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.

I've got so say, our surgery are fantastic. We have a group of them in the local area. All heavily over subscribed and you get a call back within 48 hours. They have a fantastic system. They're turning them into a superhub in a year or so. We'll see how that goes.

I think there are too many variables to know why people can't get seen quickly. Some will be because of bad management, others lack of staff, others too oversubscribed etc. There are definitely those that exist where you can get seen.

Speaking as the wife of a GP trainee, there are still reasons why doctors go into the specialty!

The pay is good
The hours may be ridiculous, but they're at least usually regular. Most of the time you have evenings and weekends off. You can afford to work part time which is then manageable (part time means full time hours really)
Enjoying the work, it's stimulating to see a wide range of conditions and get to know regular patients who come back so you can see their progress, you can do a lot of good very immediately

Hospital medicine isn't a walk in the park either, some specialties can be extremely competitive, ridiculous hours, unsociable and unpredictable hours.

Hasn't it been practice for a long time though to call first thing for a same day appointment, if it's not urgent then you'll normally be waiting a couple of weeks for a routine appointment. 15-20 years is how long my surgery had operated like this, I'm a bit surprised at the uproar. DH surgery don't even offer advance appointments, you call first thing for an appointment even for non urgent things such as asking for a referral for a vasectomy.
If you can't wait two weeks then call back at 8am tomorrow for an appointment.

I'm not sure why it is oversimplified to state that GPs need more government funding / better government management but not oversimplified to state that the reason some practices seem to be doing better is just down to better GPs / less greedy partners? If people can't get appointments it is probably because the appointments don't exist - either because there are not enough GPs or too many patients needing to be seen. I really don't believe that there are greedy partners sitting back and popping their feet up whilst their population suffers. Differences in the quality of services provided by practices are far more likely to be to do with the patient demographics of the practice and the availability of GPs. And the GPs in the practices with more deprived/complex patients are probably more likely to need to go part-time (and GP part-time hours often equate to a 37.5-hour week anyway!)

Having said that, I empathise fully with your frustration. Everybody should be able to get timely access to primary care.

DOI: junior doctor who originally planned to go into GP. I have not gone into GP - very few of my cohort have.

It's NOTHING to do with funding. We pump more money into our health service than most western countries, and yet we have the worst performing health service in the developed world.

I wonder why some practices are managing really well and others not. We're fortunate that ours have coped well even though it is a busy practice

As long as the appointment request is completed first thing in morning (as it closes once capacity reached) can get an appointment the same day. Triaged by staff and will do telephone if suitable or if not the receptionist phones and makes a face to face appointment same day.

I completed the form today at 8am and was in surgery for 1015am. GP then arranged referral for scan and review appointment for in two weeks.

Nurse appointments can be booked in advance by phoning up.

It's a system that seems to work well. Or at least it does for me and I seem to have needed quite a lot of GP appointments this last couple of years. Im falling apart!

Because part time is full time hours, and full time hours is something like 60-70hr per week

Most people on 6 figure salaries work long hours though. In the private sector, the option of working PT for 4/5 salary or whatever barely exists, because demand cannot be met in that time. But this is the NHS and it is - and always will be - run for the benefit of its employees and contractors, and patients are just an inconvenience.

I no longer see the point of GP's. They have no diagnostic equipment, limited access to tests, get their referrals knocked back or overruled by algorithms, and are paid casino money to make educated guesses about what tf is wrong with people every 10 minutes. I could not do the job, but nor do I think the service they (largely fail to) provide is remotely fit for purpose.

At least they will all no longer use Oxford commas

Yep, all of the above is the same for hospital consultants too. Lots of DH’s colleagues are being forced into early retirement as continuing to work will see the hammered by enormous tax bills. It’s insane!

@Aiionwatha

That is blatantly untrue

Good luck without us. If there was no primary care gatekeeping, the rest of the NHS would collapse fairly swiftly. Out of interest, if you were a young woman with abdominal/pelvic pain, who would you go and see if not a GP? A surgeon? A gastroenterologist? A gynaecologist? A urologist?

That is also a lazy and overly simplistic view. There is a shortage of GP's. Number have dropped significantly since 2015, and there has been an increase in part-time rather than full-time GP's over the period. This means that we are short an estimated 4000+ full time equivalent GP's and that figure is projected to rise by more than double by the end of the decade.

www.health.org.uk/news-and-comment/news/a-quarter-of-gp-and-general-practice-nursing-posts-could-be-vacant-in-10-years
www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis

What that means is that if we started training new GP's today we can't change any of that - it takes a 5-year degree in medicine, a 2-year foundation course of general training and a 3-year specialist training course in general practice. And because we can't fill vacancies fast enough the level of GP burnout will increase the shortfall yet more.

The government promised to address this known issue long before the pandemic by recruiting 6,000 additional people - they haven't delivered on that. So yes, it's a political issue. It's also a ticking time-bomb. Perhaps you could outline what "local health teams" could do to address the fact that there aren't enough GP's, they are dropping like flies as well, and we aren't training enough to even replace the leavers never mind the existing shortage?

Unfortunately the NHS can't magic up more GPs out of thin air, so if they somehow tried to strongarm GPs into working 'full time' they simply wouldn't. GPs tend to be educated people with options. They will jump ship. Not to mention that absolutely nobody should be forced to work 70hr weeks for a 'full time' salary. It's not a race to the bottom. People in other sectors that receive pay for full time hours but work full time and a half or two full time jobs need to advocate for themselves too. I think we need to be careful about saying 'it's shit for other people so it should be shit for GPs too', frankly. Nobody wins glamorising excessive hours other than companies. You only have to read about sectors where suicide due to overwork is rife. You don't get a medal for sacrificing the rest of your life to purely work as a GP, and for those who've found a way to work and serve patients and also have a life outside of work then good for them.

Salaried GPs aren't on six figures either. 71,727 is the average salaried GP wage in 2022. Partners are on six figures, while at that stage a bulk of their working week is spent managing the practice rather than on patient care.

All of the GP's in our practice work part-time. But that doesn't mean they do full time hours as part-timers. They are mostly women, and they each do one day a week, so they are, truly part-time. Many of them do private work on their "days off", so obviously not overworked. Don't get me wrong, they are actually a good practice, and when you need to be seen, you are, however, I don't see that any of them are having a terrible work/life balance.

What the government could do tomorrow would be change the tax status of the NHS pension. I know GPs who have had the same income for a decade and are suddenly getting five figure tax bills that they didn't have before. They are leaving in droves.

No longer see the point of GPs? What % of patient interactions do you think are successfully resolved by these pointless UK (I know other health care systems are run differently) gatekeepers of primary care without need for further diagnosis and interventions by acute? You must know to have decided that free access to specialists for often undifferentiated conditions would improve things?

I still don't understand why it all happened so sudden. Pre covid everything was relatively ok, you could see a doctor within an acceptable time. Then covid hit, and you couldn't see a doctor, and now it's the norm. Why couldn't it go back to how it was before covid.

@passport123 Yes it would collapse, but that's because it's the NHS and it has spent its entire existence either collapsing or on the brink thereof. The fact that the NHS is hopelessly inefficient and has to manage demand by overpaying primary care clinicians to act as a human shield to proper healthcare is no reason to maintain the current shitshow.

I have lived in 3 countries without an equivalent GP service and they coped marvellously, much better than the NHS in fact. Most recently, if I was unsure of the source of my pain I would see an internal medicine specialist or a family doctor (at my election) and they would carry out initial tests, typically on the spot at the clinic.

Interestingly, I did go to the GP in the UK as a young woman with abdominal pain. I saw 5 different GP's over 30 appointments, none of whom diagnosed me with anything more serious than dysmenorrhea (and, inexplicably, depression) and were so arrogant that they didn't think I needed a referral to a grown-up either. What I actually had was advanced bowel cancer. That was an expensive year for their insurers.

Good for them. They've put in the hours and training and found a way to have a career that supports them while also enjoying their lives. That's awesome.

I work for the NHS and wouldn't personally ever do private work as I fundamentally disagree with it. I don't have any issues with others doing it, but I want to use my skills and time for the public good rather than offering them on such a selective basis only to those who are privileged enough to be able to afford it. But totally accept that's my own view and others feel differently. It's nice to hear of at least some doctors with a good work/life balance.

Agree with this too. Pre-Covid we could get a physical appointment within 2-3 days. Now it's 2 weeks, on the phone.

Ah, your comments make perfect sense knowing what you went through having cancer missed over and over again. I'm really sorry that happened to you. It shouldn't have, mistakes are sadly sometimes made and I hope you were able to complain so that things could change in the future for someone else. I hope your health is okay now.

Because the covid only focus had consequences we're now having to pay for?

Shutting everything down was a disaster and has had huge impacts on healthcare globally. Not just in the uk

My DP is a GP and he spends much of his day trying multiple times to get hold of patients for their phone appt. There are so many people who just don't bother answering, it's crazy.

If it wasn't fine before covid, it never will. Ours is relatively back to normal. My husband had same day appointment and tests.

COVID is the government's cop out excuse for everything but the truth is we have serious issues with GPs that pre-date COVID and are a direct result of government choices. Brexit doesn't fucking help for a start.