NHS services: alternatives to GP and hospital

NHS services: alternatives to GP and hospital: which should I choose?

The NHS is very large, the biggest employer in Europe. It is so large and complicated, it is hard to know which part of the NHS to use.

This page describes the main options, and which is best for which problem. Pros and cons. Yes, it is quite confusing which one to choose.

• If you are unwell or injured, it’s important to choose the right service to make sure you get the best treatment as quickly as possible. You may not need to see your GP or go to A&E
• For example, NHS111, Walk-in Centres and Pharmacists are underused. These are especially good options out-of-hours (late and weekends). If you’re unsure of where to go for help, start with NHS 111 online
• Also, you can often refer yourself to a (‘first contact’) physiotherapist or NHS counsellor (IAPT) without going through your GP.

We will now describe the full range of NHS services, including GP and hospital-based, and alternatives to them.

But let’s start with self-care.

Self-care

• What for: many illnesses and injuries can be treated at home – e.g. cough or cold, sore throat, headache, sprain, grazed knee, hangover. Staying at home can also help to stop spreading some viral infections.
• Pros: (very) local!
• Cons: not many
• How to contact: ask yourself and family
• What else can they do: watch TV, have a cup of tea and a biscuit

Ensure your medicine cabinet is stocked with things like paracetamol, aspirin, plasters, gauze, rehydration mixture, a thermometer and indigestion remedy.

Telephone or Cyber

1. NHS111

• What for: advice (especially for urgent care, if you do not know which bit of NHS to use)
• Pros: easy to get through to initially; experienced
• Cons: can be frustrating as initially a ‘facilitator’ asks you questions before a health professional rings you back; this can be in an hour or two; will not know your medication or past problems
• How to contact: ring 111, or use website
• What else can they do: book you appointments; guide you for emergency dental, eye care, or emergency prescriptions

Community-based

2. GP

What for:

• Mild or moderately severe new problem, with symptoms lasting over 2 days; many problems get better on their own with no treatment (usually within two weeks)
• Deterioration of longterm condition
• Recurrence of an old problem

Pros and Cons

• Pros: know you, your medication and past problems; experienced; can refer you to hospital specialist
• Cons: cannot easily get big investigations (e.g. CT scan); general doctor, less specialist knowledge about rarer diseases
• How to contact: ring, or email admin address at GP practice. You do not need to be registered to see a GP, you can get care there if you are a visitor to the area
• What else can they do: sick (fit) notes, help you get back to work

Notes

• You can register with a GP of your choice but you must live in their catchment area. It is very important to do this, even if you do not currently have any health issues
• Even though GPs run an out-of-hours service, this is for urgent problems that cannot wait till morning. They will not usually be your normal GP and may not have full access to your medical record or medications.
• So NHS111 or a Walk-in (or similar) Centre (see below) may be a better option. But please do not use any of these, for things that can wait till morning (e.g. repeat prescriptions).

3. GP Practice Nurse

What for:

• Monitoring of a long term disease – e.g. diabetes, CKD, high blood pressure (BP), Parkinson’s Disease, epilepsy
• Wound dressing, stitches
• Vaccination

Pros and cons

• Pros: knows you, your medication and past problems; experienced
• Cons: may not be able to prescribe medication
• How to contact: ring, or email admin address at GP practice
• What else can they do: discuss you with your GP or other specialist nurses

4. Pharmacist

What for:  

• Questions about medication
• Repeat prescription
• Medication review
• Many ailments including colds, flu, headache, upset stomachs, urinary tract or eye infections (UTIs and conjunctivitis), rashes, dandruff, insect bites and stings
• Other functions: advice regarding which part of NHS to use (like face-to-face NHS111); vaccination; contraception

Pros and Cons

• Pros: simple being local; no wait; do not need appointment; open late and weekends; experienced; a good place to start
• Cons: cannot change current medication without discussion with GP; only your normal pharmacist will have a record of your tablets
• How to contact: go to the pharmacy
• What else can they do: emergency prescription; some GPs work with a ‘clinical pharmacist’ who has access to your notes and can treat you

Note. Most pharmacies have a private consultation area where you can talk without being overheard. You can speak to the pharmacist in person, or ring them for advice.

5. District Nurse

• What for: nursing issues (e.g. wound dressing, or giving injections) through visits to your home
• Pros: a service based in your home (good if you are housebound or frail)
• Cons: not many
• How to contact: ring them (they should give you a number) or ring GP reception
• What else can they do: can discuss your problems with your GP (e.g. take photos)

6. Midwife

• What for: pregnancy, and newborn (up to 10-14 days post birth when they handover to health visitor; see below
• Pros: can discuss with your GP and a hospital obstetrician (pregnancy specialist); experienced
• Cons: you are usually not delivered by midwife you know
• How to contact: ring them (they should give you a number; or find online at local hospital) or ring GP reception
• What else can they do: help you with anxiety or mental health problems

7. Health visitor

• What for: post delivery, and child health upto 2.5 years
• Pros: will visit you in your home; with first visit 10-14 days (taking over from midwife), then every 3-4 weeks; experienced
• Cons: do not work at weekends; visit as part of standard plan but difficult to get more frequent visits if you just need support
• How to contact: ring them (they should give you a number; or find online at local hospital) or ring GP reception
• What else can they do: advice on vaccination

8. ‘First contact MSK (musculoskeletal) physiotherapist’

• What for: bone, muscle or joint problems (e.g. shoulder, hip, knee or ankle pain)
• Pros: may know more than your GP; can organise an MRI or CT; experienced and specialised
• Cons: not many
• How to contact: can self-refer in many areas (see GP website or Google ‘first contact NHS physio + your area’) or ring GP reception
• What else can they do: can get an orthopaedic surgeon to see you, and arrange an operation

9. Genitourinary Clinic (GUM)

• What for: sexually transmitted diseases; emergency post-exposure HIV prevention medication, emergency contraception
• Pros: helpful, not judgemental, experienced
• Cons: not open at weekends
• How to contact: ring or just turn up (you do not need an appointment)
• What else can they do: contraceptive advice and supplies of condoms etc

Mental Health

10. Counselling (Talking therapist, previously IAPT)

• What for: mild or moderate mental health problem (e.g. anxiety, depression and panic attacks); relationship issues
• Pros: local
• Cons: can usually only give one course (e.g. six sessions)
• How to contact: you can often self refer; Google ‘IAPT’ + name of your area; or ring GP reception
• What else can they do: can discuss your problem with (or get you to see) a Consultant Psychiatrist (mental health doctor)

11. Mental Health Crisis Team (MHCT)  or Consultant Psychiatrist

• What for: severe mental health problem
• Pros: specialised and experienced
• Cons: MHCT often only responds if really unwell and not if becoming really unwell; consultants can be difficult to contact
• How to contact: MHCT: ring them if you have their number, if not, Google ‘urgent mental health helpline or crisis team’ + local area; consultant psychiatrist (if you have one): ring their secretary (at the hospital they work)
• What else can they do: can get you admitted to a mental health hospital if you are very unwell

Now we turn to hospital-based care in the NHS, and describe which NHS service you can use there.

Hospital-based

12. A&E (Accident and Emergency)

What for:

• Severe physical problem – e.g. chest pain, stroke, new confusion, shortness of breath, severe abdominal pain or bleeding, road traffic accidents, major fractures, head injury, severe burns and collapse.  MyHSN has list of 10 common reasons to go to A&E
• Severe mental problem – e.g. if you or someone else is having a severe mental health crisis, or are considering suicide
• Pros: best place to go if seriously unwell; can get emergency investigation (e.g. CT scan) or have emergency operation; open 24h a day, 7 days a week
• Cons: can wait a long time; may be seen by non-specialised junior doctor
• How to contact: go there; ring 999 (for ambulance) only if cannot get there by other method
• What else can they do: good place to go, if have severe mental health problem (can get a mental health nurse or doctor to see you)

Note. If you have a more minor ailment, you may get a bad experience. It is NOT what they are for. Many quite bad things, are better dealt with by NHS111 or Walk-in and similar centres

13. Walk-in Centre, Urgent Treatment Centre (UTC), Minor Illness/Injury Unit (MIU)

• What for: things you would consult a GP about; they can also deal with a sprain, stitches, minor broken bone, or minor head and eye injury
• Pros: open out of hours (e.g. 7 days, 8am-8pm); often do not wait long; often at or near a hospital (so can get you seen there if needed, or take their advice); can do x-rays
• Cons: MIU may not have a doctor
• How to contact: just turn up, no appointment needed
• What else can they do: emergency prescription

14. Hospital Consultant

• What for:
  • Serious or rare disease
  • Specialist treatments (e.g. operation, chemotherapy, dialysis)
• Pros: knows a lot about their specialist area; you may see their deputy (called a registrar); both will be experienced
• Cons: can be hard to contact; may not know much about other health issues
• How to contact: ring their secretary (or their specialist nurse, see below)
• What else can they do: write a letter to your employer if you need your work pattern changing; ring your GP to discuss your problems

Hospital Specialist Nurse (works with Hospital Consultant)

• What for: knows a lot about their specialist area; experienced
• Pros: often easier to contact than consultant; can talk to other specialist nurses
• Cons: may not know much about other health issues
• How to contact: ring them (they should give you a number)
• What else can they do: get a message through to your consultant

15. Dietitian

• What for: weight loss or gain, or other dietary advice
• Pros: know a lot about nutrition; can help with diabetic control (and even get rid of diabetes)
• Cons: hard to contact
• How to contact: ring them if you have their number (get it when you first see them)
• What else can they do: can also help with fluid restriction, if your doctor has asked you to follow one; refer you for bariatric surgery if ‘natural weight loss’ is not working

Social Care and Help

16. Social prescriber

• What for: help with life problem, loneliness, or practical issue (e.g. shopping)
• Pros: can help with a wide range of problems, especially for the elderly
• Cons: only some areas have them
• How to contact: Google ‘social prescriber + local area’, or ring GP reception
• What else can they do: help you with visiting doctors and nurses

17. Social worker

• What for: life, financial, work and social problems; can help you organise a nursing or residential home, rehabilitation, support workers in the home; rest for carers
• Pros: local
• Cons: may have limited ability to discuss with your doctors and nurses; no access to your medical record
• How to contact: ring your local council
• What else can they do: help you with benefits and housing

Other

18. Dentist

• What for: dental and mouth problems
• Pros: local
• Cons: not open at weekends; may have to pay
• How to contact: ring up, or just visit
• What else can they do: prescribe antibiotics etc if needed; talk to dental surgeons at local hospital if the procedure required is safer done at a hospital

Note. If you have a serious dental problem at weekends, ring NHS111 and they will guide you to an emergency dentist; you may have to travel some distance to see them

19. Optometrist (optician)

• What for: eye problems
• Pros: local
• Cons: not open on Sundays; only free on NHS for some people
• How to contact: ring and make an appointment or just visit
• What else can they do: some also do hearing tests and aids

Note. If you have a serious eye problem (e.g. blindness, loss of vision or severe pain), it is best to go to an A&E department that has an ‘eye casualty’ (i.e. eye doctors). NHS111 or an internet search can guide you to nearest one. You may have to travel as it may not be your local A&E

20. Podiatry

• What for: foot or toe problems
• Pros: local
• Cons: only free on NHS for a few people
• How to contact: ring and make an appointment
• What else can they do: if you have diabetes, can work with your diabetic team, to prevent gangrene etc

Summary

Yes it is confusing. We have described alternative NHS services to GP and hospital; and advised you on which to choose. We hope the options are a little clearer now.