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?

Australia / NZ, early retirement due to burnout, reduced sessions due to the days getting busier and longer, especially when childcare is a factor. Foreign born trainees going ‘back home’ due to brexit and associated uptick in racism, hostile government, visa issues, the money they’re earning here is worth less and less relative to what they would earn elsewhere.
Early retirement / cutting hours due to the entirely predictable pension issue.
My pay as a GP is now significantly less than my husband earns in his private sector job - 10 years ago would have been a very different balance, so it’s me cutting my hours even further when I go back after the next mat leave (which will be longer - because pay hasn’t kept pace with childcare for two, and even 3 days a week is absolutely exhausting).

Tories have smashed NHS into the ground and are stamping on it, all the hypocrisy of how much they value the service during covid, it’s shameful and very sad, first ever nurses strike is imminent, NHS workers deserve to be some of the most highly paid in the country, instead they’ve been brought to their knees, no doubt Tories are proud, what does it matter to them, they and their greedy cronies can use private medical businesses, evil bastards

The Australians are paying approx £200k for a 35 hour week. Canadians more, New Zealand less but they reputedly barely work at all there.

What do you mean "barely work at all there"? NZ is short of GPs, especially in areas out of the cities. Our health system is under pressure, just like in other countries.

Labour Party engineered a new contract which relieved of the obligation to do out of hours work. It was a short sighted cost saving exercise ( GPS fairly happy to drop pay and work 9-5) which spectacularly backfired.
Now those same GPS are being hammered with stealth tax on pension contributions so it’s financially sensible to retire early.
With dwindling numbers of senior GPS the younger ones are over worked so happy to head off to sunnier climes.

Ah yes, the GPs everywhere else are just lazy. Not underfunded at every step, chronically overworked, vilified by the press, politicians and (some) public. It's an impossible job.
But yes....of course they're just lazy FFS

Out of hours was contracted out to private companies ( run by GPS). Gradually these services have disappeared, probably due to lack of funding.
The latest move is to reinstate out of hours gradually by changes to the contract. Opening GP surgeries on Saturdays is the latest move. It won’t be long before they reinstate 24/7 for many practices. Since most of the GPS who voted for changes in 2003 are retired or have disappeared abroad it is probably going to be sold to the current generation as the “solution”. In reality it is probably much cheaper to offload out of hours back to the GPs rather than the money disappearing into the Acute Hospital trusts coffers.

IMO there is a huge pay divide. You have GP partners who share profits and most who also own the building they run the practice from. The NHs pays them notional rent so they benefit from that too i.e. by retirement they will benefit from selling a property that was paid for mostly by the NHS. Whereas on the other hand you have salaried employed GPs who do not benefit from profit share or the building. There is a huge difference in what the 2 earn. So the ones driving nice cars, big home, kids in private school etc, they are usually the ones earning a lot whereas the ones leaving the country, well my guess is, these are the ones who are mostly salaried doctors. The difference between the 2 needs to be a lot less to incentivise the younger GPs. Well IMO anyway. Quality of life etc, yes I get that too.

I know a lot of doctors via my work. Many have moved to Dubai, UAE, Saudi etc because they just can’t take any more of being worked into the ground. The universities get plenty of applications for medicine but there isn’t the funding to train loads of them up. We could have lots more doctors if the government wanted that to happen - but they don’t.

And the Tories in their wisdom have cut med school placments by 25% this year.

I've no desire to defend the government - which is irresponsible and incompetent - but this often-quoted "fact" is misleading.

There was a large, unintended over-recruitment of medical students in 2021. This was a result of Williamson's assuring schools & universities that A-Level exams would take place but then deciding it would be necessary to use teacher-assessed grades (TAGs). By that time, medical schools had already made their offers and were legally obliged to accept any students who met the conditions of their offer. In a normal year, about 70% of students holding offers would meet the conditions (typically AAA); with TAGs, almost 100% did. There was a system hurriedly put in place to offer incentives to students to move from the most heavily over-subscribed medical schools to less over-subscribed ones, but there was still a large surplus nationally that was difficult to accommodate and will be putting severe strain on hospital and GP placements for the next few years.

The "25% cut" in 2022 was just a return to the planned numbers from the unintentionally high numbers in 2021. There was no way existing medical schools could accommodate another intake of the same size as 2021's, even if the Department of Health & Social Care had been willing to pay for it. Expansion of medical student numbers needs to be planned so that the right clinical placements exist at the right time in the right places. While it is disappointing - and short-sighted - that no realistic planning for this is currently being undertaken, just cramming more students into the existing provision won't work.

DH was a GP practice partner - had been a GP for over 20 years. We left the UK earlier this year - due to the Brexit vote we had planned on leaving - just got delayed due to Covid.

I think GPs get paid plenty. Any more is just greedy. Lots of my local ones are very much part time and barely see people face to face.

I’ve seen a few lately (on phone) that are just shit. They show little empathy and it feels like we are scraping the barrel for them.

I don’t think paying them 200k and making a shorter working week is the answer here.

I have lived in London/Surrey since 1980. GP services with one practice were good from about 96 to 2002. A period when an excellent GP joined. Good also from 2013/15 when we lived near a good practice. I haven't seen any correlation with Labour or Conservative governments in power. The worst mat care I received was in 1994; the best in 1998.

ENT with the DC 1995-2000 with both DC was disgraceful - had to seek private treatment for them. 2008 for Dd was dreadful.

2015-2017 MH was non existent but would have been provided where we used to live.

It's high time the political whingeing stopped and became factual. In 94 all the midwives whinged about the Tory Gov and how poor things were. By the time dd was born our local hospital had been closed almost as soon as Labour came in. I don't recall the midwives whingeing about that.

The NHS model was never going to work and only got off the ground because the GPs mouths were stuffed with gold. The system's crumbling and always has been. The staff think the public/patients should be grateful because it's the NHS and free. Gratitude should only come into play in response for excellence. Too often there is no excellence.

Many GPs have retired, fewer young ones are coming through and many of those prefer jobs with a better work-life balance then general practice
This article gives some clues

A young relative is a doctor. She wouldn’t consider GP as she likes to see results for patients. She doesn’t find the job satisfying as you don’t get to immediately resolve the issue in a lot of cases.

Our Practice has 9 GPs however they are all part time so the WTE is much less . 5 don’t work on Fridays and there are usually only 3/4 on a Monday so it is incredibly hard to get an appointment.

According to my dad, his golf club is full of GPs who have retired at extremely early ages (most of them are in excellent health).

My dad is mid 70s and still works part-time in engineering, by the way. He is not impressed by all the GPs.

I'm a GP of 10 years and this summer I made a move into a health policy role. Better hours, better pay. Mostly remote working. I also do some freelance health/medicine writing.
I believe only around 15 medics who were in my year at uni are still practising doctors. There were roughly 160 of us (granted, some didn't graduate or didn't qualify). The rest have all given up somewhere along the line. Quite a few have moved into medical teaching, tech sector, or research.

I didn't get into medicine for the money. But pay became an issue because I struggled with renting and living costs for many years. I wasn't paid well considering the effort and personal expense that has gone into my career. The cost of being a doctor is constant, courses, memberships etc.

At some point you have to consider what you're doing with your life when your friends who went straight to work rather than uni are now financially comfortable, are on their 2nd or 3rd homes, work 9-5, regularly go on holidays, eat out, have kids etc. while you and your paramedic partner are stressed to the max about work and finances and stuck renting a mouldy old flat in your late 30s!

Or maybe they became GPs in the first place rather than hospital doctors, because they didn't want to work weekends. Like any other profession, your solicitor and accountant don't work Sundays.

Plus we all seem to have forgotten our basic nursing skills, how to get a temperature down. how to rehydrate, how to deal with d&v. We get sent to A&E by 111 who are playing it safe to cover their backs (understandably) and we're surprised when we find A&E absolutely packed with people who should be wrapped up in bed at home.

Good friend is a GP. Says 50 per cent of appointments now mental health issues, related to stress at work, financial pressures etc and many others could be solved by improving social care. The country is being run into the ground by a government which doesn't care, and it's making people more ill. Friend says Mondays are often mostly fit notes for employers and anti depressants.

Rubbish. Most are children and adults with viral /self limiting illnesses who can't be too careful or want a quick fix.

Oh do fuck off

I'm "part time " I've just finished catching up from my 50 hour part time week ready for the deluge tomorrow. I am planning on cutting down more hours because it's literally overwhelming. And yes cut my pay because you know part time gets paid part time even when they work more hours.

The type of people who become GPs, often aren’t the type of people who want to do medicine longterm but want the lifestyle / might have gone into a hedgefund once upon a time. Many unfortunately do see it as a means to a lifestyle / early retirement and working past 9-5 isn’t compatible with it. This is why we need a route to GP that is accessible to nurses, paramedics and allied professionas who are already practicing medicine out of 9-5 — the ecp masters qualification is a good first step. But we need more.

What absolute rubbish. Tell her to grow up and do some GP before she talks such nonsense

Wow. Good luck with that eh? And you wonder why no one wants to be a GP with that amount of respect.
I spend half my time now supervising or managing non medically qualified HCP pretending to be GPs.