanner I am weeping uncontrollably with pain. The nurse and MRI operator are very sympathetic, assure me that they will process the results as an emergency and that the results will be with my surgery by Wedensday. She urges me to book an appointment for Wednesday. Many attempts to telephone my surgery fail, until near surgery closing time, when my call is answered, but they say they will not book an appointment for Wednesday on a Monday evening and advise me to call in or telephone Tuesday morning to do this. I am frustrated and ask if I can speak with the Dr about modifying my pain prescriptions. This is also denied. I am advised to go to St Andrew's Walk-in Clinic, where eventually I am given a prescription for stronger pain relief (but even this is not very effective).

The next day I phone, as instructed, and get through to the surgery at 8: 50am. The exchange went like this:

After the receptionist answered the phone I was continuously asked to hang on while they spoke to others in the office.

Eventually I was able to explain that I'd had an MRI scan yesterday evening, which the clinic is processing as an emergency and you will have the results tomorrow. I would like to book an appointment for tomorrow.
the receptionist said that they can only book emergency appointments 48 hours in advance and can book me an appointment for Thursday.

So I explained that they'd have the results on Wednesday. Again I was told No, we can only book you an appointment for Thursday.

Again, I explained that the clinic they told me to book an appointment for Wednesday and when I rang the night before I was told I could do that if I rang the following morning., but I was told again that I can only have an appointment for Thursday.
I said look, I am in extreme pain and the clinic assured me you will receive the results tomorrow.

Etc. , etc. - this exchange continued fruitlessly for 18 minutes. An example of seeming capricious policy about appointment booking, poor communication, inability to listen, inefficient use of telephone time (some other patient was on hold during this lamentable exchange).

Then the pain had escalated to a degree that the only comfortable position is leaning over sofa with left knee on the sofa. No pain medication is having any effect. I am crying with pain and my partner phones an ambulance. Eventually, at A&E, the MRI results are obtained from the clinic and pain medication regime of combined medications is prescribed and thoroughly explained. The treatment at A&E was caring, capable, efficient and respectful.

In the evening a doctor from my surgery rings to tell me in a mumbling, reluctant tone of voice that the MRI results have been received. I don’t bother to tell them that I have already received the results at A&E nearly 12 hours earlier.

On Thursday at my appointment with a different doctor, the pain medication regime I have been prescribed by the A&E department is confirmed, repeat prescriptions of all medications are produced and discussed. The doctor advises that if my medication is not dealing with the pain and the dose needs to be increased or if I have any questions to come back to them. I tell them it feels impossible to get through by telephone or to make an appointment. So they advise that it is possible to book a 5-minute telephone appointment. I leave with that new bit of knowledge feeling perhaps continuing care will not be as difficult as it has been thus far, getting the problem addressed in the first place.

As advised in letter from A&E, she will request appointments for Neurology or Osteopathy (which will take a long time) and Physiotherapy (which will be quicker). I will be notified of appointments by letter.

In the meantime, I book appointments with a private physiotherapist. I am a self-employed person and cannot take any further time off work.

Also - please note: several of my previous consultations on this problem I have been able to piggyback onto appointments already in place for an annual health check (which equals two appointments). For this I have had to be insistent and demanding beyond my normal level of professional interaction with service providers.

A week after my doctor’s appointment my symptoms have changed and so I need to alter my medication accordingly. I asked at a local pharmacy for advice and the pharmacist suggested I discuss my medication with my doctor.

Repeated attempts to phone surgery have to be abandoned because I have to work or travel. Late in the afternoon I phone my surgery at one of their recommended ‘less busy times’. I am on hold for 1 hour at which point the phone system terminates the first call and initiates a second and I am sent to the back of the queue again.

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Response from Barts Health NHS Trust

Thank you for your comments on the care and treatment you received during your visit to the Emergency Department. It is always good to hear when a patient has been given the care and compassion we work hard to provide.

We will share your comments with the team responsible for your care.

Best wishes

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