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

Absolutely! The very idea is obscene - GP practices run like capitalist for-profit partnerships and they are paid for by the taxpayer like in socialist countries? Really? This is madness. And for those who would say - our GPs will go private or go and work abroad if they are forced to be salaried - wake up - nobody in the UK would pay to see a private GP - a private specialist, yes, for their skills. But to pay somebody to google symptoms? Seriously? Nobody in the UK would go to a private GP. And if you think UK GPs are in high demand abroad, what with their marvellous language skills and superb (not) training? What a joke.

Proof please? Because this is nonsense.

Who in their right mind would go and see a private GP? For what? To google symptoms privately? Seriously?

I think it's very unreasonable to suggest this about all GPs, to be honest. Our local surgery have been absolutely fantastic and always proactive. I also have two GP friends (not at my practice) who are run ragged trying to fit in as many people as possible, while also trying to ensure their appointments aren't rushed and that nothing is missed. I appreciate that not everyone has the same experience as I've had, obviously, but I think it's unfair to suggest that all GPs are a 'weak point'.

You are correct - diabetes care in the US is very variable. The NHS has a world leading diabetic eye screening programme for instance - every single diabetic has an annual eye exam with retinal imaging. But this is funded and administered via centrally and GPs simply refer into it once the patient is diagnosed and it runs with a large team of graders and linked data.

CGM uptake is also restricted but there has been a massive programme of work and engagement with industry. - 70% of type 1 diabetics and it is NICE recommended for young Type 2s as well.

The NHS has promise - it is difficult to have the level of universal coverage we have for some things without such a system. But there are gaping holes - that are getting wider.....

Yes, they'll continue to be cut because there's no funding to pay for it. It wouldn't matter whether GPs were in charge of commissioning or not. They've cut to the bone already.

I also have type 2 diabetes and live in the USA. Statistically, the UK has traditionally done better than the USA for diabetes outcomes (overall; the US has really variable results). This is not simply about the insurance system but about a number of social determinants of health, but the UK having a strong primary care based approach was superior. Based on comparing the care I get with what other people with diabetes report in the UK, I am not so sure these days and await updated statistics. And T1s don't seem to be doing better, with the NHS being restrictive about access to tech.

(I see my primary doctor every 3 months, get regular blood work, get eye exams yearly, have a CGM, and get yearly foot checks. I wish I could tell you everyone in the USA gets this level of care but for various reasons they don't. Outcomes in the South particularly are really poor.)

They ran perfectly well for years before the switch. It was an ideologically motivated change. And it significantly decreased the focus of the practices. The influence of GPs on commissioning is also of concern - MH services will continue to be cut. I will continue to say what I have observed.

Correct. I earn less than £30 per hour, which for my level of experience is not a huge sum in my opinion. A friend of mine does online tutoring for £50 per hour.

When I need a doctor I get to see one either same day or next day. What I don’t spend in taxes I spend on medical care. When I lived in a blue state on the east coast with high state income tax, Medicaid was treated the same as private insurance so everyone gets to see the doctor without it bankrupting them.

The NHS system is broken because the system was designed, like everything else, by a single white male who has a wife taking care of them. Visiting the recycling center and traveling through airports I can see the same flaw. They need to ask mothers with 3 children and disabled people to design these processes.

A GP is called a primary care physician in the U.S. and their income tops out at about $250k annually working 80-90 hours a week. From that income they have to repay at least $500k+ in tuition and training.

In the UK most GPs income tops out at £80k a year. They work about 60 hours a week and have debts of about £50k which is repaid based on their income.

I don’t think GPs are grossly overpaid at all. Their income should top out at £120k a year. It’s extremely difficult for two adults in a family household to work these hours so you need to overcompensate to cover the lower income of the other adult. If you want people to be committed you need to pay them accordingly.

In the U.S. and Canada no medical workers are working unpaid. It’s only the NHS that I know of that where medical staff are working longer than their contracted hours without pay. In the US it’s mandated that anything over 40 hours is 1.5x pay for salaries less than $67k a year. However, most employers pay 1.5x hourly rate for all working more than 40 hours a week because otherwise no one would work the extra shifts.

Poor service - but that isn't to do with whether they are salaried or managing it themselves. Also reflects the need for more GPs, nurses etc - as you have nicely demonstrated the reduction in service over the past 5 years.

The number of diabetics (as an example of a chronic disease, there are many more) in the UK has increased by almost 1 million each year. Number of fully qualified GPs decreased by 1% in the same time space. That is why the service provided is demonstrably worse

The funding model needs to change. They need to be paid "per consultation", i.e. £x for a GP, £y for a practice nurse £z for a HCA. Then they'd start actually doing the consultations if they were paid for what they do rather than the "per patient per year" where they can do as much or as little as they want and still be paid!

I have T2 diabetes - I've had it for 25 years, well controlled. The GP practice get extra funding for "managing" a chronic condition like diabetes.

But they do bugger all to "manage it" for me. There was a time when I'd get two appointments per year with the practice nurse, have my feet checked, have blood tests, blood pressure and weight taken, and maybe a little chit chat about healthy eating.

For the past 3/4 years, all I've had is a once yearly blood test done by a HCA who then asks the same questions from a computer questionnaire but offers no advice or comment on the answers I give - it's clearly to "prove" they're "managing" my condition, but they don't check my feet anymore, ask me to check my own BP in the waiting room and hand them the note with the reading on it, and ask me my weight - they don't even weigh me anymore.

Money for old rope. Just pretending they're "managing" to get the dosh!

If that wasn't bad enough, despite getting a text every year to say my bloods were "OK", I actually saw a GP last year and asked him for the blood sugar readings for the past 3 years. They were steadily increasing, which I wasn't told, and were higher than the recommended readings for a T2 diabetic. He said I'd need increased medication and "lifestyle" advice to get the readings down again and said someone would contact me (Heaven knows why he couldn't add a drug to the regular prescription, he's a GP after all!). A couple of months later, a random nurse phoned me to ask for another blood test. I went in for that. Then radio silence again. I chased and chased, only to be told they had no diabetic nurses ! It took six months to get the new prescription, and then I did another blood test three months later, which I got the usual text saying "OK", so I had to phone to ask for the reading, and it had actually gone up.

"Management" my arse. Mis-management more likely. They're taking the money and not providing the service!

Interesting thanks

Except they’re not “independent”. Their payments come from the government, fee which are set by the government and they run the practices.

They have to maximise profits, otherwise there isn’t enough to pay for staff, the overheads and equipment.

Its miserable!

It won't be a doctor giving the vaccination! That will be given by a nurse, possibly not someone who works for the practice even - the vaccination service will be paying to use the space.
And frankly as a taxpayer I strongly object to having to pay more for routine out of hours services so your employer doesn't have to give you paid time to attend an appointment Mon to Fri.

“ Many times the pay of top hospital consultants”

I’ve no idea where you get your (mis)information from but that’s complete nonsense. GP’s aren’t paid a fortune and as for “running at a profit”, I hate to tell you this but that’s how businesses work!
No profit = bankruptcy!

I’ve had a call at 9pm from my GP and emails on a Sunday.

New GPs will not sign a contract of servitude unless it is attractive to them. So the discussion should be what conditions improve their lives and prevent burn out - not lose your autonomy and work for us. The BMA and the RCGP will shut that down and it won't get anywhere

Wes Streeting has already announced that more of the NHS budget will be diverted to primary care - that is a start

Additionally many conditions that were managed in hospital previously are now managed by GPs and chronic conditions have increased exponentially.

£10 billion a year is spent on management of diabetes. Almost 6 million people in the UK have diabetes now - much of that increase is lifestyle driven and has added pressure on what may have been the cushy job of a salaried GP described above.

What can we do - as the public - to stop 6 million diabetics becoming 10 million diabetics? Because that is the direction of travel!

Someone's already pointed out lots of GPs are set to retire. Have the one ones all employed directly.
Make that the new normal.

People need GP services. Let's discuss waya to improve the current mess which doesn't work.

GPs won't agree to this - so the discussion is dead in the water. And you can't make them - because we are not in a communist state. The GP contract needs reform and the tax payer can certainly state what they are willing to pay for their services but cannot force them into servitude.

Some GPs would very much prefer being salaried - and there are advantages including being able to leave your job at the office and not worry about keeping the lights on and paying staff but most simply want a better funding model and to retain autonomy

OMG @OptimismvsRealism are you for real?

Look at the real picture:

Eg. GP practice with 8 partners
15000 patients

Paid £108 per annum per patient under contract.
£1.6 million quid
8 GPs to pay mix of partners and salaried
10 nurses, 5 reception staff and admin staff plus a Practice Manager
A large building to run and maintain.

Not great is it?