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

See my earlier post, @DreamTheMoors - you've misunderstood what's being suggested.

What do you do for a living, @OptimismvsRealism?
If you’re happy to force somebody else into employment they might not enjoy, then buckle up. You aren’t going to enjoy what’s in store for you.
If only people thought one simple step ahead.

I agree fully, for the most part the GP service is completely broken and not working. The number of people I've known, who've been fobbed off and turned away from their gp (usually with a prescription for some basic med or pain relief) is astounding. And then they've ended up in A&E when a serious condition has been overlooked and escalated to critical.

It seems you have to almost harass them into seeing you, nevermind taking your symptoms seriously or referring you to a specialist. Their seems to be a common theme of not listening to the patient properly, not examining them thoroughly and premature diagnosis - just deciding it's the most common trivial ailment and ignoring the possibility of anything more serious.

There was my 20 year old friend who'd been to his gp endless times since he was 17, complaining of hip pain. GP just kept giving him stronger and stronger pain meds. Until he collapsed and went to hospital, where they discovered he'd got a tumor in his hip, but it was too late for anything but palliative care. He just made it to 21. Or my best friend who was fobbed of by GP as having IBS, despite being incredibly ill and passing blood for months. GP never examined her properly or looked at blood test results properly. In the end she got so weak she could barely function. I nagged and nagged her to call 111 and they told her to get straight down to A&E. They discovered advanced ulcerative colitis (normally takes years to progress to that bad), and an immediate colectomy was the only option left that could be done. Thankfully it was successful. She's switched GP since, but the new one seems no better - 6 weeks to get an appointment, and that's just a telephone appointment, forget seeing them face to face.

I know quite a few more horror stories like that unfortunately. I actually think GP surgeries should be shut down - half the GPs moved into pharmacies and the other half put in hospitals. It's tragic, but NHS 111 telephone service seems better than what GP's can offer these days.

Having said all that, my own GP surgery has been absolutely brilliant. They recently came top in my county on patient satisfaction survey, and they totally deserved it.

There should be the option for new GPs to work as salaried employees if they wish. Many good doctors aren’t suited to being self employed. It’s the one size fits all approach that is wrong.

Because pay would likely go up - there was a lot of discussion about this when AfC was first introduced, and the BMA junior doctor committee was in favour. An F1 would be a band 5/6 an F2 would be a band 6, an SHO would be a band 7, an ST4+ would be a band 8. Big jump in money once the extra hours and antisocial pay is applied (doctors are generally contracted for 48hrs a week, AfC is 37.5.

My GP friends are hard working, dedicated, overworked and undervalued professionals. I see them on their knees, absolutely exhausted and destroyed by their impossible workload.
Walk a mile in someone’s shoes…

The issue with GPs isn't that they're money grubbing. It's that too little of the NHS budget is devoted to primary care, relative to how many services it provides. That's why the quality of service is declining.

in Canada, family doctors (GPs) have control over their patient lists. When they close the list that is that. There's no guarantee of access to a family doctor. About 20% of Canadians, iirc (varies by province) are not registered, and you go to a walk in clinic if you get sick. I have a friend (near Montreal, one of the hardest places to get a doctor due to Quebec politics) who spent a full decade on a waiting list before being assigned to one. That's the trade off. In the UK, they just push more patients onto lists, so the doctors work overtime and appointments are hard to get.

I think you're misunderstanding the OP's suggestion.

'Focing them to work for the NHS' is slightly ambigulously phrased, but in this case doesn't mean taking a random selection of doctors and forcing them to be GPs. It means changing the employment status of existing GPs from contractor to direct NHS employee.

From a clinical point of view the job would be much the same - and they would be entirely free to do the job or not - but with a different funding arrangement so the GPs would not be running their own business.

Good question! I also wonder why doctors pay is not under the Agenda for Change and is totally separate as are doctors pensions - always wondered that??! I worked in nhs A as an AHP for years and was seconded to HR for the job assessment projects. So many historical inequities within healthcare- largely focusing on doctors hmmm?!!!

No it doesn’t that’s bullshit.

Health boards hate having to run gp surgeries - it costs them a fortune and the service is far shitter.

As someone who isn't a doctor, or an avocado, which autocorrect nearly made me (or you), I'd say for 30 hours work a week, as a GP, my thinking would suggest you should be on about £45k a year?

There are plenty of managers that work hard, and nurses that don’t and vv.

You won’t solve a thing dealing in cliches like that.

I am a GP and I am f—ing exhausted!

• primary health has been underfunded for decades
• the government loves to blame GP for things that are not their responsibility eg inability for me to refer to specialist
• I am not able to practice the way I was taught too.. good luck in seeing a gynaecologist where I work .. they will only see patients with cancer and unless you have cancer you won’t have surgery so if you have heavy bleeding and a haemoglobin of 80 despite iron infusions.. I am sorry, we won’t offer you a hysterectomy, go back to your GP.
• GP’s are leaving in droves and those that stay are not able to work “full time” because you would kill your self.. my “part time”Gp job can be 50 hrs a week
• I can be at my desk at 8 am and still be there at 8pm looking after scripts and paperwork. I have often had 15 mins for lunch. I am struggling to exercise and am utterly exhausted.
• I work in a country with a similar health system to UK but not in UK. At least we have 15minute appointments as standard .. I wouldn’t be able to work with the 10 minute model and take my hat off to UK docs.. their workload is not compatible with good primary care.

They’re not ‘the weak point’, they’re the lynchpin. Traditionally the money was very good - practices who mismanaged / didn’t focus on productivity still functioned as there was money in the system. There were some (a minority but probably not as small as we’d like) who made a fortune.

Those days are long gone. Practices have to be efficiently run and mop up a huge amount of stuff that many aren’t paid to do through their contracts - nursing, phlebotomy, coordination of secondary care inputs etc. Many have huge mortgages on their properties, which often are not valued at domestic prices. Most GPs work really hard and increasingly do portfolio carers - it’s a brutal job - demanding and rude patients who are suffering from all the wider determinants of health and want everything immediately like Amazon deliver, staff management, business management, hate from the press, increasing pressure to do xyz they’re not paid for appropriately. These people train for years - they are skilled and we will only keep them for a decent wage. It’s all well and good shrinking wages back to what the average person thinks is reasonable. These doctors, who have a tonne of debt from training, will simply up and leave for Australia where they can earn double. We need to be very careful what we wish for.

And no, I’m not a GP / married to one / a family member of one.

Yes because when a GP practice is not run like a business - redundancies happen and practices close. So yes, they have to have business managers to ensure they remain a going concern to enable them to serve their patients

I’m a GP. I’m near to retirement so I’ve reduced my hours. I now work about 30 hours per week. I trained for 9 years to become a GP, I’ve also got several post-graduate diplomas, and I’ve been a GP for 30 years, so I’m pretty experienced. My practice is in a fairly average medium size town.
OP, tell me how much you think I earn.

@Musicaltheatremum , my elder son is a GP Partner and his working life is pretty tough. No one believes it though…

From gpworld:

General practitioners (GPs) in the UK can earn a wide range of salaries, depending on experience, location, and type of GP:
Junior doctors: Earn between £32,398 and £37,303 during their foundation training
Doctors in specialist training: Start at £43,923 and can progress to £63,152
Salaried GPs: Earn between £68,975 and £104,085 in England, £71,738 to £108,249 in Wales, £69,993 to £104,468 in Scotland, and £69,974 to £105,592 in Northern Ireland
GPs in London: Can earn an average of £114,000 per year, but some community GPs can earn up to £150,000
..........
Consultants' basic NHS pay will be between £93,666 and £126,281, with average full-time NHS earnings likely to be around £143,100 once additional earnings are included to cover things such as on-call responsibility, medical awards, geographical allowances and additional activity.
...........

Both seem reasonable to me.

My GP surgery is excellent, everyone works hard and the medical staff are very caring.

Love this “that’s pretty rich”… I’m on holiday so I don’t know the ins and outs of what Canadian doctors do / don’t do but it was definitely said with a smug “we’re better than you” tone

😭

i believe billing/funding and liability have changed making it really unattractive to be a gp at the present time. the coding of all complaints the ability to only code so much per visit is problematic and often not a reflection of what the actual appointment visit is like. i believe the amount of people with complex and chronic conditions is more difficult to manage especially when even doctors have difficulty getting the specialists to see people in a timely fashion.
the population is sicker there are less gp's so more pressure with less support by the equally less than required specialists, other health professionals, and available hospital beds.
i think it's a case of shit flows down hill and the gp problem is a reflection of issues higher up.
being a hospital physician is a totally different specialty with different support systems in place to assist in providing care different overheads and a different level of expertise.

@Apolloneuro Yeah definitely not my view. I’ve had a hard time over here this week with people talking about our tiny racist island 😢 and part time doctors. And our shit weather.

And do you guys know what? Canada has MANY problems. I cannot wait to come home.

(PS I also work part time! Canadians don’t have much annual leave - I wonder if they’re bitter!)

I've heard so many conflicting reports on GPs I've no idea what to think!

As somebody who has also worked in the Canadian healthcare system - that is pretty rich! A part time NHS GP is generally still working 40-50 hrs a week, seeing 30-40 patients a day. A Canadian GP is seeing about half that number, for twice the pay.

Wonder why NHS GPs migrate to Canada but not many Canadian GPs migrate over here? 🤔

@OpizpuHeuvHiyo , yes that is true my elder son is a GP and his hours are punishing. His practice has been given 2.5 ish % uplift this year while all expenses are rising way above that and staff wages are up by 10%.

That was the agreement that Nye Bevan had to make to get the GPs to agree to be part of the NHS.