GP care or lack of it

[Scotdoc123]

I’m a GP and sometimes too avid mumsnetter (NC for this).

It’s very dispiriting that every time I look at the boards lately it feels like there is constant criticism of my profession. I fully understand the frustrations people have with not being able to access primary care and sympathise but surely people realise that we are experiencing unprecedented demand and the reason access is difficult is there are not enough clinicians available and not enough funding for practices and staff. It seems like the narrative is that the reason people to struggle to access a GP is that we’re all lazy and too busy eating biscuits to see patients. Is that really what the public thinks?

It feels like every bad encounter with a GP is used to smear the profession as a whole which I don’t see with other professions like nursing or secondary care docs. Of course there is no excuse for poor care but nobody is perfect and doctors are included in that. If you have one or even several poor encounters by all means complain and post for support but you should not generalise across a whole profession. Remember people who are satisfied with their GP care will be unlikely to post about it.

The other common complaint is “GPs are useless at mental health/gynae/etc” GPs vary a lot in their skill sets and interests and some have more expertise in certain areas than others. I am interested in both those areas for example and have undertaken more training in my own time and at my own cost. Certainly some GPs could benefit from more training in certain areas but the fact remains if we were to refer every patient to specialist services the services would not cope with the demand. In my area psychiatry services for example is reserved for the most severe mental illness, everything else is bounced straight back to us. The Royal College of GPs have been calling for GP training to be extended for several years - that would allow more training in specialist areas, this has not happened because the government won’t fund the extra training time. There are many postgraduate courses and diplomas GPs do in specialist areas but these are almost invariably funded by themselves, not the government or health boards.

Constantly stating on the internet that GPs are undertrained or not good enough in a particular area destroys the patient’s confidence in their doctor which can be detrimental to the clinical relationship.

The government want to run down primary care so they can get private providers in who will cherry pick the easy patients and the rest will be stuck. I firmly believe this will not offer a better service nor more value to the taxpayer. These threads are feeding exactly into that narrative.

AIBU to ask posters to consider this?

@Iwouldratherbesailing

"We" dont pay for anybody's medical training. I'm a single parent studying medicine and will be in excess of £100,000 in debt when I qualify. I exist on student loans like every other medical student....except the international students that come to study in the UK and will likely end up working within the NHS, they pay £38,000 per year for their medical education. "We" are not financing anything except a small bursary paid to us in our fifth year of study.

Each GP surgery runs it’s own system so sometimes (in hopefully rare cases) it can be the fault of the individual surgery

If someone has a prebooked telephone appointment there is no reason why they can’t be given a time ( with the proviso it might be half hour either side )
To say it could be any time all day is obstructive to the patient
Most places have one GP on call the others should be able to manage booked face to face or telephone appointments
If this is impossible there should be a team that goes and helps the surgery re arrange their systems or offer appropriate support to the surgery.
E consult needs looking at

If someone has a prebooked telephone appointment there is no reason why they can’t be given a time ( with the proviso it might be half hour either side )

I had an odd one. Phone appointment booked for 4.15pm. I waited, and waited, and call came. At 6pm on the dot, exactly when the surgery phone line is supposed to shut, I got a text saying she had tried to call (she hadn't) and if I wanted to speak to the GP to ring the surgery ... before 6pm. The line was closed.

I still haven't spoken to her, two months later as 'there are no appointments'.

By the time you even get to be a fully qualified GP you have already done at least 5 years full time mainly shift work in hospital posts BTW. Years of ever changing, unsocial hours shift patterns that are very much not compatible with family life. I really do not think you need worry that the public is not getting its pound of flesh for 'funding' Drs training.

That is to the extent that they do actually find it given fees, loans to be paid back, GMC fees, compulsory indemnity insurance and professional exam fees. That little lot will run into thousands to get to be a qualified GP.

We are well paid. I am not complaining but I do feel affronted at the suggestion that Drs uniquely should be banned from LTFT working! That's going to be great for women in medicine isn't it.

I worked full time until I had my DC and then 3 and now 4 days a week. Lots of women in many professions make a choice to work PT when DC are pre school. Should Drs really not have that choice?

The GPs I know say they earn enough to be happy working 3 days a week

This shouldn't be the case. Doctors are too expensive to train to then pay them enough to live very comfortably working part-time.

really do not think you need worry that the public is not getting its pound of flesh for 'funding' Drs training.

I do. Doctors are far more expensive to train than teachers. In another country they would be paying for that training out of their salary (oodles more than here) for most of their working lives. Five years of being a junior doctor here does not address that debt to the public.

@namechangingforthis19586

The GPs I know say they earn enough to be happy working 3 days a week

This shouldn't be the case. Doctors are too expensive to train to then pay them enough to live very comfortably working part-time.

Please remember that a 3 day working week for a GP is still probably between 30-35 hours, at least. They don't just work surgery hours, but once they've seen patients have hours of admin to do. I'm a doctor (hospital) and at present I'm working "part time" but my part time is 3x12.5 hour days - so 37.5 hours, which to most is nearly full time.

Also want to second what PP has said about the fact that doctors also pay for things that private sector workers would have paid for by their work.
I pay over £400 per year to the GMC for the privilege of having my license, plus indemnity (which once I'm a consultant or GP may run into the thousands). I have to pay for compulsory exams (often £1000+ a pop), and if I was a GP and wanted to do extra courses or diplomas (e.g. for coil fitting etc) I'd also have to pay out of my own pocket.
Essentially the average junior doctor in training probably pays £2000 ish out of their own pocket every year once you add that all up - just to be able to work.

Because as a country we have flexible working. Why shouldn’t GP’s benefit from it too?

Because GPs are taking the micky.

You can work part time and be the main bread winner as a GP while patients go with access to GPs because they have no need to do full time hours. That is ridiculous and not true of other state funded professions. If that's flexible working, maybe we shouldn't have it in this country.

We're not talking about working mums run ragged. We're talking about bread winners who just don't fancy full time hours yet have enjoyed that benefit of a MUCH cheaper education than they'd get elsewhere.

without

glitterbubbles

I know exactly what they do and do not do, it's the family business.

Please remember other professions like testing teaching have many hidden hours.

No GP I know works evenings. Unlike any other job I know.

@namechangingforthis19586

Because as a country we have flexible working. Why shouldn’t GP’s benefit from it too?

Because GPs are taking the micky.

You can work part time and be the main bread winner as a GP while patients go with access to GPs because they have no need to do full time hours. That is ridiculous and not true of other state funded professions. If that's flexible working, maybe we shouldn't have it in this country.

We're not talking about working mums run ragged. We're talking about bread winners who just don't fancy full time hours yet have enjoyed that benefit of a MUCH cheaper education than they'd get elsewhere.

Please don't blame the GPs - blame the system and the government for chronic underfunding of primary care and understaffing. As doctors we are paid well but also carry a lot of risk which is unusual in a job. Literally our skill and judgement can mean the difference between life and death. Not to mention it is mentally exhausting (not complaining - I love my job - but it's a fact). I can see why in the current system very few GPs work full time. It would be unsustainable. Would you rather have GPs who were so exhausted they were more likely to make mistakes?

@namechangingforthis19586

glitterbubbles

I know exactly what they do and do not do, it's the family business.

Please remember other professions like testing teaching have many hidden hours.

No GP I know works evenings. Unlike any other job I know.

I didn't say other professions don't have hidden hours. I worked in a GP surgery as a more junior doctor and they had regular appointments until 7pm, or starting at 7am, and staff would often be there until 8pm finishing off admin.

but also carry a lot of risk which is unusual in a job.

Tell that to the paramedics and nurses.

You'll argue you carry responsibility. I'll argue you should be held accountable but very often you're not.

The GPs in my family don't work the hours you describe (the ones in my generation don't, my grandfather's generation certainly did and more for much less money).

I don't disagree there are problems with the NHS and funding. I do disagree that we should be grateful that our GPs, having enjoyed a five star education for a fraction of the price, now mostly choose to work part time. Yes, part-time. And at a time when we desperately need our state trained doctors to put their degree to good use and show up as clinicians five days a week. I think we're stupid to pay them an amount which means it really isn't worth their while to do so.

We won't agree so let's leave it there.

But many of us are literally both working mums run ragged AND the main wage earner.

I went part time out of necessity when my first child was born like many women do. Had I continued to work over 60h a week for the NHS I would never have seen my DC. I'm still the main wage earner because sadly I failed to marry a city lawyer or banker. In fact I'd like to go back full time now my kids are in secondary school but my employer doesn't want to pay for me to do that because I have shot myself in the foot working so much unpaid overtime that for their POV why pay more when I am doing the job in less hrs.

How are Drs being hugely subsided for their training such that they should not be allowed to work LTFT like every other person in the UK when they pay tuition fees just like for every other course? There's loads of part time teachers too and part time nurses and civil servants. Why is it only Drs that owe that state their whole lives?

The government caps the number of Drs because that's as many as they want to pay for. They do realise that people work LTFT. If all Drs suddenly went full time the government would train less of them.

Essentially the average junior doctor in training probably pays £2000 ish out of their own pocket every year once you add that all up - just to be able to work

Why are you not claiming the tax back (allowable at 40%)? I'm not sure where you get the idea that other professions are feather bedded - I pay my own professional fees and relevant indemnities just like every other professional I know. In the event an employer contributes it is treated as a benefit by HMRC and taxed at the relevant rate.

You can claim back tax on the fees but not on the exam costs which are extortionate because those are 'not essential' although in fact they are if you want to progress.

I don't think anyone was suggesting that other professionals don't have to pay fees (although I would think indemnity insurance for some parts of medicine eg Obs and gynae is more than most other professionals) just that it seems unjustified to suggest that Drs uniquely out of all jobs, all state funded jobs even, should somehow be excluded from LTFT working because we allegedly owe the state more.

You can claim back tax on the fees but not on the exam costs which are extortionate because those are 'not essential' although in fact they are if you want to progress.

But that's a choice in many professions. The higher qualifications mean a lot of time committed to study and related costs but the pay off is moving up the ladder.

Similar doing many more hours than the contract states is normal in any high paid profession. I've certainly done my share of all nighters and still do at times.

I don't think anyone should be excluded LTFT hours but the frustration I see on a lot of these threads is the refusal to acknowledge that problems people experience in GP services are not just down to lack of funds but also down to the quality of service some GPs provide. Why should different GP practices in one area provide vastly different quality of care when all have similar demographics and budgets per patient?

It helps neither group to pretend this isn't an issue and that money is the only problem.

namechanging
Re no GPs working evenings and weekends, who do you think covers all the out of hours work?? GPs (and advanced nurse practitioners for some of the work depending on the area). I’ve been working out of hours for 15 years on top of my usual in hours work. If GPs were ‘forced’ to work full time I suspect it would be even more difficult to cover out of hours work.
And btw 4 days is easily 40 hours (and probably a fair bit more).
I do 3 days in hours, out of hours at weekends and am working 40 hours a week.
My in hours patients might think I’m part time as only in practice 3 days but that’s not the case. I have colleagues who do a lot of education as well, they split their time between the 2 jobs. Other colleagues to GP led hospital clinics each week
So just because a certain GP is not at work 4 days a week it doesn’t mean they are part time. And if they are part time then they are probably all the better for it and this is a valid choice!

I’m just trying to make a suggestion. It takes 12 years or so to train as a GP, there is a restricted amount of people that are allowed to train, then if most people work part time everyone is going to end up over worked. Supply and demand.

Doctors are expensive to train.

They damn well are, for their parents.

But do you not think the government knows how many Drs work part time?
Of course it does and it trains as many as it thinks it needs taking part time work into account

The obvious solution is for the government to train more Drs rather than just to deny employment rights to the ones they have

They don't do that because it costs more money (as in fact it would if they all went full time)
The government is happy that a lot of GPs will accept part time work and do tonnes of unpaid overtime. Its cheaper than them actually paying full time for all those extra hours
And the public are happy to accept the narrative of lazy part time GPs which I am sure makes the government very happy

It's no coincidence that many of these part time GPs are women. No-one suggests that those thrusting masculine cardiothoracic surgeons are overpaid and should be denied their right to work less than full time and fill up their hours in private practice do they?
No working on private practice is absolutely fine it's just taking time off to raise children or educate the next generation of Drs that is the issue.
It's the same as teachers being fair game for a bashing because so many are women.

I've skipped some pagesbut the issue with the UK (not an HCP but have worked in the policy area) is that they tie GPs hands and let the sht wind up on them. The training* NHS GPs get is actually very goodI actually have an UK trained GP here (Brit living in the USA). The issue is as PPs have said, they are expected to take on specialist areas that aren't covered in standard training because there's only so much to fit in, and government doesn't want to extend GP training.

But GPs are expected to do more than their equivalents in many other countries and to take on tasks that would often be sent to specialists, and to restrict referral to secondary services because there aren't enough of them. They have to have 10 minute visits only. They're told to hit targets about seeing patients within 48 hours--so they respond to that target and stop scheduling advance visits.

The NHS has been run on a shoestring for decades. The UK is rightly proud of it--you cannot extract a penny's more care per pound spent than the NHS does. But the lack of funding catches up with it. 90% of UK health expenditure is public-sector, which is (IIRC) the highest in the OECD.

But the public doesn't see the decisions made behind the scenes. What they see are the results, and they blame the people delivering it.

How are Drs being hugely subsided for their training such that they should not be allowed to work LTFT like every other person in the UK when they pay tuition fees just like for every other course?

How much does it cost to train a doctor? I read £220,000 and upto £630,000 for some?

A history graduate gets 8 hours contact a time for 30 weeks of the year, with tuition fees of £9,250 pa - which is three times what medics pay for 20 - 25 hours a week, for how many weeks of the year (is it 46 weeks?).

Then say a history graduate goes into a law or accountancy training contract, the firm bears the full cost of the training contract and maybe ten years post qualification training, to get them to partner level, if they are lucky! Nothing comes from state resources. Typically in London, they are paid for a 35 hour week, but may be working 60 - 70 hours a week; more at busy times of the year.

A medic gets F1, F2 and say three years GP specialist training - when presumably they are trained and supervised by more senior doctors, using materials and equipment all funded by the state?