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?

Apparently doctors here in the UK are paid rather more than many in Europe

We have the highest paid GP’s in Europe and the lowest cancer survival rates. 🤷🏻‍♀️

As for earlier in the thread around why there is more demand:

An aged population living longer but with more issues with their health requiring ongoing care

Obesity and other lifestyle choices meaning we are a sick country overall

The closure or scaling back of other services like sure start centres, HV clinics, mental health care in the community etc means GPs picking up additional workload that would have preciously been dealt with elsewhere

Employers requiring fit notes for x amount of absence etc

Misuse of services- people making apps for ridiculous things or making apps and not showing up, if you had to pay per app this wouldn't happen on the scale it does

Long waits for hospital referrals etc means often people have repeat visits to help manage symptoms before they're looked at properly and treated

There are more and it's not unique to the UK.

Absolutely not true. There was a report a few years back that stated propritionate to other occupations they were paid second highest, that says more about the state of our pay across the country though than what GPs actually get paid. Compare workloads as well and I'm sure you'll be surprised.

Second highest then…Jesus 🙄

Show me a comparably paid profession where you can work PT on demand, dispense a shit service and still get your maw stuffed with cash, and I might concede yin have a point.

And my DH is a doctor so yes I do “get it” and yet still think Gp’s are not worth what they are paid.

I'm curious where the £300k figure for doctors comes from though seen as though they pay uni fees, don't get paid for placements, have to pay for lots of their own training and portfolio stuff etc- and their pay as an F1 is insultingly low. Trusts do get paid to host students but 300k per student is stretching it in terms if the cost to the taxpayer.

I don't know where £300,000 might have come from, but the total cost of a 5-year medicine degree is usually quoted as approx £200,000, of which the student pays £37,000 in tuition fees (but this is paid up-front by Student Finance England, and repaid later by students who earn enough and remain in the UK or coninue to repay from abroad). The rest is Office for Students (OfS) high-cost funding to universities (£33,000 per student), NHS payment of tuition fees and bursaries after 4th year of study (approx £11,000-£12,000 per student) and tariff payments from Health Education England (HEE) via medical schools to trusts and GP practices (approx £100,000 per student across years 3-5). Tariff payments have mostly gone down a bit over the past couple of years but they're still not far off that amount.

I'm not sure what gets paid into foundation programmes by HEE to support supervision. I don't know whether that might account for a further £100,000 per FY doctor over the 2 years.

We should be investing in hospital A&E departments and specialist equipment such as scanners. Not trying to attract more GPs when no-one wants to be a GP because all they do is paperwork (not their fault).

Not many people want to be A&E doctors, either. That's why there's so much pressure in some parts of the country to merge A&E departments across hospitals.

And a scanner is no use unless someone tells the radiographer what specific scans to do, which requires that someone to know what they're looking for.

Not sure why there is all this surprise that the NHS is collapsing?

If course it is: it's underfunded and not built for purpose. It was built for people who were in absolute dire straits health wise in the 1940's.

So how should it be funded?
Higher tax?
Co-payment by patients?

Everyone loves to complain, but what is the solution?

Maybe no one envisaged the law of consequences. If you improve the health of a nation the life expectancy goes up. Along with that comes more complex needs. Add in medicine which can go much further now due to to advances in science.
It’s the perfect storm
The NHS has NEVER balanced the books which is why dental and optical charges were introduced early on.

So … what do the people want??
If you want free at the point of service for all things, then brace yourself for massive tax increases to cover it.

I agree with last few posts but when you say underfunded - how much more and who pays?

Social insurance model as they have in Scandinavia/continental Europe

What will happen is that it will collapse in chaos and the govt will sell it under the table to their mates and we'll end up with a US style system.

NI is mass insurance but you must mean something else - What’s the difference? Who pays more / less etc

You have the option to use a private GP already, so do you?

usually there's a small charge, some of which can be claimed back, less if you are deprived etc. some models you pay everything up to a few hundred pounds per year - protects those with serious health needs but might make young fit people think twice about calling me with 'I've had a sore throat for 2 hours, no I haven't taken any painkillers'

Now those same GPS are being hammered with stealth tax on pension contributions so it’s financially sensible to retire early

This is correct. However, it always makes we wonder how MN's constantly go on about taxing the rich, which would nc. GP's, who are only in this position because they earn a high salary, with excellent pension contributions from the taxpayer, which then puts them in excess of the total annutal contributions allowed, which also applies to every other worker in the country. Why shouldn't it apply to GP's?

UK spends the average amount value to GDP among comparable countries. Less than Germany and France, more than Australia and New Zealand. The difference in service level, has therefore to be down tothe system itself and how it is run.

Indeed I do @sleepyrant. However despite having contributed handsomely to the NHS for 35 years, there is no tax rebate for opting out of the system. Notwithstanding that two of the part-time partners at my surgery hold
GP.clinics at one of our local private hospitals and another part-time partner is the official Dr for our local boarding school. I am sure they provide far higher standards of service to those who pay them directly.

@Badbadbunny I totally agree. So many things could be seen at local small cottage hospitals - sprains/breaks/ random infections and then referred up the scale if necessary- we have ended up with so many very large centralised A&Es covering off far too wide an area that I feel many non urban areas are now pretty unsafe to live in when it comes to an emergency situation

We have private and can access private GP but I don’t agree with tax rebate. We’re low users anyway but I did have births with NHS and may need emergency (touch wood not but you never know). Plus whatever is needed as we age.

The idea of small payment is interesting although behavioural studies would have to work out if it will stop pointless visits or make people wait until they get sicker and more expensive.

Mostly though think even small payment is kryptonite politically and voters wouldn’t give mandate. We are so used to free at point of care. It might be needed but Labour want to be in power so wouldn’t do it. Torys well they are in trouble anyway.

As to what will fix it - it’s a tough one. Not PFI though we’re still paying for that thanks to previous governments.

Tories rather..

They have the same duty of care, regardless of whether the patient is private or NHS so I find it hard to believe that the care you receive would be superior. I can see that the 'service' might be better because there is less demand and you are paying directly for it.

So what you resent is paying tax into the NHS and then choosing to go private because you want, what you consider to be, a better standard of service? An example you have given is being called by your formal name Mrs/ Ms rather than your first name?

So by the same token would you make all education private so you hadn't the option to send your children to private schools whilst paying taxes towards education?

I'm just interested in your thinking here.

However, it always makes we wonder how MN's constantly go on about taxing the rich, which would nc. GP's, who are only in this position because they earn a high salary, with excellent pension contributions from the taxpayer, which then puts them in excess of the total annutal contributions allowed, which also applies to every other worker in the country

Totally agree. Although left’s logic collapse and GP’s apparent lack of appreciation of irony when bleating for more to be spent on healthcare does st least make me chuckle.

My DH is paid for private work through a company, as are most of his consultant colleagues. All complain about underfunding. 🤷🏻‍♀️

@memorial your post was also disrespectful ‘supervising non medical staff pretending ti be GP’s’ wow!!
I am not pretending to be a GP, I work hard and see a lot of the shite so the GP doesn’t have. Your post was rude and I’m glad the GP’s in my practice are far more respectful than you appear to be.

But they're not second highest paid, maybe read properly what i wrote. Yes sure he's a doctor, if he is then he's part of the reason the profession as a whole is so lowly regarded, ew.

Also on the point about hospitals, how many people want to travel further to a hospital when the whole point of having a resource in communities is that it negates the need to travel miles?