To think GPs should do their job

[Wotnokids]

Just heard the news that £250million is to be made available to GPs to 'increase the amount of face to face appointments'. AIBU to think this is just extra cash for doing their job?

@LakieLady

If the NHS isn't going to be funded and managed properly, then we need to adjust expectations, but as it is they're just increasing

I don't think it's "expectations" that are increasing, but need, and funding has not kept pace with the healthcare needs of an increasingly elderly, and poor, population.

I had a partial knee replacement a week ago. I need an appointment with a GP practice for a "wound review" and to have the clips removed. I am staying with friends while I recover, because I wouldn't be able to manage alone at home, so have tried to get local practices to accept a temporary registration and make an appointment with a nurse to do the necessary. Several practices in this large town in the SE are full, none of the others can give me a nurse appointment within 3 weeks.

This is not an "expectation", it's a need. And it would appear it's a need that can't be met in a timely fashion. What's the point in carrying out surgery when the necessary aftercare is inaccessible?

Meanwhile, nurses are leaving the NHS in droves because of the hours, the pressure, the pay and the lack of respect in the way they are treated.

Hate to tell you this but it's 99 per cent likely that these other local practices are not contacted for removal of clips / sutures and it has been included in the hospital tariff for the procedure.

So rather than saying "we're busy for 3 weeks" what they should be saying is "we're not contacted our commissioned to do this, go back to the hospital."

They can then spend that time dealing with the patients that are genuinely on their books.

Take it all the people on here want the taxes to rise to match the expectations?

I don't think it's unreasonable to ask GP's to move back to at least some face to face appointments.

@Pazuzu - they haven’t stopped doing f2f - DH does them six days a week. If too many people want f2f you could wait up to three weeks for an appointment instead of a triage as to whether f2f is appropriate.

OP go enter your comments on the articles within the many daily mail bashing GPs. Would love to see these 'studies' claiming the average GP earns 100k for 3.5 days a week. Load of rubbish. GPs along with the rest of the NHS are run ragged at the moment. F2F appts are up to 60% now (source BBC) with less doctors working now compared to before the Pandemic. Before the Pandemic 80% of appts were F2F. Overrall appts are up but so is demand. So fed up of this narrative that GPs are not working.

Gp’s do NOT earn £110k for 3.5days work. What utter rubbish. No reference for your “recent figures” ( that you just got off the daily fail no doubt) I note. We are contractually obligated to publish our wages on our surgery website so if you really want to pry into what we earn I suggest you check your own GP’s website.

In happier news… www.gponline.com/cmo-praises-gp-pandemic-response-warns-exceptionally-difficult-winter/article/1730340

Whatever you earn, I think you more than earn it. Health care workers, doctors, and nurses, are extremely valuable 'commodities' worldwide. We'd be wise to appreciate and nurture what we've got, not vilify and alienate them.

They are doing their jobs and seeing patients face to face. My Mum (aged 78) has had no problems getting face to face GP appointments. I've attended them all with her.

Now where has the OP who started this thread gone? Suddenly disappeared. How very predictable.

Threads like this are intended to undermine confidence in the NHS, which will lead to support to privatise it. Please don't fall for it. The NHS might not be perfect, but it is brilliant and it takes such good care of us. It is one of the best things that we in the UK have access to.

@BelindaBumcrack I reported thread for this reason. Inflammatory comments similar to those in the DM in recent days then disappearing act. Agenda questionable.

Very few, in fact no CCG I have ever worked in has had a contract where routine post-operative wound care is part of the GP contract, in fact, it's almost always explicitly stated to be the treating organisation's responsibility

I found this interesting, @FixTheBone. I've had 3 orthopaedic operations in the last 12 or so years, in 3 different CCG areas (2 in Sussex, one in Surrey). Each time, routine post-op stuff was done at a GP practice (including the one where I dutifully made an appt to have stitches removed after an osteotomy, only to be told by the practice nurse that they were disposable and didn't need to be removed!).

I wonder if this is something done in the SE and not in other parts of the country?

Awww, another lovely GP bashing thread.
I would have thought if GPs earned 100k in 3.5 days recruitment and retention would be at least breaking even and not in a deficit.

Had two Operations in the last 5 years , post operative care in terms of stitches review/removal done by GP. Ds had an appendectomy this year, post operative care done by GP/practice nurse . My practice received the notification from hospital and they contacted me to arrange a date/time for stitches to be removed.

@LakieLady

Very few, in fact no CCG I have ever worked in has had a contract where routine post-operative wound care is part of the GP contract, in fact, it's almost always explicitly stated to be the treating organisation's responsibility

I found this interesting, @FixTheBone. I've had 3 orthopaedic operations in the last 12 or so years, in 3 different CCG areas (2 in Sussex, one in Surrey). Each time, routine post-op stuff was done at a GP practice (including the one where I dutifully made an appt to have stitches removed after an osteotomy, only to be told by the practice nurse that they were disposable and didn't need to be removed!).

I wonder if this is something done in the SE and not in other parts of the country?

As a practice nurse, I routinely remove post-op sutures and staples. I have no idea how it's billed (I have to input it as post-op secondary). I do know hospitals in the local area ALWAYS refer to primary care for follow up care. No idea if this is in the CCG contract or not.

@LakieLady

Very few, in fact no CCG I have ever worked in has had a contract where routine post-operative wound care is part of the GP contract, in fact, it's almost always explicitly stated to be the treating organisation's responsibility

I found this interesting, @FixTheBone. I've had 3 orthopaedic operations in the last 12 or so years, in 3 different CCG areas (2 in Sussex, one in Surrey). Each time, routine post-op stuff was done at a GP practice (including the one where I dutifully made an appt to have stitches removed after an osteotomy, only to be told by the practice nurse that they were disposable and didn't need to be removed!).

I wonder if this is something done in the SE and not in other parts of the country?

I’ve just had a knee op for a meniscal tear, post op wound care has been done by GP practice nurse. I’m also in the SE.

I don't think it's unreasonable to ask GP's to move back to at least some face to face appointments.

I and many others on here have described how they have had face to face consultations, even during lockdowns.

@LakieLady and @Peaceblossum22 I'm a GP in London. We (our nurses) always took stitches/clips out and changed dressings too but we're not actually commissioned to do this, we did it for free because we hate inconveniencing our patients. It's in the hospital contact to do this, not the GP contract. We had to stop doing it, we can't afford to do work for free, we have too much demand/not enough staff/appointments.

The good will has gone.

Some people feel like we should fully go back to f2f, fine. How long should your appointment be, at what number do we stop? The BMA recommendation is up to 25 patients a day, the average actual number we deal with is more like 40. If we go for the 25 a day, what do you think the waiting time for an appointment will be like? 2 months? More? I actually wouldn't mind going back to full time work if we were capped at 25 patients a day. If I worked 5 full days, that would be 125 patients a week, much more doable than 400 which no-one can safely manage so they go 'part time'.

It's not part of the standard national GP contact, you can see a list of things that fall outside of this at the following link:

www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/enhanced-services-gp-practices-can-seek-funding-for

Post-op suture removal is on the list. This is one of hundreds of different things that GPs have undertaken historically that we're not paid for (like ear syringing). There isn't any difference between SE or N of England etc. The contract is national and so unless there are specific local funding arrangements with the CCG (very rare) the GP surgery has been doing it out of their own pockets.

@Whycangirlsbesonasty

But what I am saying is if someone wants to work part time they should be prevented from studying medicine. There are plenty of other careers out there. Cause us paying to train them is a waste of money otherwise. Some jobs are simply incompatible with part time working. Medicine should be one of them.

I have to say that this is utterly ridiculous. Do you know how stressful and relentless general medicine is? Dealing with people and their health every 10-20 minutes. Referring, following up, medications, admin, following the reams of health guidance and rules, CPD, vaccines and more vaccines, etc, etc.

You clearly do not work in healthcare because then you would have a clue.
GPs NEED to work part-time (of which range from 40-50 part time hours per week if not more, so not part time the way many jobs have it) for their own health and well-being as well as that of their patients.

There clearly is a problem otherwise the government wouldn’t be getting involved if all patients are triaged this essentially takes 2 appointments if the patient needs to be seen.

Oh, the government will definitely get involved, if they can deflect blame for underfunding, undermining, and total fucking incompetence on their part, by throwing GP's and other health care practitioners under the bus.

@Pixxie7

There clearly is a problem otherwise the government wouldn’t be getting involved if all patients are triaged this essentially takes 2 appointments if the patient needs to be seen.

Yes, too much demand and not enough staff. As for the govt getting involved, hmmm, they always do cough up a small amount of cash (not quite HS2!!) each Autumn/Winter as short-term 'rescue' fixes to appease the public (what heroes!)-never seem do it anything about it long-term though (except quietly privatise GP services, that is...)

@Whycangirlsbesonasty

But what I am saying is if someone wants to work part time they should be prevented from studying medicine. There are plenty of other careers out there. Cause us paying to train them is a waste of money otherwise. Some jobs are simply incompatible with part time working. Medicine should be one of them.

Why don't we just conscript people into healthcare and be done with it? Go back to the days of nurses not being allowed to continue to work if they get married and for good measure let's ensure Drs can't get married or have families either, that'll learn 'em for thinking they aren't just objects that exist to do the public's and governments bidding. How dare they want family or have aspirations of having a life outside work. Who do they think they are?! Yes, conscription is probably the best answer all round, force them to train and work as Doctors (I'm thinking 100 hours a week?) and let's do away with any notions of HCPs being human completely.

chitchatchatter

Currently what's happening is not contracted for and GPs are being used as the end of the line to pick up other organisation's redponsibilities (like teachers) that's one of the reasons they are so stretched.

And the thought that you shouldn't have part time GPs - sexist, somewhat...

@Ciaram55

The thing I don't get is, before the pandemic you could see your GP relatively easy. Now all of a sudden you can't. Why has everything changed so suddenly? All the problems of underfunding etc were there before. Not being able to see a GP only means more people turning up at A&E units, putting pressure on them.

@Ciaram55

It’s not complicated. Demand for appointments is greater than number of appointments available. There is a national shortage of GP’s, so this is hardly surprising. I have no doubt there are some practices which could be run better, and some GP’s who are not as pro-active as others. And that the odd GP is genuinely lazy. However, the vast number of GP’s are flat out and doing what they can to meet the surge in demand. I have a number of friends who are GP’s, every one of whom are on their knees. Several of whom work in practices with vacancies and have extended their consulting hours/working days to try and compensate but cannot keep pace with demand. One is actively looking for another job abroad and has had several offers, whilst another is reducing her hours as she cannot juggle her family demands with ever increasing hours at work and she is mentally and physically exhausted. I know a few who are looking at early retirement. Another is seriously at the point of jacking it all in.

I know a number of local practices are in danger of going back to the health board as the partners are giving up. This is not good news for patients, based on local experience of board run practices.

The demand for appointments has risen significantly- local data suggesting demand is up about 2.5-fold when compared to pre-pandemic levels. At a time when the rate of attrition for GP’s is outstripping those entering the profession. It does not take a genius to work out this means longer waiting times. And results in alternative ways of trying to meet demand- telephone appointments being one way.

The reasons for increased demand are complex- there is a lot of mental health issues out there, with very little in the way of mental health service (again in no small part due to staffing shortages); lots health anxiety (demand to be seen about all sorts “just in case”); significant delays in secondary care mean lots of patients bouncing back as their symptoms are worsening or because they are frustrated and angry and want something done to speed up their appointment; an increasing ageing population- many of whom lockdown has caused additional problems such as reduced mobility as getting out and about less, which in turn has led to more falls/poorer general health etc; problems in social care- difficulty in accessing social care leading to failed discharges/re-admissions and greater demand on primary care; and also lots of things being delegated by secondary care to primary care.

If you only have 50 or whatever appointments per Dr and the demand is 100, or 150 per Dr, what do you think the outcome of that is? The answer is much longer waits, or practices looking for alternatives to try to meet demand in some way.

GP’s also have a lot of paperwork- prescriptions, referrals, acting on advice/requests/letters from secondary care, writing reports for insurance, DWP, incapacity assessments etc. Driving and other Medical’s, forms for firearms licensing… the list goes on.

Few GP’s are sitting with nothing to do, having a nice little holiday. If it were an easy, low stress, cushy but yet incredibly well paid job you would think people would be falling over themselves to do it…

"get a frosty receptionist who demands to know if you really need a dr and what is wrong. ( she has no triage training) if you have personal or mental health problems you certainly do not want to tell her.* I do think receptionists at some (certainly mine!) GP practices need more training and people skills.

When my daughter was newborn she needed to see a GP. I phoned and I got told (you get told this no matter how many GP appointments they have) that there were no more GP appointments and she'd have to be seen by a nurse practitioner. I said that because of the age of the baby she needed to see a GP. The receptionist either assumed she was right or just lied to me and said the rules had changed and the nurse was able to deal with it.

I then went to the appointment with a very frustrated nurse practitioner as apparently the receptionist had done this quite regularly. The nurse apologises and booked the baby in with a GP the following morning even though the receptionist said there were none. There's no wonder it's so hard to get appointments when they're being booked incorrectly and being wasted as a result.

@Whycangirlsbesonasty

We need more GPs so we need to train more GPs, but we can’t just ignore the part time working problem. Medical places at UK universities are limited and over subscribed. As it costs the UK government £250k to train a GP is it so inappropriate to ask people given undergrad places to train as doctors to work a full week? If every GP worked a full week, would it it not be less stressful for all of them?

I work part time, 6 sessions or 3 “days” but that is about 40 hours (one week in August 64 hours but the less I remember that the better).

What do you envisage?
50-60? No, I couldn’t do that long term.
I consider myself mentally and physically “robust”, I have a supportive DH and stable life, I think I’ve take 2 days off sick in the past 14 years (except maternity leave). I’ve gone in with raging mastitis, worked until 40 +5 last maternity leave.
I give families my mobile number if their relative is planning to die at home so if they need help they don’t have to navigate the (underdoctored) out-of-hours, I do home visits on my days off as there is rarely time in the working days.

So how many hours should I work?