Navigating GP Services - advice please

PottsnPans

Hi everyone. I'd be really grateful for some advice on navigating services at GP level. I'm 48 and I've had joint issues for the last two decades. All that seems to happen is that I call the surgery, get appointment with a GP-based physio, but they will then only discuss one joint at a time. Following a quick chat, I receive an email or text with a link to exercises.

My symptoms have been getting worse, with swollen joints, limited movement, pain and fatigue. I've not been feeling too well either, although I've put the fever/hot sweats down to my age.

Frustratingly, I cannot see a GP for joint pain/issues and only get told to see the practice physio. I have done this a few times now, but to make things worse, you're only allowed to discuss one joint/symptom at a time. I've been advised that it I have osteoporosis and that I'd only get a referral to secondary care when I'm either unable to walk or use the joint in question.

This weekend has been especially bad with my knee - swollen, painful, unable to sleep for days. Last week, I was referred for a shoulder x-ray but only because its been a year since I first reported problems with that joint and I'd previously had calcification with my other shoulder. Apparently, one year is long enough to have symptoms to look into things further.

At this point, I just don't know how to move things along. Any mention of joint issues are automatically referred to a GP surgery physio, and then exercises are given by text or email. No ultrasounds, blood tests or referrals have ever taken place, despite there being several joints affected.

I just don't know where to go from here. It seems to be GP physio or nothing so any advice on how to break that cycle would be much appreciated. I would go private without a second thought if I could afford it.

Thank you so much.

janey4

Hi @PottsnPans thank you for posting on the Online Community. Sorry to hear how you are feeling and that you are not getting helpful answers to what you are experiencing.

Due to some of the symptoms you describe, such as joint swelling and feeling unwell, it would certainly be helpful to ask for a blood test to check for any raised inflammatory levels. If there are any raised levels, then referral to see a rheumatologist should be the next step. If you feel you are not getting the help you need, then it may be helpful to ask for a second opinion or to speak to the practice manager at your GP surgery, or speak to PALS if you feel you are not getting the help you need.

I wonder if the diagnosis of osteoporosis was done by you having a Dexa scan?

Has the GP suggested it may be osteoarthritis you are experiencing, as this is the most common type of arthritis condition?

You would be welcome to call the Helpline to chat through what you are experiencing.

https://www.versusarthritis.org/about-arthritis/conditions/arthritis/

https://www.nhs.uk/nhs-services/hospitals/what-is-pals-patient-advice-and-liaison-service/

Best wishes

Jane

mosborn11

Broadly, when dealing with GPs, one thing you can try is asking for a referral. If they refuse, ask them to write on your notes that they refused and why they refused. Normally at this point, they will be grumpy about it, but they will refer you.

frogmorton

I am inclined to think I would be quite firm and ask for a face to face appointment with a GP. It's hard to be insistent, but maybe play on one of your other symptoms such as the fevers you are having just to get past the receptionist. Then if at all possible I would take someone with me for support. I feel I get 'fobbed off' less if I come mob-handed😉

I am afraid the latest business of passing all musculoskeletal issues over to physios is just a gatekeeping exercise and you have been patient long enough.

When you get there you need to tell them just how many joints are affected and all the other symptoms you are having too.

Best of luck

Toni x

jamieA

Hi @PottsnPans

I would agree with @frogmorton that you need to be more assertive with your GP practice. I would also agree that taking someone with you if you are not confident enough. I would also suggest you write down your concerns regarding your health detailing symptoms and timescales. It might be a good idea to give a copy of that to your GP either in advance of your appointment or at the time of it. My original GP practice had very unhelpful and obstructive reception staff and I know it's the last thing you need when dealing with a chronic condition.

I hope you get some help soon.

Emmasknackeredjoints

As above , but when your booking your app at the gp surgery , mention you need a face to face app, as this is global joint pain with swelling with feeling unwell therefore possible systemic condition.

Its not a MSK one joint pain at a time , which is different.

Good luck

Nurina

I'm so sorry to hear that you aren't feeling well. I'm agree with above comments. Because you have multiple joints swollen, that looks like a global issue and not a condition to be treated joint by joint. You'd need to ask for a rheumatology referral. Sending you to the physio is just because they don't have a clue about what's going on with you, sorry. Get an appointment with other GP and try again. Good luck

Trish9556

Hi @PottsnPans

I have refused to see our MSK team attached physio at my practice. She really is the worst Physio I have ever seen. I first experienced her 'excellent' professionalism (tongue in cheek) many years ago and every time I have seen her she says wear this take aspirin thank you very much and bye bye. The last time I saw her in practice I had recognised her name and thought she might have changed. She might have improved but no. She was more bothered at why, when i'd sprained my ankle years previously, I had not sought medical advice so there wasn't really anything she could do despite my pain which had recently got worse. She also told me I could not possibly have anything wrong with my wrist as I'd had surgery on it and the problem had been resolved and no way could I be in pain! Having since seen a GP who has promised to look after me, I am now on my way back to my surgeon. When my hips went, I refused to see her and opted to go through the external MSK team. Funnily enough they tried to give me an appointment with the one I refuse to see to which I replied she would be the last person I ever see again regarding my arthritic issues.

I would suggest emailing the practice manager and asking why you have been unable to progress to an external referral, x-rays etc and detail every single time you have seen the in practice MSK who is not providing you with the service you require. If you get no response from this you can put in a formal complaint with the surgery and also then involve your local Health Authority.

I would also suggest that when you phone for an appointnment you tell them it's to discuss pain relief. I have found that appointment requests for pain relief get a reponse and when asked which part of your body you need pain relief for you can tell them all of it!

The last resort would be change your GP practice. It took me a long time to find a good GP at our practice and I now refuse to see anyone else and have previously been told 'you have arthritis Mrs B, get used to being in pain there's nothing I can do'. You have to be assertive and not take no for an answer.

Trish