To wonder why we don't force GPs to work as NHS employees like every other doctor

I just looked at my practice accounts for 23/24 and we got on average an extra £12.50 per patient for all the extras we do for them. Diabetes flu jags etc so £124.50 per patient. Also with the extended hours bit of the contract they actually took money away from our core hours and made us open longer to get it back so very little incentive.

Independent contractor status is a bit of a laugh really as yes we can run the service to a certain extent how we want to but actually we have about 100pages of a contract to fulfil with the health boards so they actually tell us what hours we have to open and what we have to do in those hours. I'm retired now but I'd be interested to know how the new NI contributions are going to affect them. Some practices may go under with this.
The last year I was in practice we spent £22k on new boilers and £25k on tarmacing our carpark. Ok we don't get this every year but it's just an idea of costs that hospital staff don't have to factor in. Increases in cleaning, heating,postage, telephone systems etc all affect us.

Don't GP surgeries still get extra payments for managing chronic conditions like diabetes and things like depression, etc?? Don't they also get extra funding for things like covid and flu jabs and other initiatives? It's really not just £112 per patient is it??

people need to realise that the funding for GP services is £112 per pt for as many appts as needed. We see the equivalent of half our patients every month. If you work out the numbers and have similar style contracts to the consultant contract it would cost 2-3 times to have a salaried GP service

Do you want them to take you home?

Our surgery was successfully practitioner-run for decades BEFORE the NHS, and into the 90s. Taken over by whatever the CCG equivalent was when the lead partner died (he lived in the practice building - complicated!). They desperately wanted to be shot of it but when they tendered, a US company was indeed cheaper than the GP consortium (and both way cheaper than CCG) running it. GPs lost out, and were v upset, saying they could not see how the US sums could possibly work.
18 months later, US company ditches the contract. Practice closes down.

Some GPs do make a lot, but they are generally running a complicated business w loads of responsibilities. Most don’t. There are economies of scale that would come if everything came in under one umbrella, but LOADS of inefficiencies too.

GPs are not the weak point of the NHS. They're the major triage service for the entire NHS, reducing and preventing unnecessary patient contact in secondary care, without which the NHS would rapidly fail. A single GP can see 35 to 40 patients a day and they provide the country and provide nearly 1.5 million appointments a day all while the number of GPs falls because there are simply better working conditions privately or over seas. While you think they're paid unreasonably well, they aren't and many surgeries face bankruptcy. The pay, working conditions, terrible hours as well as the negative public opinion and ruthless abuse, all led by tabloids and false information from the Conservative government are other reasons why GPs are leaving in droves for far better lives elsewhere. The remaining few man a sinking ship, holding it together by working harder and longer without additional pay based solely on their good will.
The country perceive them as capable of providing emergency care, but thisnhas never been the case. Patients think GPs can and should do everything for them, but there is a relatively limited remit in which GPs work, that is actually contracted work. Many requests by patients are not contracted work. Much of what is requested falls outside of what they are legally indemnified to cover/treat.
Since COVID, GPs have had nearly double the amount of people requiring their attention. This is because they have new patients, as yet not referred or not treated, and they have patients already referred to secondary care, waiting vastly longer due to waiting times for their secondary care doctors input. Yet they need to wait and while their condition worsens, they seek repeat input from their GP. It has also led to your 'basic GP' treating ans managing more and more specialist conditions without the funding or resources. People think they're 'part time' however the typical 40 hour week is easily compressed into 3.5 days with their hours often being 10 to 12 hours a day. You also probably haven't a clue that around appointments and patient contact, they have hours of paperwork, blood tests and results to attend to. Most 10min appointments require at least a further 5 to 10 minutes, often longer, on this aspect of their vocation. And 'lunch'? Well the majority provide home visits at this time so aren't doing such administration work during a sit down lunch. People claim.GPs sit and drink tea all day. I'm.sure being offered a cup of tea by a co-worker is often the first and last thing many GPs have had the chance to drink. There were reports that GPs were often so busy that they felt they couldn't leave their office to simply go to the loo. People think that an empty waiting room means a quiet day! An empty waiting room means everyone is working and appointments are running on time. People moan that they can't get an appointment. Inrefer you to what I mentioned above re double the patient load and repeat attenders not yet seen by secondary care due to waiting times, which isnt controlled by GPs, but rather hospitals. You cant get through on the phone because GPs have limited staff, and limited phones. They arent a call centre, and they don't have the funds to simply expand, given the vast cut backs to primary care, as caused by your delightful government and the now defunct NHS England. GP surgeries, GPs and their associated care professionals and staff are the backbone of the NHS. Not the weak point.

I work in a GP surgery as a Nurse Practitioner not a GP.
There are multiple problems in the system but the staff not working hard enough is not one of them.
Once our appointments go on the system a month in advance they are filled within 3 days. Most of them with the same patients again and again with their complex health problems that they really need to see secondary care about but can’t get an appointment to see. That means that we have very few appointments left available for new patients. Since Covid we have seen a total change in what problems patients come to see us about, things normally that could be managed at home or by the pharmacy but patients are now so anxious they are unwilling to do so. Basic coughs, colds, skin rashes, verrucas. These then take up the remaining appointments.
On Friday I covered our GP triage system alone. These were calls or econsults from patients asking for urgent advice. I had 65 patients in 1 morning and of these only 6 required GP,or nurse clinical input, the rest could have been dealt with by common sense or a pharmacy.
Hypertension and Diabetes is through the roof as people work harder, lives are more stressful so there is less time to think about healthy eating and exercise.
Mental health problems now take up more consultation time than anything else as there are poor, overstretched and inadequate services to send these patients to.
The whole system is imploding.
We would love to give you all appointments and to be able to help you all, that’s what we came into this job to do but demand is simply outstripping supply. Everyday we go into work and do our best and every day we are unable to do what you all need. It’s become so disheartening.
We know you are all frustrated and angry but we are not the people to be angry with.

Erm probably because the current model for primary care doesn't allow it.... it's not about forcing GPs, it's the system. The dept of health or the NHS has allowed GP practices to be standalone and not sit directly under the remit of the NHS. If they changed this then the NHS would be solely responsible for every aspect of a GP practice (more burden) and GPs would sit with them or leave as is their perogative. But this model doesn't exist so it's a moot point to say why aren't GPs forced, the better question to ask is why doesn't primary care sit fully under the NHS.

It's a sign of a system that is too overwhelmed to function.

Even just sending a sensible text takes time and energy, needing to look over previous appointments, records, etc. Utterly burnt out people just stop even thinking.

Business managers don’t take the Hippocratic oath…

But when we as the community they serve find we can't get an appointment and when we do are palmed off,.misdiagnosed etc what can we do?

I would hope that there would be some consideration of the people using the service not just the money they represent. Because the Hippocratic oath is not about maximizing profits,at least last time I checked.

Not to maximise profits, but to keep their heads above water - rising costs and increase d demands and underfunding …. They aren’t out to MAKE money for profit !!!! It’s to survive. For all our sakes - doh

What do you think a business manager is for if not to maximise the profits of the business? That is literally in her job title!

But that doesn't excuse sending irrelevant texts

Read the history of the NHS to marshal a chorent argument. Yes, GPs have always been an exception, but so have dentists and pharmacists, so an understanding of how it is why it is and how it all hangs together would enable those who crticise, offer alternative, considered options.
And hospital doctors do not juust 'pick up their mess'

The problem is that this isn't GPs fault as much as you think. Someone higher up in the NHS has made a cost-benefit decision to require referrals. This is all very deliberate. Referrals are used to restrict access to manage system throughput and capacity. There's insufficient capacity in secondary and tertiary care, so it becomes the job of primary care to keep people from accessing them. If they permitted people to access allied health services (as in your examples) without referrals, then demand would rise with insufficient capacity to serve it.

It also makes work miserable for GPs. They are under pressure not to refer.

The NHS has always had a very tight referral system. They're not unique in having them, but other countries are often more generous. For example, referrals may be more open (eg you effectively can see any gynecologist for 3 years), some specialties may not require a referral, or GPs don't have any pressure to refuse and the referral system is mainly to prevent the worst abuses and hypochondriacs. (In the USA, many insurers do not require primary care referrals and I have seen some real doozies.)

Exactly, they're the gatekeepers, so everything has to go through them.

Go back a few decades and they did a lot more themselves, i.e. minor surgery, attending emergencies, etc., but it's morphed into an "admin" role but they're still the gatekeepers controlling access to everything else.

That works if they are good at diagnosing and sign posting, but a lot aren't, hence the sheer number of "fob offs", misdiagnoses, etc.

And the time and experience of highly trained professionals is being wasted on trivial stuff where people should be able to self-refer, i.e. physiotherapy, podiatry, audiology, etc. It's madness that you need a GP examination and referral for a hearing aid or an ingrown toe nail. If you have hearing problems, you should be able to go straight to audiology, in the same way you go straight to a dentist with tooth problems or an optician with eye problems.

It happened when I first needed a hearing aid, six months of farting around with the GP, getting appointments, them saying I had wax which needed removal first, then another appointment to check they were clear, then they forgot to send the referral, then a few months later, after I'd chased, they needed another appointment to check the ears again to do the referral as the time had passed, etc. Complete stupidity and waste of time.

Same with our son with his ingrown toe nail. Farted around with the GP surgery for about six months again, numerous appointments with GP and practice nurses, all with different treatments, but none worked, so finally and reluctantly referred to podiatry. Finally, the toe nail was off and healing within 2 weeks of the referral, after 6 months of pain farting around with the GP surgery!

They cause a lot of their workload by not diagnosing properly in the first place, not providing the right treatments, and delaying referrals to the specialists.

Probably as people are reliant on actually getting an appointment as you can't bypass them to see anyone else

I remember working for a commisioner and going to a meeting with a hospital because our GPs were refusing to do pre chemo blood tests. Why? Because they weren't paid to do it and so were having to find ways to stretch practice resources further. It was one of 100s of little extras they were doing for free as goodwill. GPs crying in our office was common. It was also unsafe because they were expected to interpret the results but were not experts.

The hospital were incredibly receptive - why would we say no, it's £112 per test.

The nhs is stretched everywhere. The job of a gp is... not fun.

(Although the previous government brought most of the new roles in.)

This.

They can't magic appointments out of their arse, the funding they receive and the terms of the NHS contract hasn't kept up with the increased demand on their services. Or do you believe they're just all suddenly useless for a laugh or because they can't be bothered anymore?

Doh 😩
the surgeries are money focused as they have to balance the books !
it is not about lining the pockets of the GP’s !!
GPs are precious, worked to the bone, and seemingly thought so poorly of by the general public -
the lived experience of ex-GP’s on this thread tell us why the whole system in collapsing -

It was probably taken over by the health board which is what the OP was suggesting. I have a friend who's practice was taken over and it was unbelievably badly managed.