To ask where have all the GPs gone?

[Lolacat1234]

Got sent to an "urgent care walk in centre" by 111 today because my 3 year old daughter has a high temp and was very unwell earlier today. Got there and very soon realised I had been sent to A&E, there is no such thing as an urgent care walk in centre, it's just another name for A&E. Sat there for 6 hours before deciding she needed sleep and her own bed and that I would try my GP surgery in the morning. Please no comments about I should have stayed, when I left there were 25 people ahead of my daughter and I had already been there 6 hours, she had lost it and was having a breakdown. My instinct said it was OK to leave, dose her up and reassess in the morning.

As I was leaving (I was the 3rd mum with a sick child to give up and go within half an hour) the receptionist just said they can't manage an out of hours service at all because there are no GPs. My friend I was chatting to told me her local surgery has no GPs at all just nurse practitioners and they bring them in from another local surgery if needed. It all seems very scary.

Where have they all gone?

You clearly have no bloody clue. At all.

This is absurd - talking about the 1960s. That is nearly 60 years ago. Demand was nothing like it is today. Public service was respected. Both major parties supported the NHS and gave it the tax money it needed. Grants were given to those who went to medical school so they owed their careers to the NHS.

None of those things are true today.

GPs are well qualified people. They are run ragged and they do not have to be. They have worked out like lots of professionals that they can be part time and take less responsibility (even that has big problems). Why not be a locum? Why not go elsewhere? Why not choose to avoid a litany of people who are lonely rather than ill?

You get one life - it's a job, not a monastic cult

Just wanted to offer a hug. I'm feeling guilty for taking up an appointment recently because I've still got a bad post-nasal drip and resulting cough, a sore throat and an unreliable voice two months after a bad upper respiratory tract infection. I'd exhausted the pharmacist's advice and nervously decided to bother the surgery, but the look of disapproval on the youngish GP's face told me that I'd joined the ranks of the bothersome walking well. It's clearly hell for you all and I wish you strength in getting through.

Sorry, my response was to @Olijuniper Took me so long to type it others had jumped in-between.

@TightPants the Cromwell used to offer emergency A&E Services. It seems they no longer do. My apologies.

Thanks Queenofscones. I hope you're feeling better. I would never make a patient feel bad for making an appointment especially if like you they've exhausted all other avenues of self care and advice from the pharmacy.
I do feel we've become hyper aware of our health as a culture though. The vast amount of information on the internet, whilst sometimes useful, feeds into anxiety about every single symptom. And there's always the well publicised story about that one in a million person who's developed a very rare disease that's been initially missed because it is so uncommon.
I also don't think our high demand fast paced lives help either. No one has the time to be ill anymore and we naturally seek things to try and make us feel better as quickly as possible when often all that is needed is time.
We've also recently had nonsense from my own kids school (a lot of them are my patients as I live local to my surgery) They are asking parents to provide a doctors note for anything more than 3 days of absence! I understand that the schools are under pressure to monitor attendance but it then just shifts more work onto General Practice which isn't clinically needed.

The government are also keen to run health campaigns asking people to approach their GP's for various things without actually providing us with the resources to deal with the increased workload that brings.
Honestly told you I could write an essay!

@Olijuniper

The problem in my eyes isn't the pay, it's the impossible mission of trying to do a good job to the best of my ability in the current framework.

Hats off to you for saying that. I think the BIG problem with the NHS is that it's been politicised around money. The "Answer" is always pour more money into it. Blair "solved" the GP shortage by paying them more to do less. It's a leaky bucket.

The "real" answer as you allude to is fundamental change in working practices, attitude, organisation, management, etc. Throwing more money at it and paying staff more won't solve it. Blair/Brown trebled spending and the NHS wasn't "saved" despite them promising that 2 NIC hikes would "save it" - I'm old enough to remember their "24 hours to save the NIC" speeches!

Like teaching, we've had decades of "reform" which have been nothing more than re-arranging the deckchairs on the Titanic. Huge amounts of money spent on consultants, huge amounts of money and time spent on management/organisational change, but it's all tinkering around the edges and never grasping the nettle and dealing with the inherent fundamental problems.

I'd love for there to be a cross-party reform committee set up with a remit of, say, a 10 year plan to put the NHS back on track. Short term-ism doesn't work. We need the politicians to stop playing political football with it, stop playing the short game, and commit to reforming and saving it. A committee with proper representation from all interested parties, not just "industry" leaders and big medical firms, but staff at all levels, patient groups, etc. It'll never happen of course. In another decade, regardless of party in power, it'll still be the "same old".

I couldn't agree more @Badbadbunny.

Re the sick note for schools we had this years ago during the two years dd attended a state secondary school. A letter was sent out in the run up to exams about any absence being signed off by a GP as prep for public exams in Y11. She was in Y7 at the time.

I wrote back to say that statutorily a fit note was not required until the 8th day of sickness (for adults at least) and I trusted the school would reimburse parents as the GP would be entitled to reimbursement for a non statutory requirement. Notwithstanding it was a waste of time and public money.

Parts of the public sector would never survive the real world of work.

@Olijuniper why don't you grasp the nettle and as a practice write to the Chair of Governors and copy the Local Authority and your MP?

Completely agree. It can’t be looked at as politically it’s too hot to handle. Labour won’t deal with the issues either. But it’s played off each other so we face ageing demographic without modifying the original set up, which was good for the times.

Unfortunately no political party has the guts to take on a wholesale reform particularly after the destruction of public services by the crumbling Tories.
Any review would need a model to manage training places and that GP’s aren’t going to live to work and that 3 days @ 8 hours is perfectly normal (these are the hours DH now works as a GP in Canada).

If Labour do fund it to level people prefer - how much more is it and which taxes?

Just vaguely a sense of how underfunded they think it is and who will pay

But it's not all about money. Yes, more money is undoubtedly needed, but it needs to be spent wisely on things that will make a sustainable difference. Not just throwing money at it, doing the same things it's always done, and expecting different outcomes. That's what Labour did when they trebled the spending on it - short term things changed for the better, but long term it didn't. We got lots of shiny new hospitals, but they were bought on the never-never which our kids will be paying for for decades to come, not to mention the PFI contracts requiring contractors to change light bulbs at £250 a time! We've had decades of political knee-jerk reactions to paper over the cracks, but we desperately need some long term strategies to modernise and streamline it, not just throw more money at it to keep it creaking along in an inefficient and disorganised way.

I couldn’t agree more. We’re still paying for the PFI. We need those funds even more now and I’m surprised it’s not talked about.

You cannot delay the cost and benefit politically. Whoever comes next will find it harder to cope due to demographic changes and that extra payment.

Real terms spending has gone up since then but our needs go up even more. So when others say underfunded who is paying

I only recently read an article comparing the health services of a number of European countries. Here in the UK we spend around the average. Germany spends more but has problems with facilities being under-used: I have friends in Germany whose excellent small clinic/ hospital has been closed because there wasn't enough need for it. Germany has a health insurance system. My friends say it costs about 10% of their earnings.

@Pattihews I presently pay NI and 45% tax for a system that is so unfit for purpose, I pay an additional £220pcm to PPP.

Labour don't want a cross party group. It will take away their principal stick for beating their opponents.

Labour let PFI spew. Let's not forget that. My area is getting a £500m new hospital. The existing facility has an A&E Dept with no consultant oversight, no orthopaedic or surgical emergency facilities and the highest rates of unexpected death in the country. The tragedy will be the ludt and shift of incompetence.

No idea but I can’t even book an appointment to see one as my surgery has had the online booking system shut down for the last week due to being too busy and not having enough appointments available

Before I moved, my GP surgery was a typical 60s single story building with just a handful of consulting/treatment rooms around a central waiting/reception/office area. We had 3 GPs and 3/4 practice nurses.

During the Labour years, it was replaced by a huge 3 floor monstrosity of a building across the road, with the "plan" being that it would house not only the GP surgery, but also a minor injuries unit, consulting rooms for "out reach" for other services based at the big hospital in the nearby city, i.e. consultants etc doing half days/one day per week, etc., rooms for audiology, podiatry, etc. Basically, a "mini" hospital in it's own right.

In reality, the top two floors have never been used and are just gathering dust. The bottom floor, is just a GP surgery, of similar size to what it used to be. It's regularly commented upon locally as a massive white elephant.

The real killer is that the taxpayer is paying PFI for decades to build the damn thing, that is completely unnecessary and a waste of time, space and money. They could have updated the old GP surgery for a fraction of a percent of what it's costing.

The only winners were the GP partners who owned the old building, which they sold to developers and is now a supermarket. They retired soon after the move!

‘NHS hospital trusts are being crippled by the private finance initiative and will have to make another £55bn in payments by the time the last contract ends in 2050, a report reveals’. - The Guardian

That’s the problem, Labour boosted NHS and politically it was great for them but we’re paying and we need those funds even more as the population is ageing

Wow that's what they did near us big minor injuries unit two surgeries amalgamated. Was a disaster. Both surgeries staff and GPS have walked out. It's health board locums now and closed regularly.

Just saw in local news two pharmacies are on their knees who serve the GP surgeries. Welsh government said don't bother doctors go to the pharmacy. Fair do's folk have and this is the result. Health board now trying to provide locums

That’s becoming more common - not enough appointments for the number of people wanting them. New housing developments continue to be built without the infrastructure. Each year there are less GP’s but a higher population. Medical needs become greater and GP’s are picking up more work from the failures in the social care system.

What do you want — sympathy because you're earning £150k+ pa?

I think post COVID GPs see people with more mental health issues and anxiety. Some patients have very high expectations also, and then also you have people who are fundamentally okay but are engaging with doctors because of their own particular issues, such as loneliness, isolation, social stress. One thing that COVID did do was remove this last group from the lists. GPs have often been a kind of proxy social service for some people who aren't sick and that need has probably increased.

Unless you're a partner your income is a fraction of that. If you're a partner your overheads are high. In our surgery the senior partner in his sixties did have an easier ride he sheltered at home. The other partners worked harder trying to kick the old man into the 21st century. He was so resistant to online consultation, computer system upgrades. He only does a half day a week now.

Another surgery the partners packed in seeing patients years ago but they own the building so took the lions share. One died recently the other is a concierge doctor now. He's in his seventies.

I wonder if spouse, children can inherit the practice so the cash cow rumbles on for those families

These figures are from earlier this year and only relate to England
England has lost the equivalent of 279 fully qualified full time GPs from the workforce within the past year and 91 in the past month alone

The BMA said the loss of 91 doctors between December 2021 and January 2022 equated to more than 200,000 patients losing their GP in just a month. In the same period, data showed that the number of patients registered at general practices increased by 130 598.