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 complexity of patients combined with the demand for appointments must be part of it. As an example, CAMHS in my area used to accept direct referral for ASD assessment. Now they expect the GP to refer. How would the GP, in 10 minutes, talk through all the reasons I think my daughter has ASD, take notes, then complete the referral form in sufficient detail that it would be accepted?

I downloaded the GP referral form, filled it in, then emailed it to the surgery saying 'this is the form, I've filled in all the detail, could the GP send it off, please. But I've been through the process twice before. Most patients wouldn't do that.

(I’m a GP trainee - qualified doctor undergoing postgraduate “training” to become a GP)

fund the nhs as well as France or germanys or Canada’s health system (per capita not total) and stop the recurrent reorganisation from the top, FUND SOCIAL CARE, fix the IT and stop the fear of litigation that makes everything from joining a gym to getting a “toilet pass” to go to the toilet in the school day need a Gp letter/appointment

Gps used to work 4 day weeks but now want 2.5 days. 1 gp retires and 2 are needed to replace them. Locum pay is high and you can pick the hours, ignore paperwork and pick up shifts you want.

There has to be significantly more honesty and transparency in the system. I appreciate the GP is the gatekeeper or broker. However, we all need to have more clarity about what services they are able to broker.

Someone up thread spoke of the GP's expectation for reverence. Whilst I don't think that's entirely true I am.sick and tired of GPs and other doctors introducing themselves with a title and clearly expecting to be afforded significant courtesy when at the same time they assume they may use the patient's first name. It is very reductive and if my GP expects me to address them with a title, it is not unreasonable to expect them to use mine. Courtesy works two ways imo as well as it being a question if equality.

In some.ways the system has become retrograde.

@Qazwsxefv I think you may find the NHS is as well funded as that in France. In France Dr's are paid less and complain less. For about the same level of investment, France has better outcomes and the system there is much more efficient, despite the extent to which the French love bureaucracy.

We have a home in France. Their system is head and shoulders above that of the UK - those in the system don't imply they are doing you the biggest ever favour. It's their job.

No other first world nation seeks to emulate the NHS/UK system. It's past its sell by date and it wouldn't matter if the funding were doubled.

Surely the fundamental issue is that reading medicine at uni requires the absolute best A level results - so really super bright and hard working, dedicated kids. Who then spend 7 yrs (?) qualifying with all the associated costs, working 100 hour weeks during their placements, often requiring relocation, possibly without the supervision and support they would like (because resourcing is so stretched), meaning they have to take life and death decisions on their own. After all that, they earn what, £30k a year (whilst junior doctors). Whilst still doing ongoing studying to continue progressing.

Or, those super bright, hard working, empathetic kids, could do 3 yrs at Uni, and be working at Google, a quant in a bank or lawyer, on £100k before the junior doctors have even finished studying. I apologise if I’ve completely misread the issues, (I work in finance), but my DC (11 & 13) have been asking me about whether being a doctor would be a ‘good job’. I’ve said to them both, it’s a wonderful, admirable career, but I’m not sure the effort vs reward is something I’d recommend to them. Something really needs to change to make medicine an attractive career to our kids again.

Uk health spending is £2989 per person per Yr, France is £3737.
Average UK Dr salary is £76,000 average French Dr salary is £105,101.

The UK is underdoctored and UK Dr's are underpaid compared to most of Europe, Canada, US, Australia and NZ. The NHS is under - resourced compared to all these countries as well. France is by no means the highest spending but I wanted to correct your specific point.
As a doctor you will get more money for less hours and work in a better functioning system in almost any other Western country. So doctors leave.

It’s not as well funded (see data below)

i am in no way wedded to the current nhs structure - it doesn't work.

I do want a publicly funded health service but I would be all for some of the European models (with their levels of funding of course)

I think the fact that loads of doctors are cutting their hours (and so their wages) show that uk doctors aren’t all out for the money. I would be very happy with a lower intensity reduced hours job that provided better outcomes for patients to for less pay.

There’s loads of work for those who have completed postgrad training (CCT) or who will work non training roles - doctors don’t want to reduce the doctor numbers to keep prices up - we would love there to be more of us so we could work a little less (and earn a little less) but see our families (and sleep) a bit more. The bottle neck is postgraduate medical training places as ……there aren’t enough post CCT doctors to train them.

(non training roles only exist for hospital doctors not GPs (I think this is to do with the performers list regs which only allow trainees or post CCT GPs unlike hospitals which can employ and qualified doctor). Non training roles (often called staff grade roles) are very popular and offer better hours, fixed shifts, ability to actually take some annual leave, no need to move house every four months but NO career progression at all ever and due to the madness of medical postgrad training if you decide to leave a training programme for any reason (other than statutory leave) you can never return to training - take a career break to raise your kids or care for a sick relative, or need more than a year old due to your own illness that’s it - you will never become a GP

www.oecd-ilibrary.org/sites/910674f2-en/index.html?itemId=/content/component/910674f2-en

ec.europa.eu/eurostat/web/products-eurostat-news/-/ddn-20201202-1

I’m sorry it’s not to degrade the role of nurses but I imagine the majority of nurses would fail them absolutely miserably and to pretend otherwise is disingenuous. It’s a different job.

I work in mental health and the importance of my role as a doctor is clear- I know which receptors the drugs act on, the interactions, what the neuroanatomy is etc. I know the difference between different diagnostic disorders.

The nurses do an amazing job doing 1:1 ‘s with patients, administering medication, doing care plans and generally running the place; to know the aforementioned is my job, not theirs.

Advanced Clinical Practitioners who have done a Masters and then prescribing course excepted…

The French system is completely different to the UK, though. If you have a CT scan with contrast, in France, you have to go to the pharmacy to pick up the contrast and take it with you. If you go to the hospital for treatment, you have to collect the stickers for paperwork from an office before you attend. If you need to be admitted for surgery, you have to book your hospital bed. I don't think the two systems can be compared.

@Qazwsxefv you are quoting 2019 figures. The UK.is now spending 12% equating to about £3800.

I'll link to the up to date data tomorrow. Can't do it on my phone.

Pay more?!

£100k+ isn't enough?

I agree that, if they're leaving due to stress and unrealistic expectations, then the NHS should train and employ more or put in initiatives to reduce demand.

But increasing the pay won't matter. The salary is already very high. And clearly isn't working at keeping them.

When I had a bad accident in the Pyrenees Lougle the Samu were faster than streaked lightening. I was in hospital in Perpignan within 3.5 hours, in bed an hour later. Surgery to put my wrist back together within 48 hours. Everyone was polite and helpful.

I'm not sure there's anything wrong with booking one's own hospital bed. It gives the patient some control.

No other first world nation seeks to emulate the NHS/UK system. It's past its sell by date and it wouldn't matter if the funding were doubled

This though, the NHS as it is, isn’t sustainable. You could tax every single working person in the UK 100% of their salary, it still wouldn’t be enough. But any political party who dared to reform it wouldn’t stand a chance.

@edwinbear

has any political party even considered reforming it along a Northern European model? I don’t think many of my medical colleagues (one who is from Poland and one from Switzerland) would object.

labour want to throw more money at the current system

conservatives seem to favour a USA style system

It would take a lot of time and persuasion for people to accept some up front costs and needing to be more in charge of their own care

and unless social care funding is sorted out then it doesn’t really matter because the hospital beds will remain full of well people who need social care while the sick wait in a and e or ambulances - this is the major issue that needs sorting at present

@Qazwsxefv I agree. But as a nation we’re so proud/beholden to our NHS system, which is the envy of the world (rightly so) and we’re stuck in a chicken and egg situation. We’re paying so much personal tax to support it, people can’t afford to move across to a more contribution based system. Likewise, we can’t lower tax to free up personal income to contribute, because the NHS is so expensive to maintain, It will take someone far smarter than our current politicians to break the cycle.

@edwinbear if it gets much worse I think those who can will.stop using it. The public hospitals will revert for being for the poor as they were pre NHS and we will end up with a two tier system as we had before the war. Sadly it will be closer to the US system because nobody has the guts to deal with it and introduce a Continental system.

Speaking to my dentist last week, he is on the cusp of packing in his NHS patients because the local health bodies (whatever they are called now) are so difficult to deal with and it just isn't economic. Not only will his NHS patients suffer, but he will not have work for his newly qualified staff who do the NHS work under his supervision.

That will be replicated across general health. Those with money will see GP's privately, rather than battle with the phone lines and difficulty getting an appointment, and be referred directly to the private sector probably with insurance picking up the bill.

But as a nation we’re so proud/beholden to our NHS system, which is the envy of the world (rightly so)

no, it’s really not the envy of the world.

My DP is a GP partner. He does 4 days a week. The tax they're putting on pensions means he would actually be paying to pick up extra shifts so he isn't, despite him saying he would otherwise. The govt reducing the additional tax rate to 25% the other day has just compounded that!

The tax situation is a disaster, as lots of my era are reducing or stopping with NHS altogether. But I would argue that it is purposeful, as the Government would be happy to see NHS collapse and lots of doctors reducing their NHS commitments or stopping them, years before they ever expected or intended to, is a good way to help it collapse.

no doctors don’t want to pay to go to work. They want real money now for a theoretical amount of pension they may get later? It’s a travesty.

Ive moved to private sector completely, having worked part time NHS and part time private practice since CCT. I have seen excellent colleagues retire and pursue and develop private practice, even though they had always worked FT for NHS and never did private before. But don’t want to stop work in mid 50s

By ‘they want real money now’ - I mean HMRC want real money now. Though we may not live to see the pension!

I never understood the reverence around 'our NHS'. It's a public service not a religious organisation.

The world could not care less about it.

A friend of mine is a GP. For years she was one of the senior partners at our local surgery but she got ground down not by seeing patients, which she loves, but by the business of running the surgery, government targets, not having enough staff so having to pick up the slack herself all the time and never being at home. She gave up and now does locums. Even taking the travel to different places into consideration she says she sees more of her family now than she did when working locally.

@edwinbear

Something really needs to change to make medicine an attractive career to our kids again.

There is no shortage of applicants to medical schools, most are vastly over-subscribed hence the requirements for applicants not only to have top GCSE/A levels but also voluntary work experience in care/medical settings, etc. It IS an attractive career otherwise medical school places wouldn't be so hard to get!

Indeed, Blair/Brown trebled NHS spending and it didn't solve the fundamental underlying problems. Blair signed off the new GP contract to deal with the GP shortages, more pay and opt out of anti social hours, but it didn't work, GPs just took the money and worked fewer hours making the problem worse!