That GPs do not have endless capacity

[memorial]

The number of threads slating GPs for not seeing or doing this or that is saddening.
They may say they don't blame "GPs" but that's very much how it feels.
There are less GPs doing far more work day on day. Secondary care is almost at a standstill and we are picking up a lot of that slack. Add the can't be too careful/rather safe than sorry, the aging multimorbid population and the deluge of mental health problems....
GPs are retiring and leaving in their droves, it is near impossible to recruit and locums are expensive and do much less.
Other HCP can help but a recent study has shown they don't actually reduce workload or pressure.
We are seeing many FTF but in order to manage the demand we do have to do some kind of triage.
Those of us left are working 14/15 hr days and yes I know other professionals do as well. But do you want to be the 50th contact of the day, the 200th prescription, the 100th blood result of a tired stressed doctor. Would you be happy their decision making is on point. Pilots who make safety critical decisions have enforced time and rest periods. GP are expected to provide immediate access for everyone but also not allowed to miss anything/make a mistake/be short....
I ask those who are demanding to be seen what they think the solution is? What is the priority?
I am ill after a week of seeing numerous ill kids strep or otherwise. I probably shouldn't be working tomorrow but we have one GP on well earned leave and one who has a family emergency. I can absolutely guarantee that we will have numerous complaints and abusive behaviour tomorrow. What do you suggest we do?

Did you miss we don't have enough rooms. Our patient numbers have gone up by 30% after a local practice closed down so more admin more doctors more nurses no more space...so we hot desk and use clinical rooms as we can. But you keep believing what you want I actually do not care any more. The sooner I can leave or retire the better. I've never worked harder or felt less valued in my 30 yrs as a doctor.

Okay thanks for the info ^^

I hear your pain and frustration and hopelessness OP
the NHS is in a mess and people are pushing to be fixed or reassured for so many things that they could take responsibility for themselves that it becomes almost impossible to attend to the actual real clinical needs
you are clearly exhausted -
I’m in secondary care and exhausted too …..
i as Also count the years down to retirement and hope I don’t sink in the meantime

It is really sad that someone like OP who's worked long hours to keep her patients safe and healthy for the past 30 years feels so useless and desperate. Something is really wrong with the system.

Never understood the shortages of doctors seeing as universities always seem to oversubscribed and have been for years. It’s very competitive to get on a medicine course. You have people doing biomed bachelors and then converting too.

Have they not expanded their departments and intakes? Have no unis newly entered into offering medicine? Surely the commercial way they operate it’s a big earner - more years of guaranteed fees than your typical bachelors and can partner up with a local hospital to get a lot of the clinical areas covered

It's not up to universities, @LikeTearsInRain. Medical student numbers are capped by government. If we recruit more students onto a medicine course than the number we've been allocated we suffer very severe financial penalties.

@memorial I hope you don’t mind me asking but what on earth is this really crap coughing virus doing the rounds? Is this a normal illness? I can honestly say I wasn’t half as ill with Covid which for me was a temperature for 48 hours and then tiredness for a month… but this cough is something else! It just doesn’t stop. Negative for Covid. Tested twice.

I really admire you and all of your colleagues and I’ve gotten some superb care to be honest (all from the GP service as 111 wanted to send an ambulance but that was ridiculous). But I’ve had a load of steroids, a nebuliser, inhaler and now antibiotics and the bugger just won’t stop! Never ever had this much trouble breathing or just doing daily living tasks.

I really feel for you all with all these illnesses on top of all the other illnesses. It must be brutal! 💐

Why have the government not increased the cap? Are they that clueless?

Of course they’re that clueless. We’ve had 10+ years of austerity. They’re clueless about healthcare, education, transport, infrastructure, EVERYTHING.

@LikeTearsInRain

i covered this in previous posts

medical school (undergrad) gives you a qualified doctor but they can only provisionally register with the GMC and need to do a supervised year working in hospitals called foundation before they fully register (foundation year one). They then need to complete another slightly less supervised year (foundation two) learning generic skills and competencies to be eligible to apply to train as a GP. This training then takes a minimum of three years.

there is no point increasing medical school places without increasing foundation (and Gp training places) or you get a load of medical graduates with expensive degrees who cannot legally work as a doctor in the UK as they can’t register with the GMC. This has happened a few times recently and it causes a lot of upset. So the medical school numbers are currently capped at what the the foundation programme can manage.

you will ask - why don’t we just increase foundation places

1. That’s up to the government quango “health education England” who are a load of absolute idiots.
2. there is a hard limit to the amount of foundation y1 doctors the system can accommodate- these probationary doctors need supervision and appropriate posts and the nhs is so stretched due to lack of staff that hospitals don’t have the capacity to take on more fy1s

you also have this issue in Gp training. I’m a GP trainee doctor. There are not enough qualified GPs left and those that are are too busy for them to have time to train us. Our training programme is struggling to find Gp practice placements for us - as we are training we should have a supervision session a week and a debrief after each clinic but practices simply cannot spare the time for one of their GPs to do this so are not taking on trainees or are not supervising the ones they do have properly- I should have had an two hours a week with my trainer as supervsion and mentoring in my last placement but they were so busy I got 20min in a group session between me and two other trainees - it’s not good training.

it’s also an issue with medical school placements in hospitals. There simply are not the doctors to train the students. I had three students at the same time last week which is more than I can provide quality training to. In the olden days big groups of students and junior doctors would be trained at once with a consultant going from bed to bed on a “teaching ward round” but nowadays that is not acceptable to patients who don’t want to be stared at by a huge bunch of teenagers so students have to be taught in a 1:1 type manner (which also gives better teaching imo) but that’s much more resource (doctor) intensive. I work in a massive teaching hospital attached to a big university and we simply don’t have the capacity to take on more students and give them quality teaching

we’re now stuck in a catch 22 situation where we need to train more doctors but there are no longer the senior doctors to train them

Yes. Children have a paediatrician as a GP in many countries. And GPs aren't required to refer to specialists, that's bonkers.

Yep. Been saying this for 15 years or so now. And always shouted down with "but the US!" as if that is the only other way. 🙄

£100k in London is not sufficient for such a stressful and responsible job to be considered attractive, when it requires the best part of a decade of training.

There aren't enough GPs for the population, and that's the part of the problem.
Also, GP sees everyone: babies, elderly etc. In many European countries you have pediatrician, which is better, because one GP can't know it all.
Third thing is that some medication could be prescription free, like antibiotics for UTI. This would save lots of waiting time, and women (mostly) wouldn't be in so much pain for days.

"justasking111
Why can't the surgeries block the worried well or self inflicted symptoms. We know one who's in there regularly. There's no magic fix for a pensioner who's grossly overweight, type 2 diabetes who scoffs chocolate bars, has heart problems he says. I get so cross when he brags about all his appointments."

And where do you draw the line on self inflicted injuries?

Tricky question of course, but you draw it somewhere north of stuffing your face with chocolate when you're clinically obese and diabetic.

Have we lost all the old cures - some of which were helpful and supportive and some merely helped us feel we were doing something?

Yeah, let's embrace the pseudo-science. Brilliant medicine for the 17th/ 21st century.

Yep. And again, people were warned about this impact...

All of this but also training GPs is time consuming and expensive for trainers/GPs. And as everything else tory funding for this has become ridiculous. It doesn't pay for the time never mind the backfill needed ie if a GP is training a trainee GP someone has to do their clinical work. And the beurocracy has become absurd.
It's really not as simple as "train more GPs"

I don’t mind waiting but on the other hand if it’s something urgent then I’m very happy to go through triage

Triage by an HCP yes. Receptionists attempting to do this with no qualifications is dangerous and inappropriate.

I am lucky to have an excellent GP. I've had great ones and utterly useless ones who should have been prosecuted, over the years. Like PP have said - as with any profession - some are good, some are not.

If you mean starting medical training from scratch in say mid-30s, you'd be well into your 40s before being fully trained. That's a lot of cost to train somebody for a much shorter working life in the profession.

In Australia, most GP practices have similar online booking systems and most of those seem to be HotDoc.

It is great because I can see which doctors are working on which days and what appointments are available. I can book double appointments if necessary and I can tick a box to let the doctor know if it is a standard consultation, skin check or a bunch of other things that I can’t remember off the top of my head.

I can also telephone and speak to a receptionist (I’ve never been more than 3rd in the queue) to book directly with them. I had to do this for DC recently as she didn’t meet the standard tick boxes (vaccinations) and I wanted to coordinate nurse and doctor appointments.

It is a good system, and yes, I do pay for it. First, through taxes and secondly, with a private top up.

I have Medicare, like most citizens and permanent residents and refugees and some temporary residents etc. This means if I can find a doctor who ‘bulk bills’, then I don’t have to pay anything extra. There are fewer bulk billing doctors in my city than private but I have still been able to get a same day appointment with one.

My usual GP is at a private practice. She doesn’t ‘bulk bill’. So when I go there, at the end of the appointment, I pay $100. Then I get an immediate rebate (same day, even shows up in my account before the $100 comes out) of $40-80 depending on why I saw the doctor and how much I have already spent on healthcare that year (Medicare has a ‘safety net’ - if you/your family spends more that x amount, you get a much bigger rebate).

So, for $20-60, that is £11-33, I can get a same day appointment with the doctor of my choice. It is absolutely worth it. And if I couldn’t afford it, thenI could see another doctor at another practice for free. Again, on the same day.

I don’t think Australia is really all that special. If they can run this system, so could the NHS in the UK.

And just to make things more complex - I also have private health insurance. Many (most?) people do. It doesn’t cover GP appointments (I don’t think any insurance here covers GP appointments). Because I am paying for private health insurance, I do not have to pay the ‘Medicare levy” which is an additional tax paid by anyone over 31, earning over a certain amount who doesn’t have private health insurance. If I go to hospital, I can go private (and choose the hospital and my doctors) or through Medicare (insurance would pay me).

The system in Australia is not perfect. However, I would take it over the NHS anyway.

It is very similar to the systems across most of Europe, which have far better health outcomes for patients and cost a broadly comparable % of GDP. The UK is an outlier. For 15-20 years many of us have been suggesting a similar system is implemented here and been shouted down as wanting to "privatise the NHS" or "replicate the US system" 🙄🙄. It was obvious things would get worse and worse if the status quo remained, yet here we are and a surprising proportion of people seem surprised.

No, that's just when I lost the very last remnants of trust in NHS. My list of experiences with GPs in this country includes:

1. being prescribed penicillin, reminded GP that I'm allergic to penicillin (which my file clearly states and I wear a bracelet), then being told that 'third generation penicillin antibiotics are less likely to cause an allergic reaction'.
2. being diagnosed with an ear infection when 6m pregnant - it was severe throat infection.
3. my preeclampsia not being 'caught' until I went on a 'just in case check, something doesn't feel right' (7m pregnant) to a doctor in another country. I was hospitalized on the spot and had to deliver a baby abroad. Not only was my preeclampsia was not caught by multiple scans in NHS hospital but I was also cleared fit to fly 2 days before I was hospitalized
4. Calling my GP to book an appointment after feeling a mass in my armpit on Dec 17th 2021. To this day I didn't get a call back. (I sorted it all privately within 2 days).

And I can continue. That is the reason I now have a comprehensive private health insurance (And thanking my lucky stars I can afford it) or fly back to my home country to do all annual checks.

Our surgery on Monday worked till midnight doing callbacks etc for folks concerned about Scarlett fever. Today I called in and things have settled down again. We do have some cases in the town. Our chemist in the building is having supply issues though

The whole system needs improving with more and better trained doctors. and also an end to these dreadful receptionists who seem to think they are doctors....

Yes. And that they have some right to request discussion of condidential medical information from people. In an environment where everyone can hear their conversation! So inappropriate. I've even had them question me when the GP has explicitly told me to call in X situation and be added to her call list that day and I've informed them of this. My actual doctor is fantastic but the receptionists... it's got to the point where I refuse to speak to them and just email my GP directly.

The mismatch between expectation, funding and provision is quite stark. And that is the fault of the government, the gutter press and social media.
It's like paying for cheap all you can eat buffet and being told and then expecting a Michelin class silver service meal.
The expectation and demand often from the lowest net contributors.
Bevans NHS was never designed for this level of use. It was intended to improve the health of the nation and then be run down.
A frank discussion needs to be had and the NHS removed from being used as a political football. But that will never happen as its a great vote winner.
And the government and public will continue to flog those at the frontline giving their most until it will not be in anyway fixable.