To think that the plan to nationalise GPs is a good thing?

[XantheBreeze]

GPs are apparently up in arms about potential plans to nationalise GP practices.
Many people might not realise that GPs and their practices have always been ‘private’ and not part of the NHS but contracts with it as they didn’t want to lose their independence (and high pay) at the birth of the NHS in 1948.

With all the talk of Tories wanting to privatise the NHS, and the recent rogue behaviour of some GPs deciding they prefer not to see patients unless they deem it necessary, AIBU to think this would be a good idea?

@ItsSnowJokes

I don't think this has anything to do with patients and more to do with the government bringing them in to the nhs so privatisation of the nhs looks even more attractive to investors.

“The NHS” covers a multitude of things. Are you seriously suggesting that any government attempting to privatise it would offer shares in a thing called “the NHS plc”?

Let’s say it did. Any investor would have to be insane.

This won't solve anything. The issues we are seeing with GP practices is due to the severe lack of GP's, the government can dress it up however they like but that is the issue.

Also to the PP who suggested they should be paid less for telephone appointments, that's not how the contracts work. They aren't paid 'per appointment' the baseline is based on how many patients they have and then adjustments made for offering/not offering other services.

Not all surgeries are equal. I've belonged to a doctors where you could never get an appointment (phone in morning to book for next three days, by the time you'd got through all appointments gone) you'd either get better or worsen till you needed hospital treatment (happened to me twice with tonsillitus would probably have been sorted with timely antibiotics). Surgery I am at now (9 years) is great can always get an appointment within reasonable time scale. Extended hours a couple of times a week so those that work can be schedule an appointment for 7pm. They will squeeze in a small child if it sounds urgent. They will offer phone appointments or physical ones if it's something that needs looking at ears etc.

I'd be gutted if my long established gp which has grown and adapted to support the local community was forced to change.

I would worry that every practice would have to follow the same model, rather than being abele to adapt for their own local needs.

My GP practice could do with being forced to work to a standard model. Currently the only appointments you can prebook are vaccinations (childhood, flu, pregnancy whooping cough). Everything else is on the day, and they will only book appointments for (I’m quoting the receptionist here) “acute medical emergencies”.
I sometimes see posters on here recommend e consults etc but my surgery has no online services at all beyond a form that is specifically not to be used for medical queries.

So for any health issue that is not deemed to be an acute medical emergency, there is literally no way of seeing or speaking to a Dr or a nurse at my surgery.

@DistrictCommissioner

I wonder what would happen to the GP buy ins?

To be a partner in a GP practise, you generally have to buy in - figures can be anything from £30k-£200k, from GPs I know. presumably if the practises were nationalised, they would have to be given their buy-in money back. Else nobody would be on board!

A lot (in my experience the majority) also own the buildings so the NHS would have to either purchase or rent the buildings from them.

People are genuinely idiots if they think this will result in greater efficiency.

Unfortunately the public don’t understand how the system works and politicians can hide behind this. It’s back door step to privatisation. Currently general practice is one of the most efficient parts of the nhs, both financially and from a time management perspective, because if it’s not it directly effects a partners profits. Why do you think there has been a year of media led GP bashing? So the public don’t complain when politicians introduce ‘improvements’ (hint - it’s actually not a good thing )

It would be exactly like when they decided to take over out of hours work - the Government thought all the GPs were doing nothing, in reality they had been working flat out and providing an essential service for a pittance. Providing the replacement cost a fortune.

Nationalising GPs plays into the same narrative - they hear lots about 'I can't get an appointment' and ignore the fact that GPs are underfunded, there's a massive shortage and they are all doing hours of unpaid work.

The minute they all become salaried you have a heavily unionised workforce that is knocking off on time and delighted it's all someone else's problem to fix the disasters.

Would nationalising the service make it more attractive to Doctors ? I think there is a shortage in numbers currently, how would nationalising it increase those numbers ?

DC is having an interesting F2 year and having done both ED and GP rotations is seeing first hand the impact of the failing primary care in their area (large urban population) on the hospital.
DC was unable to take any holiday at all when working in a and e and felt they should work additional shifts to try to fill the constant gaps in staffing but GP work is a walk in the park by comparison with 5pm finishes and plenty of opportunity to take holiday. Just their experience of course.

I also have skin the game and feel that primary care is becoming like the Wild West with wildly varying levels of service, including the GPs involved. Poorly run practices have gone bankrupt with massive work to reallocate their patients. At the other extreme are some seeking to profiteer. There are still many able GPs dedicated to decent patient care but whose list most end up on is a lottery.

Re ten hour days - my local surgery is open 8am - 630pm and I've had calls from my go as late as 7 pm so yes, long days.

@thebakeoffwasntasgoodthisyear

A GP friend told me a few of them would be delighted at the prospect of having better terms and conditions, decent working hours etc under the new proposals, instead of the current 10 hour days and unsafe workloads.

Interesting timing of these announcements though - almost as of the government would like to distract us from other news

So you don't want the govt to get on with the business of running the country? You just want them to do nothing in case people think they're trying to distract the electorate? Wouldn't you then be criticising them for not working? They can't win.

GP work as an F2 is totally and utterly different to GP work as a qualified GP. It is hugely protected (and rightly so), the hours are rigidly defined, there’s time for training set aside, appointment times are generally much longer and it’s supervised. I’d love to do a GP F2 job. Our F2 sees 8 patients a day. I see 36.

Last summer I cut myself quite badly and a friend took me to minor injuries to have it stitched. I had to go back there to have the dressing changed and have it checked, twice (meaning a 20 min drive and a morning off work while I waited to be seen) when in olden times I'm pretty sure this could have been done by one of the practise nurses at the GPS surgery 10 min walk from my house. Although maybe all the nurses had been deployed for covid vaccines?
A lot of the other issues I saw people present with at minor injuries were things that I imagine previously they would have gone to the Dr.

I’m sure it is, but the additional pressure they worked under in the ED due to the inability of patients to access GPs was very evident.

Sorry that was to @chinateapot

F2’s are treated as part timers at a GP’s. The rest of the practice will work normal 10-12 hours a day without holidays.

Here’s one GP’s view (also a Labour MP):

www.google.co.uk/amp/s/amp.theguardian.com/commentisfree/2019/may/08/gp-nationalise-surgeries-profit-patients-nhs

@XantheBreeze totally agree. Access to GPs is a problem both for patients and GPs - basically supply of appointments doesn’t match demand / need for appointments. Reasons for that are complex - even things like cost of living crisis feed into increased health needs. But it isn’t because GPs aren’t doing anything. Some surgeries struggle more because they’re more understaffed. If you’re understaffed already it’s harder to recruit - it’s not attractive to work somewhere where your patients are all unhappy because they can’t get an appointment and then it’s hard for you to book a follow up appointment for someone you need to see again - increases stress and increases risk of errors. So it’s a vicious circle - struggling surgeries will struggle more often.

It isn’t going to be possible to increase the number of appointments just by nationalising GPs. The problem is that we can’t recruit enough GPs and the need for appointments is steadily increasing.

@Username916

"GP's deciding they prefer not to see patients" what nonsense.

This.

This is a potentially very dangerous proposal. 23% of GPs are over 55, and will have resourced very comfortable businesses. If the model purchases these businesses and hands over cash, it would be reasonable to assume that a large proportion of staff would choose to retire. The impact on outcomes for patients might be huge.

I don't know what the answer is but GPs need a damn good overhaul. I was refused an appointment for an infected wound because it "wasn't urgent". I asked what stage of sepsis I needed to be at before calling back.

Thank god for BUPA.

The thing is, not all gps are also competent business owners. It's a different skill set. I'd think that for a good number of them, having a fixed salary but no responsibility for setting up and running a business with insurance, building maintenance, salaries, equipment etc all coming out of their income would be a big draw.

Unfortunately, since the tories have come up with this it's unlikely to actually be planned to benefit patients or doctors.

Unfortunately, since the tories have come up with this it's unlikely to actually be planned to benefit patients or doctors.

This

I welcome anything that will force all GPS to act in the same way (hopefully a good way!). I need to book two appointments (vaccination for baby and smear) I have tried a few times but most days I simply do not have the time to do the 100+ redials (I kid you not) to get through to the receptionist. They do not even have a queuing system on the phones and it's the same all day. The shortest number of redials I've made is 63. My eldest son (19yr) is severely immunocompromised and needs very regular blood tests he's given up trying to book them (he works shifts) and waits until the GP is triggered to make the receptionist to ring him to book one because he's missed a few. He was refused a telephone call when he was bedridden, hadn't eaten for a week, had a mouth full of sores and a temperature. My baby was refused a telephone call or appointment when she 1. Required antibiotics, 2. Ended up admitted to hospital. It feels utterly hopeless.

I fully appreciate that GP's work hard, but the current model isn't working, at all.

I'm now 5 days short of 3 months of waiting for my GP to actually do the follow up that the hospital were clear should have been done in the first couple of weeks. The surgery are more than aware, but haven't even managed to schedule a phone consult, much less an actual appointment.

Because it hasn't been, I'm missing medication that makes a significant difference to both the day to day of living with the condition and the long term outcomes of the issue, and have basically had to google-teach myself how to manage the condition.

It shouldn't take 3 months to see a patient to start to support a life-changing diagnosis - it just shouldn't. I have every sympathy for the actual people at the sharp end, but there's just no defending that under any circumstances.

(And, yes, I am another who ended up in A&E because I simply couldn't get the issue even looked at by my GP surgery - and anecdotally, whilst I was sitting in A&E on a winter Friday night for 12 hours, it was very clear from listening to the staff that they were swamped with people who should have been seen in Primary Care, and were thoroughly sick of it.)