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?

@ARudeTerriblePerson

"The only way to fix it is to hire more GPs. " Not true. There are plenty of other solutions. It's the system that is broken.

Duh.

What are they, if you're so certain?

And fully agree with posters saying GP are not being paid for post op wound care. There not. The hospital is paid for the OP and the post op care.

Practice nurses have often often done this so much it’s nearly routine. Many hospitals expect this. Many practices allow it to save the patient the journey to hospital. But it’s unfunded. Getting it done at your GP practice means that your GP is personally paying for it if they are a partner (they employe the nurse whose time is used to do this instead of doing something the practice is paid for so reducing the funds coming in and reducing the partners pay) so if you’ve had your stitches out at your GP you’d GP has themselves personally paid for you to have that done to save you a hospital trip ……and yet people say they don’t care about their patients.

The poster who says no surgery will do her stitches as a temp resident….the temp practice won’t get paid for that work. Yes the nurse will still make a wage but the business won’t get paid. Say you have your car fixed at Kwickfit and also pay for aftercare and it then needs a service would you expect to go to Halfords and them to do it?

@echt www.dailymail.co.uk/news/article-10094019/Nothing-bring-Peter-no-one-die-refused-visit-GP.html

I sometimes think that people don't genuinely value, or understand the value, of something they can get for free. And when it is free, a service is more likely to be overused, and abused.

Be it education, or the public health service.

www.theguardian.com/society/2021/oct/14/gps-warn-face-to-face-appointments-plan-could-lead-to-exodus-of-doctors

@Cbtb - excellent points well made

All of this reminds me of how hard it is to get support for special needs in education. Parents are continually told there is no cash, no staff etc. That's not something the public can control. If the system is broken it needs a shake up. It's all government funded and needs fixing at that level. I can not recruit my LA staff, I can not write them.a cheque. I can not feed up to management how broken and unfit the system is. Yes i can vote but politicians LIE. They all lie.

Do you think when someone told me that my non verbal child couldnt have speech therapy because there was no funding and not enough speech therapist I want home and cried for the poor local authority? Do you think I tried to protect my poor LA by excepting someone has to be the the child that misses out on therapy? Because that's what decent humans do?
So why any different for gps? Do you honestly think the general public can fix this or that be quietly excepting this that things will get better for the NHS or patients? If it's broken then it needs fixing and it that involves paying for it at source then surely it's better than this?

Also I had no idea that gps run like academy chains. How many people do? Maybe that model is out dated too.

The truth is that in both education and health care as time moves on only the wealthy can climb out and go private. So who saves the poorest? I can not get behind that.

@IncessantNameChanger do you really think the government give a shit about SEN kids or about primary care? This is about setting the scene to hand it all over to private companies. There will still be the same shortage of GPs, but it will cost us more money. Please don't be naive about what is happening.

GPs have been private businesses since the birth of the NHS. That is not new. GPs are contracted to do work by the government.

[quote julieca]@IncessantNameChanger do you really think the government give a shit about SEN kids or about primary care? This is about setting the scene to hand it all over to private companies. There will still be the same shortage of GPs, but it will cost us more money. Please don't be naive about what is happening.[/quote]
I don’t think she’s being naive - quite the opposite. It’s clear to the service-users in both scenarios (GP patients and children in need of speech therapy) that the service is inadequate. But those groups will natural feel sad/angry about their lack of service before they start crying about how stretched the service providers are.

There has been a growing shortage of speech therapists for years. It is criminal. Because the government-funded the bare minimum so fewer people do the training. I think speech funding is crucial and should be prioritised. But it is not the fault of speech therapists that there is not enough NHS speech therapy available.

Arudeandterrible person - seriously? GP numbers flat with a rising and aging population and a comparatively LOW number of doctors per capita for oedc country AND low number of hospital beds (because govt want more care in the community) - and the answer is not to get more gps?

Good primary care is far more economical than creating more in-hospital services. Investment in gp, giving good working conditions and support to modernise IT/phone systems will reap more benefits than spending huge amounts re-organising the system (yet again).

@Cbtb

”This thread shows so many of the issues - too many patients wanting too many things from too few doctors . First theirs a poster saying that they want f2f and not to use the telephone or e consult. Then there’s another poster saying why aren’t GPs using more technology to speed things up.”

I take your overall point but the above is about accessibility and it will be dependent on the demographics in this area. The way in which people access primary care is not going to be the same. It’s a bit inconvenient for me to attend a face to face but I’ll do it if needed. For someone with a disability or no access to technology, it may be impossible to use more digital technology.

Agree more GPs needed and more funding into lots of areas.

From the point of deciding to train more GPs (which in itself could take years) to creating more capacity to train medical students, to then qualifying as Doctors, to them being attracted into General Practice by it being a pleasant job with enough resourcing and support…..I’d say at least 10-15 years. And that’s from the point they decide to actually do it, which they probably never will.

Sorry to be so pessimistic, but I dont think things will get better. Would GPs or teachers recommend their occupation to their own children? ….not many would.
It will be a case of standards become more and more crap - not due to the individual Doctors or teachers and those who can pay will exit the state system and pay and the majority will be left with an increasingly sub-standard service. Nothing to do with the individual practitioners, but everything to do with government and the system itself.

Sorry if this has already been mentioned but a someone from NHS , I believe, said on R4 this morning that around 90% of GPs work part time.

Maybe that's the problem?

Because they want to have a work/life balance too? Because they want to have a family too? Because they've been worked to the brink of burn-out? Because their part time is more than statutory full-time?

Damn those lazy GP's being human!

@DroopyClematis - why shouldn’t they work part time if they want to although GP part time hours average 40 hours a week.

@DroopyClematis

Sorry if this has already been mentioned but a someone from NHS , I believe, said on R4 this morning that around 90% of GPs work part time.

Maybe that's the problem?

OMG. The part-time 'issue' has already been addressed on this thread and others. GPs 'part-time' is essentially 36+++ hours per week counting appointment sessions, admin and other clinical time. It really isn't like other part-time jobs. Added to which, due to the very nature of the job, which is VERY emotionally draining, stressful, and pretty much relentless, I, personally, wouldn't want my GP working more than part time. The risk of GP ill-health and burn out is way too high as we are seeing.

@ARudeTerriblePerson what other solutions are there? The system is broken. Most successful systems private or public have a much higher number of GP/family doctor equivalents per head that the Uk. What model of primary healthcare do you know of that has a reduced number of doctors/head than ours?

I wish we would get over this full time rubbish as well. We’re short of nurses but I don’t hear that the issue is that most nurses work part time….nursing standard hours are 37.5/week and even the daily Mail admits that most GPs work 36hrs a week. GPs apparently are part time and nurses full time? Why do people think this? A full time GP would be working 50-60hrs a week in practice (personal development of course is on top). I’ve had this at work when nurses have told me they wished they could be part time like me and then have been a bit sheepish when I have pointed out that they work less hours than me already (this is when I was 80% so worked 38.5hrs/week

I think doctors like me don’t help ourselves saying we work part time. This is a profession where the standard working week used to be 72hours and only has recently reduced to 48 with a lot of pushback. Individual doctors have fought back against this by working full time for the majority of the population hours 36-40hrs a week yet we refer to ourselves as part time. We’re not.

[quote julieca]@IncessantNameChanger do you really think the government give a shit about SEN kids or about primary care? This is about setting the scene to hand it all over to private companies. There will still be the same shortage of GPs, but it will cost us more money. Please don't be naive about what is happening.[/quote]
Yes spectacularly naive and sub normal IQ thanks.

I have done seven SEN tribunals, two held at the royal courts of justice in London, governor at a SEN school and two kids in SEN schooling.

Maybe your confused as a dyslexic of course my writing is a direct reflection on my IQ.

Paying for degrees in speech therapy and a starting wage of 28k for a four year degree. Yes I can see perfectly clearly why my child and no child in county cant get speech therapy. A private SLT can earn £60 ph so why would they want to work for the NHS? You could do a three year economics degree and earn more for life. So how do I fix this as a individual? Do I have more weight than the professionals? I complained enough. I made no difference.

Point is, how does that help the child who cant talk? In some cases if your clever and well off you might want to pay the £60 ph to get the child to talk.

However even you was blessed with superior intelligence and wages, it's no comfort when say your on hold while a lived one is in cardiac arrest so wealth and brain isnt always enough to save you from sub par nhs/ education / socail care etc.

The point I was clearly badly trying to explain is who is going to think "poor overworked x, they missed my cancer/ childs ASD/ 999 call when my mums heart stopped" naively no one I guess? You can sorry for the profession as I'm sure no one set out from uni to harm people. But in a broken system like SEN they do real harm. On balance my pity lays with my friend who on hold to 999 when he mums heart stopped beating. I feel sorry for the parents who cant appeal EHCPs etc. Because it's nothing or nothing for them.

Because like any service. Your a end user and i cant solve any systemic failures of said system.

Or am I being thick here? If I had cash I would go private. But what happens to those who dont? Or is that nieve? Can everyone offord private care? Clearly growing up in a very deprived area has clouded my views on poverty.

If you cant talk about daring to think differently. To change. Then nothing can ever change. If it cant change then what does it ultimately matter? To anyone?

I think there is a lot of jealousy on these kind of threads…..and misunderstandings about other people’s work.

Yes, GPs are well paid in relation to most other jobs. Their hours can be crazy though. As others say, full-time can easily be 60+ hours. Some people seem to think that because it’s well-paid, that amount or no limit is acceptable. And that all GPs should have to work longer and longer because they are well-paid. They seem to think that because in their own jobs they earn less, GPs should be on the same hourly rate and work longer.

When people say most GPs are part-time, they mean they deliver fewer sessions in the practice. This still involves all the admin work, calls, emails etc too and for someone doing 3 days (and being paid for 3 days) can total more hours than most people would do full time.

Why do they do ‘part-time’ when they could do full-time and earn more? Because the lifestyle isn’t sustainable full time. People at breaking point choose to leave the profession or to go part-time to restore some semblance of balance to their life.

And people forget, that no individual GP has responsibility for the entire service or to work full time or any larger proportion than they wish to. If the government insisted they were all full time (which would be illegal) they would find they’ve lost most of their workforce immediately.

With schools and teacher, and with surgeries and GPs, people forget that they key is the amount if staff available to deliver the service which determines the total hours available, not how many hours one individual will work. Schools and GP surgeries are not doing well because they are not FUNDED to provide enough staff. The existing staff have to do too much in too little time, face burn-out and respond by leaving ir going part-time.

The government need to fund these public sector roles so that there is enough money to pay enough staff to do the jobs required in the hours they are employed. While they don’t, the services will be stretched, staff morale drop and staff leave. Little drops of extra cash thrown at problems as crisis management one-offs WILL NOT solve the problem, but LONG TERM funding is needed before lasting change can be seen.

If this were to ever happen on the scale needed, most of us on here would already be dead. The scale of the issue is so great it will take decades to improve, if there’s even the will and money to do it. Which there isn’t.

After reading this thread I am so glad my DH - full time GP for 20 years is handing back his contract in two weeks time.

Parker, I hope your DH enjoys his freedom and many thanks for all his efforts over many years.

Ditto what wombat said. And also - thank you for being the support and sounding board that you no doubt have been for him. (The invisible work of the partner often goes unseen and unthanked!)

My issue is the triage system. I had an on the day f to f apptmt during the pandemic for a skin condition. Offered to send a photo, which I've done before. All about avoiding infection and just needed prescription creams.
Now v worried as have come close to fainting 3 times over last 3 months, when doing light exercise, and now often light headed just doing housework. Not like me at all. Had a phone call back from a nurse. Arranged for ECG and blood tests. Said on the phone that, apart from high cholesterol, they would both be normal. She mentioned an ECG stress test but seems to have been binned in favour of vitamin D prescription. Most people are deficient, won't make any difference to fainting.
I'm really frightened. Now only engage in activities which could bring on fainting ie exercise (which previously was fine) with other people.
Wonder if GPs are trying not to refer people to huge waiting lists?
I always go the pharmacy, GP route but tbh if the breaking out in sweat, nausea near fainting happens again will phone 111.
Problem is that I know of people who know automatically do this rather than try to get a GPs appointment or to flag their case. One in particular for very minor complaints. Does suffer from genuine depression and anxiety.
So sorry to say this but the people who previously clogged up GP time are now phoning 111 exaggerating symptoms to get an ambulance.
More specialised support and social care would ease 111 and ambulance call outs.
As a neighbour I've tried to support fellow neighbour with mental health problems but I am not a professional. Mentioning this as probably repeated numerous times across country. Dr appointment for gnat bite, often phones 111, one ambulance dispatched, another asked for. Phoned in middle of night, often when she woke, 5 am. Initially OK checked in every day, did some ferrying around, odd jobs. Listened to her thoughts: the time she tried to commit suicide and updates on whether felt like doing it today plus v risky behaviour with men. Very demanding re jobs. Became very aggressive if not on call 24 7.Dumped me in the end for oversleeping for a shopping trip.
Times x squared most likely across country.