What are GPs actually doing right how?

[Darkchocolateandcoffee]

I've just been talking to my 84 yr old mum who can't get a GP appt for love nor money and is worried what she does next as she has a serious condition that she needs to talk to the doc about.

I love 100 miles away from her but I haven't been able to get a doc appointment for my children for months either.

One had such severe hayfever all through the summer and the only appt I could get was with my GP surgery's pharmacist over the phone, who sounded very unengaged and said the only remedies were OTC ones despite me saying we had tried all of them.

I eventually gave up and did a one-off private GP appt and got him prescription meds which worked straightaway. But I wasted weeks beforehand in which he was suffering trying to get the same thing via our usual GP.

Everyone I talk to says the same. The rest of the NHS seems to be firing on all cylinders.

What on EARTH are the GPs doing instead?

My GP is usually fab. But they couldn't give me a phone appointment to get a sick note for a month. I managed to get one through the out of hours overflow practice.

I don't think there is a single profession devoid of anyone lazy. But the root of the current problems is not individual GPs, but the fact that our numbers are falling as demand grows. The Government has been claiming for years that it's going to increase GPs numbers but, instead, whole-time equivalent numbers per head of population have fallen 20% in the last 6 years.

Politically I think the govt is waiting to introduce a new form of primary healthcare and that is why there won't be any tinkering with the GP system. Once we're all unanimous that we can't carry on like this, they will scrap GPs and introduce something more workable.

As people have said on other threads, we all just google anyway. I have found Facebook groups the best source of health information.

@ErgonomicallyUnsound

I'm interested to understand what the issue is with not enough new GPs coming through.

I've been researching unis recently for DS and medicine seems more popular than ever? And more difficult to be accepted into? Many places offering students £10k to defer med school places a year last year because of demand outstripping supply. (Obvs this because of inflated grades but shows demand ).

Is there a lack of uni places/medical schools? Or are all those trained not wanting to be GPs?

Because so many of us qualify and realise we don't want to be GPs. This thread should explain why.

What's emerging is that there are crap GPs as there are crap people
In every other profession. Contrary to popular belief doctors aren't saints! But the pandemic may have given the crap ones the leeway to be more rubbish than usual
I agree with those who say the government is probably loathe to stamp their feet about it because they're probably my designing an alternative primary care model right now - one with sliding levels of 'co pay' or minimum charge. That's where we're heading.

@TataMamma

GPs are useless, and should not be paid at all. Honesty if clap for carers ever comes back I'm doing it with a sign tha says "not for GPs". Really think they should all by made to work unpaid in A&E - they are the busy ones because GPs are all so selfish. I've not had a proper appointment since the start of the pandemic - I was supposed to have a six week check up after a very difficult labour, involving stitches (surely these need to be checked no?), and it was by PHONE. My then 7 mo DD had various symptoms. Got a tel appt (that was hard enough), and was told she needed to be seen by Dr, but they couldn't possibly do any work, and so should take her to A&E. Spent 7 hours there and SHE PICKED UP ANOTHER INFECTION. Wouldn't have happened if GP had been prepared to see her

As an A&E doctor I would like to say the first part of that is wrong and most of us think GPs have a harder time of it at the moment,

@ARudeTerriblePerson

I agree with *@JaniieJones*. Even the GPs posting on here admit that there are some GP practices taking the piss. They are small businesses not run for patients at all.

I don't know what this means. They have a contract to fulfill, and service to provide to their patients within the terms of this contract. Of course a GP practice is a small business.... what did you think? The partners were doing it out of the goodness of their hearts? And living off what?

Note - they have to provide service within terms of their contract. Not do anything and everything. So if your surgery doesn't do antenatal care or phlebotomy for example, it's because it is not contracted to do it.

' you were a primary care boss you'd be sacked within a week. Nurses aren't legally allowed to sign sick notes.'

Well yes I know. My point is things need to change 🙄.

I bet a nurse is just as able to sign folk off work. Let's face it some gps don't seem to put an awful lot of thought into it.

They are not run in the interests of patients.

They have a contract, but there are many ways round it. Like blaming patients, and local hospitals, and anyone else they can think of.

What is all the cleaning about anyway. I thought they had decided that transmission through surfaces was no longer an issue and that covid is borne by aerosols.

Open windows are what's needed not cleaning stuff down unless there has been some sort of spillage of blood or something like that.

@ARudeTerriblePerson

They are not run in the interests of patients.

They have a contract, but there are many ways round it. Like blaming patients, and local hospitals, and anyone else they can think of.

Your local solicitors is not run in the interests of its clients. So what?

How would a nurse be able to sign someone off as not fit for work when a nurse doesn’t have the same medical training to know that? It’s not just about changing the legal status to enable it to happen. That legal status is there for a reason - because a doctor, after many years of training and a professional, judges it so.

And no, a contract is a contract and has to be fulfilled. If the surgery is contracted to provide enhanced sexual health services it provides them or doesn't get paid.

Well, you can complain about a solicitor who is taking the piss. GPs have a union which makes complaing very difficult for patients.

And the NHS is in fact supposed to exist for patients, not profit.

So the hybrid arrangements for GPs has many opportunities for exploitation.

@JaniieJones

' you were a primary care boss you'd be sacked within a week. Nurses aren't legally allowed to sign sick notes.'

Well yes I know. My point is things need to change 🙄.

I bet a nurse is just as able to sign folk off work. Let's face it some gps don't seem to put an awful lot of thought into it.

An Advance Nurse Practitioner probably could but wouldn't want the added responsibility. They already get paid far, far less than salaried GPs but have many of the same responsibilities of diagnosing, doing ward rounds (care homes) and home visits, referring and prescribing.

@StewardsEnquiry the GP surgery can just make sure it's impossible to access those services easily. Simples.

There’s more lucrative private work to be had if qualified medics go into surgery. Particularly orthopaedic. That’s why some GPs feel hard done by. But let’s not mention that, eh? Let’s all pretend that every doctor is a selfless hero.

Every bleating reference to ‘funding’ comes down to the same thing: give us more money. Partners in GP practices could employ better practice managers. They won’t, because they cost too much. Practices don’t need to use call centres to field calls from patients but some do, because it is cheaper.

Non-salaried GPs are business owners. That shapes their behaviour. Why is the process of requesting an appointment so tortuous, particularly for elderly vulnerable people? Because it is being delivered on the cheap. God forbid that the practice partners should accept a 10p per hour reduction in their income from the partnership to help those people.

Funny how a pile of extra cash (sorry ‘funding’, which depersonalises it and makes it sound more noble) makes it all better, isn’t it?

Before any furious GP jumps in with “you’re thick and ignorant”, as several have done already, I’m the one who spent years working in NHS senior finance. I’ve spent years talking to GP representative groups. The message is always, always the same. Give us more money or else (this is usually dressed up as them “warning the government”).

Exactly, @Iamthewombat.

It's also why receptionists are not really capable.

[quote Plotato]@Musicaltheatremum

Great post. Most people know GPs are working very hard under a broken system. The comparison up thread to the response to HGV drivers is also interesting. But I'm curious about the children who 'shouldn't have been near a health professional'. I wouldn't take my children to the doctor for a cold but that's because I know to wait it out, that anti-biotics are often no use, that I could call any number of doctor relatives and friends for advice if needed - privilege, in short. Surely every country has over anxious parents who want their children to be checked out? The UK isn't known for being a nation of hypochondriacs. So shouldn't the system be built to deal with these parents too?[/quote]
My surgery won't see you if you have a temperature. Twice my daughter had tried to get an appt for my granddaughter aged 1 and been refused. They refer you to a surgery miles away where all staff and drs are gowned up. You wait in your car and they come out to you and assess you before allowing you into the surgery to see a dr. Both times we have waited up to an hour in the car with a poorly baby. The whole system isn't good enough. No wonder a&e are overwhelmed with people turning up.

'Open windows are what's needed not cleaning stuff down unless there has been some sort of spillage of blood or something like that.'

Exactly. Yet many gp surgeries don't seem to have got the ventilation memo do they. Practices local to us often have all windows closed while they ask patients to still use face covers.

Okay, I can absolutely guarantee that there are hardly any GP partners making a killing in terms of profit. Yes, they make a decent living but I would argue that they should for the number of years of study and amount of risk they shoulder on a daily basis. Why on earth should we not pay these people a decent amount and make the profession more attractive? It seems to be hard enough to keep GPs at the moment. If they were all raking it in and sitting on their arses they would not be leaving in droves, would they?

Yes, a lot of GPs do a variety of work, a bit of clinical, a bit of commissioning, some other stuff but that is because working 5 days in a surgery is so intense and draining you would be burned out within 10 years. Plus, the non-clinical things GP do is also vital. Things like appraising other GPs have to be done.... by GPs! They have to have one every year and being an appraiser is an actual job that needs doing.

Of course you can raise a complaint against a GP or any other doctor if you feel the care has not been well delivered

Think it’s dependent on the surgery. My GP’s have honestly been amazing. I had a bad bout of nipple thrush during the last lockdown (breastfeeding) and it just wouldn’t go away at all, I had 3 F2F appointments between January and March. My toddler has viral induced wheeze which he’s struggling with atm so I contacted them today and they’re going to see him later. They have a ‘red room’ which you enter via a back door, I’m really impressed with it and it’s saved us going to A&E with him (touch wood).

We’re in West Yorkshire. I had a F2F appointment about PND in May as well come to think of it.