Are GPs ever going to get better?

[KassandraOfSparta]

Just phoned my GP to try to get an appointment as I need to see/speak to a doctor. First appointment was a telephone consult in a fortnight.

My issue is indeed something which probably can be dealt with over the phone but if it hadn't been, wait for 2 weeks to speak to someone and then wait again to be seen in person? Is it any wonder people are going to A&E and queuing there instead?

(And before anyone pipes up, yes it is something which needs a GP. I sat through several repeats of the "if you have an issue with your eyes, see the optician. Pharmacists can help with minot ailments" message. Also to preempt the other common question, no online anything, just a webform to fill in for a repeat prescription).

Out of interest, how much is a private consulation with one of those online GP things and a private script? Starting to think things are not evern going to improve.

Not until we get a change of government, this is a political issue.

I don't believe it is just a "throw money at it" issue. Far too simplistic.

Why would things improve?

The NHS is slowly sliding. It is not going to get any better without radical change.

In many areas, there are face to face private GP clinics. There are four within an hour's drive of my home. Three charge £100-150 for an appointment, and one offers a membership-based model where you pay several hundred pounds a month but get unlimited appointments. Not sure about online private services though!

Yet some GPs with high patient to doctor ratios are somehow managing to provide a good service. Poor management, greed of partners along with underfunding and dismantling of the NHS are to blame.

That's a lazy and overly simplistic view. Yes, politics contributes but it is abundantly clear that some gp practices are considerably better than others. If some can perform well, why can't others? We need to stop deflecting the attention away from local health teams. They could and should be doing better and need challenging.

Not until NHS funding stops being strangled to the point that delivering reasonable healthcare is impossible, and until the unintended pension annual allowance interaction with the NHS pension is solved which is forcing large numbers of GPs into retirement. Particularly with high inflation this year there are going to be large numbers of GPs and consultants being landed with pension annual allowance bills equating to a majority of their take home pay for purely theoretical pension rises which they may never actually see, given how the final salary section of the scheme works. I know GPS who feel forced to retire when they don't want to because they simply can't afford to pay the annual allowance bills.

Probably not.

There needs to be a HUGE investment into GP services both monetarily and staffing and the fact is there are so few GP trainees coming through the system. Plus, the government have made taking retirement much more attractive recently, because if doctors stay on, they actually get penalised re: tax.

As for private GP appointments are between £65-£110 for a 15-minute slot and you have to pay for all of your scripts (full price). Plus, private doctors cannot issue NHS scripts, so the patient has to pick up the whole cost. The cost will depend on the medication you have. The NHS subsidises the medications you get from NHS GPs so you pay a set amount (?£9.50?) A private provider won't do that.

The other issue is that GPs often won't accept recommendations from private GPs if you need to have repeats etc. Just bare it in mind as it often leads to people not being able to get medications if they want to go back to the NHS.

IMO a HUGE issue is DNA'd appointments. A family member who works in the NHS has 26 HOURS of missed appointments a month (working outpatients where they can't just book someone else in). Charge a fine of £10 and see those rates drop.

This

Should also probably add that we are in Scotland where healthcare has been devolved ever since the Scottish Parliament has been a thing. At least 20 years. Over that time we've had coalitions of various flavours, Labour and SNP. So in my direct experience, this idea that it'd all be marvellous under a Labour/SNP/Green/whatever government is just wrong.

We really need to start talking about European models of funding healthcare.

What do you mean by GP getting better?

I'm sure they're working really hard and doing a great job at it.

If you mean access to a HP. Then that's not really something controlled by the GP themselves and it's only something the government can sort out- I mean they seem to be doing a great job with access to an NHS dentist...

There are less GPs than there were ten years ago, and the average patient consults over twice as often. The amount we get funded for a full year per patient is close to what a private gp charges for one or two appointments.

we are doing our best. GPs are leaving in droves, it’s not going to get better any time soon without some change from govt,

@KassandraOfSparta

We're not though

And being devolved doesn't mean unlimited money.

Its still a set budget. Which isn't enough.

Gps case /work loads are ridiculous.

Yes things could be improved in some practices but overall the lack of money and staff is the problem along with overuse.

If you can afford to go private, go private.

Not only are fewer GPs coming through the system but two thirds of current trainees are planning on working part time when they qualify.

In many practices ‘part time’ is three x 12 hour days ie pretty close to what most would consider full time

This is definitely a "thing". When we moved here 15 years ago, the surgery had 5 GPs, three were full time, two were part time 3 days a week each.

Now there are 6 GPs, but they all do part time.

Our local GP has been amazing all the way through the pandemic and beyond. Nothing is too much bother. Prescriptions usually done same-day, can be done within a few hours if it's an emergency. Reception can't do enough for you and are kind and compassionate. Can either book a prebooked appointment a week or two away or ring for one on the day. It saddens me to see posts saying about how their local GP is crap as it certainly isn't the case across the board, so if some surgeries can do a good job why can't others?

A full-time GP role is unsustainable for anyone who wants some kind of life outside of work.

DH is currently a trainee GP and plans to work part time once qualified. Because part time is full time hours, and full time hours is something like 60-70hr per week. There's no way he could be a remotely involved father/have a life outside of medicine and work as a GP full time. Add to that that the GP salary is healthy enough to facilitate people to work part time and why would they work full time?

Also to clarify - my GP is not crap. When you speak to a GP they are generally briliant.

The issue is the access to them, or lack of access.

I think actually it is primarily a funding issue - lack of appointments is a capacity problem. More money, more GPs, more appointments, better service.

What else is it? GP efficiency? Should appointments be shorter? Should GPs need to work longer hours? - I think both of those would compound the issues you cite

If we want more people to become a GP it needs to be a more attractive career, that mostly comes down to funding

We put out an advert for GP no one applied.😑How do we improve??

So instead we employed a paramedic. Who cant do everything a GP can but a small percentage.

Increasing the salary on offer, would not have made the surgery profitable, and you may as well close.

So now because there aren't any GP's, the government are peddling other health care workers.

But when patients ring in, they dont want to talk to the pharmacist/ physio/ mental health worker, problem is too complicated for the Specialist nurse or paramedic. But there aren't any GP's applying for the jobs. Go figure.

Surgeries will have vastly differing demand depending on the number of people nearby and their demographic. You can't really compare service levels received without understand the demand and the staffing levels.

Clearly some clinics are better run than others, but the main gripe people have is about ability to secure an appointment

Sorry, my last sentence was meant to be genuine, not a dig at surgeries that aren't providing an adequate level of care. I wish for everyone that they had access to a surgery like ours.

After over 20 years as a GP, DH handed back his practice at the end of last year. The practice has closed as no other GP’s wanted to take it on. Why would any trainee doctor want to then train as a GP - horrendous hours, little appreciation and a government which couldn’t care less.

Ah apologies, I misread the tone there. I too wish the very same!