Aphra

Brief Outline:

Aphra’s had very positive experiences of GPs and feels that she has been ‘quite lucky’. She had counselling at school while she was doing GSCEs and caring for her mum. Aphra feels that her GP was particularly ‘compassionate and kind’ when she had depression because of a work situation.

Background:

Aphra works voluntarily to help improve cancer services in her area. She lives with her family. Ethnic background / nationality: White British.

More about me...

Aphra's had very positive experiences of GPs (local doctors) and feels that she has been 'quite lucky'. She rarely saw the GP as a child as she was usually healthy. When she did, she went with her mum and recalls that the doctor would speak to her first, rather than to her mum, and ask her how she was feeling. Aphra said she never felt 'overlooked'.

At the age of around 14/15, Aphra went to see the GP because of her mum, who was living with depression. The doctor wanted to see how Aphra was coping and whether she needed any extra support. At first she was 'absolutely terrified' of saying the wrong thing, but was surprised at how 'laid back and relaxed' the conversation was. Although the GP 'can be very stern sometimes', in this appointment Aphra recalled her being 'nice and friendly'. She left feeling confident that if she had needed support, such as counselling or to attend a young carers support group, her GP 'would have and could have arranged it'.

For 'quite a long time' after this appointment Aphra didn’t see a GP but had counselling at school while she was doing GSCEs and caring for her mum. She saw the school pastoral manager first, who scheduled a slot with the school counsellor. Aphra felt that the counsellor's techniques were 'very childlike' so she didn’t have 'a lot of confidence in her'. The pastoral manager 'did a lot more', though, because she provided a card that allowed Aphra to see her anytime, even if it was just for a chat. Aphra would like schools to make pastoral managers a 'more prominent figure within the school' as she feels that many young people are unaware of their services.

Although Aphra has been with the same local surgery since childhood, she registered with the university health centre while she was doing a degree. She visited the university GP when she developed what she thought was a chest infection in the first year, which lasted for three months around the same time every year. The first GP she saw told her it was probably 'just fresher's flu' and asked her if she wanted to go on the pill or get any condoms. Aphra felt that if she needed condoms or advice on 'sexual health stuff' she would have just asked. She ended up seeing around eight to ten GPs about the chest infection and felt that the surgery 'wasn't very committed' to letting her see the same doctor. She often felt that the GPs 'weren't really listening' and, on one occasion, that the doctor used Google in front of her and 'instead of going somewhere like NHS choices... they read it off Wikipedia'. 
Although Aphra has had some GPs who were 'absolutely fantastic', it was usually difficult to get an appointment with them. Her infection was never properly diagnosed but she thinks it might have been a mushroom and croup allergy.

After university Aphra moved back home and re-registered with her previous surgery. She feels that her GP 'really listens', is 'compassionate and kind', and that she can talk as long as she needs to. The doctor was particularly good when she had depression because of an abusive situation at work, reassuring Aphra that it wasn't a 'failing' in her. Aphra also feels that the local pharmacy is 'really good at listening to people'.

Aphra's advice to health professionals is 'not to assume' anything or have preconceived ideas about what young people are seeing them about. She would also like her local surgery to have drop-in clinics specifically for young people. Her main message to young people is 'not to be too embarrassed' to see a GP. She would like them to know that GPs 'are there to help' and 'give you a good service'. If they are unhappy with the service, they should feel confident to 'go back and get a second opinion'.

The GP and pharmacist knew Aphra well and what tablets she needed to take.

When I went to the GPs’ surgery Monday morning and they rang up the pharmacy, which is also in the same village, and they were prepared to give me the antidepressants off without the prescription being signed. So they just reprinted it and they said they’ll get it signed afterwards as it were. And so it's things like that which actually are really, really useful about building that kind of relationship with your pharmacist as well as your doctor, just so they're aware what medicine you're taking and why you're taking it. 

And, you know, mistakes do happen. I think it was one of those things where the temptation is to go, "Oh you're so stupid, how did you not realise that this was the problem?" Especially as I'd been to the GP like three times in that week [laughs]. But actually it was just one of the things that did happen and they fixed for me the same day, so I could go straight to the pharmacy and get the tablets and I didn’t have to worry about not taking any.

Aphra took painkillers, antibiotics, steroids, indigestion tablets, and had several tests. When she moved away from the coast, she was fine again.

Basically the best guess is that it was an allergy to mushrooms and croup at the same time. So it got to the point where they gave me asthma tests and inhalers, even though I kept saying, "It's not asthma. I've been on six sports teams for five years; I'd notice if I had asthma." And when I did the asthma test they came back and said, "No she's got the lungs of a rugby player, there's nothing wrong there." And it just took them so long to even give me pain relief. 

It wasn’t until the second year of having it that they went, "Oh you can take codeine for the pain." So it lasts for three months every year while I was at uni, and the first year I did it with no pain relief at all, and it was incredibly painful.

So three months of a chest infection?

Yeah.

In the same kind of months, like the winter months or?

Yeah, it came every February, that’s why they think it was when the mushroom spores were released. But because I'd never lived by the coast before, they weren't sure if it was something to do with the ocean. They weren't sure whether it was environmental or whether there was a different disease there. But by the time, in the first year that they decided to do an x-ray, it had already started to clear up. And then in the second year, that was when they finally said, "Oh you can just have pain relief if you think you can handle it. We won't try to give you antibiotics again" because I mean the first year I'd had antibiotics for three months straight and…

With the GP?

Yeah, and I never normally touch antibiotics because, as much as they're good for you when you need them, taking them at the wrong time is really unhelpful. And then they decided that pain relief was the best way forward because it was a different GP I was seeing, and it cleared up just as he thought it would. 

But by the time it came to the third year and I had it again, I saw a different GP who kept telling me she thought it was heartburn. And I kept having to argue with this lovely, lovely woman that it wasn’t heartburn because you don’t just get heartburn for three months of every year, and then it go away. 

And then they put me on steroids for a little while, which caused me to have nose-bleeds all the time. And the steroids they put me on actually I've only just been able to stop telling the dentist I was taking, because they stay in your system for so long. And then they tried to give me some indigestion tablets where I always remember…I always read the leaflet and one in ten people could have bleeding from the eyes and the mouth and I was thinking, 'This really isn't something I want to take.' And it made me feel so ill for the three days that I took them that I just went, "I'm not taking these again. I'll leave it and I'll go see my own GP at home." But actually, in the end, it cleared up and I've never had the problem since.

Aphra’s neighbour helped her realise that she needed to see the GP, who advised her not to go back to work. She was very tearful which was unusual for her.

I knew I was in a state because it had been a really rough day at work, and I was crying an awful lot. But it was just when I started saying, "Oh I haven’t slept in so long," that she [neighbour] went, "You need to go the GP about this, you can't go back to work, and actually it's not safe for you to go back to work." 

And it's one of those things where it felt almost a bit like I was being silly before, you know; no job could ever be that bad. But it was when the GP, that first GP I saw, went, "It's not safe for you to go back" as well, that I went, "Maybe it's not just me actually, and maybe I'm being a bit hard on myself, and actually there is something really wrong here about how I'm being treated."

So she made the emergency appointment. Was it your GP that you saw then or, do you know who your GP is, or is it different every time?

I have a listed GP, but I rarely see her to be honest. I have the same GP now every time I make an appointment especially if it's about the medication I'm on, and generally how I'm feeling with my depression and my mood, and getting sick notes. 

But for the first few appointments, because they were emergency appointments, I saw different people. But I think they were always really prepared to listen and they could see that, every time I thought about it, I'd start crying again. I'd spent so much time crying at the GP's surgery. And I was never normally a person to cry, so it's one of those things, they're going, "Well this feels a bit silly and this is a bit ridiculous." But it's just one of those things where you go, actually you can't help it. And they must be so used to seeing it, you really can't be the only person who's walked in and gone [crying noise].

All the doctors Aphra saw listened well and were very good. They reassured her that depression wasn’t ‘a failing’. She’d been in a bad situation for a long time.

I saw male doctors for the first three emergency appointments. And then it was afterwards that I changed to the female doctor I see regularly now. And I chose to kind of sign up for regular appointments with her, not because she was a woman, but because she'd treated my mum in the past, and so I kind of knew the level of care and I knew she knew the family history. But also just because I knew she was a really good doctor. 

And so…and I knew she was a regular doctor there, she wasn’t teaching or training. And so I didn’t go…I could have this doctor, but maybe only for six months and then have to change again. I know she's going to be there for a couple of years, and so I've got that regular contact that I can have.

Yeah. So the first three emergency appointments it was with different doctors?

Yeah.

Did you feel that they all listened or were one or two better than the others at any…?

I think they all listened really well and I think they were all really compassionate and really kind as well. They were all very good at reassuring me that this wasn’t something that should have happened to me, and it wasn’t kind of a failing within myself. Which is obviously one of the first things you think when it's depression. You go, "I should be stronger, I should be better.” Or “there must have been something that I could do to change it." 

And actually it's one of those things where quite often there's nothing you can do, and it's just you’ve been in a bad situation for a long time, and you just go, "Enough now, I'm going to do something different." And something different isn't always what you want, but it has its own kind of way of working itself out.

Aphra bought condoms at supermarkets. They were given away freely at the university bars.

I didn’t bother going to the GP for contraception. I just, whenever I needed it, I bought it at uni. It was just one of those things where I never got that feeling of being embarrassed going into a supermarket and just going, "This is what I need." And, because I wasn’t in a long term relationship really, I didn’t need to go onto the pill or anything like that, so it was very much just about being safe. 

But also if I had needed it, it would have actually have been easier to go to the bars at the university because they give them out free there. So it was just one of those kind of things where some people probably did because it was a bit quieter, but it depends on how embarrassed you get about it really.

Aphra saw a GP that specialised in sexual health. When she was in a relationship, it was good to go on the pill as well as use other protection if needed.

It is one of those things where, when I did make the decision to go on the pill, partly to help with my depression actually because it balances out my mood. Then I felt really like it was easy to say to my GP, "Oh I've started seeing somebody and I think this is a good idea." And she immediately went, "Yeah, in your situation let's have no children." 

And so it was really easy to arrange then and there's a specialist doctor in our surgery who really deals with all the contraception and all the sexual health issues. The other doctors can cover it, but she's the one with the most skills and she's had extra training. And so she can tell you all the statistics and all the facts off the top of your head. And it's very much that you're allowed to choose what's best for you, and if you don’t like something – they ask you to try it for a month or so, but you're more than welcome to go back and to ask for it to be changed or to try something different.

That’s good. So it's all at the GP's surgery which is easy to get to, and there you see the same GP, but is it a sexual health clinic or you just go to the GP?

You just go to the GP. So there is some instances where that GP will work in the quieter surgery. And, although I can't be certain, I'm pretty sure it is almost a clinic booked in terms of the receptionist's eyes, and everyone's there for the same things. But I only get the feeling of that because that surgery will be absolutely empty of everyone but women. But she has ordinary appointment times so you can be seeing her for anything. You know, from a sore throat to actually, you know, family planning.

And was it her suggestion or your own suggestion, or was it more of a discussion about going on the pill?

It was my decision because it had been kind of floated before that it might be something that they look at just because I was getting highs and lows with my hormones. But it wasn’t until I started seeing somebody that I went, "Actually now I think I want that extra protection." Especially because having anxiety, even though I use other protection, and I've changed boyfriends since, I used other protection again, there's always part of me that goes, something is going to go horribly wrong [laughs].

So it's a reassurance?

Yeah.

Aphra said that cervical screening (smear) tests can be unpleasant but they’re ‘worth doing to save your life’. Young people need to talk openly about them.

I think the only one thing that is important, and is only important because it comes up in the news quite a lot recently, and because I'm involved in the cancer services, about smear tests. And I think more young people need to talk about smear tests really openly and know about it sooner, because the chances are that quite soon, as long as funding allows and pressure keeps mounting as it is for smear tests will be happening earlier than twenty five. 

And obviously there's a lot of tragic cases of young people knowing there's something wrong and their doctor's not giving them a smear test. And I think that it's one of those things where it sounds awful and it sounds scary and young people don’t want to go and have it done. Well, being in Wales they come earlier, and so I can say quite safely that a smear test is about as unpleasant as it sounds. But it's absolutely worth doing to save your life. 

And I think it's one of those things where we need to get away from those taboo areas about our health and just be prepared to talk about everything a lot more openly even if it's something we don’t necessarily like to think about.

Aphra chose the surgery that was easiest to get to by bus. It was also recommended by older students who were registered there.

It was really good actually at my university. The pack that you got when you signed up to halls had a form to register with a GP. And actually they listed all the GPs in the area, and all the contact information, and then you can choose which doctor you wanted to sign up with. 

So a lot of people like me had gone for this one surgery just because it was really convenient to get to. It was in the centre of the town, and so it was one bus ride down if you weren't feeling well, and you were there. 

Some people had gone for the one that was closest, but actually that meant it was on the side of this awful hill and there was no bus route there.

You have to walk there?

Yeah. They were the people who ended up paying for taxis and things. So it was quite often there was people showing you to your rooms when you first moved in. And a lot of those people who were there, and already students, were going, "I'd go to this surgery" or, "Avoid this one, they're terrible." And so you kind of got the word of mouth the minute you walked through the door. 

But it was really useful that you got your keys, you signed up to a GP, and that was you done. It wasn’t an optional thing. It was, “You are signing up to a GP while you're here.”

Right. So you didn’t actually go into the surgery, the doctor's surgery to register?

No, there was a form and the university collected all of them. And then they worked out which ones were going to which surgeries and delivered them to them.

It took ten minutes to fill in the form and ten minutes to see a nurse afterwards. Aphra didn’t want to get ill unexpectedly and have no GP.

Did you have to re-register with the GP when you came back?

Yeah. It was the first thing I did really when I moved in was go down to the GP's surgery. But because I'd had the travel medical card my NHS number was on it, and so it was probably one form. 

And then I had to have an appointment with a healthcare assistant and she just checked what illnesses I'd had because, unhelpfully for my doctor's surgery, the notes from Wales hadn’t all come across and some of them where in Welsh, and not in English, and that’s not any use for a [name of English county] GP's surgery at all [laughs] you know. There's really no Welsh speakers here, and so I had to kind of talk through the problems that I'd had and they checked that all my records were up to date. 

They weighed me, they checked my height. But, as I say, they didn’t make any judgements about any of it. And so that felt a lot better because, you know there were days where I was going, "Oh I could be thinner," but then there were also days where I'm going, "It wouldn’t hurt if I ate that double ice-cream."

So you joined…I mean that was one of the first things you did?

Yeah.

So some people don’t register for ages, but that was one of the first things you did. How do feel about the whole thing?

I think it was just that my GP's surgery was just down the road and, knowing that I had had health issues while I was at uni, it seemed like a really good idea because there's nothing worse than coming home, not registering straight away, realising you're ill and then realising you can't get in to see anybody. Whereas it took me maybe ten minutes to do the form and it was a ten minute appointment with this nurse. And then I knew that I could get same day appointments really easily. 

Aphra felt very tired and hadn’t slept properly in weeks. Her neighbour noticed something was wrong and made Aphra an emergency appointment. The GP signed her off work.

Did you ever need to phone in and say it was an emergency appointment or?

I didn’t need to phone in the first year and a half or something like that. But then when things went really badly with the job I was having I…actually my neighbour was the first one to make me an emergency appointment because she realised the state I was in. And she just said, "There's something really wrong, you need to go to the GP." 

And they saw me within an hour and a half; it was literally a case of, "Come down, we'll get you in." And I got signed off for a week then because my job had been quite abusive, and I don’t think at the time I'd realised I was suffering from depression. 

I think it was one of those things where I just felt tired all the time. I'd had insomnia for two weeks before, maybe even three. I couldn’t really remember the last time I'd slept properly. And so I just felt a bit worn out. So they said, "We'll give you a week off and then come back the next week if you need to." 

Well I hadn’t bothered to make an appointment for the next week, but again on that day I called up and said, "I need an emergency appointment, I can't go back." And so they signed me off for a bit longer then, and then they gave me sleeping tablets. And then I got into the pattern more of booking a regular appointment, but if I need my medicine changing then I'll get an emergency appointment.

Patients at Aphra’s surgery always get seen by the GP if they come in and wait. The surgery often closes as late as 8pm.

If you rang up and you said it was an emergency appointment, they would give you sit and wait appointments either in the morning or in the afternoon. But my doctor's surgery is regularly not closing till maybe half seven/eight o'clock. Because if someone says they need to be seen that day, they take it as they need to be seen that day. 

And it might be that they tell… they’ll give you a card and you have to do it as quickly as you can, but sometimes, you know, if it needs to be a longer appointment, they’ll give you that longer appointment. It's about rushing through those who are quick fixes, and taking the time on those who needed a bit longer.

The receptionists move along the desk if someone wants to talk privately. They’re friendly and often remember Aphra’s name.

The reception area is really obvious and really clear. And they have all the signs that say, 'Please wait behind this point, and respect each other's privacy.' And it's a very kind of open and sweeping reception desk. So even if there's somebody talking to the other receptionist, you're not too close. So if you need to say something that you feel a bit more embarrassed about, then you can do. But if you wanted to talk to the receptionist in private, then they’ll move you along further still, just so that no one else can hear what you're saying.

Has that situation ever come about where you’ve kind of felt, 'Oh I wonder if everybody can hear me, and can we move along so that it's a bit more private?'

It's not happened for me, but I've been in the queue when somebody has said, "Oh actually can we, you know…" Or "I don’t want these people to hear." And there's never any look of irritation on the receptionists face, they are really happy to just keep everyone happy as it were.

So have you found them to be friendly and approachable?

They're really friendly and they don’t always manage, but they do their best to kind of remember your name, especially if you go in quite often. So sometimes it's those little things of going, even if it's just where you’ve gone and given them a piece of paper, they go, "Oh thanks very much." You know they might have just read your name off the screen, but it's those little touches that actually make you feel like you're a human being and not just another one of the masses.

It’s easier to talk about mental health on your own. Most people are less honest when a parent is there. Parents would only worry more if they were there.

Well I went on my own at university all the time, I didn’t really have much of a choice. I could have probably took a friend but it never really crossed my mind. But either when I was going through my early stages of depression and things, I still chose to go on my own just because I felt that it was easier to talk to my GP about what I was feeling without having a family member there because I don’t want to worry anyone. 

That’s an overarching feeling; it's natural that they're going to worry and there's nothing I can do about it. But at the same time I think if they heard all the thoughts that go through your head, then that’s the point where it'll become more of a problem. And obviously as well I don’t think I'd be so willing to be honest with my GP. So I think it's better for my health if I go on my own.

Aphra prefers her current GP and surgery. They listen to what you say, and they give health and lifestyle advice without ‘shaming’ you.

So I think I've actually been quite lucky with the surgery that I'm at. It's been the surgery that I've had since childhood and then I went away for university. Went to a different surgery for three years and came back. And I find that my local surgery actually really listens to me, which I know can be a real difference. And I've had some friends go to the same surgery and go, "That doctor's absolutely useless; they never pay attention." But I don’t know if it's partly because I never went very often as a child, so I think when I went in the last year or so I've started going, "Oh I've really got something wrong with me." They immediately went, she's probably telling the truth, we never see her. 

And I do think that this surgery is a lot better than the one I was at when I was at university in Wales, just because I remember the first time I went to the one in Wales. I'd got a terrible chest infection, and the doctor didn’t listen to me. She was going, "Oh it's probably just Fresher's flu, you'll be absolutely fine." And then she just went, "Are you sure you don’t want to go on the pill, or do you want to get some condoms?" I was going, "I'm not here and lying about having a chest infection for sexual health stuff. If I needed condoms I'd just come in and tell you." 

But you don’t get anything like that at the surgery I'm at now. It's a lot more about they trust you to go in and go for the complaint that you’ve actually got, or from you know, if you need to go on the pill they’ll just go, "Yeah, you go and see this doctor and see this nurse." 

And I like the fact as well that when I've been and it's been the general kind of health check-ups, and they go, "Get on the weighing scales." They don’t just go, "Ooh you need to lose weight straight away." They just go, "Oh lose a bit, but at the same time who doesn’t need to lose a bit?" There's no kind of shaming there. And every health problem you have doesn’t come back to, "Oh just lose some weight, or go get some exercise." There's a lot more of, "Actually we'll give you a blood test and we'll see what's really going on there."

The good GPs Aphra saw were friendly and listened. The bad ones went through her notes during the appointment, didn’t listen very well, and were less experienced.

So you mentioned that some of the GPs there at the university, they were fantastic – all the locals wanted those same GPs. What made them fantastic, can you remember the kind of qualities that…?

They really knew what they were talking about and they were a lot more patient. They'd invite you to come in. They'd quite often meet you at the door and kind of shake your hand and say hi to you. And they'd sit down and listen to what you had to say for a few minutes. They won't be fiddling, they won't be reading your notes, they'd be listening. And then they might check the notes and ask you a couple of questions before they kind of started trying to do an examination. 

And the bad doctors were normally going through your notes while you were talking to them, or they'd be listening kind of but you'd see them fiddling with some jewellery or something like that. With flicking a pen around, kind of that obvious ‘I'm bored and I've seen so many people today’. 

And they just…they didn’t give that impression that they knew what they were talking about. They didn’t seem that confident in themselves, whereas I think some of the older doctors were the better ones. They'd, you know, spent ten years as a GP and so they knew exactly what you were going through and they were really sympathetic at the right moments. And they were really going, "I know what's best to do here."

Aphra saw the first counsellor for 6 sessions at her local surgery. She’s now seeing a second therapist in town and feels ‘like I’m in control’ again.

When I'd finished with that therapist, because the only catch was is that it was limited to six sessions. And I remember thinking at the time going, 'Oh six sessions, I won't need all of those, I'll be fine in no time.' I was really kind of confident in that I would bounce back out of it all, and actually you know I'm on my second therapist. I'm just about to finish with her, and now I feel like I'm in control.

Did you…so you were seeing the GP, and the GP was prescribing the antidepressants?

Yeah.

And separately then you were seeing the counsellor? 

Yeah. So the therapist I was seeing through the GP again stays confidential. So the GP only knows how many sessions you’ve had, or if they think there's a problem then actually they tell you, and it's up to whether you talk to your GP about it or not. Which came up after I'd had my six sessions with the first therapist. She thought I could benefit from a higher level therapist which would mean that I'd have to travel, but only into the town centre to their actual kind of head office as it were. 

And that took a couple of months to come through, probably almost three months before I could see somebody there. But those sessions were every week and they were an hour long, so it's a lot more intensive and it's all cognitive behavioural therapy. So it feels really practical and like you're taking steps to fixing yourself as it were rather than just talking about how low you still are.

Was that how it was at the GP's surgery?

The GP's surgery had some cognitive behavioural therapy, but there was a lot more talking as well involved; it was a kind of mix of the two. And but those sessions were only half an hour and they were every couple of weeks, so there was a lot more time in-between. And I kind of see it almost like the ones I had at the GP's surgery was a triage kind of thing. So it was about making sure that I was eating and making sure I was sleeping and paying attention to what kind of activities I was doing. 

Getting to the sexual health clinic can be a problem. Aphra feels comfortable talking to her GP about sexual health. It’s got easier as she’s got older.

What do you think are the main issues that affect young people – reasons for maybe for going to GPs?

I think a lot of young people do go to the GPs for contraception especially if it's convenient to get to, because otherwise for where I live, the nearest kind of sexual health clinic is two bus rides away. So it's not going to be easy for most people to get to. And it's one of those things where when you drive, it's easy to pop into, but otherwise it can be a real problem. But I do think that they go generally for stress quite a lot, and just for feeling ill and getting kind of almost the common ailments – sports injuries and things like that.
 
I think probably if it wasn’t for sexual health that stress and depression would be one of the more prominent things locally just because all the young people are under so much pressure. If they're not going into further education then they're joining the world of work. And there's an awful lot of them that are constantly told they're not good enough almost. And so they struggle to find jobs, or they're only working in warehouses, but they have terrible conditions so they swap jobs every six weeks. And people go, "Oh can't you hold down a job?" Well actually if you tried to do a twelve hour shift in an office at ten at night, I don’t think that you'd stay either.

So anxiety and depression is a big thing and sexual health as well?

Yeah.

In terms of sexual health, you mentioned the nearest sexual health clinic would be two buses away?

Yeah.

So it's quite hard to get to. Would you feel comfortable talking about issues with your GP about sexual health or?

Yeah, I think I'm really honest and open about it. I think it's one of those things where, maybe when I was sixteen/seventeen I'd be a bit more awkward and a bit more embarrassed. 

Aphra has no preferences in terms of seeing a male or female doctor. For her it’s more important to be seen and be given good care.

Did it matter whether the doctor was male or female?

Not for me. I think that whether it's an STI test I've got to go for, or whether it's, ‘I'm just going for an appointment’, I'm very kind of matter of fact about my health. I think if I'm going along, it's more important that I get seen to and I get a decent service. So it never really kind of makes me feel uneasy. And quite often as well, if it's things like going to the GUM clinic for an STI test, I'm going that’s kind of what got me into this mess anyway, I really…now is not the time to be embarrassed. 

The school pastoral care manager was ‘a really lovely woman’. Aphra preferred her to the two school counsellors she saw.

For my school they had a counselling agreement with Relate. So she was only there for one afternoon a week, and to be able to go you had to go to the pastoral manager who was a really lovely woman. And I actually would say that the pastoral manager probably did more for me than the counsellor did. Because the pastoral manager had given me a card that said if I needed to go out and get some air, I could. And any time I wanted to, I could go to her even if it just meant sitting in her office and having the radio on, I didn’t necessarily need to do some work. 

Sometimes I did just work in there because I found that environment was better for me. And I always remember as well that my teachers were really surprised I was going to the pastoral manager because they always associated her with the kids who were in trouble, or who were truanting and just generally the problematic people. And they kept going, "But your grades are so fine, why on earth would you end up there?" And you're just going, "Because it's actually not about the grades, I'm coping, but I just need the break." 

But she has been able to get me a slot with the counsellor, and I had to wait about a month before I could go. And then they did have all the normal agreements that it was entirely confidential, and they'd only break that confidentiality if they thought I was at risk. Which luckily for me I never was. 

But I didn’t have a lot of confidence in her, partly because I felt that, when you're a young carer, you act a lot older than you are anyway. Because you're used to having to deal with things that are just more difficult and more adult. And some of her methods were very childlike.

Doctors are there to help and give a good service, whether the problem is a minor illness or sexual or mental health.

I think the main one for young people would be to not be too embarrassed. And that sounds like a really easy thing to say, but it doesn’t matter whether you're going to the doctor because you’ve got a cold, or a rash, or if it's sexually related, or if it's mental health. Those doctors are there to help and they are there to give you a good service. 

And if you're not happy with the answer they’ve given you, or you don’t think that they did something right, then tell the surgeries and the practice managers, and go back and get a second opinion. Don’t just kind of go, "Oh well I don’t feel right, but the doctor says I'm fine so I must be." If you know there's something wrong with you, then there's something wrong.