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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

To ask where have all the GPs gone?

324 replies

Lolacat1234 · 27/11/2022 21:36

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?

OP posts:
Ponesta · 28/11/2022 10:59

Not enough people working and paying tax. Too many people existing on benefits who are able to work (I am NOT criticising anyone who is disabled or genuinely unable to work, they deserve more). Therefore not enough coming in to fund health services adequately and the squeezed middle don't want to pay more tax.

Lack of respect for the 'free at the point of need' health service - pre pandemic my GP practice had hundreds of appointments every month where people just didn't turn up. People turning up at GPs and medical facilities for minor ailments which can easily be treated at home.

Medical staff fed up with being abused by the public.

Basically lots of reasons.

RosesAndHellebores · 28/11/2022 10:59

@Guitarbar @SeenAndNot
Perfectly happy to have to wait a little on arrival because someone else may take precedence. What I object to is as I open the door being faced with a huge sign in capital letters (shouting), that if I am late, I shouldn't expect to be seen, particularly when it has taken me 60-90 minutes to make an appointment in the first place. If I were, for example 5-10 minutes late due to a road traffic accident or late train, they reserve the right to refuse to see me despite running 45 minutes late themselves. And there is never an apology.

AFAIAC if my GP practice has time to faff about with 6 prescriptions a year for Levothyroxine at a dose that hasn't needed changing for 25 years, they must have far more time on their hands to waste than me. Perhaps they should spend as much time complaining to NHS England as they do about their ungrateful patients and their workload.

They are self employed, they do not rely on me to pay them a fee. Therefore there is no compunction to upgrade their phone lines or employ enough people on NMW to answer them. Too many GPs seem to think their patients shoukd not be afforded the same level of respect they deserve. Everyone is treated the same by the NHS. Badly. It is not new.

PauliesWalnuts · 28/11/2022 11:05

My surgery had six GPs and three retired in a year - there was nobody available to replace them. Now they have to make do with locums; I haven’t seen the same person twice since I went on HRT five years ago. A friend who is a GP (and single) does locum work 8 months of the year and goes and climbs in the Himalayas for the other four with a bit of volunteering in remote villages - says it’s partly for tax reasons and partly for his mental health.

ILoveAllRainbowsx · 28/11/2022 11:16

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Guitarbar · 28/11/2022 11:22

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Is this serious? If so then...yikes.

ILoveAllRainbowsx · 28/11/2022 11:28

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Guitarbar · 28/11/2022 11:29

RosesAndHellebores · 28/11/2022 10:59

@Guitarbar @SeenAndNot
Perfectly happy to have to wait a little on arrival because someone else may take precedence. What I object to is as I open the door being faced with a huge sign in capital letters (shouting), that if I am late, I shouldn't expect to be seen, particularly when it has taken me 60-90 minutes to make an appointment in the first place. If I were, for example 5-10 minutes late due to a road traffic accident or late train, they reserve the right to refuse to see me despite running 45 minutes late themselves. And there is never an apology.

AFAIAC if my GP practice has time to faff about with 6 prescriptions a year for Levothyroxine at a dose that hasn't needed changing for 25 years, they must have far more time on their hands to waste than me. Perhaps they should spend as much time complaining to NHS England as they do about their ungrateful patients and their workload.

They are self employed, they do not rely on me to pay them a fee. Therefore there is no compunction to upgrade their phone lines or employ enough people on NMW to answer them. Too many GPs seem to think their patients shoukd not be afforded the same level of respect they deserve. Everyone is treated the same by the NHS. Badly. It is not new.

Imagine if everyone was late though, it wouldn't be workable. Appointments are so chocablock there's no give in the system to allow for people running late. You're also wrong, performance and other metrics are heavily monitored and do affect certain things; there's a ridiculous amount of performance related reporting. Of course there is room for a tonne of improvements, but whilst some GPs are simply crap, the majority are doing their best in a really chalenging system. If they had sufficient funding from the NHS (who contract their services) they could afford more staff and upgraded phone lines- as is, margins are tight.

ILoveAllRainbowsx · 28/11/2022 11:30

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Guitarbar · 28/11/2022 11:31

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No they can't. Nurse practitioners are highly qualified, knowledge and experienced so I'm not diminishing their professional status or capabilities, but a GP and a nurse, no matter what postgraduate qualifications and level are different. Sure for many things it makes sense and is sensible for other HCPs to be appropriate utilised, but hard disagree from me about getting rid of GPs.

ILoveAllRainbowsx · 28/11/2022 11:33

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MarshaBradyo · 28/11/2022 11:38

longwayoff · 28/11/2022 09:52

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

What is the figure on arrivals?

Net migration is up sharply post Covid (after big drop), a visa system should be used to get the skills

Another issue is other countries are facing shortages too

www.politico.eu/article/france-doctors-europe-too-far-too-old-too-few/amp/

pattihews · 28/11/2022 11:40

One of the GPs I encountered socially had converted to be a GP after years of emergency medicine in A&E. Once qualified as a GP she worked a couple of days a week as a locum, earning £800+ a day. I don't think we have a single full-time GP at our local surgery, which has a list of about 15 names on the noticeboard. You can't really blame them, but it doesn't lead to an efficient system.

Badbadbunny · 28/11/2022 11:43

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Certainly, there's merit in reducing the "gatekeeping" role of GPs. Yes, lots of patients are capable of "self referral" to the appropriate service.

For example, it took six months and several GP appointments for my son to get the magic referral for proper treatment of his ingrown toe nail. Once referred, he was seen for review within a week and then had the sides of his toenail removed the week after. That was after the GP faffing and farting around, saying there was a massive waiting list for the podiatry dept, trying all kinds of creams, bathes, etc., and then treating the inevitable infections with antibiotics. I've had ingrown toenails myself, I knew the nail either needed removal or the sides cutting, as I'd also gone through months of my GP (twice) trying creams etc. The podiatry dept had no backlog at all - it would have been less harmful/painful and taken up less NHS resources for me to have been able to make an appointment directly with the podiatry dept. In fact, he now has an "open" appointment and can make direct access to podiatry if it ever happens again!

Likewise getting my hearing aids. What a pallaver. Took about a year of GP appointments to get the magic referral to audiology. First appointment showed some ear wax, so told to try to OTT ear wax removal drops. Went back a few weeks later to see GP - ear wax still there, so he prescribed some drops. Went back a few weeks later, wax gone, but now there was an infection, so antibiotics. Went back a few weeks later, finally, all clear, so he'd do the referral but "expect to wait a few months). After 3 months, I'd heard nothing, so phoned audiology to chase and see if they had any cancellations - they had no record of me at all, so I'd have been waiting forever had I not chased it. I phoned GP surgery, they checked records, and found referral hadn't been sent. But they can't send it now, as it's too long since my ear inspection, so I need another GP appointment to check my ears again to check no infection, no wax. Luckily there wasn't, so referral made. This time, I phoned audiology a couple of weeks later to check they'd received it - they had, and they made me an appointment about 10 days later! Finally.

In both cases, it was the GP that caused the delay, and once the referral had been made, the actual consultant with the dept and treatment was remarkably quick.

Literally all of the appointments for the toenail and ears could have been done by a nurse rather than a GP. Even better would have been the availability to "self refer", just like patients do with other NHS services such as dentistry, opticians, etc. The "gatekeeping" model is outdated for the basics.

Guitarbar · 28/11/2022 11:44

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Bloody hell I knew general perception of what a GP does was bad, but there's a whole load more ignorance it seems. No wonder there's little respect for them when people are clueless.

Badbadbunny · 28/11/2022 11:45

pattihews · 28/11/2022 11:40

One of the GPs I encountered socially had converted to be a GP after years of emergency medicine in A&E. Once qualified as a GP she worked a couple of days a week as a locum, earning £800+ a day. I don't think we have a single full-time GP at our local surgery, which has a list of about 15 names on the noticeboard. You can't really blame them, but it doesn't lead to an efficient system.

Indeed, why get a "permanent" job with the extra workloads, admin, etc., when you can earn shedloads by being a locum, there's always demand, and you can virtually pick your own shifts - all due to the shortage of GPs. It's self fulfilling.

I believe the same now happens with pharmacists, where there is likewise a shortage, so rich pickings and flexibility to work as a locum instead.

RosesAndHellebores · 28/11/2022 11:47

It's experiences like BadBadBunny's that make one weep. So much avoidable waste but it's the patient who suffers due to the inefficiency.

WhistlingInWhistler · 28/11/2022 11:50

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Many successful health systems overseas have GPs, although I agree about self referral in certain circumstances.

One huge difference I've noticed in France compared to the UK is that there are no nurses in out-patients. That's across multiple specialties (including cardiac) in multiple hospitals and clinics. That must save an immense amount of money.

SomethingOnce · 28/11/2022 11:51

My eldest wants to do medicine, one reason, is because she sees it as her ticket out of the country. I have three children, they all want out of the UK and are planning routes to do this.

@Kendodd, are they not concerned about the state of the country their ageing parents will be left in if everyone younger does the same? And not bothered about having grandparents close by for their own DC?

MarshaBradyo · 28/11/2022 11:53

SomethingOnce · 28/11/2022 11:51

My eldest wants to do medicine, one reason, is because she sees it as her ticket out of the country. I have three children, they all want out of the UK and are planning routes to do this.

@Kendodd, are they not concerned about the state of the country their ageing parents will be left in if everyone younger does the same? And not bothered about having grandparents close by for their own DC?

Parental influence will be a key part of it. So if you are overly negative dc will more likely go. But as a family who is placed around the world for a few generations now these are good questions.

Guitarbar · 28/11/2022 11:59

SomethingOnce · 28/11/2022 11:51

My eldest wants to do medicine, one reason, is because she sees it as her ticket out of the country. I have three children, they all want out of the UK and are planning routes to do this.

@Kendodd, are they not concerned about the state of the country their ageing parents will be left in if everyone younger does the same? And not bothered about having grandparents close by for their own DC?

I mean to be fair the NHS poaches many HCPs from other countries with little regard to the effect on the populations there and how this contributes to shortages; so I don't think people should be emotionally blackmailed into staying here. That said, studying medicine just as an escape route is ridiculous, plenty of other routes and it won't be as easy as once was as numbers wanting to do so increase.

Vinvertebrate · 28/11/2022 12:04

Like any other profession, your solicitor and accountant don't work Sundays

I’m a solicitor. I work Sundays if client needs dictate. Never finish at 5pm.

Earn half of a salaried GP. Same training period. Would earn double in Australia - their wages are higher across the board. 🤷🏻‍♀️

There is ignorance on both sides of this debate.

RosesAndHellebores · 28/11/2022 12:05

Indeed @Vinvertebrate NHS staff cannot or will not comprehend that other professions work equally hard for significantly less security. When was the last time a Dr or Nurse was made redundant?

passport123 · 28/11/2022 12:06

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Who do you think supervises the nurse practitioners and sorts out the patients who are outside of the NP skill level?

JusteanBiscuits · 28/11/2022 12:11

user1477391263 · 27/11/2022 23:15

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.

Those GP's have probably worked more hours by the time they retired than your Dad will have done by the time he retires. And all those extra hours are unpaid in medicine, not the cushty overtime in engineering

RoseLemon · 28/11/2022 12:15

I have read the whole thread and haven't seen anything specific on this but I have seen a few comments around it.

Can I ask, where people say there is increased demand, what is driving this? I know we have an ageing population so more pressure on certain areas of medicine, but what else is driving the demand and does anyone know a good place to look at data?