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?

@PasswordEarth

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.

My figures may be slightly out but I think in 2020 there were about 4K more GPs than in 2010.

However in that time the population has grown and aged and demand for GP appointments has increased. So no, there aren't less GPs but they are now more stretched hence we have a severe lack of GPs.

As sensible PPs have said:

1. This will enable the recruitment of 0 GPs, PNs, ANPs.. while leading to the exit of arguably many.
2. GPs are private businesses so presumably this nationalisation will be notional or expensive. I suppose they could refuse to renew some contracts and build in-house capacity but that won't be a cheaper delivery model nor add to capacity. I suspect that would lead to the exit of many GPs.
3. I doubt employees of large firms will work harder than GP partners though this IMO.
4. Cynically, large MNCs are investable and offer directorships and cope for consultancies so would be more attractive to this (English administration instance of the UK) Government than small GP practices.
5. Given our PCN vaccinated more than acute or pharmacies here, I would have thought rolling out a new vaccine initiative to a MNC-owned primary care would have led to more spending on comnsultancies like track and trace or more interesting and profitable fast tracked contracts like PPE.
6. It is interesting where a populist non-conservative Government's priorities lay to favour the base. Who next in line?
7. FWIW, we've never had a day when we've not seen patients F2F while vaccinating c30,000 patients at our PCN while government appears to have sabotaged our operations and the populist press seem determined to attack primary care and make decisions to maximise infections. Anfield, Cheltenham, Eat out to help out, always too late, always too early.
8. If you had to list all the deficiencies in the UK, nationalising then privatising primary care would feature where in the top 10,000 priorities?
9. Primary care, safe in the government's hands.
10. If Primary care is such an easy ride flying a screen and such a gravy train then why can't we recruit GPs, why have whole practices handed back their contracts to NHS and why are early and mid-career GPs leaving the profession (medicine, not primary care) entirely in significant numbers. All three are unseen to me in previous decades.
11. There are many problems in primary care, almost all are a result of deliberate decisions by the Government.
12. Everything else sensible PPs have said.

@Brainwave89

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.

Totally agree.

@PasswordEarth sorry just realised I may have read your post wrong, I'm not sure if you are saying there are more GPs or not but obviously the points in my reply still stand.

@travellinglighter

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.

Yep.

My GPS friends are incredibly stressed and unhappy at the moment. They are genuinely looking for other jobs.
Two I know both work 'part time' and see 30+ patients from 9-6, then work until midnight checking results and doing referrals. They feel unable to do their jobs properly.

Given that it was incredibly difficult to get a GP appointment before the pandemic even began, some sort of shake up needs to happen before the system collapses completely!!

@weebarra spot on. I suspect some PPs with firm opinions about what constitutes PT don't have a real understanding of how long a patient-facing session lasts and then the amount of essential non F2F clinical work (often dismissed as admin) that must happen afterwards to keep patients safe.

@PasswordEarth

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

Some of the issues with phone appointments at GP surgeries aren’t an issue with the hospital. For example, my mum is a teacher and needs to speak to her GP about something. She’s fine with a phone appointment, but they can’t give a time. When she asks if she can be put at the back of the queue, so that they call after school hours, they say it’s not possible. I assume this issue also applies to any students where she works, as they won’t be able to find a private area to take a medical call during breaks and aren’t allowed their phones in lessons. She booked one once hoping they’d call at a convenient time but they rang in a lesson when she couldn’t answer so she wasted an appointment that could have gone to someone else. Luckily she has school holidays so can try for an appointment then, but plenty of people can’t answer their phone anytime at work and don’t have this.

Whereas a couple of weeks ago I had a video call with a consultant because my midwife referred me, and I had a specific appointment time. Much easier for anyone in any job where they can’t just answer their phone any time, at the drop of a hat, because it can be pre-arranged like it would be if it was a face to face appointment.

I should add I don’t have an issue with phone appointments for me. I can arrange work to make it possible to answer the phone whenever, so phone appointments are actually infinitely more convenient because I don’t have to travel. But there should be provision for people who cannot use them.

@SickAndTiredAgain in some circumstances, I think it's a function of a GP trying to help more patients also, some consults are 'drop everything' where the patient needs emergency support. In many out[patient clinics in acute (and I know this will not always be the case before hospital colleagues disagree), the Dr has a consult time which is generally longer than 6 or 10 minutes, sees the patient, completes the admin while the patient is there or immediately afterwards before the time to see the next patient. There are lunch breaks for some non-shift work specialisms and they start and leave from say 8-9 to 5-6. So more like continental train departures where there are longer stops so fewer trains depart late. If GPs managed the workload the same way, they could offer more certain timed appointments that stay at that time unless the patient is going to crash but arguably only about 1/4 to 1/3 of the number of patients would be seen. GPs tend to push the clinical admin to the end of the session hence the long hours that some critics don't see. Many GPs would welcome the change but I expect the numbers of patients complaining about not seeing a GP would sky-rocket.

We are desperately, desperately short of GPs, which isn't going to get any better since the government likes to flog public sector workers in the press until the public blames them for everything (see also: teachers, hospital staff). Training and recruitment needs to be the focus, not swizzling money around to make everyone look in one direction while all the back-room crony deals happen out of view.

Agree with @ItsSnowJokes and @SilverDragonfly1. Show me one bit of action by this particular Tory government that hasn't been a) to distract the public from their fuck-ups, b) to financially benefit them and their mates, while costing the electorate a huge amount, or c) both.

How would this benefit patients, exactly?

@PasswordEarth

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

The difference is that hospitals give proper "appointment" times. My OH has had numerous phone calls with his consultant (and others) for his incurable cancer, and all have been bookable in advance at convenient times, and nearly always, the call comes at or near the time agreed.

His GP phone "appointments" have been the opposite. No facility to ask for a specific time frame, not even morning or afternoon, unhelpful receptionists refusing to even put a note on the system to give any preference, so, most times, the phone call comes at a time he can't answer the call, meaning he has to go through the same procedure again, and again.

It's a lovely sentiment but it's not doable- to buy out each practice (just the property and equipment) that the GP partners own (have bought themselves- not NHS funded) would cost billions.

The GPs would need to do less work if they were privatised- they could charge for work done, rather than now where they have to do continuing professional education, quality improvement work, multidisciplinary team meetings, practice meetings and often result checking and referrals on top of their clinical time. (Without getting into the debate of phone/face to face etc).
To pay them for their time would mean a wage increase, which the government won't do. At the minute they do it for patient care (duty of care) but also, I imagine, to protect their own surgery. No ownership= less personal investment (time, emotion etc).

And imagine if GP partners were bought out by the nhs- with a windfall from the sale of the surgery many would have enough money to retire early. I know that's what i'd do...

DOI: NHS worker but not GP. Recent excellent phone support from GPs.

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.

Yes, I agree the pay per patient system doesn’t work. I’m not sure how much they get - is it about £140 per year or so? Certainly less than I pay to insure my dog. Can you imagine if you could pay McDonalds this amount per year then go as often as you liked - it’d be impossible to get in there too.

I think the 2011 reforms achieved their aim which was an open secret in DH at the time, to identify what was the then most trusted component of the system (primary care) to act as gatekeeper for funding and referrals while loading additional duties on primary care to erode the trust in that final part of the NHSt with restricted funding and structural changes. Failure was designed in and a feature. not a flaw.

I'd be more than happy for protocol-based direct referrals though I suspect this would break acute even if more money flowed. It would also lead, IMO, to much worse patient outcomes as many patients have successful treatment in primary care without requiring a referral to acute or require different specialisms in acute than they initially are convinced they need (even if the patient is the expert in their health). A longer waiting list to be seen by the wrong specialism in acute who then become a default GP to re-refer correctly won't help patient health or survival IMO.

Totally agree that GPs should be part of the normal NHS and on the same payscale as other similarly qualified NHS staff who work similar hours.
Plus it might iron out some of the differences between one surgery and another.

I find the ironic thing is that the HCPs fighting for patients and against changes that they are reasonably sure will disadvantage all but the richest patients are the ones who I suspect would financially benefit from changes. Unless the government sets up and privatises a national provider then I suspect GPs personal income would increase in a fair market though the Government might find it has a much worse negotiating position with that powerful entity than it has now when it can dictate adverse contract terms.

The GPs from acquaintances in one of the local practices who handed back their contract and closed certainly have a better work life balance and more income from their fully private model and much less difficult consults given the self-selection of patients. I doubt it would be in the interests of the 95%+ of patients for those changes that would financially suit the GPs though.

My worry is that the government will make the terms and conditions so unappealing for GP 's very few in reality will take up the offer. Leading to the nightmare that is the NHS dental service!

The tortes get to say look how we tried and we end up with a worse service forcing those that can afford it to go private and the rest are left with an ever lower provision service.

I may be wrong but privatisation is always a Tory policy.

@SickAndTiredAgain when I've had telephone appointments with my GP practice they gave me a time and said they would call me within 15 minutes of the appointment time.

Every single time they called me at the actual appointment time.

I actually changed to them from another practice nearby where I had to get myself chucked off the books. That GP practice was a nightmare to get appointments pre-Covid and treated me poorly.

Interestingly one of my neighbours, who is at the same practice, has had an issue with one of the GPs at the practice so refuses to see that individual GP.

So what you get with GP practice depends on the individual practice and each individual GP within that practice.

[quote RedWingBoots]@SickAndTiredAgain when I've had telephone appointments with my GP practice they gave me a time and said they would call me within 15 minutes of the appointment time.

Every single time they called me at the actual appointment time.

I actually changed to them from another practice nearby where I had to get myself chucked off the books. That GP practice was a nightmare to get appointments pre-Covid and treated me poorly.

Interestingly one of my neighbours, who is at the same practice, has had an issue with one of the GPs at the practice so refuses to see that individual GP.

So what you get with GP practice depends on the individual practice and each individual GP within that practice.[/quote]
And that's why a nationalised system looks attractive, i.e. to get a standardised quality/provision of service to get rid of the "post code" lottery as to whether you get a good or bad GP practice. It's a shame that more service levels/guarantees can't be put into the existing contracts/structure to try to iron out some of the massive fluctuations seen between surgeries.

@Username916

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

You must be one of the lucky ones, getting to see a GP in person around here is like gold dust. I understand their need to protect themselves but while many surgeries have returned to normal many are prolonging their self imposed isolation. Personally, I find the attitude of these GP’s a little precious.