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?

@DerAlteMann most GP practices are privatised already (except for some run by acute and some by 'Virgin' and the like) partnerships in which the partners usually have to be HCPs hence there is little scope for shareholders to invest in them and make returns nor to have sinecure NEDs for politicians, consultancy fees, scope for political donations to parties and the like. One possible goal for a populist government would be for the services to be run by a few MNC corporates that have shareholders, sinecure NEDs, political donations and consultancy fees. What do you think the political donations and monies channeled by MNC healthcare groups to UK politicians currently amount to, in aggregate?

*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.*

A hospital/GP pension is worth 1/58th of your salary per year you pay in. They are average salary pensions now, not final salary.

They also cost a GP 30% of their salary which they have no choice over, you cannot change your contributions up or down. So for a GP on £100k (which is not a guaranteed salary) they can expect to receive about £1700 per year for a contribution of £30k per year. You can't claim this now until you're 68 (or whatever the national pension age rises to) so your chance of seeing your money's worth isn't really that great!

@AndSoFinally

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!!

Actually it is in between £120 - £150 per year (baseline depending on how you count) per patient regardless of how many contacts. The average number of contacts (pre covid) was between 6 and 7.

Is that the same in Wales? I'm not a GP but last I looked it was much lower

Sounds good. I've had one GP in the last two years who outright refuses to see anyone but will take a phone call, really not ideal in a lot of scenarios. And the current one took 9 weeks to register me when I moved and you can't get through on the phone, if you try after the usual 8am malarkey you'll get through to a voicemail to he phoned back by someone wfh that tells you to phone back at 8am and ignores all protests that you only got a busy tone or switchboard. Great!!

Not sure about Wales. £120 is bad enough. At £38 it would definitely be time to pack up and go home!

I've just looked it up. About £90 here, uplifted in 2020/21 from not sure what

@AndSoFinally

I've just looked it up. About £90 here, uplifted in 2020/21 from not sure what

Off the top of my head I think it was £85.35 in 19/20 uplifted to £93.46 per patient in 20/21.

For comparison, at my private GP practice, it's over £100 per consult. So 1 consult (e.g. tonsillitis, HRT start = 1 year of GP GMS.

So we really don't need to worry about "nationalisation" and would actively welcome fee for service - we'll be better off and the public will get better healthcare (but it will cost more).

@AndSoFinally

Your thoughts about the pension are spot on. I left the scheme a while ago (well actually I duck in for 1month per year to preserve DIS benefits for my wife) but there's no way that I'm contributing 30k per year for the next two decades - IMO I simply won't see my money back. And that's assuming they don't need with it between now and retirement.

*assuming they don't MESS with it..

Is that all you need to preserve DIS benefit? Just 1 month per year? Am thinking of opting out because of the tax charges but I thought I'd lose that completely (hospital consultant)

For us, it's enough although I'm not sure if the officer and practitioner sub-schemes differ, so worth checking with a specialist accountant.

And remember there's no medical for re-joining so you can get back in immediately if there's an issue.

@AndSoFinally

*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.*

A hospital/GP pension is worth 1/58th of your salary per year you pay in. They are average salary pensions now, not final salary.

They also cost a GP 30% of their salary which they have no choice over, you cannot change your contributions up or down. So for a GP on £100k (which is not a guaranteed salary) they can expect to receive about £1700 per year for a contribution of £30k per year. You can't claim this now until you're 68 (or whatever the national pension age rises to) so your chance of seeing your money's worth isn't really that great!

I don't think GPs are retiring in pensions of £1700 per year.

It’s hilarious that some people think GPs will worker harder under a nationalised system. Clearly they have no idea how much extra work GPs do.
If I was employed to work shifts as hospital doctors do, I reckon I would probably do about 30-40% less work than I do now. I’ll happily see patients for 8 hours, no problem at all. Then I’ll clock off and someone else can read the hospital letters, check the blood results, write the referral letters, do the medication reviews, do the medication requests, issue the sick notes. Alternatively I can fit all of that into my 8 hour shift, but obviously I’ll see far fewer patients.
Currently I do all of this, and my working day is 12-14 hours long.
Nationalisation - bring it on!

Of course it is! Anyone who thinks that this is being done to benefit patients or Gps is utterly deluded and really hasn't paid the slightest bit of attention to the conservative party modus operandi.

GP Practice Manager here for 8 years. The Gp partners and I work full time. Everyone else is part time. All GPs work an average of 12hrs a day, part time or not. We had our main doors closed for one month in April 2020 but patients that needed to be seen came through a side door. We adopted a telephone triage system in 2018 so when Covid hit both patients and staff knew what to do to. Everyday we start a fresh. Patients are called back within 1 hour and seen in the same morning/afternoon. We work very hard, enjoy a great reputation, provide a superb service and are lucky to be fully staffed. But we are not the norm. And we are a small Practice, so continuity of care of outstanding. Bigger Practices are like conveyor belts. We have F2s,medical students and gp registrars. Their workload is much lighter than a qualified GP. AMA

Patients are called back within 1 hour and seen in the same morning/afternoon

That sounds great. We don't get called back within an hour, it can be any time up to 5pm and we're told to come in the following day (if we're lucky) along the whole thing a ridiculous waiting for the GP to ring game. As I said earlier if you wfh it's just about doable but a nightmare if you're working outside the home.

I don't think GPs are retiring in pensions of £1700 per year.

They are not. It’s either been presented badly or disingenuously.

Somebody in the NHS pension scheme, earning £100k like the example given, contributes 13.5% of their salary pre tax. In exchange they get 1/58 of £100k per year to add to their final defined benefit pension: £1,724.

So after ten years they’d accumulate an index linked annual pension, paid every year on retirement, of £17,240. After 20 years that’s almost £35k per year. Not bad, eh?

The PP suggested that a GP has to contribute 30% of his or her salary to get this but I surmise that she’s talking about GP practice partners paying their own employer contribution in addition to the ‘employee’ contribution. And why shouldn’t they? It’s one of the costs of running a business.

Our GP friend retired and moved to another area. He needed a GP there and is vociferous about their uselessness and laziness.

@Username916

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

No it isn’t. I can’t get an appointment at all. It’s all phone appointments. I have to wait by my phone all morning. It’s ridiculous. If staff can work in hospitals why can’t GPS go back to work?

This has been answered a gazillion times. Most practices are using a hybrid model with some or full initial telephone triage and escalation to f2f when required. This allows us to deal with more problems overall as some things can be handled without F2F. Yes, some people have two contacts with this method but overall we're still dealing with more problems than before. At our practice we have a full complement of staff in the surgery, no-one is working from home unless isolating.

Many hospital OPD appointments are still telephonic - I'm not aware of a single OPD service in our area that is working fully as before (even the breast clinic which is largely F2F is still doing telephone work for some FUs which wasn't the cast previously)

www.pulsetoday.co.uk/news/breaking-news/gps-saw-five-million-more-patients-in-august-compared-with-last-year/#:~:text=If%20Covid%20vaccine%20appointments%20are,to%2023.9%20million%20last%20month.

GP’s are seeing more patients than ever before. Unfortunately it’s supply and demand. There are more patients wanting appointments than there are available.

@Parker231

www.pulsetoday.co.uk/news/breaking-news/gps-saw-five-million-more-patients-in-august-compared-with-last-year/#:~:text=If%20Covid%20vaccine%20appointments%20are,to%2023.9%20million%20last%20month.

GP’s are seeing more patients than ever before. Unfortunately it’s supply and demand. There are more patients wanting appointments than there are available.

A lot of that will be the backlog from when patients were given the "bugger off" message for months on end by some practices.

A lot of that will be the backlog from when patients were given the "bugger off" message for months on end by some practices.

Not here as we never stopped seeing patients and our volumes in 2020-2021 and in year 2021-2021 are both higher than pre-pandemic levels.