GPs contracts

(109 Posts)
MoreKopparbergthanKrug Mon 15-Feb-16 16:10:46

Inspired by another thread but OT so I thought I'd start afresh...

There's a crippling shortage of GPs, mainly are retiring, recruitment is in crisis etc. But I thought there was a massive renegotiation of GP contracts not so long ago that was heralded as a "massive coup" by the BMA and a "complete capitulation to outrageous Drs demands" by the press.

Ok, so the truth probably lies between those 2 extremes but has something changed that's made the new contracts unexpectedly rubbish or were the BMA (and the press reports) lying when they said the GPs had got what they wanted?

zeezeek Mon 15-Feb-16 19:55:06

The issue is that more and more work is being piled onto GPs and they are getting less and less money. Whilst the SoS and the Daily Mail interprets this as GPs being lazy and overpaid, the truth is that General Practice is ,Ade up of independent contractors so are effectively small businesses - we wouldn't expect a plumber to take on extra work for no pay, so why should we practices? And the money isn't all going into the GPs pockets it is being used on staff salaries, overheads and providing a service for their patients.

90% of NHS work is primary care but they only receive 9% of the NHS budget. Is that fair?

ABetaDad1 Mon 15-Feb-16 20:07:37

The GP contract renegotiation fed directly into increased strain on A&E.

GP surgeries no longer open at weekends results in more people in A&E.

In or town the minor injuries clinic also closed at the same time.

Now anyone with a sick child or a minor injury ends up in A&E.

It was not joined up thinking at all.

Our local GP has tried to make ends meet with salaried GPs that seem to rotate through every 6 months, really the service has dramatically reduced in quality and availability.

My own view is GP surgeries are clogged up with far too many elderly patients going there for free prescriptions. Many more drugs for relatively minor ailments should be taken off prescription to take the strain of GP surgeries.

The whole provision of hospital, GP, district nursing and care in the community needs to be joined up. The cutting or changing one feeds directly into pressure in other areas.

the answer is not to impose new contracts on GPs and junior doctors with more unpaid hours. It needs to be made efficient, joined up and focus on illness that requires actual professional intervention.

Musicaltheatremum Mon 15-Feb-16 20:07:57

2004 was our last contract renegotiation. We got a good pay rise but that is because we proved that we were doing the work they thought we weren't. I think what the government wanted was that we would gradually do all these things they wanted and our pay would go up gradually but they were wrong. So then they said ok , we will take ££££ away from you and you need to do x to get it back. We are getting busier and busier, we cannot find locums to cover holidays pay has gone down massively in the last 10 years our pension payments have soared and GPs have to pay both their employers and employees pension contribution so I pay 14.7% employers and 12.7% employees pension contributions.

Then did you know
1. We pay for our staff
2. We pay for all our electricity and gas
3. We pay for all our medical supplies, urine dip sticks, couch rolls, cleaning, products.
4. We pay for the photocopier, the ink we use, the postage for sending letters as not everyone has a mobile.
5. We pay for the place to be cleaned £1000+ per month for us.
6. We pay for our medical insurance £20000 per year
7. If we take on any more doctors we pay for them.
8. If we want our surgery decorated we pay for that.

Etc etc so as expenses go up and income stagnates the result is less income, we can't afford to get more GPs even if they existed.

It is going to get worse.

In 2004 in scotland GP got 11.5% of the health budget. We now get 7.4% and all the hospitals are trying to get us to take on more of their work.

We are in a serious crisis.

I love my job, I love my staff and my partners but I hate the beaurocracy that comes too.

We can'tsqueeze any more out of us. The toothpaste tube is well and truly empty.

MoreKopparbergthanKrug Mon 15-Feb-16 20:09:00

It doesn't sound fair certainly; then again non-primary healthcare equipment eg MRI scanners (first thing that popped into my head) are pretty expensive; so eg do GPs pay for a session in a scanner if they refer you for one, so does it come out of the 9%?

So is this extra stuff not covered by the 'new' contract or are the terms being breached? I just remember the new contract being reported as a "pay" increase for less (eg removing out if hours cover).

Clearly there's something going wrong otherwise GP recruitment wouldn't be so buggered, I'm not disputing that, I'm just trying to understand where it went wrong.

ABetaDad1 Mon 15-Feb-16 20:20:22

Musical - "We now get 7.4% and all the hospitals are trying to get us to take on more of their work."

Very informative post and I see that the Trusts are fighting to shunt costs to your P&L. That is a very good example of the lack of joined up thinking.

Ultimately, we cannot wring any more our of the existing system. It needs complete reform. A complete redesign.

In my own view every hospital should have a permanent 24/7 GP surgery funded by the Trust providing out of hours service that private GP providers can't under the existing contract.

I also think that the entire way in which prescriptions operate should be reformed. I am on permanent Amytriptyline and my GP has to sign a script every 3 weeks. Its insane He will not be seeing me again for a year but every 3 weeks he has the job of signing a script. Its silly and a waste of his time.

There are many community healthcare issues that don't need a hospital visit or GP intervention but a good network of district nurses - all releivng strain on higher cost part of the system.

Spending money to save money and removing some pointless bureaucracy would be a start. It seems GP surgeries are the dumping ground for everything that the rest of the NHS no longer does.

Sidge Mon 15-Feb-16 20:32:07

My own view is GP surgeries are clogged up with far too many elderly patients going there for free prescriptions. Many more drugs for relatively minor ailments should be taken off prescription to take the strain of GP surgeries.

Nope, GP surgeries are clogged up with otherwise well people who want seeing immediately for a sore throat they've had since they woke up that morning, a plaster for a cut finger, a cough they've had for 3 days, D&V for 2 days, some cream for their sore foot where their new shoes have rubbed.

Elderly patients are there with heart failure, COPD exacerbations, dementia, leg ulcers, diabetes and chest pains. They're living longer, and living with conditions that used to kill but no longer do due to medication, medical interventions and social support. They're no longer under the care of a geriatrician, or in a nursing home, but being cared for by the GP and nurses in their community.

Letthemtalk Mon 15-Feb-16 20:34:30

Government also massively underestimated how much out of hours care would cost, and in our area it's virtually impossible to get gps to cover oohs shifts. We have a huge number of gp vacancies, lots of practices in negative equity practice wise, a couple of practices about to shut because of lack of gps, and somehow the health board has to provide gps for the lists of the closing gps. It's a bit of a nightmare - and the public know nothing.

writingonthewall Mon 15-Feb-16 20:36:57

Musicaltheatreum

What she said
couldn't have put it better myself

wouldliketoknow1 Mon 15-Feb-16 20:45:45

I've never understood how my GP surgery works. I think all the staff are direct employees of the NHS - all staff other than GPs wear the national uniform (e.g. reception wear green blouses) and they have the same systems as my work (also nhs) e.g. their stock gets delivered via central stores, their lab stuff is picked up by a porter and that sort of thing.. Does that work differently in terms of ownership pay? Do the doctors just get a salary from the nhs, as I do?

They never seem to have a problem with appts, I've had 4 weekly appts since 2009 for long term mental health and it's never been a difficulty at all. Also have an excellent phone consultation system and various enhanced services. If they aren't a partnership would that necessarily have a positive effect on things?

ABetaDad1 Mon 15-Feb-16 20:45:46

Sidge - that is true old people have serious conditions that used to be cared for elsewhere in the system. However, there are I am sure a lot of visits by many people of all ages for treatments that are unnecessary as you say.

My MIL used to be a home visitor for old people and it was common to find them with cabinets full of creams and pills on free prescription they could have bought at Boots quite safely and which they didn't use or had too much of and gave away to friends and relatives. There is a lot of waste and bureaucracy in the prescription system.

Its just one example of may things GP surgeries deal with that are crying out for reform. If the traffic through GP surgeries could be cut by 20% it would be a good thing and at no detriment to essential healthcare.

MoreKopparbergthanKrug Mon 15-Feb-16 20:48:36

"Contract negotiation was 2004", wow, my life is flying by, I genuinely thought it was about 5 years ago if that.

It certainly seems like the current system isn't working for anyone - recruitment in crisis on one side and patients who can't get appointments, patchy (charitably) out of hours cover which knocks on to A&E on the other... what a mess and no will to make proper reorganisation happen.

Jollyphonics Mon 15-Feb-16 20:48:56

The contract you refer to OP involved QOF targets.
Basically the government thought we sat around doing nothing, so they said we would get payments based in targets we met - such as checking cholesterol levels, maintaining BP levels etc. They imagined that us lazy GPs would struggle to get off our arses and achieve these targets, so they wouldn't have to pay us.
However, what they didn't realise was that we were already doing all these things for free! So we just carried on as we were, achieved all targets, got maximum points and got the money.
So, after a couple of years of this, they realised it was too expensive, so gradually they've removed the target payments. We used to have to do A and B to earn the money, so they said "OK we're not paying for A and B any more. You must keep doing it, but we won't pay you. We'll only pay you if you're doing B and C.". So we so A,B,C and D. Then they say we'll only be paid for E and F. And so on. And that's essentially how, over the years, the workload has become unmanageable.

Noeuf Mon 15-Feb-16 20:53:19

I do wonder if oap centre s would be a good idea. Every time I go to the drop in, the oaps have been queuing for the hour before it opens, outnumber everyone else and take ages. Would specialist centres work/ be affordable?

Musicaltheatremum Mon 15-Feb-16 20:57:16

ABeta, there already are 24 hour GP services run at various locations in towns. Often locate in hospitals.
I give 2 months medication to all patients who are stable. We could argue for more but this is probably a compromise.
Our DNs are squeezed too. They do what they have to do which takes all their time. We employ a phlebotomist who does bloods in the community but she is only part time. If we need a blood doing on a day she is not here a GP has to do it. Such a waste of time.

Musicaltheatremum Mon 15-Feb-16 20:58:04

Jolly phonics and writing. United we stand. :-)

Letthemtalk Mon 15-Feb-16 20:58:11

We are going to have to use new models of care for people with long term conditions. Rumour is that (in scotland) gps will become more focused on acute medical issues and the new integrated joint boards will pick up the long term condition stuff. God knows where the medical cover will come from though - salaried gps?

Mrsmorton Mon 15-Feb-16 21:03:37

Musical I read horror stories about indemnity fees for OOH GPs. Can you shed any light? These papers were quoting tens of thousands...

caroldecker Mon 15-Feb-16 21:33:05

Most GP's self-employed the not so secret private NHS that terrifies everyone on here. They are paid by a complicated formula, but basically an annual amount per patient on their list and more for performing certain services (such as contraceptive advice, immunisations, etc). They rent their premises and employ the staff (including some salaried GPs) and keep the rest as profit.
An average salaried GP gets £53k, an average self-employed GP gets £100k, so not really poor.
Many GP's are retiring early because their pension pots are well above the government capped level, so it is better for them to take it early rather than pay higher tax bills.
Number of GP's has risen by about 25% since 2004 - more are wanted, but the numbers are not falling. Young doctors prefer to become junior doctors in hospitals.

caroldecker Mon 15-Feb-16 21:33:05

Most GP's self-employed the not so secret private NHS that terrifies everyone on here. They are paid by a complicated formula, but basically an annual amount per patient on their list and more for performing certain services (such as contraceptive advice, immunisations, etc). They rent their premises and employ the staff (including some salaried GPs) and keep the rest as profit.
An average salaried GP gets £53k, an average self-employed GP gets £100k, so not really poor.
Many GP's are retiring early because their pension pots are well above the government capped level, so it is better for them to take it early rather than pay higher tax bills.
Number of GP's has risen by about 25% since 2004 - more are wanted, but the numbers are not falling. Young doctors prefer to become junior doctors in hospitals.

Glasgowgin Mon 15-Feb-16 22:01:03

I've been a GP since 2002 so briefly worked before the new contract and have worked in both England and Scotland since. The job has changed out of all recognition in that time- the amount of frail elderly with multiple medical problems and the amount of work that has been devolved from hospital to GP have both increased massively. Also the average consultation rate has gone up- so everyone is actually seeing their GP more frequently but our funding is going down.
Even hospital doctors don't often understand how we're funded- musicaltheatremum explains it very well. Remember we also pay for not being responsible for out of hours- the problem is the government massively underestimated how much it would actually cost.
In our area the GP training scheme is half empty. We're very lucky to have recruited to replace our outgoing senior partner; other surgeries locally haven't been so lucky, and you can't get locums for love nor money. God knows how GP is going to look in 10 years time, but I sadly don't think it's going to be good.

ABetaDad1 Mon 15-Feb-16 22:38:15

musical/Glasgow - not sure if you are in England but anyway. Perhaps you can shed light on what happened at our GP surgery.

First off all the partners suddenly retired about 4 years ago and the surgery was sold and the remaining partner moved to a PFI funded health centre quite a along way from my house. The GPs who now work there seem to be salaried or locums plus the one partner. There is a phlebotomist and a practice nurse.

It seems as if it has become harder and harder to see a GP. Mostly, I don't go if I can help it. If I want a specific GP I have to wait 3 weeks or phone on the day and take pot luck. There is another GP surgery just 200 metres from my house but that surgery just won't take me on their books after asking on and off for 3 years. However a friend who lives 4 miles away comes to my nearest GP surgery while I walk past it and go 1.5 miles up the road. I find it hard to walk some days and I don't drive.

What was it that caused these adverse changes for me. Why has my local GP no incentive to take me on their books? Its a lot to do with incentives, costs and pressures in the system I am sure..

Glasgowgin Mon 15-Feb-16 22:45:10

Not in England so the rules are a bit different, but if the GP surgery 200m from your house won't take you on that suggests their list is closed- we're not allowed to pick and choose who we take by any criteria apart from where you live (ie in practice area or not).
If their list is closed then they are not taking on any new patients in an attempt to maintain some sort of service to their current patients- almost certainly because they have lost doctors and not been able to replace them. You should be able to ask them if this is the situation, and if not they should be able to explain why they won't take you on. HTH.

RaskolnikovsGarret Mon 15-Feb-16 22:48:22

Is it true that GPs (after paying staff, expenses etc) earn £100/200k, or is that just an unfounded rumour?

A close relative stopped work just before the 2004 contract negotiations, and saw his junior colleagues greatly increase their salaries and reduce their on calls. Or did that not happen either?

I'm guessing the above cannot be true, otherwise there wouldn't be such a recruitment crisis.

ABetaDad1 Mon 15-Feb-16 22:52:05

Glasgow - than you that is very helpful. On the few occasions I have tried I get a sort of non committal 'you'll have to write to the partner and ask' from the reception desk.

I suspect they have effectively closed their list as I do live so close to the surgery. I know one of the partners is about my age 50 ish so a long way from retirement but I don't know about the others. Perhaps they have lost staff and are also surviving on part time locums - mostly young female GPs coming back from maternity it seems and thank goodness they are coming back as we would have no GP cover at all.

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