Sure I kept the doctor away, but now I'm out of apples. Where do I go from here?

March 2, 2011 8:46 PM

How do I go about seeing a therapist, gynecologist, dietitian, dermatologist, or even a personal doctor in the UK?

What are the steps needed for me to start seeing something like the aforementioned health professionals?

Are there instances when I'll be required to pay for the service received?

I have yet to even register with a GP yet and am still unsure as to what that involves.

posted by Vrai to health & fitness (10 answers total)

The NHS has a help page about registering with a GP, complete with links to a directory of local GP services and the Primary Care Trust, who can help walk you through the process.

(I'm assuming you're a British national.)
posted by fairytale of los angeles at 9:59 PM on March 2, 2011 [1 favorite]

Almost all care on the NHS is accessed through your GP. As a rule, British women don't use gynecologists for routine care - you can either see your GP or practice nurse, and they have the relevant training and will refer you as necessary.

Accessing dermatologists or therapists through the NHS may be tricky (I think it's much less common for people to see either specialist in the UK). By all means, ask your GP, but the NHS has waiting lists for non-urgent care and your GP may be unwilling to refer you unless they think it's essential. You can choose to go private for either of those services instead.

If you are resident for more than 6 months you are usually entitled to NHS care on the same basis as everyone else. When I move and need to register, I just phone up a GP surgery and ask to do so. They usually schedule an initial appointment.
posted by plonkee at 11:25 PM on March 2, 2011

You can get a referral to mental health services through your GP but there will be a waiting list and the course of sessions won't be very long. It's good for working out what you might need, but I think most people struggle with getting long term therapy services.

Dermatologist, you can get referred to - again, there'll be a waiting list.

Gynaecology stuff is done by the practice nurse and/or doctor, although if it's a particular issue you can get referred to a women's hospital or other specialist.
posted by LyzzyBee at 12:00 AM on March 3, 2011

Nthing what everyone else said above - from my own experience, I would add that if you need counselling/therapy, it might be worth to explore what the local charities have on offer, especially if you are a member of a (loosely defined) minority - LGBT, ethnic etc. I have been incredibly lucky in managing to bypass the NHS waiting list for counselling (something like up to 18 months for six measly sessions of cognitive behavioural therapy) and have managed to access excellent therapy services via a local LGBT charity. It is for free, long-term and excellent quality, so worth looking/asking around (and there might be programmes for women, expats etc. in your area and since usually not so many people know about that, the waiting lists are non-existent or very short). In terms of other things you mentioned, you will have to become Zen about having really limited access to specialists for run-of-the-mill things as your GP/practice nurse will be your first port of call. Not bad, just different.
posted by coffee_monster at 1:48 AM on March 3, 2011

Good answers above.

I know a lot of GPs socially, so here are a couple of tips.

You may have some choice in which practice you register with, so if you know people locally, see if you can get some insights into what each practice is like overall. Not just the GPs but the practice nurses etc. Some GPs have specialisms and your practice might link to one that's right for you.

As said already, you access services through your GP. Use the NHS link to find out more and once you've chosen a practice, ask them to explain exactly how they work. Thing is, GP's don't like people coming in and demanding stuff. They want to involve patients in decision-making about services etc, but don't want to be told what to do. All the GPs I know seem to have bad stories about people who demand stuff, and good stories about people who will discuss their conditions, listen to the options and make a joint decision on what's best.

Your other option, although it's not available everywhere, is to pay and use a private practice. We have one where I live, and you'll probably find one in larger towns, cities and better off places, but not so much if you're living rural. I've never used mine so can't comment. You can also get private medical cover but with pre-existing conditions, you'll pay more for coverage and you'll still need to pay for services. But I'd start with your local NHS GP.
posted by dowcrag at 1:58 AM on March 3, 2011

You may have some choice in which practice you register with, so if you know people locally, see if you can get some insights into what each practice is like overall. Not just the GPs but the practice nurses etc. Some GPs have specialisms and your practice might link to one that's right for you.

Also note that the NHS website has reviews of different practices. Find ones in your area here: that page will show you the opening hours, reviews, languages spoken, special services offered, and opening hours.

I'd suggest calling and asking about how to register. It's not too difficult, but each practice seems to have slightly different requirements.

Nthing comments about waiting times. I waited so long for CBT that by the time a place became available I'd moved boroughs, and the process had to start again. Was only a 3-month wait in the other borough, though, and I've had more than 6 sesesions.

And you won't pay for any of this: the main issues you face are waiting times and availability of services.
posted by Infinite Jest at 2:06 AM on March 3, 2011

Unless you qualify to have it waived, prescriptions cost £7.20 a time. Dental care for adults on the NHS also costs money, unless you go to a teaching hospital - which I can't recommend enough. The students are very well-trained and well-supervised and the care is great.

For a gynaecologist I suggest using the NHS search mentioned above to find GUM (genitourinary medicine) clinics or other sexual health clinics in your area. They are an amazing but underused resource. For example at the Hallamshire in Sheffield you can get a full range of swabs and blood tests, and some also have contraceptive clinics. These places also give free medication (i.e. no prescription charge) for STIs, UTIs, idiopathic pain issues like vulvodynia and other GU problems. The Hallamshire even have a psychological support service.

My GP told me about the GUM clinic but I didn't need a referral, mostly you can just call up or drop in for an appointment.
posted by teraspawn at 3:50 AM on March 3, 2011

Unless you qualify to have it waived, prescriptions cost £7.20 a time.

That's only in England. In Northern Ireland and Wales, there is no prescription charge, while in Scotland (where the OP has his location set) it is currently £3, but will be free as of 1 April.
posted by knapah at 5:28 AM on March 3, 2011

Anecdotal filter: I found the NHS difficult and frustrating to navigate, coming to it with (quickly shod) Canadian expectations. As noted, your GP will be your gatekeeper to other services - start with fairytale of los angeles' link to get a list of local providers and contact them, as mentioned.

Generally, docs have about six minutes to see you, in which time you can only comfortably mention one or two issues without being taken to task. (I joke, but not. They've got a lot of people to go through in a day.) You'll have to take time off work for each visit. (Luckily, employers tend to be fairly awesome about that kind of thing.)

As noted, access to specialists may be limited, and waiting times are long. You can probably get a referral to a dermatologist, though, if you have a moderate-to-severe condition. Derm care, I found, lags a bit behind North American standards, because of NICE guidelines (they do whatever actuarial accounting justifies the rationale and distribution of drugs and treatments on the NHS). (E.g., prescribing oral antibiotics for mild acne.) You can get fancier treatments privately - expect to pay £200 for a consult.

No idea about dietitians - may be similar, but I could be wrong.

Re: lady stuff - no gynos for routine care. Your GP won't do a clinical vaginal exam, though s/he may take a history if you've got particular symptoms. The practice nurse will swab you, but only to perform the mandated biannual cervical screening test; anomalous results will go to the doc to be interpreted. GUM clinics will help with treatment of STDs and contraception, but they're not so great on general reproductive health. (E.g., a senior GUM doctor once told me that endometriosis had nothing to do with infertility. OK, that's a one-off, but the clinics just aren't geared towards full-on functioning uteri.)

Had no experience with therapy on the NHS (though I probably should have). I did investigate private options, and you can access reasonable care for 40-60 quid/hour. The BACP has a list of providers. If you're in London, see the Tavistock Clinic - if they can't help you, they can refer you elsewhere. Note that while CBT is gaining in popularity, the psychodynamic approach to mental health treatment is alive and well in the UK. (Which isn't necessarily a bad thing. Necessarily.)

Also - the general population, including medics, really does have a 'stiff upper lip', almost macho attitude to illness. Self-advocacy is subtly disapproved of, and care-seeking thought to be a bit suss.

I'm trying not to be too hard on the old NHS, or its hard-working staff. But you may find you need to adjust your expectations.

If I were to go back, I'd probably try to find a private insurer, which I didn't do on philosophical grounds, preferring instead to be perpetually annoyed. Since I didn't go that route, I can't offer insight in that regard.
posted by nelljie at 9:44 PM on March 3, 2011

Oh yeah - some of the walk-in centres provide excellent care for minor but urgent ailments. Waiting times aren't dissimilar to walk-ins I've experienced in Canada (1-3 hours). Often, there's no GP on staff, but there will be a nurse practitioner, who can prescribe certain medications, and regular nurses. Personally (and I've no idea why this might be) I found the walk-in ladies to take much more thorough histories and attend more carefully to clinical exams than GPs (I had three docs while there). It might be that I was just unlucky with doctors.

(Amending non-sequitor in previous response: it is not atypical to be prescribed oral antibiotics, like tetracycline, for minor acne. I think this is because NICE decided the razmatazz topicals are too expensive to be accommodated within the prescription fee system, more than any other reason.)
posted by nelljie at 10:08 PM on March 3, 2011