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?

If we compare with NHS acute, most Trusts are legally non-Crown and except for a few, there are no standardised quality/service levels that are met in practice. There is absolutely a post code lottery of how long for each specialism www.theguardian.com/society/2021/sep/01/huge-discrepancy-nhs-england-waiting-times-common-procedures

NHS acute have their own issues from COVID but comparing primary with central NHS is perhaps not the compelling argument?

What happens if a significant number of GPs decide that they don't want to be "nationalised?" Does this not risk making GP access even more limited - and thus only available to those who can afford it?

The current system is far from perfect, but nationalisation won't solve the root cause of the problem when it comes to GP access - that there are far too few doctors per head of population. Far fewer than in most developed countries that the UK likes to compare itself with. Barely half the number of doctors per head compared with Austria. A shortfall that repeats throughout the health and care services (fewer hospital beds, fewer ICU beds, fewer nurses and technicians etc).

And within ghe first other someone comes on to say how fantastic their GP husband is.

Why is it whenever someone on MNs comes on and wants to discuss the sub-standard care from the NHS does someone rock up with that line. It is brilliant that your DH is a great GP but a lot of them are providing anything but brilliant service. Stop defending shit standards and people might have more respect for you if you called out your colleagues when they failed to provide good medical care.

Many are making seeing a GP impossible. Yes GPd were told to stop standard services for the Covid vaccine roll out there wasn't a vaccine in summer 2020 so why couldn't I get care then?

Based upon my interaction with various NHS professionals and GPS over the past 2 years many of them need to be told to stop being so aggrogant, listen to patients and to start pulling their finger out and actually do their job. My son was left to suffer for nearly 12 months because of GPs (I saw multiple different ones) fobbing us off and not listening to the symptoms fully.

[quote Floundery]@Iamthewombat

Everything you have said about consultants' pensions is true - and my husband is one. GP's are on the same pension. Part of the problem is that most doctors have only been employed in the public sector and have drunk the "we're so hard done by" Kool-Aid for far too long. They're generally not. Probably some truth in that for GP's too.

I'm at the point where I don't give a tinker's curse about privatisation - I'd happily pay just to be able to see a qualified person in a reasonable time. There are not enough GP's to see the number of people that need seeing, and we can't magic up more GP's immediately - so we need to devise a system with less reliance on them. The increased protocol-isation of healthcare (e.g. when to refer cancer symptoms under TWR) should allow many referrals to be processed without the need to convince a GP to refer appropriately to a specialist (which is often far harder than it should be).[/quote]
I love it when people boldly post things which just aren't true - sigh.

GP pensions and Consultant pensions are very different. We contribute both employee and employer's contributions whereas Consultants obviously don't. And the method of calculation is very different, with GP pensions using the CARE system.

In future it may be wise not to post about something you obviously don't know much about - you're in dangerous of misinforming people.

Amusing thread though.

I know...10 hour days....I did 11 hours yesterday. And my half day today was 6 hours.

All practices in Scotland that have returned to health board control..that is a totally salaried service... cost far more to run and the health boards can't wait to get them back to independent contractor status. They openly admit they could not do this for all practices as it would bankrupt the health board.

Remember when the energy price rises come into force we don't get any money to cover that it comes out of our own pocket...as do all expenses.

Everything I posted about hospital consultants’ pensions remains true. I still don’t know why somebody found it advisable to hijack a thread about GP services to rail against the supposed unfairness of hospital consultants having to pay tax like everybody else.

I am a centralist - I don't like postcode lotteries. We pay the same tax and we should get the same services, within reason (obviously some services vary according to locality eg not much call for lifeboats inland unless you live near a big lake).

So anything that provides a national policy for eg healthcare (rubbish disposal would be another one) is a good thing as far as I am concerned.

If this is even true (doubt it), they will be nationalised to then be later privatised in one big group to a huge company e.g. SERCO, owned and operated by Tory donors and old school friends with all kinds of undisclosed interests and backhanders and at a cost which makes it extremely poor value for taxpayers.

The current status quo of GPs being privately owned individually or in small groups doesn't allow Tory party and senior ministers to line their mates pockets

It's the Tory way

@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 this. Nationalised to resale in bulk to big private US medical companies or businesses like SERCO.

Spot on.

GPs would in the main be much better off if the service was nationalised: standardised pay in line with hospital consultants (usually higher than a GPs pay), 9-5 working hours or paid on calls, no longer having to pay the 15% employers contribution to pensions, covered by crown indemnity so their indemnity insurance would come down massively (currently about £10-12k a year), and no longer being responsible for generally running a business. I think most GPs would jump at the chance.

The effect for patients would be catastrophic, but patients generally whinge about the current service so probably don't realise how much worse for them this would be. You don't know what you've got til it's gone...

Will the changes magic up thousands of new GPs? No? Then they are not the solution.

Taking away control and limiting pay of GPs won’t exactly help with the recruitment crisis and will make access WORSE - how can people not understand???

@AndSoFinally yes. I suspect GPs would have even better pay and conditions if primary care was privatised though all the GPs I know and work with genuinely think the current model is the least worst for patient care even if it's not in their personal interests. I know many PPs will find this thinking alien

@Floundery.

I genuinely don't know what your final point is. Are you talking about NHS consultants setting up companies to provide private work or GPs surgeries?

@LampLighter414 Indeed something to look forward to - primary care delivered by Virgin, Serco, Capita or any of the large USA corporations.

It will be a massive disaster. The root of the problem is that the UK has a massive shortage of GPs. The "psotcode lottery" is heavily down to that. Meanwhile they keep shoving more to do on them. That's why you can't get an appointment.

Putting them all on standardised pay scale and conditions sounds attractive. Some salaried GPs may find it fine. Partners will not. It will cap GP pay, making it less attractive to train. Then the NHS is going to find that the business of running primary care is as difficult for them as it was for contracted GPs.

This is going to be massively mis-sold to voters as an improvement in GP service and that the GPs and BMA are only complaining about losing a silver spoon. It'll be fairer, they say. They'll point to those GPs who show up in Mail and Express articles making more than consultants (a tiny fraction of GPs). Meanwhile GPs will retire or emigrate and the NHS won't train enough to replace them.

@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.

An F2 doing a rotation in a GP practice is nowhere near the same as an actual GP, either salaried or partner. It’s highly, highly protected. I’m a hospital doctor, more senior than an F2 but not at consultant level. Some of my friends are fully qualified GPs and their work load is incredibly heavy - they might not see patients all day but they are often in their practices for 10h+. There aren’t enough GPs in this county but good luck recruiting to it as it’s a system on the brink and an easy target for everyone’s vitriol, when the issue is far, far bigger than ‘my GP is rubbish because they won’t see me’.

@AliceW89 PMSL at that post. Even newly minted GPs don't always realise the protection and behind the scenes work that goes on but if an F2 said that then it perhaps shows more about their lack of insight.

Regarding PPs, it's worse than ‘my GP is rubbish because they won’t see me’. it's 'all GPs are rubbish because they won't see me'.

You will know already and I don't envy secondary with the backlogs to clear but If primary care were a licence to print money, why can't we recruit? Why are practices handing back entire contracts and exiting NHS primary care?

@Floundery

GP pensions and Consultant pensions are very different. We contribute both employee and employer's contributions whereas Consultants obviously don't. And the method of calculation is very different, with GP pensions using the CARE system

Salaried GP's pay the employer contribution? News to me. You're splitting hairs there.

In future it may be wise not to post about something you obviously don't know much about - you're in dangerous of misinforming people

You sound nice. What is your pension worth exactly? When do you plan to retire? And do you work 1, 2 or 3 days a week?

GP's have absolutely no idea just how hard those earning £100k plus have to work outside the NHS. The woe-is-me schtick really boils my urine.

Salarieds Doctors' employer contributions are paid by their employers, IE GP Partner GPs. But this is about nationalising the GP system, ie ending GP Partnerships which is the context for this. To claim that GP Pensions and Consultant Pensions are the "same" simply isn't true but I suspect you know that.

I'll pass on discussing my personal plans with you, I work c.50h in the NHS and some more privately, and so I'm sure my retirement will be well provided for. But my Partner earns 100k in IT + benefits - she's good at what she does but is only mid level (self described) and self admittedly works less than me, 9-5 for a start (which I'm glad for). 100k is much easier in many professsions.

You sound very angry - I feel sorry for you.

@Username916

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

This is literally what the GPs at my mother's practice have done, and continue to do.

My mother has had some pretty serious issues but the GP has not seen her. They are a voice on the phone if you are lucky. If they think that you need to be seen they do not invite you to the surgery or make a home visit, they send the paramedics, who of course then turn up in an ambulance, thereby tying up even more precious resources. It is so bad that it really has to be seen to be believed.

Few people in her town have seen a GP at all in over 2 years.

Scoff if you want to, but I assure you it is actually happening. Yes, we are in the UK before anyone asks.

I’m sorry @Zilla1 I’m not really clear what you are getting at? Probably me being silly! I was just trying to make the point that the expectations of an F2 in a GP practice are completely different from a GP. 5pm finishes and lots of holiday is not what I’ve seen amongst my GP friends. I’m very much on the side of GPs - I think years of under recruitment and an ageing population with increasing frailty has finally caught up. The rhetoric that GPs are this feckless, lazy group who refuse to see patients is offensive to the profession at large and also massively misses the mark as to where the problem lies.

"Few people in her town have seen a GP at all in over 2 years." sounds like hyperbole to me though I suppose there's some wiggle room about 'few'. I can only speak for my practice which has never stopped seeing patients F2F for a single day and, partly due to remote consults have seen more patients in 2020-21 and 2021-22 that in pre-COVID years, even with the time0consum,ing infection control around F2F visits and delivered c30,000 vaccinations within the PCN. All while funding has been covertly reduced, making some targets apply across the PCN and unachievable and so on. It's broken some colleagues. Threads like this augment the desire to throw in the towel and have patients enjoy the golden hills of privatisation.

@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.

I really don't follow this. How does it make it more "attractive"? Plus, what to you actually mean by "privatisation of the NHS". It's a term used a lot but nobody ever seems to explain what it means. Also, why now? The Tories have been in office for most of the NHS's existence and it's still here.

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?

Ha! I think it's about £38!!

@AliceW89 Apologies due from me for writing an unclear post and ranting. I was trying to agree with you. I'd seen the original post from the not-an-F2 about what the F2 had told them when they were being not-a-GP. I'd lost the will to live so didn't reply to them but was trying to agree with you and grateful for a perspective from someone with some insight but who isn't a GP so isn't posting from self-interest, if that makes sense.