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?

There's no reason why GP services should be paid by insurance, social or private. Insurance is for unexpected large expenses that most people might not be able to afford out of normal income. Hospital and specialist treatments fall into that category, GP visits don't. I would like to see GP practices advertise and charge whatever fees they like. People on universal credit and those who GP's think need to be seen regularly would have their fees paid by the NHS.

Introducing market forces into GP appointments would remove the mismatch between supply and demand quickly and permanently.

4,000 returned to EU so we can enjoy our lovely country without them foreigners. Thanks Brexit voters.

There's a shortage due to age and retirement patterns across Western Europe so jobs can easily be got by GPs outside the UK where of course the whole atmosphere of work is more positive. So, yes, another entirely predicable Brexit bonus.

Payment admin fixes of increasingly an increasingly cruel nature don't work when you're not got the talent to start off with.

Having said that, I'd much prefer to see a Nurse Practitioner than a GP for just unwellness or a minor injury, their approach is much more practical.

It doesn't help that there are not enough training places for junior doctors once they have finished their foundation years.

Surely that's not correct? 4000 EU GPs have left since brexit? I mean, I'm completely anti brexit and pro EU membership, but that number has to be wrong.

Everyone is upset about the whole thing, unless they pay privately. The whole system is a shocking mess, and all the staff, from doctors down, are beyond pissed off. Many are now depressed, because of the shocking working conditions. Others have left, or plan to. Lots are looking for an out, even if it's just working fewer hours.

Some of aren't impressed by gold club liars, full stop.

We are all burning out and leaving. I do many less days seeing patients than I would ever have thought, but if I'd have carried out at my previous rate I'd have had a nervous breakdown by now. Don't blame us, blame the current administration and in particular Mr Hunt.

www.bma.org.uk/advice-and-support/nhs-delivery-and-workforce/pressures/pressures-in-general-practice-data-analysis

and it's not just GPs. I'm on a FB group called 'alternative careers for doctors'. It has over 36,000 members. We take F2 doctors (second year after med school) in our practice. Five years ago I was largely helping with their applications for further training in the NHS. Now I'm giving them a bit of career coaching as to their options in and outside of medicine and providing references for Australian agencies.

Our GP surgery is excellent. A couple of weeks ago we received a text to say that there were no GPs available at either location due to covid and other sickness. It was only for a short time, but that really shocked me.

The working patterns for doctors were established based on life about 60 yrs ago in the UK, eg male doctors dominated and had SAHW to deal with family responsibilities.

These days more and more doctors work part time, lots are married to other doctors and their kids would simply never see mum & dad if they worked full time.

However we haven't compensated for this by changing how many doctors we train, and actually its very hard to, because most doctors do work full time in the earlier/training years. If we attempt to train enough to cover them all going part time later on, there won't be enough jobs/training places when they want to work full time.

The only answer is a massive shift in how we structure the jobs and hours, to make it more compatible with having a life outside work.

It's been known for a long time by those in power that a disproportionately huge number of GP's would be coming up for retirement within a short number of years. Nothing was done to plan or prepare for so many doctors leaving the Health Service within such a relatively short space of time. That time has now arrived, coincided with Brexit, Covid etc, and unsurprisingly we're f*cked.

I have never understood why the UK Govt has consistently, over decades, failed to provide enough domestic medical training spaces, and has instead made it a policy to import doctors and other healthcare staff from overseas. I think immigrant doctors, nurses, etc do a fantastic job and are the backbone of our NHS and am so grateful for their hard work, but I can see so many benefits to ensuring more of the necessary skills exist nationally.

I have never understood why the UK Govt has consistently, over decades, failed to provide enough domestic medical training spaces, and has instead made it a policy to import doctors and other healthcare staff from overseas.

Its not rocket science. Why pain to train clinicians yourself when you can let other countries do it & poach them

why put in place decent planning for the NHS when you really want the NHS to fail so you can sell healthcare to your mates........

www.theguardian.com/society/2022/nov/27/stress-exhaustion-1000-patients-a-day-english-gp-nhs-collapse?

There was also an article I can't find about the numbers of EU doctors who have returned to the EU and aren't returning. I think it was 4000.

I think the situation is terrifying, there is a barely functioning under funded health service, we are sitting ducks, I don't know why people aren't out on the streets.

Id suggest there needs to be an acknowledgement of the work required on top of appointment times and then you need offsetting shifts eg 7am - 2.30m, 2 - 9pm etc.

The GP funding model is quite twisted as well. I know a lot of GPs and they earn a lot - definitely far more than hospital doctors hour by hour. I'd prefer to see all doctors employed by the NHS directly without the semi privatisation of the GP model which imho is worst of both worlds.

@MilkyWay Well yes, that's true but it's so short-sighted. It would definitely be an investment in the longer term. I know we also have the problem of training people very expensively here, only for them to emigrate once qualified. But I suspect solving that problem would involve improving pay and working conditions, which is something else our government doesn't want to pay for.

Blair "improved pay and working conditions" because of the GP shortage crisis around 15-20 years ago. That worked well, didn't it?

I missed that. Personally I’d rather have a GP running late because they are being thorough. Some people are too impatient.

@passport123 why put in place decent planning for the NHS when you really want the NHS to fail so you can sell healthcare to your mates........

Absolutely, privatisation by stealthy collapse. It's so depressing isn't it?

And all this from a political party who claim they want good, high-paying jobs for the British people. But not NHS staff or teachers or carers or local government staff or railway staff or post office staff. I could go on. But then this is the party who apparently believe in a strong economy but delivered us the shitshow of hard Brexit. Lying hypocrites. I don't understand why non-rich people with limited assets keep voting for them. Surely the cruelty, lies and hypocrisy are too blatant to keep ignoring?

The GPS were really happy in the mid 2000s.

lots of my friends went into GP. Most now work compressed hours (we need to stop calling doing 50hrs over 3 days “part-time”) and are utterly sick of the pressure.

Many are plotting an exit.

i’m a mid 40s consultant. I’m burning out and about to be hammered by pension tax. I’m cutting down so I might actually live to get my pension.

I remember an appointment with a midwife once running about an hour late. Then eventually the heavily pregnant women before me came out, she'd clearly been crying and was being sent straight to hospital. I then felt really bad for getting annoyed about the delay. Also, I'd be very surprised if the midwife got any lunch that day.

This was on a Sunday so no local GP service running - 111 was the only option. In the past as mentioned before we are usually sent to a lovely local cottage hospital where a locum GP is on duty and get seen very quickly. Service at my local GP when you get through and they are working is still very good thankfully, it's out of hours service I was shocked at, and that at this point in time in my local area there seems not to be one at all.

People forgot that Brexit meant those people with very transferable skills often 'transferred' and not all to Australia, Dubai etc- plenty went to France , Spain, Germany, Scandinavia etc. Brexit created a vibe and a narrative that a lot of liberal intelligent people no longer wanted to be part of .

I feel another biggie is the ability now at 55 to draw down on pensions with lump sums etc- it's meant many with big pension pots and houses paid for etc realise they can get by without the stress and hassle and live on less. This isn't just medecine- it's lots of professional jobs

@passport123 why put in place decent planning for the NHS when you really want the NHS to fail so you can sell healthcare to your mates........

Medical workforce planning has been shocking for decades though. The example I gave upthread showing absolutely no desire to sort things was during the Blair years. When WTR came in for junior doctors, money was thrown at creating non training posts to fill all the gaps. Then there was nowhere for all these people to go so they moved endlessly through fixed term posts with no future.

The cohort becoming consultants today started at uni around 12+ years ago. That's why top down planning is so important, we need to be planning for what the service will need in the mid 2030s now, and putting those people through medical school next year. And we aren't.