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?

@HorsesHoundsandHills thank you for taking time to explain - you put it more eloquently than I could have!

It is not ‘GP bashing’ to engage in reasonable debate about our publicly funded health system. To call it that is false and irresponsible.

@Dhcfisssifjrsnxfjds

It is not ‘GP bashing’ to engage in reasonable debate about our publicly funded health system. To call it that is false and irresponsible.

Is that what is happening though? I see people claiming GPs. I don’t see the press (eyes Daily Mail) or the government acknowledging and seriously fixing the issue of under funding.

They announce money that’s already been committed, claim it as new and then reel out bollocks such as league tables.

@Iggly

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

No you couldn’t. The GP shortage has been known about for a while now and is a pre covid issue. Covid has made it worse.

Yes, 900 GPs (headcount, not WTE) left the NHS in July and August alone. And Covid has caused demand to sky-rocket as hospitals and mental health services can't offer as many services as usual (not their fault, obviously). Everything defaults to the GP.

One of the ironies about the furore about face-to-face appointments is that our waits are shorter than they have been for years, despite fewer staff and more demand, because telephone appointments allow us to deal with about 40% of issues over the phone, freeing up F2F for those who really need it. Thanks to pressure from the DM, we will now have to revert to older working practices, which will mean less appointment availability.

@ Iggly - is the £250m already committed? What was it committed to?

I’ve put yanbu as I think it’s good they’re getting extra money however I just don’t think it’s right that appointments still aren’t all face to face and I’ve heard of too many stories of things getting missed because a telephone appointment was done. I just don’t think it’s a job that can be done over the phone/ internet. IMO you should be able to ring and they ask if you want phone or in person appointment as a lot of people would be happy with the phone - eg if it’s a problem that can easily be dealt with over the phone, and would be a lot easier for people than taking the morning or afternoon off work, so this would still alleviate some pressure on appointments, and then if you want to be seen you ask to be seen, rather than having to justify or ‘push’ for an in person appointment.

@ MissLucyEyelesbarrow - I think experience of this varies, at my GPs the wait time for phone is at least 2-3 weeks (FTF pre pandemic was less than a week) and at least 2 weeks after that if FTF is deemed necessary. So up to 5 weeks for FTF, compared to 7-10 days pre pandemic. May be other factors at play here but it seems that for many telephone appointments are not translating to quicker appointments and just feels like an unnecessary barrier to getting a ‘real’ FTF appointment.

Problem is if they go face to face and covid goes through the practice which is possible and then all the GPs are off sick, potentially too sick to even do phone call appts then there will be a problem.

I think the idea of triaging people somehow and deciding if it can be done by the phone or needs a f2f is good

Tbf @MissLucyEyelesbarrow I think people have issues with getting the tel appointment in the first place (see the frantic ringing at8.30am)
The fact that, fir many practices, they can’t tell you when they will ring doesn’t help. Or when they just don’t ring at all.

Personally I gave a issue with tel consultation. It’s the fact you don’t see the person and have to rely solely on what the patient says. And they are not always very good at telling you what’s going on. They might feel uneasy at the tel consultation, have issues with hearing/accent etc..,,
I think it can make trickier but it durant seem to be acknowledged at all.

@Wotnokids

Recent figures show average GP works 3 1/2 days and average salary is over £100k. By definition, that means some do lots more time but also some do less. Same with salary. My issue is not what they get paid but that additional funding is being provided from the existing NHS budget (so where will the cuts fall to pay for it?) for doing something they should already be doing!

I do 3 clinical days and that is around 40 hours work. I was doing my job before COVID, continued to do it through and I am still doing my job now. I am thinking of leaving though, I’d leave tomorrow if it didn’t leave my patients and colleagues in worse conditions. It is getting unbearable. I think the phrase is “moral injury”. Simply too few GPs.

I can’t see how this money will help me, I need another colleague, I don’t want to/couldn’t cope with more hours.

www.bma.org.uk/bma-media-centre/government-s-rescue-package-for-gps-is-flawed-and-patient-care-will-suffer-as-result-warns-bma

BMA statement today

My gp works 3.5 days but thats 42 hours a week in the practice then they do a day a week in hospital too or training also in that 42 hours they see 420 people a week on average that is alto of cases and people to see and now with phone appointments they have around 600 a week we need more gp ms and less people wasteing appointments

Thank you for the supportive posts.

To respond to a couple of ideas:

Teaching/ training:

1. You probably see a skewed population of GPs on here in favour of those of us who also teach/train, as it's more flexible. For instance, I can post on mumsnet on an academic day knowing that I will make the time up elsewhere, in a way that I can't on a clinical day.

1. Teaching and training does need to be done by GPs. We are training people to make complex clinical decisions, at a pace not really seen elsewhere in the NHS (except for perhaps A&E/MAU on a busy shift) with a fraction of the resources of a hospital. That needs to be done by people who are themselves trained to make those complex clinical decisions. I have many extremely bright, highly trained and talented non-clinical academic colleagues who are invaluable to the training of medical students, but they cannot teach a skill or way of thinking that they do not possess themselves.

1. GP Trainees and F2s in practice need a lot of clinical supervision in order to be able to learn their skills safely. Please don't lose sight of the fact that even a newly qualified GP will have gone through 10 years of intense medical school and post-grad training, and will still have a lot to learn. One of the worrying things about so many newly qualified GPs going into locum work is that they never get the feedback and support needed to really get to grips with complex clinical decision making, and therefore are more likely to make poor decisions, or avoid difficult decisions. This is one of the reasons that locum work is considered much higher risk medico-legally. So if we want more GPs, we need a lot of GP Trainers.

Admin:

1. GPs do not do routine admin tasks. We only get involved in the admin queries/ hospital letters etc that require clinical decisions to be made. We have receptionists, managers, IT support, medical secretaries, administrators... The only thing I can think of that could be delegated that hasn't been already, would be if someone was trained and employed to sit in on every consultation and make notes on the computer whilst I consulted with the patient. Funds won't stretch to that, and many patients wouldn't like it - they won't even tell the receptionist what the problem is, let alone accept a random admin person sitting in on the consultation!

1. Automated appointment systems and e-consultations exacerbate inequalities in access to healthcare. We had to switch off our e-consultation system because we were swamped by undifferentiated, mostly minor, requests from our large student population, which then had to be responded to within 48 hours (government target), which took a lot of GP time out of the system and disadvantaged our many older and/or poorer patients who don't have internet access at home.

Likewise, online booking for appointments only works if you have access to the internet. We have many patients who don't even have a phone, or have learning disabilities, or who can't afford to top up their PAYG data this week, or don't speak English, or are illiterate, or vulnerable elderly, or a combination of these. All of these people need someone at the front desk they can come and see. On top of that, because we are always short of appointments, almost everything has to go via 'on the day' anyway to keep on top of access targets, so online/phone/ in person, there still aren't enough appointments to meet demand.

Good receptionists and admin staff are very skilled, and frankly deserve a hell of a lot more pay and recognition than they get. They are all bound by the same confidentiality as doctors, and take a lot more abuse (many patients are awful to the receptionist and then nice as pie to the GP!).

My GP has been fantastic throughout the pandemic snd myself snd my family have always been able to get an appointment when we have needed to. However, I know friends who go to different doctors who are not doing face to face and sent her son straight to A snd E instead of seeing home.( he didn't need to go to A snd E but the receptionist said there was no alternative!) I think what lots of people are wondering is why pre- pandemic you can see the GP but now as lots of NHS services are seeing face to face again a lot of GP surgeries are not and why not?

@Wotnokids

Recent figures show average GP works 3 1/2 days and average salary is over £100k. By definition, that means some do lots more time but also some do less. Same with salary. My issue is not what they get paid but that additional funding is being provided from the existing NHS budget (so where will the cuts fall to pay for it?) for doing something they should already be doing!

Where do they get these salaries?! DH is a GP earning around half that. Any doctor will advise a junior doctor not to be a GP. It's a terrible job and I can't wait until DH joins the masses quitting. Unfortunately attitudes like OP perpetuate the problem.

When GPs advise sending to A&E without seeing F2F it's either because:

1. The patient has called with something that will need hospital assessment regardless (eg central crushing chest pain, stroke symptoms, acute severe confusion in previously well person).

1. After telephone consultation, they are so concerned about the patient that they don't want to add in the additional time it would take for the patient to come to the GP surgery and be seen, as they're very likely to need hospital assessment anyway (eg very hot and very drowsy child, breathing difficulties, post-seizure, severe abdominal pain.)

1. There is simply no more capacity at the surgery that day, every clinician is booked solid and all the extras that can possibly be squeezed in have been. No more patients can safely be seen that day, or the following morning either, yet an unwell child still needs to be seen by someone, hence direct to WiC/A&E. This used to be rare 15 years ago. Pre-COVID is was happening perhaps once every couple of weeks, more in winter. Currently about twice a week at our surgery it is like this by mid-afternoon, and it's only October.

[quote DreamingofTimbuktu]@brittleheadgirl - important though your role is you aren’t making life or death decisions. Most graduates could theoretically retrain as a teacher in 2 years, becoming a GP would take closer to a decade. I am not saying “random” graduate would be able to teach but it’s a less specialist role than a doctor.[/quote]
You've missed the point.
I obviously know they do an important job but £100k for an average 3 1/2 day week?
Really?

Is it it that they are paid PRO RATA so £200k is the salary for a full time, 5 days a week job.

Having finally got a telephone appt and now need to go in for a F2F. The process is a mess. Too much inward looking solutions that suit the surgery and I understand that some people might not have access to a phone of any sort but surely that isnt the biggest issue to consider. Dont make things complex because xx % dont have the tools.

Also, how many people have no landlines, no mobiles, no one to call for them? It must be tiny. Dont ignore the majority and allow a tiny minority to dicate your processes.

@Dhcfisssifjrsnxfjds

It is not ‘GP bashing’ to engage in reasonable debate about our publicly funded health system. To call it that is false and irresponsible.

It is what’s happening though .

Even my 82 year old grandmother has jumped on the bandwagon, telling me that her GP is a ‘silly little girl who sits on her bum all day’ … too much time spent reading shite newspapers !!

@TravelLost

Is it it that they are paid PRO RATA so £200k is the salary for a full time, 5 days a week job.

No. I have already posted the figures with links to the sources above. Pay start around 60k for a whole-time equivalent and the norm for full-time is 100k.

@Franklin12

Having finally got a telephone appt and now need to go in for a F2F. The process is a mess. Too much inward looking solutions that suit the surgery and I understand that some people might not have access to a phone of any sort but surely that isnt the biggest issue to consider. Dont make things complex because xx % dont have the tools.

Also, how many people have no landlines, no mobiles, no one to call for them? It must be tiny. Dont ignore the majority and allow a tiny minority to dicate your processes.

Yes, let's just chuck equality, diversity and inclusion out the window. You know, that mandatory training that everyone in healthcare (and other services) have to do and abide by. It's not just lack of the tools to do it, it's lack of knowledge or lack of cognitive ability to use them even if they have them.

The problem isn't the processes, it's the fact there aren't enough people, or enough funding to make these processes work in a way that includes everyone's needs adequately.

Salaries £150,000 pa. for a full time partner. I know of a practice getting this in Outer London.
Compared to other professions such as Engineering, of which I have experience it is extremely good.
If we the taxpayers (which includes doctors) pay over this much then the Practice employs temps and pays them £80,000 for similar hours. It means that the Partners are pocketing a share of the difference,£70k per Dr. over their own salary of £150k.
If my maths is wrong please explain it to me.

Again, £100,000 is the average for a FULL TIME GP PARTNER, who takes actual personal financial risk like any small business owner.

For 3.5 days salaried work, you're looking at more like £60,000 for 42 hours per week of high-intensity clinical work, after several years of experience post-qualification. These are highly trained professionals, on a par with any hospital consultant. For comparison, my hospital consultant DH makes £100,000 per year for the same number of (less intense) clinical hours, and is considered 'more than full time'.

In NHS primary care, 'the taxpayer' pays around £15-20 per GP consultation. In the private sector you'd be charged at least three times that, and more if there was no NHS option, as there would be higher demand so prices would go up. I looked into becoming a private GP once, after my burnout, and Nuffield were charging £100 for a 20 minute F2F appointment. Some of the online GP services were charging £40 for a 12 minute video consultation, plus you had to pay extra if you got a prescription. Most of my patients simply could not afford that.

And yes, in my practice in a very deprived area there are a significant proportion of patients who cannot reliably contact us/ be contacted online or by phone. I'm sure that e-consults etc work very well in areas with a more well-to-do working population, but there are no blanket access policies that will work for every practice.

You will read on here the fury that elderly parents are unable to access appointments because they can't use the phone or internet well. Many elderly people have no-one to call on their behalf. We actually employ a full-time person at our practice to help vulnerable patients to get their shopping, attend appointments, access the benefits to which they are entitled, liaise with council housing/ utilities companies, and anything else that needs doing to support them. We could use two more like her!

Half the reason you can’t get through on the phone is because some people are generally a bit dim.

We put a statement on our website, SM pages, added to the recorded message on the phone line saying PLEASE DO NOT CALL US ABOUT FLU CLINICS, WE WILL INVITE YOU WHEN WE HAVE AVAILABILITY AND ARE READY TO BOOK YOU. We can send texts, letters and will call vulnerable patients directly.

What do we get? Dozens of people sitting on hold then finally getting through (having listened to the recorded message) asking to book a flu jab, that haven’t been contacted to book.

It ties up the phone lines and makes it harder to deal with other calls.