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.

In my job (not GP, NHS though, I run clinics) I book in 5-6 hour long slots per day and every day have one or two cancelled or non attended appointments. I'd estimate between the cost of my time, the office building, admin support, materials etc. that each appointment costs the NHS £100+. A full course of treatment here is twenty hour-long sessions, which would cost £1600-1800 privately, but people are given it in the NHS. Patients think nothing of just not showing rather than cancelling, not letting us know they don't want to come anymore and instead just not showing, cancelling with two minutes notice with an illness they've had all day, etc.

There are obviously problems on behalf of the NHS and I'm the last person to suggest patients are to blame for all problems but the impact that patients not attending appointments has on the NHS must be catastrophic. And unlike GPs, there's not much we can do that's equally productive during that time. You can't just see another person. You're just sat twiddling your thumbs.

@Ishacoco maybe having a window of (say) between 9am and 1pm (as in our practice) doesn't work for them. I guess some are teachers, bus drivers, window cleaners? Again, it's always about the convenience of the GP and never the patient. I have a desk job, but I might have 20 different calls/meetings over that 4 hour window and in many cases it will be impossible to answer.

Fair point.

Honestly... I cant see how. Which is why I am another GP currently trying to find a way out. I am exhausted and utterly, utterly miserable knowing that however hard I work and what ever I do, it will never be enough and I'm fighting a tidal wave of need on one side while looking over a precipice into a chasm where services used to be on the other....

Not sure whether you are mistaken or just lying @Aiionwatha but this chart clarifies: www.statista.com/statistics/428295/health-expenditure-per-capita-in-selected-oecd-countries/ that we don't spend the most per capita.

You have to also look at all the peripheral cuts the twats Tories have made e.g. cuts to Surestart, youth services, drugs services, pregnancy prevention, smoking prevention, social care blah blah blah.

Plus we have a poor population now, our population is poorer since 2010 in comparison to many European countries which leads to more health problems.

How would this 'european' style health service fund elderly care?

sorry to hear this.

Don't know what to say as I want to say 'please don't go' but also why should A.N.Individual carry the burden if society won't listen to what is needed?

Thanks for your work to date whatever you decide!

Isn’t it the case though that if all GPs worked full time, then a ‘full time’ GP week wouldn’t be 60-70 hours a week as there would be more GPs on shift to help take care of the load? That must be partly true?

There's a shortage of GPs.

I'm sorry to hear about your illness xx

@Deguster

How do managing competing clients time?

Here's some information for you about the problems that predated covid
www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis

I'm at the point where I'd consider paying privately for the appointments I need. I have MS but the care is shite.

We don't have a neurologist either as the ONE (we only had one!) we had moved away and the Hospital is struggling to recruit. I have an appointment in October, only 42 weeks late and the neurologist is from 250 miles away!

The original neurologist was part time (2.5 days a week). His secretary only works on Wednesdays, so one day a week and then if you call her she says she's too busy to talk.

Well no shit sherlock, you're always playing catch up. 🙄

I wonder if they wanted to push us to the point where we'd have to consider private?

Sigh. Sorry I'm all ranty. I feel horribly unwell and my whole body hurts and I can't walk. MS is shit

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?
if it’s something urgent or that you say needs seeing they’ll fit you in at ours but yes, otherwise it can be up to a month!! We go to our gp practice because the main guy is a skin specialist and we’ve 2 with horrendous excema but last time was a 3 month wait so we may as well change (but wouldn’t because it’s so hard to get into any others)

(Sorry I meant to say the neurologist is visiting from 250 miles away)

These threads are always interesting as no one really understands how the system works.

3 days a week is not part time hours it’s a lot of hours condensed into 3 days!

The NHS is entirely set up as primary care ‘front door’, so you need it to get any referral for almost anything specialist with very few exceptions. Yet even when they triage it on to specialist secondary care (having jumped hoops of forms, tests and first-third line treatments first), often the patients have unbelievable waiting times or hoop jumping (2WW all in one clinics like breast clinics aside) and the GP has to hold that patient (in pain, suffering) until they are seen and treated. This doesn’t allow for more patients to pass through the front door, it’s less. Think of it like a blocked pipe with a wide end at the top (GP) and all the patients bunched up at the small hole (secondary care) trying to get through together, very slowly moving through the pipe section, drip by drip.

Sigh. Sorry I'm all ranty. I feel horribly unwell and my whole body hurts and I can't walk. MS is shit
Sorry to hear that, hope it eases up a bit🌸

FWIW I have just had a private prescription of 2x meds. 21 tablets of one antibiotic and 42 of another and it came to £7.54 in total.

The cost of a private script depends entirely on the meds issued. Asda pharmacy tends to be cheaper than Boots.

The drop from 0.52 GPs per 1000 patients in 2015 to 0.45 GPs per 1000 patients by 2022 is surely very significant - that is quite a percentage drop. Almost all of the drop pre-dates COVID (it was 0.46 by Mar 2020 first lockdown).

This.

60-70 hour weeks are typical in other similarly paying professions.

Yep. Me too. Updated my CV yesterday. I'm done. BMA says 28 patient contacts a day is safe. We are doing upwards of 80. Whose responsibility is that when I inevitably make a mistake? It is literally an impossible job. And it's a bloody shame because I genuinely feel I'm really good at it. I am incredibly efficient. But I can't go on with it anymore- it's too much to work hard and well and effectively and still be told we are failing. Again and again and again.

The sort of healthcare where everyone just books in to see a specialist just doesnt exist here.

There isnt the capacity

There aren't hundreds of internal medical specialists sitting around twiddling their thumbs, who could then review patients and tell them who they need to refer themself to. I mean that's pretty much what a GP does with the gate keeping role.

In fact the hospital Consultants are intentionally specialising into specific specialities. The General Physician just doesnt really exist any more.

And again there aren't hundreds of spare cardiology appointments, orGastroenterologist appointments.

I mean why are people that we refer having to wait up to 18 months to see a Neurologist? That's when we have sorted out the easier presentations, and only the more complicated things are referred. How long would the wait be if everyone with a headache referred themself to a Neurologist?

Until Secondary Care is overhauled-the kind of care seen on the Continent where people self refer to a Specialist just isnt feasible here.

Theres a saying,

healthcare can either be,
quick and inexpensive or
Quick and good quality or
Good quality and inexpensive.

But it cant be quick, inexpensive and good quality all at the same time, which is what people want.

Maybe the fact there is a wider problem of people being asked to work too many hours needs addressing too.

Being a GP is very emotionally demanding. It is draining as every consultation is important, there are few waffley meetings where you can look out of the window while pretending to listen to the presentation.

Reality is that a GP used to be a well-paid manageable job. Now it is a well-paid unmanageable job.

for you too.

Thank you for all your work to date and sorry the system has done this to you.

Here we have one MRI machine. The NHS waiting list for that MRI is months and months and yet I managed to book a private scan on it within 7 days of calling because there was an empty payable slot.

If its free then it's free. Get patients in there ffs.

And yet they don't, the NHS backlog just gets longer and longer and longer..... until someone goes "fuck this, I'll just fucking pay and go into debt for it"

Silly. And says a lot about the people who run practices and hospitals (not front line nurses and Doctors!) but the actual paper pushers behind the scenes working their 1 day and 2 day weeks.