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?

www.mirror.co.uk/news/uk-news/fears-doctors-suffer-burnout-nhs-23498066.amp

The government promised additional GP’s - instead more are leaving the profession. I’m glad my DH left before the workload got even worse.

@Brainwave89
At our surgery the GPs seem to already retire in their 50s anyway. They then come back and cover for holidays and get paid very nicely. And it's practically impossible to get an appointment on a Friday because they can't get GPs to work on Fridays. All Friday appointments are done by practice nurses (no complaints about them - they are very good), I guess with a doctor overseeing them. Even the practice manager has Friday off.

@XantheBreeze

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.

Well... my GPs don't finish at 5.00pm to start with. The surgery itself closes at 6.00pm anyway AND they always have more work to do afterwards.

That's why a lot of the GP don't work full time but part time. Your dc could chose to do that too instead of taking more shits on etc...
Would it cause problem in the dperatment? I bet it would. But nothing is going to change when doctors and nurses are constantly filling up the gaps at their own costs (health and wellbeing wise but also financially - see the fact some consultants end up PAYING for the priviledge they've done extra hours to support their department...)

@borntobequiet

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

This

Yep I agree there. There is something afoot behind that. Either it's a smoke screen or a forst step to then sell said surgery to some big american company.

I think it would be a good thing as I think it could help some GPs concentrate on clinical work and help to even out the postcode lottery of what services are provided. Some areas have private companies managing the practices - which hire GPs. That’s what is in my relatives’ area.

@MouseyMoose

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.

And that's the core problem. They're paid "per patient" so it doesn't hit them in the pocket if they don't provide appointments.

The answer is to change it to "pay per appointment" with differential rates for the type of appointment, i.e. length, face to face, or telephone. Then their pay will be linked to services provided.

You can bet your bottom dollar a lot more appointments would suddenly become available if that was how they were paid.

My youngest daughter lost conciousness yesterday at school. Our GP refused to see her despite the advice on the NHS website that you should see a GP if you have fainted without a known cause. We were given a phone call later that day, because that is an excellent substitute for the physical examination that should be carried out

I keep having heart palpations that have caused me to have dizzy spells and have actually passed out from one set - did manage to get a telephone appointment, told me that it is probably stress and I only need to see a DR if I get dizzy with them. I explained that I was and that is why I called. Was told to monitor and take pulse whilst it is happening and sent a PDF on palpitations being caused by stress and seek medical advice if you get dizzy spells.

On the other hand, booking and attending smear test and to have bloods taken have been no problem so it does seem GP's reluctant but nurse etc all seem to be doing ok in the practice.

Your dc could chose to do that too instead of taking more shits on etc...

Am I bad for laughing?

But nothing is going to change when doctors and nurses are constantly filling up the gaps at their own costs (health and wellbeing wise but also financially - see the fact some consultants end up PAYING for the priviledge they've done extra hours to support their department...)

You’re hijacking the thread to moan about the supposed plight of hospital consultants. Of course, nobody advocating for the rights of these poor beleaguered consultants ever mentions that the cause of their dismay is that their state-funded defined benefit pension pots are worth more than £1m, and that is why a tax charge applies to any contributions over the lifetime limit. Just like everybody else.

But no, hospital consultants are special, it seems. They could always leave the NHS pension scheme. Problem solved. They won’t, though. They want the money that the NHS would have paid into their pension, and they want it tax free, too. That means grossing it up. I won’t explain the mechanics but for highly paid people that means that the real cost to the NHS will be 2-3 times the value of the contribution. And they want all of this to be funded by the NHS, ie taxpayers, ie everybody else.

Don’t ask me to cry over the plight of highly paid people with £1m pension pots who don’t want to be taxed in the same way as everybody else, including nurses and hospital porters and cleaners and a multitude of other NHS frontline professions. All of whom put in just as much effort.

The problem with GP surgeries is that there aren’t enough GPs. So how would this proposal solve that I wonder 🤔

There aren’t enough nurses or hospital Doctors either. Oh could it be that working in for NHS is a bit shit? Perhaps instead of bashing healthcare professionals we could start supporting them instead?

Working in the NHS might be considered ‘a bit shit’. So might working in a care home, or down a mine, or on a building site, or in a shop for minimum wage on a zero hours contract. I don’t think that GPs have the worst of it, career wise.

I haven’t seen anyone on this thread ‘bashing’ healthcare professionals. I have seen people questioning why those healthcare professionals should have special privileges, though. That’s not ‘bashing’. Do you think that healthcare professionals should be exempt from all criticism or questions?

Someone is going to join to tell me that it’s ‘not a race to the bottom’ any second now. I can sense it.

[quote madisonbridges]@Brainwave89
At our surgery the GPs seem to already retire in their 50s anyway. They then come back and cover for holidays and get paid very nicely. And it's practically impossible to get an appointment on a Friday because they can't get GPs to work on Fridays. All Friday appointments are done by practice nurses (no complaints about them - they are very good), I guess with a doctor overseeing them. Even the practice manager has Friday off.[/quote]
Ok, but anything which incentivises even more staff to work part time or leave the profession entirely is going to cause issues.

I'm not going to say it's a race to the bottom, but I am going to say that worldwide, there is a huge shortage of healthcare professionals, and that already the UK has a recruitment and retention problem. I'm thinking that pragmatically, issues of access to GP's, are going to have to be solved by addressing these issues.

@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!

Exactly. You can't just appropriate a privately owned partnership. The Government would need to buy the partners of each one out at market value. Anybody seen a calculation of what the Government reckons that will cost? 😂

@MouseyMoose

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.

Which is why they are struggling: as the population ages and medicine becomes more complex, providing good service to the average patient becomes increasingly more expensive.

I'm not at all convinced that a centralised Government top-down approach would provide a better service for patients. Most likely it would result in a gradually reducing standard of average care.

This is mostly just a squirrel-based publicity stunt, and doesn't even seem practically feasible. Especially when we're all being told there is no money and we need to pay more tax. Who is going to pay the billions for this privatisation?

If I'm reading some of the comments correctly, nationalisation is a precursor to privatisation of already private practices? Makes sense.

Can't fault my local GP to be honest. Even during the height of the lockdown, when needed they saw DS1 face to face as the phone and video calls weren't 100% to the GP's satisfaction. He was in hospital under an hour later. They've seen me face to face too when required.

They are keen to stick with phone consultations simply because it knocks a lot of the chit chat out which allows them to sort out more people.

@Pazuzu

If I'm reading some of the comments correctly, nationalisation is a precursor to privatisation of already private practices? Makes sense.

Can't fault my local GP to be honest. Even during the height of the lockdown, when needed they saw DS1 face to face as the phone and video calls weren't 100% to the GP's satisfaction. He was in hospital under an hour later. They've seen me face to face too when required.

They are keen to stick with phone consultations simply because it knocks a lot of the chit chat out which allows them to sort out more people.

Yeah, a privatisation to the Government's friends, rather than GPs owning their own practices as partners - people who actually understand patient care and care about this as that is their profession. People who live in the communities they serve, rather than pharmaceutical companies or other detached investors who have no interest in anything except cost cutting and profit maximisation. But you can't sell it to the investors for a profit unless you own it first, so...

@mbosnz

I'm not going to say it's a race to the bottom, but I am going to say that worldwide, there is a huge shortage of healthcare professionals, and that already the UK has a recruitment and retention problem. I'm thinking that pragmatically, issues of access to GP's, are going to have to be solved by addressing these issues.

Yes. Better working conditions are needed to attract more doctors to become GPs, and fewer GPs to emigrate. It's not going to be a quick fix hence the Government is not interested.

Not sure how the proposal to nationalise one of the most efficient parts of the NHS at great expense does anything to address the above.

Do you know how shit it is the government makes money from GPS? They don’t get paid as you think, they get money for say doing 60% of people blood pressure in a year. Then the next year they get told, you did 60% last year so this year we won’t pay you unless you do 70%. So less time to see patients with problems they get no money from as they need to actually pay their overheads.
More GPS than a decade ago, don’t believe the headlines.
Your GPs want longer with you, and would love better hours and pay. They also want to go abroad where they are treated better.

Everyone complaining about GPs not doing face to face, erm, most hospitals are still doing phone consultations and this isn’t an issue?

@HootOwl I agree totally with everything you say, my comment re how the contracts work was just to correct a PP (and a common misconception I've seen regularly on here before).

I don't know what the answer is but GPs need a damn good overhaul.

This. I actually think too much responsibility has been pushed onto GPs. Patients should be able to self refer for things like gynae and mental health without having to see their GP.

People with diabetes (or thyroid conditions) should be seeing specialists rather than going for check up with a designated diabetes nurse at a surgery (I'm sure some are brilliant , my MIL's was awful, clearly didn't have a clue what she was talking about and got rather flustered when asked questions) and once you've been referred to a consultant for a chronic condition you should stay under the consultant instead of ongoing care being handed back to a GP who may know very little about a condition.

I do think if that happened nationalisation could work because GPs wouldn't need to rely on supplying services in return for the extra money and could focus on Primary care.

And that's the core problem. They're paid "per patient" so it doesn't hit them in the pocket if they don't provide appointments.

The answer is to change it to "pay per appointment" with differential rates for the type of appointment, i.e. length, face to face, or telephone. Then their pay will be linked to services provided.

You can bet your bottom dollar a lot more appointments would suddenly become available if that was how they were paid.

I agree. However, in a society with an ageing population with ever more complex health needs, the average number of appts per patient required to provide good care has hugely increased and will continue to do so. Hence GP appts being so scarce. Then GPs leave/ doctors don't become GPs in the first place because they are so overworked and you have a self-reinforcing downwards spiral.

The model you suggest might improve things over time if it gradually improved workloads by encouraging more GPs into the profession and to stay there. But it would cost the Government a hell of a lot more money, and I can't see them signing up for that. Who will pay for it?

That is why we should be highly suspicious of this suggestion to nationalise practices. If anybody thinks it's because the Government intend to inject much more funding into a nationalised service to fund the level of care you describe then they are deluded. They could do this now with the current ownership model...

[quote MouseyMoose]@HootOwl I agree totally with everything you say, my comment re how the contracts work was just to correct a PP (and a common misconception I've seen regularly on here before). [/quote]
I wasn't disagreeing with you. It's all crazy isn't it?

It’s prepping for privatisation. GP practices are thousands of separate businesses. The big American medical companies don’t want to deal with thousands of small to medium sized businesses so privatise the lot, break it up into large gp groups so that instead of the thousands you get 50 or 60. These will have CEO’s, boards, sales targets and maximise profit.