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?

Eleganz - you're wrong. Yes, GPs can apply to their CCG to close their list but have to jump through so many hoops to do so especially as it will impact on nearby practices who are also under the cosh. It is often refused.
But yes we can refuse to register patients outside of catchment area (and deduct existing patients who move out of area). That does free up space for new patients.

@tradition no I am not wrong. They can shut their lists and some do do so. You claimed that GPs were not allowed that is very different from their being a process in place to manage it with CCGs. Giving a false impression on what patient's rights are regarding GP services does not help defend GPs

Also the process you mention seems to be for "formal list closures" and there appears to be an "informal list closure" procedure set out in the regulations too. Or is this article on the website of a UK local GP area group I correct?

www.somersetlmc.co.uk/gpcguidannceonlistclosures

*incorrect not I correct

[quote Eleganz]@tradition no I am not wrong. They can shut their lists and some do do so. You claimed that GPs were not allowed that is very different from their being a process in place to manage it with CCGs. Giving a false impression on what patient's rights are regarding GP services does not help defend GPs[/quote]
She didn’t. GPs cannot close their lists without submitting a formal request that goes to a non conflicted panel. Even then a list is not closed to all.

Patients have the right to register at all other practices and if they are refused that right will be upheld.

The entire system gears itself around getting people registered in general practice and all the incentives are in place for that. Which is why GP registration rates are so high.

The problem is that primary care is not then given the resources to manage all the people woul need access to general practice.

[quote Eleganz]Also the process you mention seems to be for "formal list closures" and there appears to be an "informal list closure" procedure set out in the regulations too. Or is this article on the website of a UK local GP area group I correct?

www.somersetlmc.co.uk/gpcguidannceonlistclosures[/quote]
That’s guidance from a group representing GPs. It refers to the ability to take reasonable steps to reduce demand in certain unforeseen circumstances. It is an arguable point of interpretation

They publish NHSE guidance where they state contractual action can be taken where practices refuse to accept patients.

In reality it’s not the issue you think it is. Access is the issue.

@LemonTT

What was posted was:

GP surgeries are not allowed a cap on numbers and cannot refuse to register people moving into their catchment area. And with all the new build housing going up there is no thought for how this will increase demand on healthcare.

This is clearly not true. They can shut their lists and, according to the Somerset page I have found they can even bypass the formal procedures as well, unless this is incorrect.

As you allude to in your post, there are financial reasons why GPs won't close their lists. Trying to claim that this is because they are not allowed to rather than that they face financial consequences is trying to misrepresent what is a business decision for practice partners.

@Eleganz - I can assure you if GP practices were allowed to close their lists at their own will, many would do so immediately. We can get in excess of 50 registrations per week and we can't cap it. Often it's patients unhappy with their existing GP wanting to change practices because they can't access their GP. But it's no different anywhere.

We know the system is broken, it's awful we can't offer appointments (whether face to face or telephone) to all that want them but please don't blame and pile on the GPs that are working so hard and doing their best.

@lemonTT

This issue is honesty about what patients can expect and what practices can do.

Claiming that practices cannot close their lists for any reason is false. I was simply trying to correct that falsehood. Instead I get the circling of wagons trying to gaslight me again.

You are right, the issue here is access and the apparent postcode lottery we have on quality of service. I was not the one who raise the claim that GPs were oversubscribed because they could not shut their lists.

@tradition the regulations state that you are allowed, it is just that the consequences of doing so (presumably financial given the talk of incentives and contracts here) is unpalatable. That is a business decision, don't try and dress it up as an absolute inability to do something.

[quote Eleganz]@tradition the regulations state that you are allowed, it is just that the consequences of doing so (presumably financial given the talk of incentives and contracts here) is unpalatable. That is a business decision, don't try and dress it up as an absolute inability to do something.[/quote]
www.pulsetoday.co.uk/news/practice-personal-finance/one-in-three-gp-requests-to-close-practice-lists-blocked-by-nhs-england/

This is an old article. But it's still true now. NHS England reject lots of applications to close lists.

The fact is, GP numbers have not kept pace with growing population plus aging (more complex patients). Thus, it is not surprising that people are unable to get appointments. Corona has exacerbated this with gp burnout and increased infection control measures.

There should be a govt target on numbers of patients a practice serves (with a given number of GPs adjusted for socioeconomic area factors). Equivalent of safe staffing levels (which are not currently in hospitals), but which have been shown to be beneficial.

Relatives live in a town with a new development. GP had been under special measures, then handed back contract. Went through a period of several locums - but hard to get appts. Only after several months have they started with permanent staff. Relatives have tried registering with other practices in area, but not eligible. This is a manpower, planning and funding issue that the tories have ignored like the social care issue.

There are too many old people needing GP care. Too many "worried well".

But mostly, if you vote Tory then you voted for this. Underfunding of the NHS allowing a "rational" argument for privatisation down the line. And we are almost at the end of that line now. And if you voted Brexit you voted for this - as many European GPs left the Uk.

Did you know Boots offers a private GP service, for example! There's the thin end of the wedge for you.

Soon it'll be Tesco's GPs. See a GP when you pick up your shopping.

[quote Eleganz]@lemonTT

This issue is honesty about what patients can expect and what practices can do.

Claiming that practices cannot close their lists for any reason is false. I was simply trying to correct that falsehood. Instead I get the circling of wagons trying to gaslight me again.

You are right, the issue here is access and the apparent postcode lottery we have on quality of service. I was not the one who raise the claim that GPs were oversubscribed because they could not shut their lists.[/quote]
And again I say we cannot close our lists at will despite what the regulations you quote say.

Many contracts are being handed back to NHS England as GPs are no longer able to cope. But that's what the government want. They can say Primary care not fit for purpose let the private sector sort it all out. Once everyone is paying for the privilege of seeing a GP you'll remember the good ol'days and wonder what went wrong.

I am puzzled by all the hostility to GPs who have had an awful couple of years and were overworked and understaffed before that.

I don’t want a return to face to face appointments, who has the time?! There is very little a GP will learn from a face to face meeting that they can’t learn from a zoom call / phone call with photos.

When I worked in London a ten minute GP appointment meant at least half a day off work. So I rarely got medical advice when I needed it. I think online appointments are wonderful.

@tradition my practice has definitely closed its lists though, the doctor there was very clear on this to me and its in their newsletter too. Also they’ve written to registered patients who moved 2 miles away to say as you have moved we have taken you off our list and you will need to register with a new GP.

Pragmatically, creating an unappreciative, hostile environment towards GP's is ultimately self defeating. GP's are already in high demand, with insufficient of them to go around. Making it even less attractive means more are going to hang up their stethoscopes earlier, or look elsewhere for employment, with better pay, conditions, and attitudes towards them.

@Skysblue

I am puzzled by all the hostility to GPs who have had an awful couple of years and were overworked and understaffed before that.

I don’t want a return to face to face appointments, who has the time?! There is very little a GP will learn from a face to face meeting that they can’t learn from a zoom call / phone call with photos.

When I worked in London a ten minute GP appointment meant at least half a day off work. So I rarely got medical advice when I needed it. I think online appointments are wonderful.

Exactly. If I need to be examined I get a face to face appointment. A video appointment is brilliant and saves me so much time. It is what private GPs have been offering for some time. And now ordinary GPs offer it it somehow becomes wrong. Stupid.

[quote Skysblue]@tradition my practice has definitely closed its lists though, the doctor there was very clear on this to me and its in their newsletter too. Also they’ve written to registered patients who moved 2 miles away to say as you have moved we have taken you off our list and you will need to register with a new GP.[/quote]
And I'm sure they followed the process set out by their CCG and had to 'prove' that they were on the brink of collapse before they were allowed to do so. This can take many weeks and lots of form filling and meetings with NHS England

What was being suggested by another PP was that a GP could just close its list on a whim. And the reason they didn't was because they were money grabbing. I do object to this as our GPs would happily close the list today but that would have a knock on effect to other practices locally.

@ARudeTerriblePerson

GPs could go and work inside hospitals, which would be best by far for patients, but they won't do it.

How the fuck would that be best for patients?

My nearest hospital is 8 miles away, a journey that would take 40 minutes by car because it involves crawling through city centre traffic, or 2 buses and a train. It would take about 90 minutes each way.

Primary care needs to be local to be accessible.

There are 5 GP practices in my catchment area. 4 of them have closed their list to new patients, even in the catchment area, except for children of those already registered for now over 2 years.

It leaves one which is totally oversubscribed and not coping. Primary care is in complete crisis in my area.

@Skysblue

I am puzzled by all the hostility to GPs who have had an awful couple of years and were overworked and understaffed before that.

I don’t want a return to face to face appointments, who has the time?! There is very little a GP will learn from a face to face meeting that they can’t learn from a zoom call / phone call with photos.

When I worked in London a ten minute GP appointment meant at least half a day off work. So I rarely got medical advice when I needed it. I think online appointments are wonderful.

Yes, I completely agree - much quicker and no need to spend hours sitting in a germy waiting room.

There aren't enough GPs to provide face to face appointments to everyone who prefers one. That is not the fault of GPs.

@Namenic

The fact is, GP numbers have not kept pace with growing population plus aging (more complex patients). Thus, it is not surprising that people are unable to get appointments. Corona has exacerbated this with gp burnout and increased infection control measures.

There should be a govt target on numbers of patients a practice serves (with a given number of GPs adjusted for socioeconomic area factors). Equivalent of safe staffing levels (which are not currently in hospitals), but which have been shown to be beneficial.

Relatives live in a town with a new development. GP had been under special measures, then handed back contract. Went through a period of several locums - but hard to get appts. Only after several months have they started with permanent staff. Relatives have tried registering with other practices in area, but not eligible. This is a manpower, planning and funding issue that the tories have ignored like the social care issue.

This is so true, especially in the SE.

The amount of new houses and massive new estates being built has led to an increase in population that hasn't been reflected in increased health provision. GP practices are just expected to magically absorb the increased demand somehow, and it's clearly not feasible.

GPs are actually seeing more patients than before the pandemic. If you make them see everyone fact to face, some patients will die of covid caught at the GPs. And GPs will see fewer patients.

If you read the proposals, I think the idea is that patients must be given a choice, and must be able to see a GP f2f if they want.