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?

[quote ARudeTerriblePerson]@StewardsEnquiry the GP surgery can just make sure it's impossible to access those services easily. Simples.[/quote]
They get audited on the service provision. Sorry if you couldn't get an appointment. Again, this sounds like demand outstripping supply.

Health visitors, on the other hand, seem to be non existent. My youngest hasn’t been weighed since his 6 week check up, he’s now 14 months old.

@NotPersephone

MissLuxyEyelesbarrow explains things nicely, I'm working NHS today and my day with be 8am to 7.30pm and then probably an hour or so for blood results and electronic prescriptions from home tonight. Quite easy to work 50h over 4 days.

That's 48 hours and the original post was "50 to 60 hours" PT. Hyperbole. And it's obvious to anyone who has ever had to use primary care that there is massive inefficiency - do referral letters ever get where they're intended the first time? How many phone calls are made to chase up things that don't happen because antiquated systems are used and people don't do their jobs properly? How much of that time could be used more efficiently?

You seem to have a very strongly held but ignorant view of the situation on the ground, especially when your main source of information for this is "My Husband Who Is Not a GP."

Yes, he's my only source of information. Oh apart from the fact that me, my DH, DC (who has special needs BTW and has been catastrophically let down by the NHS) also have to use GP's, along with every other so-called GP-basher on this thread, and that - by any standard - the current system (including but not limited to primary care) is an unmitigated clusterfuck.

But yes, me and everyone else on this thread who has had overwhelmingly negative experiences is just a Tory stooge/on glue/ignorant/lobotomised.

8am to 7.30 and then an hour or so on top as it says in my post. X4. That's 48h?

Would you like to count again?

Referral letters are sent electronically, so yes, they get to exactly where they need to be first time.

We do plenty of chasing, but that's mainly for things that the hospital should have done (like oncology secretaries telling the patient to speak to their GP about scans not requested by us etc).

As to the rest of it - you're a patient and you know some patients. So am I. And so are my relatives. So what?

My point is that you claim to have some knowledge of the provider side of things and you really don't. And it's clear your husband doesn't either.

On a broader note, the NHS is indeed broken. People need to pay more than £120-150 a year for primary care if they want any kind of good service. It's unsustainable, and patients as well as GPs should acknowledge that. That doesn't mean NHS GPs aren't working really hard at the moment.

@StewardsEnquiry

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

Try it! Not advisable for anyone who is not themselves a doctor.

@Iamthewombat

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”).

So your expertise on GP finance is based on occasional conversations with GPs? OK.

GPs receive £150 per patient, to cover all costs, other than mortgage/rent. The average consultation rate is 7.5 per patient per year so GPs receive £20 gross per consultation - less than NHS 111 receives for a call to a call handler who has had 2 weeks' training and way less than any hospital appointment (around £190). The margins are wafer-thin.

Hospitals go over budget all the time, and get bailed out. GPs who go bust often lose their homes and other assets, because they are unlimited liability partnerships (not our choice - the DH won't give contracts to LLPs).

The narrative that practices are choosing not to recruit so that they can increase profits does not stack up. Practices are folding because they cannot recruit. GPs are handing back their contracts, often at a huge financial cost (because of early redemption charges on mortgages) that they bear personally .

As an expert on economics, perhaps you can explain why it's so hard to recruit to a job that's apparently so over-paid and piss-easy?

@privateandnhsgp you concede that the NHS is broken, yet GPs continue to insist that they are providing an adequate service. They are not. GPs need to down tools and refuse to pretend that patients can access adequate primary care. They cannot.

The picture is muddied by the fact that, quite clearly, there are some GP practices staffed by people of moral integrity who can serve their patients adequately. But they too should look to their morals and refuse to collude with a system which is so awful for the nation's health - yes, the national health.

@IamthewombatAs @MissLucyEyelesbarrow says, PMSL at the notion we are not recruiting to increase partner profits. We spend considerable practice time trying to recruit. Why can't we recruit into this golden egg of an opportunity? Why have we had a partner revert to salaried? Why have practices handed back contracts other than through retirement? All of these are unseen or regarding recruitment unseen at this scale in my career.

@NotPersephone. What an utterly ignorant and ill informed post - based on second hand hearsay from someone else WHO ISN’T A GP !! Your sweeping generalisations don’t help the situation do they ? And how is it tired nonsense to make an observation that someone close to me has been working harder than ever during the pandemic ? It’s my niece who is a GP and she works 50 hours a week on average, plus not insignificant input on her days off. There are some GPs out there who have done a great job during the pandemic - my own included and have given ftf appointments wherever necessary. There will always be the the not so wonderful GP’s - as pointed out upthread somewhere, they were crap before Covid and the pandemic only served to highlight their ongoing shortcomings. And by the way - GP’s were ‘pissing about with red flag symptoms’ long before Covid. My own husband was a victim of GP shortcomings, being treated with painkillers for shoulder pain attributed to ‘a trapped nerve’ for months on end. Despite no improvement and other symptoms being reported nothing was done until he collapsed with pneumonia and on admission to hospital he was diagnosed with an advanced lung tumour which had been sitting on a nerve, thus causing the shoulder pain. All that was needed was a proper investigation and they would have discovered it - possibly before it spread. As things stood it was untreatable and he died ten days later. So I know some GPs aren’t up to it. Some. Not all.

@NotPersephone I'm fully aware of who the customer is. If a service is run with no eye to the business then there IS no business soon enough. Practices already can't recruit or retain staff: doctors or admin staff. They are knackered. And if the partners don't have enough income to pay wages then the practice gets closed. So the patients won't have a practice at all.

[quote ARudeTerriblePerson]@privateandnhsgp you concede that the NHS is broken, yet GPs continue to insist that they are providing an adequate service. They are not. GPs need to down tools and refuse to pretend that patients can access adequate primary care. They cannot.

The picture is muddied by the fact that, quite clearly, there are some GP practices staffed by people of moral integrity who can serve their patients adequately. But they too should look to their morals and refuse to collude with a system which is so awful for the nation's health - yes, the national health.[/quote]
GP surgeries provide good care for £150 pp per year. Pre-pandemic this was for 6-7 consults per person on average, a marginal cost comparable to a phone call to NHS Direct.

Want better service? Pay more.

Plenty of people are happy to pay £120 per consult to see me privately on a private day - and we have same day availability. But flexibility requires spare capacity and the NHS doesn't want that.

@Rosscameasdoody sorry to hear that. That would have been terrible even if there had been adequate diagnosis and timely treatment. Sorry for your loss.

[quote Zilla1]**@IamthewombatAs* @MissLucyEyelesbarrow* says, PMSL at the notion we are not recruiting to increase partner profits. We spend considerable practice time trying to recruit. Why can't we recruit into this golden egg of an opportunity? Why have we had a partner revert to salaried? Why have practices handed back contracts other than through retirement? All of these are unseen or regarding recruitment unseen at this scale in my career.[/quote]
If I could 'like' this post I would do so x1000

@NotPersephone

My point is that you claim to have some knowledge of the provider side of things and you really don't. And it's clear your husband doesn't either.

Erm, he's a clinical director with an academic and clinical role alongside his management one who has spent the best part of the last 25 years working FT for the NHS. But yes, he's just as stupid and ignorant about NHS provision as everyone else who thinks GP's are taking the mickey.

On a broader note, the NHS is indeed broken. People need to pay more than £120-150 a year for primary care if they want any kind of good service. It's unsustainable, and patients as well as GPs should acknowledge that. That doesn't mean NHS GPs aren't working really hard at the moment.

Yep, agree. So why gaslight the public by pretending that remote appointments are safe and effective? They clearly aren't and we all know it. GP's are colluding in a system that harms patients. The public have every right to feel aggrieved that services that were available in 2019 have disappeared in a puff of smoke, that the existence of any kind of functioning healthcare system is illusory (or at best, a lottery) and that we have inadvertently created the most appalling 2-tier system since the US. Because people like me and DH will be alright, but there are plenty that will not.

You've said elsewhere what your H does, but we're talking about provider side GP provision, not hospital care provision, about which you and he have no knowledge at all. If anything that shows that he's even further removed from coal face primary care.

But the 2 tier system that you refer to is not being created by GPs. It is being insidiously created by the government. Previous posters who referred to getting rid of GPs and letting nurses run primary care... be careful what you wish for. Because that is what is coming for the many. The wealthy few will have access to a GP who has had 5 years of medical school and at least 5 years more post graduate education. The rest.... well. A mixture of nurses, pharmacists, physiotherapists, physician associates, paramedics. But doctors? No.

@StewardsEnquiry why do you think that will be worse?

@StewardsEnquiry If we need to see a doctor, we will be referred. And we're much, much more likely to be treated courteously.

[quote ARudeTerriblePerson]@StewardsEnquiry If we need to see a doctor, we will be referred. And we're much, much more likely to be treated courteously.[/quote]
You should be happy then, you'll get exactly what you want if you dislike Doctors.

As above, I'll be taking my family to see a doctor in the first instance and so will most people that can afford it. There's a surge in private GP provision, but a surge in people paying that want to see AHPs first line for a diagnosis? Not so much.... But why worry? Let the market set the terms...

@NotPersephone

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

Do you seriously need this one explained to you?

Solicitors attract clients who pay them or they go out of business. That winnows out the less competent or those who can't be arsed to do a good job.

GP's have one meaningful customer (the NHS) and offer their services on a "take it or FO" basis. That customer is not the patient and it shows (especially on this thread). There is limited supply and no meaningful choice.

Exactly this - plus the fact that the GP 'business' receives funding for a patient even if they never see said patient.
It is really not in their interests to see patients as they get the money anyway

• is it £1000 per year per patient?

You're an order of magnitude out.

It's £120-£150 per patient per year, for an average 6-7 consults (probably slightly higher now).

Good luck getting that elsewhere - privately we charge that much for 1 consult.

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

Ever tried it? Because it’s a living hell.

Because while those allied health care professionals are excellent in their own right, they are not the same as a qualified General Practitioner. They cannot do the same things. Some of them cannot prescribe. Some do not consult children under the age of 2. Only a doctor can sign a fit note or a death certificate.

Most of the general population values being able to see a doctor without first going through a nurse or whoever.

It is well established that there are health inequalities related to socioeconomic deprivation. Those people who would most benefit from the qualifications of a GP to oversee their healthcare, to coordinate the management of their possibly many chronic conditions, to advocate for them - are least likely to have a GP in this brave new world. What a terrible thing.

@StewardsEnquiry spot on as ever.

@privateandnhsgp

You're an order of magnitude out.

It's £120-£150 per patient per year, for an average 6-7 consults (probably slightly higher now).

Good luck getting that elsewhere - privately we charge that much for 1 consult.

Ok fine - I did put a ? after the figure. The point I was trying to make is that the GP gets that £155 regardless of whether they see the patient or not. It is not the GP practice getting money for a service to their customer (I.e. us)

The fact that an average of 6-7 consults pp are delivered takes account of this. So yes, the surgery gets £150 for some people that aren't seen at all. But they also get £150 for people that are seen 40 or 50 times.

The point that I'm trying to make is that NHS GP is insanely good value for the funding it gets and for what it delivers.