To ask if GPs are leaving NHS and why?

[CloudyYellow]

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

Work load, stupid hours, being expected to work evenings and weekends.

Cost of premises, poor availability of skilled locums.

I'm a GP partner and it is burnout that has almost finished me off. I love my job, love the patients and am invested in making sure the practice functions as well as it can. I am officially 'part time' and also do half a day a week in an essential NHS role as local primary care network population health lead. My usual 'part time' hours are about 45hrs a week.
For three months recently we had three out of five partners off sick and I was doing more than 60hrs a week. Logging in at home past midnight to try to finish scripts and lab results etc as there was nobody else to share the load. We had a locum for two days helping with patient facing work and I don't know what we'd have done without her.
I have plenty of money, we need to be able to employ more staff or encourage more doctors to be partners. It's not the money, it's the working conditions. I can't continue until retirement age like this, my mental health has and will continue to suffer. I am also a single parent and thank god they are teens and mainly self sufficient. Sometimes I do not know how I manage to get through the day.

What do people in the field think about increasing nurse specialist roles in primary care? You get plenty of hospital nurses specialising in say in women's health, cancer etc. I think the paramedic roles can be an awkward substitute in lots of instances and there is a few of those locally.

Thing is you might prefer to see a GP but sometimes it's just not necessary. I'm mid 40s so I grew up at a time where you would see the Dr for everything. I think we really need to adjust our expectations and trust that other medically or clinically trained people can more than meet our needs and let the GPs concentrate on the more complex patients.

Three 14 hour days is still a 42 hour week plus you will probably find they are doing other non patient facing stuff on the other two days

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
^this😕
I completely understand that GPS need a proper work life balance but my work life balance feels precarious now that there isn't a healthcare system that we can rely on 😫
Maybe that's the only way that we will take proper care of our own health..... if there's no safety net whatsoever? 😬😱

"What do people in the field think about increasing nurse specialist roles in primary care?"

Where are these nurses supposed to come from? The NHS is already short of thousands of nurses.

Next issue brewing in the background - 140,000 NHS nurses and nursing associates are over the age of 50 (half of these are over 60) and will retire in the next few years - something that Hunt failed to address when he was Health Secretary and for which there is no coherent mitigation plan. Even if there are now more nurses in training, the attrition rate is high and the number of new nurses is barely sufficient to keep pace with the number retiring.

The issue is that the role of a PA and their limitations and responsibilities isn't clearly defined. Many are given responsibility above their training and capabilities. Nurses no issue at all with, there are clear boundaries and actually recieve more training, more placements and so even a NQN in a practice nurse role will be better qualified to see patients imo. PAs would work well as actually physician assistants, but that's not how they're being used, they're being used to plug gaps and scope is ever creeping as they want more opportunities to develop.

Pay -erosion

pension and tax situation

workload-10 mins per patient

politicians bashing them

newspapers bashing them

public bashing them like a few ignorants on this thread saying they ‘only work 3 days a week’ when the hours worked are that of a full time job. It’s like they are so dumb they can’t do basic math. Oh wait…

Actually a lot of nurses earn a lot, but that isn't publicised.

@Guitarbar I am not familiar with the PA role. I worked in the NHS but 20 years ago when I was managing the expansion of nurse roles in women's health which worked brilliantly. I think expansion works with any role from HCA upwards as long as it's done in defined and regulated way which you say is lacking. Why are these roles so ill defined? Is it a commissioning issue?

DH, aged 50 has given up being a GP after 20 years. Covid and the constant criticism in the media and by some of the public was the last straw. He saw patients daily throughout lockdown, never less than 60 hour weeks and people still complain. Going forward due to there being more patients but less GP’s, everyone is going to have to change their expectations as to how quickly you can get an appointment. Perhaps an urgent appointment within a week and within a month for non urgent?

1. the hours are too long. I work “part time” which I feel lambasted in the press for. I work around 45 hours a week
2. when my colleague is off, no one comes to cover so I work 50+ hours that week
3. people think there is an answer/solution for every ailment, that they should have access to and can be found quickly - not realising

• there might not be, there may be no explanation or may be no solution other than coping with it
• they might not have access to the solution
• the solution is within their control eg lifestyle but they want me to “do it”
• things can take time to be clear

so I am constantly trying to adjust expectations. 4) it’s hard every day to know you have spent 12 hours trying to help people and all the people you couldn’t get to (as demand way outstrips supply) are so dissatisfied 5) I used to work in A&E and orthopaedics and think about returning when I see people complaining about such trivial issues. They have no awareness how inappropriate it is to bring these to a GP when the health service is so strained. At least in other specialties some of that is “sieved” 6) many of the problems are just “shit life syndrome” 7) it is stressful managing staff with year on year cuts to practice income and increased bills. Receptionists suffer abuse. Being understaffed puts a strain on all 8) things are going to get worse 9) if my GP colleague dropped dead/ too sick to work. I would not be sure I could recruit. I estimate it would be about 1-2 months of 50-60 hour weeks before I would have a breakdown, who knows, I have seen it happen and don’t want to find out. If I did have a breakdown or decide to quit I would be liable for redundancy which currently would be at least £65k - that I don’t have 10) I’d tell patients to reduce their hours/ consider other jobs for their mental and physical well-being if they were my patient 11) if my children are sick I don’t miss work (only if hospital admissions) if I am sick I work from home

I have 4 children, neglected friends, do no regular exercise, hobbies all lapsed. Without bragging I am very employable elsewhere.

Should I continue?

I am type of person who hates doing a bad job/ half job / rushed job. In a resourced system, with time needed to fully assess/discuss - there would be patients I would worry about/ honest mistakes would occur etc
When I can’t properly do this, as too many to see, the feeling of fear about risk of injuring someone /missing things is amplified.

I haven’t RTFT (usually avoid these threads because I find them quite triggering), and have NC for this post as I’d never usually out myself as a GP.

If I could easily leave, I honestly would. The only thing keeping me going at work is my colleagues, and I know some of them feel the same. As a partner in a surgery, we’ve been struggling to recruit for years to replace planned retirements. We are giving ALL patients the option of phone or face to face appointments now and have been for a while. But there simply aren’t enough. Demand is ridiculously high. No idea why. If we prioritise same day emergency access then there’s a 6 week wait for a routine appointment, and to create more routine slots we’d have less for same day. Can’t win. Patients complain if they can’t get what they think they need. It’s so depressing. The entire system is on its knees. Have given all our staff the cost of living pay rise.. salaried GP’s are expecting more and more money to get them in.. and I’ve had a pay cut over the last 4 years because these things aren’t funded.

I cried at work the other week because we had no appointments left to give out. But we can’t work any harder than we already are.

sure everyone will appreciate the nhs we once had when it’s all gone.

And it’s the constant criticism on social media, in the tabloids etc.. that also makes me want to quit. Every negative headline results in less GP’s to go round.

I did read the the whole of this thread and was pleasantly surprised at the amount of understanding! Often this is not the case.

On the positive it has made me more distrustful/ aware of hidden agendas in media reporting, which I try to apply to other things in life.

GPs in England treat up to three times more patients than safety limit demands

GPs are struggling to cope with as many as 90 appointments and consultations a day – more than three times a recommended safety limit.

GPs who spoke to the Observer last week say that almost every day they breach the British Medical Association (BMA) guideline of “not more than 25 contacts per day” to deliver safe care. One doctor said he had more than 90 consultations on one day.

^www.theguardian.com/society/2022/nov/20/gps-in-england-treat-up-to-three-times-more-patients-than-safety-limit-demands^

And they still cannot keep up with the demand. No wonder so many are quitting.

@DontEatAnythingWithoutAFace your post echoed my life! I don't exercise either, most of the day chained to a desk . When my kids were little and unwell, they came to work with me and sat/ slept in an empty room. Now they are teens they stay home alone. One recently had to walk themselves home after vomiting at school. Ex DH is around but often not contactable, so little help there.
I feel torn in all directions, trying to do my best. At the expense of my own family and my own health.
I managed 3 months recently at 60+hrs to cover sickness and I think that would be my limit in future. It's just not sustainable. Why would anyone think this is an attractive career?!

The ones I know work 3-4 days and also write books, do podcasts, write columns, teach and do private work. There are many ways to boost income and get a work life balance. They seem to make it work and yes working full time for the NHS might be increasingly rare

@Parker231 do you mind me asking what your DH does now? Or a vague idea of the area of work he's moved into?

DH is French Canadian - came to the uk when he was 21 on a scholarship. We moved to Quebec earlier this year and DH works three days a week in a large medical clinic. Standard eight hour days. There is a lot wrong with the Canadian healthcare system but nothing like as bad as in the UK.

Feels like the UK is about to experience a crash in life expectancy
you're either robustly fit and healthy .....or you're dead ☹️

My dh is a consultant and his specialty definitely provide 7 day cover in the hospital, in fact across two hospitals! Most of the other specialties do exactly the same. I wish the Government would stop insisting that Consultants won’t work weekends- that shows their bloody ignorance!
And yes the pension tax will mean that Dh has to take retirement between 58-60 (the calculations are deliberately tricky to do).

Why is it that doctors think they are the only ones for whom full time means working more than 35hpw.

I work as a director in a public sector organisation. I earn about the same as a GP. My contract of emoyment says "as required". I usually work about 55hpw. It is the norm. I have also blown my annual allowance re my pension scheme. I am privileged to have done so - it is evidence of how much I earn and the size of my pension. I made 125 people redundant last summer. How many NHS staff were made redundant last summer. If I continually complained about my job and pay to my stakeholders I would be dismissed.

DH has a senior role in his field. He works about 55hpw. (Not the 70+ when he was a young man).

When I was diagnosed with thyroid disease in the late 80s, my physician (the late, great Sir Richard Bayliss) said to me "look once this is sorted out, you'll just need a little pill every day". The only inconvenience will be a yearly blood test and collecting a prescription once a year. Then they introduced 28 day prescribing, now 56 day. I have to tiddle about six times a year - usually the practice buggers it up once at least. Multiply that by every patient. If my GP has time to tiddle up the wall for unnecessary nonsense, overwork is their problem, not mine.

I don't mind who sees patients as long as they're trained correctly for it.
The trouble is if the 'easy/simple' patients get directed to the PAs/CNPs then GPs effectively become a Complex Care Consultant, with none of the recognition, resources or time.
In a day of ten min appointments you might run over for an unwell and complicated patient, or a suicidal one etc and then make up the time with an easy tonsillitis or UTI or something.
If these patients aren't seeing GPs anymore their patient load just expands and the work each patient contact of this type generates can be immense, as is the risk, the worry, the follow up.
If that's the direction of travel for GPs then it needs to be done honestly and in a supported way otherwise you're just setting a group of conscientious, caring and hard working people up to fail - and endangering the population.