UK General Practice is in Crisis

[chocolatenutcase]

I'm prepared to be flamed and told that GPs are lazy, money grabbing individuals who don't really care about their patients but this is not the reality for the vast majority of the GPs I know and work with.

The true state of UK general practice is not being reported in the media. It is in crisis.

The current imposed contract for 24/25 has offered a 2% uplift to the GP budget. This doesn't even cover the minimum wage rise, never mind any kind of wage rise for other staff members. The deficit will be borne by GP partners who will take a pay cut, as they did last year. So it is predicted that many practices will have to close because they will be financially unviable. There is no easy way of bringing in income. It is fixed by the government.

GPs value continuity of care but this isn't important to politicians. The move is towards massive hospital led GP practices, staffed by non GPs as the first point of contact, with GPs supervising many of these.

We are training more GPs but there are no posts for them. The government has given 1.4 billion for extra staff but this doesn't include doctors or nurses. That's why you're seeing a PA or paramedic.

The wait in A&E is not down to GPs. In 2919 there were a total (England) A+E attendances December 2019 (before Pandemic): 2.181M. December 2023: 2.179M So there are not more people going to A+E.

GPs are delivering more appointments now than pre pandemic.

I am a patient as well and I fear for my future accessing high quality health care.
I'm feeling very despondent at the moment and struggling to hold onto the general practice I know and love.

It is in crisis.

My DD was admitted to hospital in the summer of last year, thankfully nothing to awful, but quite significant. She is yet to have a face to face appointment with our GP. I've called 111 numerous times because of her issues, and when she sees Out of Hours GP's, most of the time they can't see her full history.

Its a nightmare getting an appointment at our GP Surgery, you have to be quick on the dial for a same day appointment, if you're not through by 8.10, you have to go through 111 or ask first.

You can request a "non urgent" telephone call but there is a wait of around 4 weeks for one of those.

Each time I call our surgery, I speak to either a locum GP or an AIP over the phone. As I said before, she has never had a face to face appointment - it has been almost 9 months since her issue started. Her continuity of care is non existent.

2% increase is totally unacceptable when inflation has much higher and all the increase in running costs are down to the partners.
Unfortunately the media do not inform the people so we still have many patients blaming the GPs and not the government.

Yes the salaried GPs and staff need a 6% pay rise and costs are generally rising so it's not good.

The partnership model costs far less than a salaried model to run as you have the GPs taking all the risk. Hence why the health boards don't like to run practices.

@MrsDilligaf I am so sorry to hear about your DD. That is totally unacceptable but the truth is you will be one of many trying to see a GP. The government doesn't value continuity of care. They just see people as a health care interaction which can be managed by a non doctor and by telephone if that's what's available. That's the direction of travel for U.K. general practice. Before the pandemic digital appointments were being promoted -GP at hand was the one in London but this might be ok for minor illness but not for the people who require the skills of a GP. We start our assessment as soon as someone walks through the door. I've been in my practice so long I can see when my elderly patients have deteriorated before they tell me. I'm saddened by all these stories I hear. Patients do deserve better.

@Musicaltheatremum I have heard so many stories of practices being in the red and partners not being able to pay themselves. There was one that hit the media where they ended up making 3 salaried GPs redundant just to ensure the practice could continue. There's a whole host of practices out there no none will know about that are struggling and I expect there are practices where the partners will only find out they are going to go bust when they get their annual accounts. The staff wage bill is going to be crippling.

Yep. My DH is a GP. Depressed, stressed, overwhelmed.

Who would be a GP partner? It makes no sense. If our kids were younger we would be going overseas.

@chocolatenutcase yes agree totally. Financially our practice was ok and we were fortunate to recruit. We went back to face to face appointments in November 2021 as we were all having panic attacks trying to fit the appointments in. It takes a long time to get a history over the phone then as long again to see and examine the patient. I much prefer to see my patients as you can tell a lot from seeing them.

I used to phone patients for review even before the pandemic where it was appropriate but for acute illnesses F2F is the only way as patients don't always express themselves well when unwell

Our profits fell a lot last year before I retired as we had to pay for 3 new boilers and to re tarmac our car park. This comes out of the partners' pockets. So we took home less money (don't get me wrong, still a good amount plus a gold plated pension) but staff and salaried GPs didn't have to worry re drop in pay.

Plus the earnings people see on the websites for GPs is income before paying staff etc so my income looked like £200k but I paid over £100k to pay staff and building insurance heat light postage cleaning etc so what I took home was a lot less.

I do think some practices don't help themselves though. I'm registered with a practice that does only telephone calls and they call you back "between 8 and 1 or 2:and 6 I did complain but "patients like it" apparently!

Even at the height of the pandemic we would give the patient a rough time eg your appointment is 9.20 but the GP may phone before that or up to half an hour after and we did have sympathy for those people in meetings

Also mobile phones don't always connect so yes, phone them back!

I'm glad I'm out of it all to be honest but reading all my retirement cards from patients makes me feel very humble.

I need some exploratory blood tests for a couple of hereditary illnesses, rang on Thursday and the soonest appointment is 10th April. One possible illness is a deficiency so I'm managing it myself, going to keep trying to get a cancellation but I'm on the verge of paying for private blood tests to put my mind at rest rather than worrying for a month!

It's shambolic and not the surgery's fault

@Musicaltheatremum congratulations on retirement and on your service.

I'm 5 years off retirement but I don't know if I will make it that long. That makes me sad that the system will push out an experienced GP. I'm trying to figure out how I can use my skills but not work myself into an early grave.

We went mainly back to face to face too and I got stressed not being able to see people and doubling up on workload. It's so much easier but I can see telephone calls suit other people. I just love being a GP - cradle to grave but that's being eroded.

@Lovelynames123 that would be the same in my practice. We can't manage the urgent demand and do the non urgent requests in a timely way. We see 1% of our practice population with urgent medical problems on a Monday (90 patients) and often can still offer appointments up until 5pm. But that's at the detriment of routine appointments. It's deckchairs on the titanic- the demand is too great for the clinicians available. And patients lose out. It's not right.

@chocolatenutcase you're "old fashioned" like me. Enjoy F2F hate telephone appointments though they do have a role for some things. I hated having to discuss gynae/intimate problems whilst they were clearly in the check out at Tesco's which is why we went for roughly timed phone calls.

I miss my colleagues but not the job. I've now relinquished my GMC registration so can't practice even if I wanted too.

Keep going but do consider reducing hours if you can. I really struggled with the 12/13 hour days at the end. By 3pm I was exhausted and still had several hours to go. I think COVID burnt me out totally.

For non medics reading this I do think you're getting a rough deal and I hate my own gp surgery's system but there's only so much we can fit into a day.