to think you'll miss your GP when they're gone...

[macdoodle]

I have been roundly criticised on other thread for trying to express this. And whilst I admit that highjacking someone's thread may not have been the best way to do it, the crisis in NHS GP is very real.
I have bee around MN for a very long time now, and sometimes the anti GP sentiment is astounding and utterly depressing.
So read this...he is not a GP (I am), but this article absolutely sums up the current problems and morale in GP at the moment.
I have been a doctor for 20 years and a GP (or in GP training) since 1999 and can honestly say that NHS GP is in very real danger of being gone very soon.
For those who continually slate GP's , please tell me what your better suggestion is, because I trained in a country with no national GP service, and it really isnt better in any way.
www.conservativehome.com/platform/2014/03/from-adrian_hilton-the-looming-manpower-crisis-in-gp-land.html

I haven't read the full thread so forgive me.

However, I really wanted to post as this topic struck a cord for me.

Me and my family are blessed by a wonderful GP surgery which since the birth of DD I have been regularly grateful for. The GP's in the practice listened to me, took my concerns seriously and accepted everything I said as though I was an educated and sensible person when my dd was ill in her first few weeks. She was not seriously ill but the shock was terrible and looking back, I genuinely think I would have become terribly depressed without their on going support.

I can get an appointment on the day without it needing to be an emergency - I just need to call at 8am and I have never felt that I was wasting anyone's time.

Looking back now I cringe when I think of some of the things I used to take dd in for but their kindness and empathy meant such a lot. Hence why I have now become a bit of a GP evangelist!

I have been lucky never to have been seriously ill and was lucky that my dd was easily treated. However, I have the utmost confidence in my own GP should this change.

It makes me sad and frustrated that there is such uneven care for patients across the board and that good GPs feel unsupported

Or what he govewnt want is to privatise thevwholevsystem but can't afford to say it. So it makes impossible to work , make people unhappy about the GP and says that we need to privatise everything because then it will work better.

Tbh reading the posts on here, this plan seems to be working quite well so far.

I don't know what I'd do without my GP, she has been my rock for the last few years and one of only two people I trust 100%. In terms of medical care I have never had a problem with the service she and the rest of the practice have provided.

However, I work frontline in the nhs. Between three of us, we care for up to 25 patients for 12 hours and 15 minutes with 70 minutes allocated to breaks. The patients have injuries and illnesses ranging from locked in syndrome to parkinsons to recurring brain tumors. Most need assistance 90% of the time, at least a handful need 24/7 care. Most need help showering, feeding, toileting. Some are pleasant, some are very challenging and some are outright aggressive and frightening.

I have had days where I have had to wash a woman no older than me who has soiled herself and the bed whilst she cries and asks if she will ever get better, before going to a lovely gran and discussing her terminal diagnosis and how her grandchildren are taking it.

Not to mention the fact I have at any given time 25 meals to serve, 25 x 6 charts to be completed, urine bottles to be disposed of, fluid balances to be recorded, bowel monitoring to be done, samples to be arranged, beds to be changed once, twice, three times.. clothing to be changed, bins to be taken out, bedpans and commodes to be given, water to be dolled out, juice to be handed out at specific times, toilets to be cleaned, showers to be cleaned and checked, beds to be moved, patients to be taken to theatre, mri, ct, patients to be taken for a fag outside, patients relatives to be calmed and spoken to, phone calls to be answered, televisions and radios to be sorted, weights and heights to be measured, multiple wards and rooms to be kept tidy and stocked...

I get to pee - but only if the buzzer isn't going, if there's not something more important to do first.

I certainly don't get a coffee if I don't have a scheduled break time - I get a paper cup of water from our water fountain at the nurses station and maybe, if I'm lucky, a tic tac or polo to clear mouth a bit.

I know it's hard being a doctor. I know my own GP well enough to know that.

I get to sit down for 70 minutes in the staffroom over 3 breaks, and sometimes two minutes if I'm feeling faint or too exhausted in the afternoon.

I don't get PLT days. I don't have the guarantee of going home for Christmas, or weekends, or the ability to pull out of night shift and overtime.

I get £15k a year. Some GPs get nearly seven times that and they sit down for most of their job.

I absolutely adore my job, and I love working with my amazing colleagues and patients. I wouldn't switch it at all. But I do wish that sometimes GPs would accept that they are not the only people who struggle. It's a choice you make sort of, going into healthcare.

I'm a consultant psychiatrist in a community mental health team and wouldn't be a GP for all the tea in China. Mental health services are by and large shockingly poor and I would hate to see general practice go the same route.

It's a choice you make sort of, going into healthcare

Yes, I agree, it is.
And there won't be an argument from me that many, many health care workers are shockingly underpaid for the work they do.
The NHS has survived for many years on good will and people going the extra mile, whether they were being paid for it or not.

As a doctor I wound never complain about my income, but would ask people if they would expect their lawyer to draft a letter, have it ready within the hour/by the end of the day and not pay for it?
But truly this whole debate is not and should not be about pay.

zeezeek, I fear you are v right in your analysis.

The NHS can only work if we all accept that there is a finite pot of money for all. And that those of us fit and well pay taxes to keep that pot going. Those of us fit and well will support those of us not so well. Who knows when it might be our turn to benefit?

To clarify, I love being a doctor and in particular being a GP (although sometimes I miss A+E, so I must be deranged and you can all feel free to ignore me… ), but being constantly slated for working jolly hard under sometimes quite trying circumstances wears people down.

I would not be a psychiatrist for all the tea in China although often wish I had more than 10 minutes to spend with a distressed patient, whatever the reason.
Btw, when we are running late, it's because somebody (or several somebodies) needed more than 10 minutes, not because we were picking our noses. I hate running late; stresses me no end.

About 2/3 of what I do is reassuring people, safety netting, advising on the natural history of conditions - and that's absolutely fine, I love it. Almost 1/3 is increasingly complex chronic disease management and small fraction is sudden disaster that needs urgent action.
Oh, I forgot hundreds of blood results which need to be looked at in contact. clinical letters which may need action taken, referrals to be done (which need to make sense), insurance reports, sick lines etc. Oh dear, I've run out of thirds… just like in RL then.

It is shocking when bad drs/GPs don't seem to get dealt with effectively. There is no excuse for the inexcusable and by that I don't mean mistakes (they will happen until we are all looked after by robots), but rudeness or not listening or dismissing of concerns. But be aware that what you hear or read is often only one very one dimensional side of the story, because no doctor can ever defend themselves in public due to confidentiality issues.

The GMS says I should offer a chaperone for every intimate examination I perform - I often forget to offer (more so when it's women) and when I do people are horrified at the suggestion. However, somebody I do not offer it to could complain about me. I try not to think about it too much.

The vast majority of, say, 20something people who come along with bloating/abdominal cramp/alternating constipation and loose motions will have IBS. If bloods and an examination are normal a trial of treatment is reasonable with planned review. The very occasional such person may end up turning out to have something more serious. If we referred everybody for scans etc into Secondary Care the system would collapse within weeks. And some of those undergoing tests (most of which be normal) will come to harm by the tests. Another think I try not to dwell on too much.

The population is ageing.
We all live longer.
GP training schemes cannot be filled.
There will be less and less GP working against a tidal wave of need.
Whilst being slated for doing a poor job.

That's the one I really don't want to think about...

The assumption is that the GP system won't be replaced by something better.

I can see the OP is implying that there is nothing better. Yet that is surely absurd. Do we really have to shut up and put up with something that really isn't working, because we mustn't on any account wonder if there's a better way to do things?

What do you suggest, MrsRTea?
Affordable, fair AND looking after those most vulnerable in society?

Of course there are other systems, I just don't believe that looking at health care as a 'market place' is the way forward.

I'm not an expert in this field! I just don't think patients should be told to suck it up and be grateful because there IS NOTHING ELSE in the whole wide world.

I have not had the same GP twice (which is a real shame for stuff like smear tests, when I'd like to feel comfortable with them!) so I wouldn't miss them directly. But I get appointments very quickly...heck, even if it isn't an emergency, I can just turn up tomorrow, if early in the morning, and I will get an appointment. Always happens. It's amazing. I love the NHS. I've worked in countries where there is zero medical care unless you're very well off and people die because of broken legs, and even in the US, there was a thread recently where they were searching for some way for a woman to afford treatment for cancer- and nope, nothing, for someone with cancer, ffs. I LOVE the NHS and I am deeply proud of it and I appreciate anyone working for it, the conditions sound pretty shitty.

How about switching the focus, and expecting GPs to empower people to look after their own health? Particularly by preventing illness. Reduce the dependency.

Oh, I don't expect particular gratitude for me doing my job beyond normal civility ('please' and 'thanks' always goes down well IME not just in health care ).

Yes, I'd love more empowerment/taking ownership of own health, but sadly politicians pay lip service to this kind of thing, don't support in practically and continue to hobble the service.

No way should people put up and shut up, but it is worthwhile what superb value for money the NHS is and that provided we want a health service for ALL (not just those who can afford it) then I struggle to see (in principle) a better system.
There are loads and loads of other systems in the world and many of them work well, but are often much more expensive (to the state or individuals).
The US is a case in point: the best healthcare in the work - if you can afford it. If you cannot and you are a working poor, there's v little health care accessible to you. And many people are happy with that approach.

Have only read the OP. I did not realise there was an anti GP feeling. I have no problems getting an appointment (am in Northern Ireland) and am happy with the service my family gets. Could not fault it at all.

I would be very unhappy to lose the service.

I think OP is trying to convey her frustration at a job in which the work is constant and the only way to control it is by being faster, or prioritising.

It's naive and short sighted and a little bit mean to say" tough, it's your job" because no one goes into medicine for the money it's very much a vocation... You work during training until you drop with little food and water or break time and its very physical ...you get covered in blood ,wee,vomit, with great regularity because when a patient is sick, you do all you can for that patient as quickly as possible. It's a very altruistic job.

With pay, GPs pay a huge amount in insurance indemnity which is compulsory, on GMC membership. Also the amount GPs take from the business pot of money, called drawings, is nowhere the same as the amount the business earns.

We do doctoring because we want to help people, make them better, enjoy the challenge, because we learn immense skills during training.However, with changes the last few years it can be a hard life.. A lot more intense than it used to be, having to cope with bullying from patients and often relatives too, our employers are led by managers who don't look after us very well, such as providing rest spaces, work spaces, fair contracts and pensions and we are not heard and are not very assertive about our rights.
It's complex and saying we just have to put up with it all is not fair... Traditionally the deal was we slog our guts out for our patients while our employers look after us with accommodation , respect and try to make things easier in other ways but that deal no longer works and we tend to be exploited.
Doctors who are dedicated professionals ARE leaving , because too much is expected and although we still do our best to make people better, no one says thank you for going that extra mile anymore...they are angry they haven't had their scan yet, angry no one ran down to speak to their family yet, angry that they have no bed yet. We are the cure all but no one is looking after our requirements and stress. You can compare it with investment banking or the army or police... But those jobs do not tend to be lifelong like medicine because of their either very physical and /or demanding nature. Medicine is extremely physical and tiring and we no longer have govt support either...look at DC and his private reforms, everyone taken in by the NHScsupposedly failing( it's not but it needs funding adequately)

This isn't to get the violins out...all Drs I know are tough individuals and want to make a difference but there should be recognition that one Dr cannot solve everything, do everything, be everything...and we in the NHS should be reminding the public of this... Eg in the nature of the AE announcements along the lines of Go home unless you have an accident or emergency... Instead of he govt giving the impression we can be everything at once when we are doomed to cause anger and disappointment. Expectations are completely unrealistic now at a time when funding and backing is at an all time low...If you want to hate someone, try the give who are cutting funds and making it all much harder as well as eroding our respect and trust from patients .
I am NHS Dr but not GP.

It's the NHS 66 th birthday tomorrow, you'll miss it when we are gone

Actually, the NHS has just been declared the best Health Service world wide.

The public should be responsible for stopping smoking and reducing alcohol and obesity...

"Actually, the NHS has just been declared the best Health Service world wide"

By whom?

All the gp's in my surgery are good, I'd be really sad to see them go, they've all been great with me. I did feel that the ones I seen when my son was being diagnosed ASD weren't the best on the subject but he was referred to a paediatrician who was much more on the ball, aside from that they've went above and beyond, phoning me with test results, seeing me with a sick baby straight away when no appointments were available, etc.

www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

[http://www.commonwealthfund.org/~/media/images/publications/fund-report/2014/june/davis_mirror_2014_es1_for_web.jpg?h=511&w=740&la=en graph showing UK overall best]]

graph showing UK health service overall best

I think this is a tough one. People's expectations of GPS have changed, at the same time as there being more patients per gp. Also the recent contracts seem to be detrimental to patients.

The gp above who cannot refer all patients with abdo pain is basically admitting a 2 tier standard of care, with private patients better looked after.

I feel sorry for GPS because the work load is awful and patients are often less than grateful. On the other hand, there are plenty of awful gps about. The local one who treated a pregnant woman for menopausal symptoms without doing a pregnancy test, out gp who decided my son was asthmatic because he had a cough (he's not) etc etc.

I really think we do need some payments to filter out time wasters. Yes, it would put some people off, but all systems have downsides. Ultimately, people off all incomes have to pay for some essentials (food, heating, water etc) so why should medical care be different? Even £5-10 would make a huge difference to attitudes ( both gp's and patients'). And people with complex conditions could be excluded.

The current situation with waits of up to a week or a 5 minute 'emergency' appointment after queuing for hours is just not acceptable.

Sounds liek we should all move to Ireland...

OP you're automatically going to get flamed by some posters like any nurse/teacher/policeman/other public servant who ever dares to imply they might be anything less than perfect, selfless and have no life of any kind other than service delivery every second of every day no matter what the circumstances. It's a frequently seen viewpoint on MN, people in these jobs aren't allowed to have feelings, get tired or frustrated, need to pee or be human, it's the Daily Wail 'I employ you' theme.

My GP's practice is in the process of going under. It's run off its feet, it's virtually impossible to get one of the few appointments that can be squeezed into the day, and if you work and can't sit at the phone at 8am and be prepared to keep ringing and ringing until you get through to play roulette for the few clinic appointments available then you haven't a chance. I recently rang in tears with chronic pain that has moved out of my control, the very sympathetic receptionist managed to mess with the system to get me an appointment slot in ten days time which she shouldn't really have done but it was the only way to help. On the day that was cancelled due to staff cover difficulties, and she had to explain that not only were there no appointments that day, she had no idea where or when I could be offered a replacement appointment. She said to me, quite honestly, 'it's appalling, I'm so sorry but I don't know what else to do'. I still haven't seen anyone. If a charge comes in for seeing a GP I won't be able to afford to go unless I'm utterly desperate, and I suspect the appointment slots will be stuffed with those who can afford to pay (and now expect the earth since they're paying for it, plus will come with unnecessary things because they're paying for it), and those who are exempt. We'll have a whole band of society that either go to A&E when desperately ill or who start dying of minor things for want of antibiotics and major things for want of a referral in time.

I've been with my practice 18 years. Nothing wrong with the practice, it was fine until about 18 months ago, the main problem is the political strategies that have pushed it to this point.

Our GPs are amazing. You can always get a same day emergency appt and a routine one in a few days. They will make home visits if absolutely necessary and they always have time to talk when you have an appt. sometimes you wait a while past the appt time but no one minds because we know that we will be given extra time if we need it. Similarly an in and out appointment doesn't take too long.
We most certainly would miss them.