GP Partner @witleymilford 🧑⚕️ 🦀| Former RAMC Officer 🇦🇲 | ND 🧠 | BBQ enthusiast | Health-tech Consultant
South East, England
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With no great surprise having declared us through the pandemic, this morning in primary care looks very much like an explosion of pandemic infections and people poorly with it. Who could have guessed that would happen???
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1/4 of the GP workforce off with COVID today. #freedom
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In 2019 the GPs in my surgery did 56000 consultations for 11,000 patients.
In 2021, this rose to 79,000. We had no extra staff.
This year looks to be busier again - general practice is working flat out, regardless of what the media would have you believe.
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Abuse to my staff members today from patients asking what do we actually do, why aren’t we seeing patients. We’re lazy. Now, we’ve not changed how we work for 3 years. We do great in patient surveys. This is direct abuse from right wing media nonsense. It has consequences
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Just as an insight for people outside of GP - 0950 on post bank hol tuesday, we've had 160 patient care requests submitted as of now (12,000) practice. Likely to hit 400 for the day.
EXTRA PHONE LINES DON'T GIVE YOU EXTRA STAFF TO MANAGE THIS
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Patient coming to see me this morning checking 'you're still wearing masks aren't you, not doing what those bloody idiots say?'. People know.
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🧵 Why the PA debate?
🥼 Doctors aren’t against other people in their space. We already have advanced nurses practitioners, consultants in other disciplines. It’s not that.
It’s this.
It took me 14 years to qualify to be a GP. 14. Let that sink in.
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On duty this morning and the near-constant upset that patients are relaying to me in terms of NHS care failing them (as it slowly crumbles) has really left me feeling flat and somewhat low. It's not the service I joined.
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🧵 Watched 'Breathless' last night. It was raw, visceral...a flood of memories from my time as a GP during the pandemic. Scrubbing down at the back door before hugging my kids. Holding staff who broke down, terrified they'd never go home. @doctor_oxford #Breathless
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Local community nursing team now refusing new referrals as no capacity. Minor injuries turning people away as full. CMHRS ... well. Secondary care appointments months and months away. GPs and ED colleagues, are we now on our own??
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✈️ GPs about to exit 🇬🇧
Job advert I found tonight for Vancouver Island, GP.
💰 £250,000 - £300,000 Pa
🧘♀️ 8 hour practice days
“We have recruited UK physicians who now live in beautiful large homes overlooking the ocean”
And UK gov?
GPs can 🖕off and work to death.
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4 days in hospital after a nasty 🚴 💥
Interesting being on the other side. There were generally well meaning, caring people around. But.
1. Not enough staff
2. Compassion fatigue evident
3. Bed pressure is wild
4. Care fits available resources, not what is needed
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Day 3 in GP of a crisis - huge numbers presenting concerned re GAS. Antibiotics running out, has *anyone* seen any central guidance from NHSE???? Anyone?
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A difficult week in general practice 🧵 :
The bread and butter of general practice is having the time, skills and relationships to work through undifferentiated symptoms and help steer the patient to safety, whatever that may be. It could be reassurance, referral or medications.
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I was pretty shattered yesterday and told quite a few patients I needed to call them the next day so I could have a chat about their problems when fresh. Everyone so far has been absolutely lovely about it, and kind. I think we see a very focused subset of malice in the media.
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So we can have-at-it for NYE while at the same time the NHS is setting up chemical warfare standard field hospitals in car parks with the Army... Right, right.
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EXC
The NHS is too often run for the benefit of doctors, not of patients, Wes Streeting warns in @theipaper interview alongside Rachel Reeves.
He promises a decade-long reform programme to empower patients to take control of their own care.
Story: inews.co.uk/news/politics/nh…
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102,000 hairdressers in England with 40,000 salons
27,000 GPs with 6200 Surgeries
31 million people visit GPs every month, a similar number have haircuts.
In can see some issues with this comparison. Not sure anyone died if they got the wrong haircut.
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Thank you Wes. I believe you really mean it, which is a catharsis in itself after the nightmare we’ve been through. You shouldn’t have to feel like that either - any help you ever need, shout.
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Quick peek at the surgery inbox this morning - catastrophically high levels of infectious illness. The NHS can't sustainably cope with this level of driven demand. Predictable, preventable, will significantly impair quality of service delivered.
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This is extraordinary from a health sec. Threatening to wilfully sabotage care provision unless doctors stop exercising their lawful right to strike. From a labour government. No words.
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To secondary care colleagues from GPs - we’ve got your back, you’ve got ours. Respect. Not division
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Very busy in GP-land today. Mental health (lots), problems with test and trace, patients wanting to sit in for discussions despite rising cases. GPs are doing a brilliant job against the odds
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Live footage of uk GPs going to work today
-Victorian diseases on the rise
- Rationed healthcare
- Those who can pay, do well. Those who can’t……
Never thought I would see the like in my lifetime
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And here we are. This is pretty much a normal day now
Have you ever wondered what the collapse of the NHS would actually look like? It's in the small things - my latest @Independent newsletter: link.e.independent.co.uk/vie…
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Photo memory lane is proving excellent. My very favourite photo ever - last 20 mins in uniform, just back from tour. Second time I saw my daughter
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It's Monday, it's triage time. The mystery illness giving everyone a fever, cough and sore throat continues. What could it be?
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F1/nurse/HCA and so on - it looks a terrible, horrific ordeal at the moment
Glad to escape, happy to have my life saved but equally terrified at a system I don’t recognise from my training.
Good luck hospital colleagues, and thank you 🏥
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Well bloody hell. Sat on hold for emergency services. Shit really has hit the fan hasn’t it in the U.K.
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Running tally of patient interactions so far today (0852). These are things that require cognitive input inc consults, bloods, letters etc. Let’s see what the day holds! @Parody_RCGP @DAUK_GP
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5. Hospital is scary - navigating it *as* a physician was still terrifying
6. Iatrogenic harm from system failure was evident around the place
I really felt for the staff. Going home, first thing we said in the car was *who on earth* would train in that system now
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I’m delighted to announce 📣 I’m joining NHSE as their head of QOF- well being.
I’ll be spending the next 12 months 📅ensuring the well being of our GP teams with more checklist exercises📋 ☑️
Strongly feel this is the best way to prevent primary care collapsing 👍🏻
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Duty list so far:
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Sore throat 😶
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
Cough 🤧
That is verbatim.
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You want the *most* qualified people doing this. We trust our nurse and paramedic colleagues precisely due to their training, experience and unique skills.
We will take all the help we can get. So long as it’s safe and regulated.
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Some days you cry in between patients, dry your eyes and carry on.
I am absolutely in despair at the state of mental health services.
Really ill people are given sticking plasters and turfed back. Endless day of it today.
Hope - hard to find at the moment. We do our best.
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Nearly 3 weeks since LFT +ve and first time woken up feeling actually normal. That’d be about the worlds worst ever cold…
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Amazing how many middle aged male cyclists live in communes together judging from the runs out.
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We’re being told, you can do it in 2, work (what is in practice) unsupervised in the hardest branch of medicine.
We see horrors when they look like minor illness.
We have to know enough about everything.
Switch from psychosis to skin cancer to an early lymphoma.
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No pleasure in reporting how difficult it is in GP at the moment but thank you to @ashishskynews, @RachelSkyNews and @SkyNews for supporting us during the primary care crisis. news.sky.com/story/soldier-t…
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This isn’t an inevitable future. The workforce could be saved and care continued; it won’t be with mergers/places/local systems though. It will be brave decisions to reset care to minimum bullshit factor and maximum output with protected staff. {end 🧵}
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Retention, retention, retention.
I started training 2000. I’d say I became ‘good enough’ as a GP within the last couple of years.
20 years of experience to be good enough.
*Thats* why we are desperate to improve conditions, pay and morale. It’ll take a generation to rebuild
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I lost count today at the number of people who gasped when I told them the estimated NHS wait for their needed speciality. And who then reached into their savings.
Striking isn’t just about pay, it’s about keeping a workforce (and growing it) so we don’t lose the NHS.
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🧵 - limping into 2024
🏥 Hospitals spilling onto the streets. Like a war zone
🤒 So many febrile, coughing people that finding the really sick among them is challenging
✋ referrals getting turned around with instructions to essentially conduct an outpatients in GP
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Ah yes, going to war with the bedrock of the NHS. Wonderful. I can’t actually recognise this government as a labour government. I genuinely wouldn’t give that as an answer, if I had a sudden memory loss and had to work it out from their words and actions
1 in 3 GP partners now earn more than the PM, so the BMA's claim they lack resources for online bookings simply isn't credible.
We’ve backed general practice with £1.1bn extra funding & by employing 2,500 more GPs - because people deserve a modern service
thetimes.com/uk/healthcare/a…
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😢
Can the last GP partner turn out the light?
The 2% uplift makes GP untenable. This year, many practices will be laying off staff.
They’ll struggle on, and as time passes it’ll be too much. Contracts back.
@doctor_katie and @BMA_GP we will fight with you as long as we can
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Mind. Blown. chaos at @NHSEngland
Prof Vig is paid to spout the govt line - so she does. Employ the unemployed doctors ,offer a path back to earnings parity with 2008, provide training places and career paths for newly qualified doctors. Otherwise the collapse of the NHS will continue.
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I talked about my breakdown today. I didn’t need to for my sake. I’m ok. But the responses I had showed me why I had to.
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We are now full today - I can't physically see anymore people. This has never happened to me before. We're all struggling. thanks @NHSEngland for sterling work with your letter and the subsequent media attention.
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coming up for air for a minute on duty today. Tuesday 20th Dec. No better than Monday. Absolutely apocalyptic levels of concern re fever/cough/cold. Running on a knife edge to work out who is actually big sick. Solidarity to all those in #TeamGP , ED and Ambulance too.
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We told you. We told you that prancing around on VE Day and unofficially declaring lockdown over would have consequences. 17 days later. Here we go again. 😔
Weston General Hospital is temporarily stopping accepting new patients, including A&E, as of 8am today (25 May). Arrangements are in place for new patients to have continued access to treatment & care in other appropriate healthcare settings if needed. uhbw.nhs.uk/p/latest-news/te…
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GPs! A boatload of 3D printers are helping me with this for our primary care and community teams. Get on to your local ones! @jaa_adams @JTJ_08 @MichelleBull4 all yours if you want some
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Have mercy on us secondary care colleagues and write to patients, not GPs, in clinic letters. Spending Monday translating letters to patients is not helpful.
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Thoughts at the end of Monday. I want to get back to being a proper GP, not managing pandemic damage control. Can we just have some space to do the job we are best at? Please?
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NHS IT in a nutshell. Sat in a cafe, 7 year old MacBook. Running EMIS on a windows emulator. Through my phone internet connection. *still* quicker than being sat at my office computer 🤦♂️
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secondary care tweeps, did you know you can find GP bypass numbers here: finder.directoryofservices.n…
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I’m blown away pay restoration for GPs would be 53%.
What little 🐸 in boiling water we are
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For my own practice, a Monday 4 years ago saw 180 people consult us. We now have 300, with less staff and roughly the same amount of patients. The cognitive load trying not to harm someone is very very big
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Are. You. Kidding.
You can now request appointments at your GP online.
We're working with GPs to make it easier to get an appointment, when it works for you.
Find out more:
gov.uk/government/news/onlin…
ALT Drake making a disapproving gesture in the top panel with the text "Calling your GP at 8am" and an approving gesture in the bottom panel with the text "Request an appointment at any time."
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Absolute explosion of COVID +ve this weekend, 50 when I got in. Seems weird, who's betting omicron is endemic already?
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If you work in primary care, why not leave a positive review for the GP surgery that looks after you and let them know you appreciate them. We all need a bit of a lift right now.
#TeamGP #bekind @pramitpatelgp @thecanniff @Dr_Ellie @drmarkporter
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Anyone else in this boat?
the thought of a @UKLabour government has been one of the few things giving me hope to keep going as an NHS GP. Terrible sinking feeling that the only glimmer of hope is being snuffed out @wesstreeting @RachelReevesMP
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I’m sorry, this is wrong. PAs as they are being used now are replacing doctors. We all know it.
What we *thought* we were getting, Physicians Assistants, would have been helpful.
Don’t blame PAs as a group, blame the policy makers.
On behalf of Professor Sir Sam Everington, we share his thoughts on the process towards the regulation of physician and anaesthetist associates
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0800 - not surprisingly again everyone seems to have a mystery cough, fever, sore throat and the odd gut symptom. What could it be?
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Short 🧵 on duty yesterday and why for a moment, I was back in Afghanistan 🇦🇫. It was and horrifically busy throughout. There's no stretch in the system, and the winter viruses are creating chaos. @Parody_RCGP @RoyLilley
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In a running theme - there’s always a tweet.
The Government have lost the confidence of the NHS workforce.
Their refusal to negotiate with striking staff has had a devastating impact on patients and staff for the last seven months.
When will they act to avert further strike action?
standard.co.uk/news/politics…
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I genuinely dread, and hate, all our public holidays since working in the NHS. Absolutely crazy amount of work in the run up, and you know you'll be punished as you return to work. Anyone else the same?
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Surgery business this week:
HEPA everywhere ✅
FFP2 for routine work ✅
FFP3 for hot encounters ✅
Split team working ✅
NHS staff deserve the best protection we can afford them. We need them, the PPE regulations are clearly deficient. Lead from the front and get it done
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🧵🚨 As a GP in England, I'm increasingly concerned about the state of our out-of-hours healthcare. Despite the hard work of healthcare professionals, the system is under immense strain. #NHS111 #OutOfHoursCare
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Bit bereft this morning with @UKLabour Heath sec interview.
No rescue coming for GP, apparently we’re the enemy. ‘Murky and opaque’.
This is not the language of an ally.
So many are holding on hoping Labour may turn it rounds. I expect more GP partners to sign off now.
So it turns out GP partners are what’s wrong with the NHS - who knew?! A Short thread @dave_dlt @TheSecretDoc @LisGalloway @DrSteveTaylor @DrPeterWeeks1 @DrSimonHodes
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Looking back to our worst mid-winter Monday from 4 years ago, around 180 patient request. 210 yesterday. In summer.
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Hi @Keir_Starmer at least twice in the last 24 months ‘back pain’ was in fact neurosurgical emergency. Not the physio requested.
GPs are good at sorting this.
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General practice was set up deal with an average of 3 consultations/patient/year. We are now verging on 9, with less doctors and our hospitals imploding. There’s an existential crisis amongst GPs as we worry about missing ‘that’ diagnosis amongst all those people.
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The PM can piss off, after months of orchestrated media gaslighting of GPs with fractured skulls and broken spirits to show for it we aren’t in the mood for platitudes
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Hi Dr Rosena, as another doctor I (a) felt your tone was respectful and spot on and (b) echo the sentiments of the question you asked. Thank you for speaking for us.
I will respectfully challenge the Government - I want our country to succeed.
However, I will not 'watch my tone' when dozens of NHS and care staff are dying unnecessarily.
A clip of my Q to the Health Sec today.
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So we have reached that perfect storm ⛈ we warned about. The system is currently eating itself as no supply matches demand, and provision gets worse and worse. Add in the loss of that relationship and staff being screamed at while burning themselves alive to provide care…
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1.9% uplift.
They don’t care about you accessing primary care. They want us closed.
*no-one* can take a 20% operating budget drop over the next 5 years and run at anything like the capacity they do now.
Accessing GP appointments is a priority for the public.
And thanks to the brilliant work of our GPs, practice nurses, physios, pharmacists and others we’re making progress.
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I was very happy to share my experience, it was very telling that so few people were willing to go on record with their experiences.
The NHS is a toxic place, and we have a long way to go to make it right.
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Normally, we could manage this but factors are confounding us. The workforce is burnt out. Secondary and social care are falling apart. The trust in GPs has been devastated by media campaigns. So what does this look like on a daily basis?
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I'm really baffled, how do you get notified of an LFT *while* having a meeting. From when/who?
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Dying with laughter. A poll of just over…..
200 doctors
The BMA didn’t put our offer to their members and now we know why: they wouldn’t have backed their unnecessary and irresponsible strikes.
They should give their members a say, call off these strikes and stop risking the NHS’s recovery.
thetimes.com/article/c039c2b…
ALT Junior doctors’ strike: most don’t back BMA walkout, poll reveals
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🧵 1:Today, I find myself at a crossroads of care and crisis. The collapse of our social care and healthcare systems isn’t just a headline; it’s the reality I live every day. The moral injury of witnessing this decay is profound. #HealthcareCrisis #MoralInjury
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Brand new e-stethoscope for our *completely* no touch hub - broadcasting to Doctor in the next room. Amazing kit ! Using it today and so chuffed it works so well @MinalBakhai @MarcSchmid
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Has anyone actually found that making GPs triage all day every day has improved appointment availability?
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