I'm a GP, and a long term mumsnetter. I have read these threads with increasing dismay over the past few weeks.
Firstly, £100,000 average pay is for a FT GP Partner, not the part-time, mostly salaried GPs who are working '3.5 days per week'.
A newly qualified salaried GP will take home around £55,000 per year FTE, rising with experience and/or difficulty of job to a max £88,000 FTE on the BMA salary scale. In hard to recruit areas with particularly brutal workloads, that has risen to £90,000 per year FTE for an experienced salaried GP.
GP Partners make more money (the average is around £100,000, but can be much higher than that in well-off areas. In deprived areas some partners are making less than salaried GPs!), but they also have to fit in the actual running of the business on top of the clinical workload, they have to respond to all of the diktats that come down every year from the government and NHS England, and they are personally financially liable if the business loses money or goes bust. It's an absolute mugs game. They have all of the risk of running a small/medium sized business, with none of the freedom to innovate or decide what services to offer. In addition, the way the funding works actively penalises practices with hard-to-reach populations, because the work of chasing patients for things like health checks/ annual chronic disease reviews/ cervical screening increases massively, and no allowance is made for this. Hence the disparity in GP numbers between more and less deprived areas.
I have been a qualified GP for 16 years, and earn £38,000 for my 16 hrs and 40 mins (4 sessions) per week of paid salaried clinical work. I do around 8 hours of 'unpaid overtime' every week, as I work approximately 12 hours per day on my two clinical days. I make over 150 clinical decisions per day, including 32 F2F/ telephone appointments, 1-2 home visits, 40-50 abnormal test results, 15-20 tasks (sick note extension requests, DWP/DVLA forms and admin queries, responses to e-consultations), 50-60 prescription requests, and actioning 4-6 letters from hospital consultants. In addition we have a range of requests for taxi medicals, HGV medicals, adoption medicals, insurance forms etc, which have to be fitted in.
We have not been able to hire enough GPs for many years, so we have several Advanced Practitioners who are fabulous, but this means that the cases that the GPs see are the most complex, so it's far from straightforward decision making. We are always aware that we can miss things and cause harm. Bear in mind that '3.5 days per week' translates to around 42 hours of actual clinical work.
When I'm not working clinically, I also have a 5 sessions academic job, teaching undergraduate medical students and doing research to improve medical education. This also has a lot of 'unpaid overtime' involved, but is much more flexible and less intense than clinical practice. I also have a school aged child, a DH who is a full time ITU/Anaesthetic Consultant, and ageing parents/MIL who need increasing support. GPs are humans too.
The main limitation to increasing F2F consultation in our surgery (we're currently at around 55%, so slightly below the national average of 58%), is that social distancing has still been required in clinical environments and, like most surgeries, our waiting room is too small for this. The lifting of this requirement announced today will allow us to go to our preferred option of offering patients the choice of F2F or telephone. It still won't get us more GPs. The amount of money 'for locums' sounds like a lot, but divide it between all the surgeries in England and then consider that the worsening lack of GPs has driven up locum rates to around £800 per day, and you'll see that it won't go far. The sick notes and DVLA requests are a tiny part of our workload and will make little difference.
Almost all of my GP friends have reduced our clinical hours over the past few years, rather than burn out completely and leave the profession. I will be reducing my clinical hours again at the end of this month, for a while at least. I have burned out previously trying to keep a struggling small practice going (I eventually had to leave and the practice closed), and have no intention of going down that dark road again.
Most of the 'part-time' GPs are women with young children who are not the primary breadwinner, but most 'full-time' GPs mix their clinical sessions with either teaching or management roles, as consulting is incredibly intense, and extremely hard to do well for 8 sessions per week.
These past two years have been brutal, the massive delays for hospital appointments and treatment has caused a knock on effect, as more unwell people keep coming back to their GPs in desperation when there's nothing further we can do and they were referred on months ago. There is a massive need for mental health support brought on by the pandemic, and mental health services are on their knees, so again we are supporting people. A good 80% of my appointments are patients with severe mental distress at the moment, and these appointments take far more than the 10 minutes we are given.
We and our staff are bearing the brunt of public anger and are helpless to respond, hog-tied by lack of clinicians, secondary care delays, and NHS England 'guidance'. The turnover in admin staff is massive because it's a thankless job and the abuse they take is horrific. It's increasingly dangerous, a GP in Manchester was recently assaulted and has a severe head injury, with four of their staff also sustaining lacerations in the assault by a disgruntled patient. We have plenty of volatile patients, it would not at all surprise me if something similar were to happen at my practice. The inexperienced new admin staff needing more support, and stressed GPs reducing hours in order to cope, is causing a downward spiral where there is ever more workload for fewer GPs. Those of us who are left are struggling, and the current anger being directed towards us by the press will be the straw that breaks some of the remaining camels' backs.
I know people are struggling to access their GPs, and I am truly sorry for that. My colleagues and I would love to have the support and funding to be able to offer a good service, after all, we all went into this speciality because we enjoy seeing patients and helping people. We are here, working as hard as we can, and it's intensely frustrating to know that we have multiple staff answering the phones constantly from 8am-6pm every day and it's still not enough. People can queue on our lines for hours due to sheer demand. It's frightening for us too, the thought of missing an unwell child or a cancer because of not being able to fit people in keeps many of us awake at night. Look up 'moral injury' - that it what your GPs and their staff are experiencing on a daily basis, and it is breaking us.
The GPs I know that have left or retired early have not done so lightly, but because they simply couldn't take any more stress. Please don't blame us for systemic problems that have been worsening for over a decade, despite us telling the government over and over again that this crisis point was coming, and have been thrown into sharp relief by the pandemic pressures.