To ask if GPs are leaving NHS and why?

[CloudyYellow]

Seems like numbers are going down and it sounds like the job is unsustainable.

The jist I got from a GP secretary is that there are more working part time now for a work life balance. Practice managers are working hard to keep them by protecting the hours they work.
The government could help by making medical degrees free - as it’s impossible to retrain.

Many GP’s work for private companies who are commissioned/paid to do the job.
Its a high pressure job and they regularly get slagged off on places like MN, so I don’t blame them.

There are too few medical school places, demand is already very high and most applicants are rejected. That's the real problem. We've not trained enough for decades.

I’m not a GP, but work alongside them in a similar role. I’m at a point of burnout, the workload and expectations are unsustainable. I frequently work around 30-40%+ unpaid overtime to ensure all the paperwork eg referrals are completed in a timely manner. On top of this I am continually doing CPD in my on time to ensure I can offer the best care. I struggle to switch off and every day I go home and constantly worry certain patients. I’m already less than FT (have 2 very young children) but now considering reducing my hours right down whilst considering other career options.

The hours and stress isn't sustainable.

Plus conditions and pay are much better abroad, so unsurprisingly many leave to work abroad.

In order to retain medical graduates the UK needs to pay better. I am a doctor and a significant proportion of those I graduated are abroad and have no plans to return.

I agree with this.

In other countries they train far more doctors, especially in communist and ex communist countries. It's not treated as an 'elite' profession. It is treated as a highly valued and extremely skilled profession but just a job.

Too much weight is heaped onto doctors. Having lots more would help.

Of course the real elephant in the room is the aging and sick population with no proper care strategy. That is essentially collapsing the health service.

Well Medical school places have actually increased in recent years but it’s the shit working conditions that drive doctors away. A significant number of graduates never start, and yet more leave during and after foundation training to other careers or other countries. An additional factor now is the pensions issue whereby senior doctors are having to reduce working hours to avoid huge tax charges.

The job is very busy and intense. A 'normal' day extends beyond the hours your surgery is open for with lots of admin (letters and test results to look at, targets etc) such that more and more GPs don't work 'full time' (ie not 5 days a week), because the days they do work are stressful enough it's not sustainable. This in turn has an effect on the number of appointments available etc.

The average spend per person for primary care in the UK will be somewhere around £180 ish pounds per person per year, maybe a bit less, maybe a bit more, I haven't checked in a while.

That means a GP practice is running it's whole operation on less than the cost of a fairly cheap phone contact per person. I'm not surprised it's stressful and I'm not surprised they're leaving or cutting down to part time hours.

My cousins wide loved being a GP, she just didn’t love ten minute appointment slots and 12 hour days. She moved abroad, she now gets appropriate length appointments, only sees her patients (so actually can get to know them), doesn’t work 12 hour days. One big difference is that when she refers patients on to another service they aren’t waiting months, where as under the NHS she was having to constantly turn down patients who she wasn’t able to treat/help as they specialist care they needed had such long waiting times.

It’s also very difficult to return to work as a Dr. I had a break because of children, particularly because two had chronic health issues.
Ive done my GP training, have the MRCGP, but was told I have to work for three years again in hospital- if I want to be a GP.

Absolutely no way. I did all that when I was young, and I’m not doing it again.

Why an already trained Dr cannot be retrained to take on a specific role to support other Drs is beyond me.

Ive had to have GP appointments myself recently. I haven’t seen a Dr, it’s been a Nurse Practitioner and a Paramedic Practitioner. They were both good, and I’m sure highly trained. But there seems to be a trend to have lots of people be like Drs, but not actually be Drs.

Why? It takes Nurses and Paramedics away from their own roles - already short staffed..

It must be about money.

I would also add in that as well as doing all the things mentioned above, GPs are also expected to sit on planning & commissioning meetings around service delivery. I sit on local ageing well boards & attendant sub groups - all of them have 2 or 3 GPs on them usually cranking it in between morning & afternoon surgery

Cramming

On radio 5 a doctor was very critical of the latest budget realising any additional hours/weekend work salary would be taken by the taxman. He referred to salaries of £125k plus.

Being a doctor is highly specialised and is an extremely tough gig. However when a nurse earns about 1/3 of this it seems a disparity and I would imaging lots of doctors leave as it's very stressful, leaves little work life balance and the salary affords them an early retirement.

Yes yes yes. It's about the money and saving the government money.

The band 4 roles should never have been invented it's a waste of resources. They are far too many fancy job titles and nobody knows what each job entails because all these uniforms look the same.

Burnout.
I'm in a clinical role - not GP - but imagine some pressures are similar - increasing workload, pressure both from top and from the public, ongoing 'do more with less', increasing risk and complexity, unflexible systems and time consuming admin. Hardly anyone I know works full time, as this is just not possible to maintain, esp. if you have a family.

General practice is hideous atm. Our clinics are rammed for weeks ahead, and yes, mostly with older people with chronic conditions and complications on a multitude of meds living longer and longer.
I'm a practice nurse - two of our nurses are retiring early in Feb, another is 60 and I'm out in four years. We had one applicant when we last recruited. Another staffing time bomb.

The part time GPs can be a bit of a red herring
A part time GP is often working up to 39hrs a week, FT is up to 59 hrs.
However the gov.uk definition of FT is anything over 35hrs a week.

The lack of medical student places is compounded by the need to train for a portion of their career in work but their is lack of senior doctors to train/ supervise them due to being overworked / shortages.

Drs are retiring, some earlier due to stress, burnout and just being sick of the working conditions. We lost a chunk of drs due to Brexit, European drs feeling less welcome and now the job is less attractive than it used to be. .
It's not just GPs but that's where people are noticing it most.

My former husband was a GP who stopped one year ago (personal stuff I won’t get into now). 30+ years a GP. Most of his 12 hour days were spent doing admin work (dealing with rejected after rejected referral letter because the meticulous to the point of absurd box ticking exercise went wrong), or in time-wasting meetings about how much money they would flush down the toilet for yet another NHS initiative that would fail like all the others, or chasing targets in order to outrun CQC inspectors breathing down their necks. You’d almost forget there were patients to treat!
I pay privately myself. I can’t afford it but I do it because I get results. I’d never go back to my NHS surgery. Can’t even book a phone consultation let alone see a doctor. Oh but I can see my GP for Botox injections.

I left medicine 4 years after graduating. I couldn't bare further training in any area but GP was right down the bottom of my list.
The risk, the unachievable workload and public disdain are just 3 reasons why I couldn't ever do it. I take my hat off to colleagues who can and do.
All this 'why are they all part time' bollocks when often a working day is 8am-8.30PM realistically, of course they're not going to do 5 days a week! Nurses work those hours and no-one berates them for 'only' working 3-4 days a week!

This is not to say that I think general practice is a perfect service. As a user of the service I share the frustrations that others have. But not enough to continue my training and put myself through that hell.

@RedRosesPinkLilies are you sure of your facts? If you were a qualified GP you would need to go through the induction and refresher scheme - the length of which can be as short as three months depending on your needs

Having been married to a GP I'm confused by your disdain- it's not an individual GPs fault if the booking at their practice is fucked, and they are entirely entitled to work elsewhere privately on their days off.

@Neanov the NHS needs to save money tho we as a country can't afford it! I love the PA at our surgery, you can get an appointment usually same day, in and out within 5/10minutes as she usually running to time and she can actually work the video consult tool properly. Yes for more serious issues you need a GP to refer to secondary care but for the mundane issues our PA is great. I think the NHS could save a fortune having them based in pharmacy style walk in services. I also wonder if dropping the honour Dr tittle from medics might help people being more accepting of paramedics, nurses, PA etc providing primary care.

Reasons for leaving the NHS or doing less NHS hours
*They negotiated a good pay deal (better for agenda for change)
*Burn out
*Unpaid but expected overtime
*Real terms pay cut
*Unreasonable targets
*Changing population/attitudes to GP services
*Delays in secondary care
*Growing chronic disease burden and the effects that has on acute care

I'm a scientist in secondary care we are at the stage financially (I'm only 32, was a young man) and career wise I could go back to uni to do a MBBS? but actually despite it being something I wanted to do when younger with the current state of the NHS it's not something I can see myself doing (need to make a final decision on that one in the next few months). I don't want to work 50hr weeks, get abused by patient rightly frustrated with the standards and not be able to care for acute patients because of the demands placed on the NHS by social care issues.

There’s certainly loads (most?) working 2 or 3 days a week.

The issue is not with completing the university element of the degree, but in having enough training places in medical settings, no point training tonnes of people if they can't complete the training. It's like many student nurses have had placements cancelled as there aren't enough placements spots and mentors for them- and we have a chronic shortage so the cycle continues.

People leave the land of GP because its shite. Long, long hours, pay isn't as good as it is elsewhere, and you get abuse from people who read the DM and assume you're lazy and don't do anything. There has been a shortage for a while but its definitely getting worse.