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.

And this huge element of entitlement is a massive part of the problem

People are not entitled, they pay for the service via their taxes and they expect to receive healthcare in return. We've always had waiting lists etc but you were able to see a GP within a day or so, or make an appointment within a week or two for non-urgent things.

And because it's so poor, you even have to wait when you go privately these days because more and more people are paying to see a consultant or pay for an expensive operations.

There are other problems, such as following out of date protocols and making people sicker, so when they eventually do get treated they don't recover as well. As an example, make someone wait for a knee replacement until they can hardly walk. So they are less fit when they have the op and recover less well. What's the point. Have it privately, even with a bit of a delay, and the recovery is way better because the person could have it before they were in agony and were still fairly mobile and therefore fitter.

I'm also sure the gp surgery could make other arrangements (f2f, phone at a specific time etc) if the situation was explained

Ha ha the naivete. Yes, some probably do. Others don't give a monkeys.

@gatehouseoffleet

People absolutely are entitled about their use of the nhs.

If you dont realise that then I can only presume you have no experience of the reality

People aren't 'made' to wait.

The resources are finite. And are restricted by things outside of nhs control (pandemic/brexit/war/govt)

There are soooooo many examples of completely unreasonable expectations from the general public on what the nhs can provide with the staff and funding it currently receives. And thats before you acknowledge the poor general health and aged population

What a terrifying concept you describe. Good healthcare is holistic

Of course it is, and that's why it needs to be funded by insurance. The NHS can't (or won't) do it. It fixes serious problems - often too late. I don't know where you got the idea from my post that it would be terrifying - it was completely the opposite!

The NHS would provide free care for things like accidents, heart attacks and cancer.

But if you wanted IVF or a knee replacement or something else that wasn't life-threatening, you'd claim on your insurance. Just like people do in continental Europe and therefore get better treatment more quickly.

The NHS cannot afford to give holistic care. Most people can't afford private healthcare, so you need compulsory insurance. But you also need a state run accident and emergency service.

@gatehouseoffleet

Yes.

Some gps are utter shit. Some don't care. But not all.

@gatehouseoffleet

So only the wealthy would get knee replacement or ivf?

Everyone else would just be kept alive if possible?

Great plan.

People aren't 'made' to wait

yes they are. By the fact that they cannot see a GP. By the fact that once they see one, they are fobbed off. By the fact that GP practices won't make simple changes to their procedures that would make their services more accessible, eg refusing to take repeat prescriptions over the phone, or only taking them over the phone. There is no notion of customer service because they think everyone is getting it for free.

I am sure there are idiots out there who abuse the system. But the NHS approach is to assume everyone is abusing the system until proven otherwise and that has to stop.

Also the system is poorly run and lacks common sense procedures eg being able to make and cancel appointments online.

I think you are wilfully misunderstanding my posts.

In other countries everyone has insurance, not just the wealthy.

But we don't here.

People are used to free at point of use.

Where they are told by the govt that they should get exactly what they want as soon as they want it. And should decry how terrible and awful their free at point of use care is if it they don't have every whim attended to.

So in order to change to an insurance system you'd have to convince everyone to pay it. I can guarantee lots wouldn't. Either because they genuinely can't afford it or because they won't think they should have to.

Your experience of gps isn't mine. Or even the majority I think.

Non standardisation of service is a huge issue, I agree.

I find it really hard, putting in a 50 hour week at a school and taking work home with me at weekends, to feel sorry for people working a 40 hour week taking telephone consultations.

The job is demanding. Why do people sign up for it if they don’t want to do it?

I'm sat here with my phone - being told I'm currently no. 3 in the queue... I've been number 3 for the past 47 minutes....I have a query about a batch prescription which has been stopped for no given reason and I presume I still need it. I can't order it online as I usually do -I've tried with this particular item before and it was ignored.
Prior to that I spent 30 minutes ringing the Chemist to order it, they subsequently voice mailed me to advise they couldn't fill it and to contact them. I rang them again - twenty minutes later they answered the phone and advised me to ring the surgery and here I am, number 1 now.....sigh

We can all show off about being martyrs. When I was training (which took nearly 10 years as I am jointly qualified), I worked 108 hours per week, one week in three, and 70-80 hours per week in the intervening weeks. Overtime was compulsory and paid at one third of normal time (you read that right - not a time and a third), so I averaged less per hour than the cleaners. I was frequently the most senior doctor in the hospital overnight at the age of 28.

GPs of my generation are socialised to work incredibly long hours, and to take on ever increasing burdens. That's why we have 4 times the suicide rate of the general population, and the 2nd highest rate of alcoholism of any profession. Many of my contemporaries are utterly burnt out. Two of my close colleagues have died by suicide in the last year alone.

The younger generation are seeing what has happened to us and rejecting it. I don't blame them, but it is irrelevant whether you agree with them or not. They have a choice. There is huge demand for UK GPs from Australia and NZ, plus any GP in the UK can become a locum, and earn much more for none of the responsibility of running a practice.

People demanding that GPs work 5 days a week (which equals at least 60 hours) never explain how they would recruit the GPs to do so, when every one of those doctors has better options.

I'm just training to work in a GP practice at the moment as one of the ACPs (not a doctor, targeted to manage the more acute 'simple' problems to let the GPs focus on the complex. So have some experience on both sides of this.

Obviously the difficulties around primary care are complex and no easy solution. But a big issue currently that's being discussed is that approximately 40% of consultations are for not GP related problems /very simple minor ailments that in previous years no one would have contemplated seeing a GP for fill our days 'slight tickle in throat 1 day history feels otherwise fine, and "my child had a fever yesterday but now seems well, could you check her over"', another parent had demanded an emergency call back regards their child and when I asked how they were this afternoon they were at school! So clearly not an emergency.... These are just examples just from today!

My surgery trailed easy access book online via the website appointments but had to shut it down because it was even more overwhelmed with mad requests for things that just didn't need to be seen, with many of these not even showing up to the appointment when booking was easy.

The upshot of this is that the solution will probably not come from more Doctors/or more not-doctors, because it would never be enough for demand. At work no one really has a solution to this, just to continue trying to do the best for the patients you see. Personally I think people's fears will be confirmed and paying for access will become more the norm,

I was waiting for this poorly thought out idea to come up.....

1. If as an employer, the only way you can get people to work for you is by indentured service, then you have to look very hard at how good (bad!) an employer you are
2. As a junior doctor I worked hundreds, if not thousands of hours of unpaid overtime. Force me to be indentured to the NHS and I'll be leaving bang on time or charging for that time, and I'd be charging at a sensible professional rate, not the £15 an hour or whatever it is that juniors work for
3. This would be extremely difficult to actually enforce
4. Applications for medical school would plummet
5. It would be illegal and discriminatory to refuse part-time working

25 years ago I was refused annual leave for my own wedding, despite giving the hospital a full year's notice. Things have not got any better for junior doctors. If the NHS treated doctors as human beings and paid them fairly, there wouldn't be a workforce issue.

@InstantMagic

I'm sure the gps could cope of they also had 13 weeks holiday a year.

It's not that easy as you don't know how long each call will take, and my list of calls is constantly being interrupted by things going on in the surgery, but each day I have a few calls with a note that says something like 'is a teacher, please call between 10.15 and 10.35 or 12.30 - 1.30' or 'will be on underground from 8 - 9, please call before 8 or after 9' and I honour those.

We started full telephone triage over 10 years ago. We had to, because the number of inappropriate appointments, and people who didn't turn up, was ludicrous when we allowed booking via reception.

@MissLucyEyelesbarrow for PPs benefit, would 5 days be 60 hours for a partner? Even for a salaried, would this cover all the admin which is misleadingly called admin if it requires clinical judgment and accountability? Realistically, how many hours will one of the three or four days a week PT GPs that patients complain about work?

For PPs, if being a GP is such a golden goose then why are practices handing their entire contracts back and disbanding, unheard of by me for most of my career. Why are early/mid-career leaving the profession entirely to earn more for fewer hours and less risk and less stress, again unheard of by me for most of my career?

IMO, there is no political trajectory to one of those lovely Western European cooperative/third sector/insurance-based and better funded systems whose providers don't want to expand. The only trajectory once that door is opened is to the US system with corporations wanting to be involved in a commercially different UK system to the extent they are funding MPs and lobbys to the extent of £10s+ of millions and who would offer consultancies and NEDs to the recipients of those donations?

Exactly. Everyone thinks we don't need GPs, they could do a better job, it's a cushy well paid number. So why are GPs leaving in droves if it's so easy?

Lots of them leaving, patients put off complaints during covid are now having bigger problems, some patients have problems caused by covid, number of patients just increases but number of GPs doesn't, it sounds like many services are rejecting referrals or have long wait lists so patients keep going back to GP. Ours are good at doing same day phone consults but in person is still pretty rare. My colleague was having trouble getting a face to face appointment at their GP though and GP dismissed problem and suggested exercise (they had an injury and could not exercise). They saw a private GP who said it was tendon damage and surgery would be needed! The exercises would have caused more damage.
There is a definitely a GP problem and it's only getting worse. Need more money, more GPs, better access to other services instead of them rejecting referrals

Any practices squared the circle of increased utilities and most input costs, staff facing real-times pay cuts and insufficient revenue increase to be in a position to fully compensate?

real terms...

That is absolutely untrue. I have friends and family in both the USA and Canada - many of the poorest and most vulnerable people have no insurance cover. A closer friend of mine in Ontario is 73 years old and terrified of dying, because employment in the area is poor and seasonal. Her daughter has Crohns and is unemployed for five months of the year. To keep her daughter stable she and her husband pay for her medicine out of their pension when she's not employed because otherwise she wouldnt get it - health insurance is through the employer.

Health inequalities in countries depending on health insurance are well known and publicised. Didn't you get what Obamacare was about?

Yeah. As a society we have plenty of money to wage wars and stage major world events, just not enough to provide people with full time jobs which do not require wages to be topped up.

Where children go to school hungry, it's impossible to get a GP appointment and nurses, yes nurses and health care workers claim benefits.

Tell me it's not political.

@Quveas

The ignorance is astounding

The idea that we can just muster up an insurance based health care system that would deliver dramatically improved care (under the tories no less!) that everyone cam not only afford to pay into but would be willing to?

Because every other country does ot so much better?

Crazy