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

I'm a qualified GP with 10 years experience.
I haven't worked as a GP for over a year now. Because it's a nightmare. I don't have enough time to see my patients properly. There's so much demand it's very difficult to get any continuity. I was seeing 18 patients in the morning and 18 patients in the afternoon and 2 or 3 home visits up to 7 miles away. Also looking at 40 or so blood results, 10-15 hospital letters and another 10 or 15 tasks. I was permanently exhausted, late home from work, terrified of missing something. And I didn't have the continuity and ability to care holistically for patients that attracted me to work in primary care in the first place.
I had a salary of around £75000 for 40 hours over 4 days per week. Now working as a speciality doctor in secondary care for around £10000 less but feeling much better. Primary care certainly needs changing but you won't solve the problem by ending GP partnerships, you'll probably generate new problems because then you'll lose those people's work running small businesses.

Except it is cheaper. That fact is born out when you compare health board run practises with GP partner run ones.

If it was cheaper, any time a partner run practise offered to hand in their contract the health board would bite their hand off.

Yes, some GPs are paid more than some consultants. But they’re generally more widely qualified and do more. A partner run GP practise does all its own staff recruitment, pay setting and management, patient administration, payroll, records etc. A health board one uses non clinical staff at the health board to do all that, and as we know the corporate administration side of the nhs is wildly inefficient.

5 years ago I would have disagreed thoroughly with you. We had a fantastic doctor. Did home visits, never failed to slot someone in. Checked up on you later if they were concerned. Even offered to drive a friend to A&E (and look after their dc) when they needed urgently getting there.

Then our GP surgery was taken over.

In the last 18 months, these are the contacts I had with the GP:

1. Requested GP appointment for ds who was not able to even sit up without going dizzy. Given appointment for 8 days time. Result: ds ended up in hospital on drip 5 days later.
2. Left (written) message asking to speak to a dr re counselling saying I was struggling mentally: Received text with link to a group that didn't do the sort of counselling I had asked about (in fact only did the type of counselling I had specifically said I didn't want)
3. Left message explaining that ds' medication now was prescription only for under 18s, and the pharmacist had said he needed to get a prescription: Received text saying: "Ask your pharmacy"
4. Tried to get an online appointment for me (how they want you to book appointments). Online says it's urgent, phone GP for an appointment today. Receptionist says there aren't any appointments, so I ask to go on the phone triage. Receive text telling me to book via online application (you know, the one that wouldn't book me on earlier)
5. Asked for a GP appointment for ds with something they have seen him for before. Needs basically checking and potentially medication, but needs to be checked before decision on medication. Can make things much worse by leaving. Received text: "Go to A&E" (who said it was, as I knew, a GP matter. They were not impressed when I showed the text.)

According to our local FB chat, anyone who goes to the doctor is singing their praises because it's so easy. Apparently there's no one else there. Can't imagine why.

A&E was absolutely heaving, there was a queue to sit down. Many of the people I spoke to had been sent by the GP. Many of them either would have been able to be treated by the GP, or had been put off by the GP and so had got worse.

This government wants as many underqualified people as possible to go and work in General Practice because it is cheaper. The fact that people are dying doesn't matter.

Let's not forget when a previous government decided to take over GP out of hours cover, because they thought they could do it more cheaply. Ended up costing the taxpayer a fortune, because they couldn't.

The original reasons for GPs not being NHS staff are still relevant today: GP partnerships own their own businesses and premises, and the government doesn't want to stump up to buy them out.

AIUI there's a general movement in the direction of having all GPs as employees anyway, as being a partner is nothing like as attractive financially as it used to be. Every year the money paid to practices through their NHS contracts falls further behind the amounts they have to pay their staff (salaried GPs, practice nurses, healthcare assistants, receptionists, clerical staff...), and partners are left with less and less money.

There is now minimal if any incentive to become a partner, bearing in mind the need to 'buy in' to the practice. Much simpler to work as a salaried GP or more flexibly as a locum.

Before i worked at a gp practice I had the impression that they didn't work all day.

I worked for a 3 gp practice with over 5k patients.
Gp 1 male worked every hour they could.
8am to 6.30pm. During that time they saw patients, sorted out blood tests and other investigations. Read over 500 letters/results and requested further tests per week.
Gp 2female as above but on part time hours.
8-3pm but sometimes didn't finish until 5pm.
Gp3female as above but did all home visits before 3pm.
Gp1 had a heart attack from the stress died just before retirement. He was the gp everyone wanted cared and looked out for his patients.
3 years later and we are struggling to fill his place.
Most want to be a locum no stress but no relationship with the patients.

General Practice is generally the most value for money part of the NHS. And very few GPs are on significantly more than senior NHS consultants. And I’m an NHS consultant.

Ah yes because the rest of the NHS is functioning so well. The GP model works well when the government isn't fucking it up, like giving pots of money for unqualified staff in lieu of actual doctors.

Are they? There seems to be rather a abundance of doctors that can’t get full-time contracts within the NHS at the moment. Perhaps they might consider primary care as an option versus driving an Uber.

I wouldn't want the NHS to be running GP practices, they would be even worse than they are now.
I am so lucky to have a good GP practice. I know some are awful, but this is what the CQC is for and they need to get tougher. We really need to be looking at the community funding bodies. In my day it was Clinical commissioning groups, I think it is something else now. These are the people who need to be heavily scrutinised because IME these are the people who control the money and service provision. When I was running a service in GP, we had completely unqualified people making huge decisions about services and funding. It was very frustrating and dangerous.

Im sick of seeing all these anti-doctor posts from posters who know fuck all about the whole subject. It’s pathetic.

Because we abolished slavery about 200 years ago?

@theduchessofspork
i think you are misinformed. Not all Dr’s are employees of the NHS. Junior Dr’s in training are employed by the NHS trust they work for (there is also some funding from the training programme deaneries towards costs of training). Consultants, however, are contractors to the NHS and not employees. GP’s are independent contractors- the practices have a contract with the NHS trust to provide general medical services.

you are also factually incorrect on the rest of your statement. I’m a Dr and not a GP. If GP’s were paid a fortune and had an easy job then they would not have the shortage of GP’s that we have. Most GP’s are not paid more than hospital consultants. They also face significant impact of rising costs of running a practice (cost of equipment, heating and staffing) which we in secondary care are entirely insulated from. Many practices are giving back their contracts as they are no longer financially viable. There are some large consortiums forming, where the “head GP’s” are earning a lot of money, but their salaried GP’s really aren’t. There is also a reasonable amount of evidence that NHS run GP practices do not have better outcomes than those run by partnerships- and they cost more to run. There are undoubtedly practices who are poorly run (this is also true of NHS trusts or even individual departments), and individual GP’s who are either lazy or incompetent (also true of every profession) BUT I don’t think is true of the majority. Many of the issues within general practice are systemic and long-term. Bashing GP’s is not going to improve any of these issues. Nor will trying to force them to become NHS employees.

I agree there are problems within general practice- the causes are long-term and complex but include (but not limited to): chronic lack of funding to match increasing workload; a rise in the aging population placing greater demands on community health and social care services; a significant shortage of GP’s; issues within provision of resources within community services (both health and social care); longer waiting times for hospital are also impacting GP’s (we have a lot of evidence that this is feeding back into increasing demand for GP appointments); and a rise in “worried well”.

You mean why don’t we force them to work for American finance houses and provide a shit service , these days?

If you think all a GP does is google symptoms then I don't know how to convince you of anything.

I’m glad we don’t force them. They are already bad enough. All they do is give you pills and send you on your way.

UK trained GPs are in fact in high demand abroad . and have a much more pleasant working life .

And how would that deal with the "worried well", and the neurotic mentally ill people who are convinced every twinge or sensation they have must be indicates of cancer? The gatekeeping is there so that people see the most appropriate specialist, and there are NICE checklists to go through and pathways of which more-likely conditions to eliminate before you get to the waiting list for the expensive diagnostic appointments requiring the big sophisticated machineries. In the UK the GP administers that and the treatment is free to all NHS patients. I am not familiar with the system in these other countries but I suspect there may be gatekeeping of another kind - yes you can make the appointment youself but perhaps does your insurance provider have similar checklists in place so that they don't have to pay for a specialist oncology appointment for the batshit person who thinks "it must be stomach cancer" whenever she gets indigestion? If you have to pay out yourself if your insurance won't cover your irrational conclusions then that works as a way to moderate the demand for each specialist's time, but I don't see how a system with no gatekeeping and no financial impact to the patient who makes inappropriate appointments could possibly work. Or do those countries have fewer neurotic hypochondriacs than we do?

This could be made more efficient still if all of the gatekeeping was eliminated completely and patients able to directly book appointments with the relevant specialists themselves .... as is possible in some European countries, such as Germany, Switzerland & Belgium

If I call our local private GP I can see them on Thurs afternoon & get a prescription & reassurance from a Dr I have a relationship with who I like and trust. They know me & my medical history.

Our NHS GP has one doctor I rate who I can never see as so in demand. Locums otherwise & different ones every time. Two week wait plus. As a child we had a trusted family Doctor we could see when needed who knew us.

Any doctor who was qualified when the NHS was established 75 years ago is most definitely retired and pushing 100 so trotting out the 'GPs were against the NHS' line is very outdated.
Most parents & teachers used corporal punishment 75 years ago, but that's not relevant to modern discussion on the subject.

You clearly don't know much about how practices work & what the major problems are. The key issue is rising patient demand & falling full time equivalent GP numbers. There's a huge amount of info & analysis on the problems- do some reading then maybe you can tell us how to solve the problems

https://assets.publishing.service.gov.uk/governm

So why on earth would people become doctors in the first place if they dont want to do what you think they should be forced to do? would there be not less doctors overall then?

regardless have you actually thought the idea through properly?

There are over 2,000 private GPs in the UK, so clearly some people do pay to see them.