But I thought there was a shortage of GPs?

[Decisionsdecisions1]

https://www.theguardian.com/society/article/2024/jun/21/four-in-five-locum-gps-in-england-unable-to-find-work-bma-study-finds

I am genuinely surprised to read this - I’d always thought the difficulty with getting a GP appointment was because there weren’t enough qualified GPs. I assumed fewer people were going into the profession (which wouldn’t surprise me as the NHS seems a very stressful place to work right now)

How can it be that GPs are struggling to get work while patients are struggling to get appointments?!? I feel I must be missing something obvious.

I think it's budgets - surgeries are simply not using locums when they should be because they don't want to/can't pay for them.

Investing money in other types of clinician - paramedic, nurse practitioner, physician associate. There’s work for GPs but the funding has been allocated elsewhere. Big change from a few years ago where GPs could happily fill their week with locums if they wished.

Not enough jobs for GPs equals not enough GPs for us to see.

it’s a political choice not to create the jobs…

Locums are very expensive. I imagine a lot of practices just can’t afford them.

Locums are a lot more expensive than salaried staff - the article is confusing as it isn't clear whether these GPs are locums through choice, for the flexibility and higher wages, or whether they can't get any GP job, including contracted ones.

I have little sympathy for the former, but if it's the latter we clearly need a system change.

surgeries are restricted as to where they can spend budgets - they may need GPs but are not allowed to spend funding on this

GPs struggling to find jobs while patients are ‘crying out’ for appointments, says College (rcgp.org.uk)

I’m a GP.

GP surgeries are currently getting extra funding to employ staff that are NOT GP’s. It’s ring fenced and not allowed to be spent on GP’s, but can be spent on paramedics and PA’s. It’s a deliberate strategy to cost save.

I think the governments plan is for a two tier system: Too poor to pay? See a paramedic or PA. Can afford to pay? see a private GP.

Our surgery has two Gp’s on mat leave and one off long term after a horrible accident and they’ve very openly said that they can’t afford to have locum replace them.
They’ve taken on another nurse part time to try and help and the attached pharmacy (the wife of one of the partners is the main pharmacist) has increased their opening hours by an hour three days a week.

Its a nightmare atm getting appointments, and normally they’re really good.

Did you read the article? GP practice's are spending money on associate physicians (these are note qualified GP'S) so they can see more people at a lower cost. This is an issue because they generally can't diagnosis a lot of conditions or prescribed medicines like a GP can. But it also means that they can't hire the GP'S that are available either.

I've seen one twice recently, once at an out of hours clinic. Which was luckily running late as I needed antibiotics and would have had to wait for the GP on call to come in and prescribed them (the GP came in while I was waiting luckily otherwise I would have had to wait around anyway). The most recent I wasn't as happy about as it was a phone call and she didn't actually tell me she wasn't a GP and they are supposed to make sure you are aware that they are not a doctor. I only knew as I'd read the info sent through on the email which did say, but I'm sure not everyone would have noticed that.

I remember seeing a locum at a walk in centre a few years ago who flew in from Germany for his shift because the money was so good. Whilst I get the need for bank staff for emergencies locum staff in the NHS overall cost a fortune. Was there a time they were just used for emergency cover? that makes sense.

The issue is because moat GPs went private and left a shortage for NHS Dr's at the surgery. So the surgery then have to bring in locums to fill this....which is expensive. Our local surgery pays £1000 per day for each dr from 8am-6pm.
Truth is....most Dr's I know go where the money is.

I think GPs will be replaced by AI in time. A recent study found that AI was significantly better at diagnosing than a doctor. An ANP or Paramedic could then interpret the AI results and refer to a central hub for doctors who would be qualified to assist/review if necessary or the AI wasn't delivering.

How many times do people report that they're not being diagnosed correctly by GPs anyway? Some resulting in avoidable deaths. My friend had this experience and I urged her to get a second opinion, but she was of the generation who generally trusted doctors. A few months later and an emergency hospital admission and she was dead. My late husband was misdiagnosed with a virus which turned out to be a malignant tumour. Even I could tell he was presenting with serious neurological symptoms, but was given short shrift by the GP when I politely queried it. Within 24 hours he was blue lighted to hospital. I have literally had GPs sit like 😐 in front of me because they don't know what to do. I've also seen GPs mess up palliative care and pain relief in serious conditions or they don't want to get involved and fob you off.

I'm sure there are some very good, hardworking GPs out there, but let's not kid ourselves that they represent the gold standard of primary care.

Locums are more expensive for surgeries to employ than salaried staff because they have to charge a reasonably high rate per session to cover their salary and indemnity insurance, tax etc. This is all cheaper when done centrally through the surgery.

Also, the amount of money that the government is providing this year to doctors’ surgeries to see patients has, in real terms, gone down because the surges are having to pay more for utilities and for the salary increase that the government promised to support staff (but hasn’t funded).

Doctors are, basically, being asked to do more with less. Please remember this on July 4th 🙏

I've been suffering with repeat chest infections, I can see AI can assess my symptoms but can they listen to my chest? GP had a quick listen and immediately said my left lung wasn't taking in air/oxygen (can't remember which) and I'm not sure how AI could do that.

It’s getting less and less common to see an actual qualified doctor both in gp surgery and in hospital. I REALLY hate it when medical staff don’t actually tell you what they are as well.
You are supposed to be sort of triaged through health care assistants, nurses ( if you’re lucky) physicians assistant, before you actually get near anyone with a degree in medicine.
Haven’t read Labour manifesto yet but I hope they don’t intend to carry on this caper and intend to fund many more doctors.

That's where an ANP or Paramedic would step in and do a physical examination. These people sound peoples chests already in the course of their work.

As previous posts have said, surgeries are employing other staff instead of GPs. It is not what patients want, and it essentially means patients cannot access primary care while potential GPs lack employment.

I haven't seen a GP since before the pandemic, and nor has my son, and I really tried to get him seen. Meanwhile I am being chased for my "health check" which would be a pointless 5 minute appointment with a bored nurse who will check my weight and BP (both fine) and ask if I smoke, then tick a box which helps the surgery meet a target for which they get paid. They don't actually need any doctors to operate as a surgery - if a nurse can't deal with it you should go to A&E.

A GP surgery is closing near me as they can't afford to stay open, and the GPs that are there are overwhelmed and handing back the contracts. They need another GP or two for it to meet local demand, but they aren't allowed to hire another. It doesn't matter how many GPs there are looking for work, if the government won't allow practices to hire them. The government could change this both by changing how budgets are organised and by giving GP practices more money.

There is a shortage of appointments in some areas because the practices can't afford to pay for any more gp time. There are plenty of gps about. Demand is about 300% higher for the same amount of patients than it was 30 years ago.

Interesting points about AI - my immediate thoughts are that someone ultimately takes responsibility over a decision, and currently that's the individual treating combined with the NHS. If you add in an AI company, the first thing that would need to be figured out is who gets sued if it goes wrong - but that depends on so many variables and how it works in practice - ideally the AI company would take on some of the responsibility/ownership but there's easier money to be made in AI than having that over your head. Interesting one.

When are GPs ever sued because they've failed to make a correct diagnosis? Patients mainly shrug and get on with it because expectations are so low.

Thanks all - really interesting posts. It almost feels like GPs are being phased out - I don’t understand how that would work (taking the point on AI but it’s isn’t developed enough yet I’d assume).

If nurses and clinical physicians can’t by law do everything a GP can - then surely locums are still needed when GPs are on holiday /sick leave/parental leave etc.

As another poster said, it does feel two tier. We’ve had to use a private GP ourselves as we couldn’t get an appointment for dd (with anyone, GP or otherwise). People can’t just be expected to turn up at a&e.

Demand is about 300% higher for the same amount of patients than it was 30 years ago.

In fairness I would say both recorded demand and activity are now inflated by the number of patient episodes a patient has to work through for one query. In the past a woman who wanted to start HRT might have seen a GP once. Now she will first talk to a nurse, then be sent for a smear test before anything else can happen, then talk to a gynae nurse or clinical pharmacist, then if any questions arises about family history etc finally talk to a doctor. All these episodes are recorded and activity looks high but nothing of value has been added.