To think that the screwed up NHS is partly the gps doing...

[seriouslygardening]

Please read before you roast me, sorry it's long and possibly complicated…

Brief timeline
Well before covid hit - gp surgery brilliant
Couple of years before covid, gp merged with large GP group which now covers 3 cities and many many surgeries. - appointments much, much harder to get.
Covid hit- GPs formed a private limited company making themselves directors and running all the vaccinations in the city. Appointments at all surgery’s like hens teeth- scarce- understandable.

Covid, now “over” and the surgery’s haven’t gone back to normal, they have closed smaller practices and outsourcing their work to the Private limited company where all the GPs are still directors and appear to be working. Patients have to wait 3-8 weeks (usually the latter) to get a phone call from their practice GP.

Excuse for closing down smaller surgeries "no receptionists to deal with abusive patients" in reality, all the receptionists moved to the private company, and they advertised for new positions at below national living wage (£9.50ph).

They have outsourced their online and telephone triage system to another company about 200 miles away, so some outsourced GP(?) decides whether you get an appointment or not.

In our city, patients are finding no alternative but to use A&E, Urgent care, Out of hours, Minor injuries (all based at the hospital) after getting frustrated at the lack of service and phoning 111. The hospital are all aware that the increase in patients through their door are from this one GP group, yet they aren’t able to do anything.

So in effect, the gps get paid by the NHS for the (lack of ) service they provide at the nhs surgery, the NHS pay the private company(plc) to run, the GPs then get paid as GPs of the plc and as directors of the plc, they are also shareholders so get dividends all whilst the patients aren’t being physically seen and costing the NHS hospital to see the patients and treat them.
Looked on companies house website and this company has nearly £1.5M in the shareholder (GPs) fund, their creditors and assets equal out and they have £3M in cash in the bank. All whilst putting more pressure and using more resources at the hospitals. Now this amount of money is small compared to the overall cost of the NHS but if you multiply it over the whole country, it would add up especially for one patient the nhs can end up paying 3 times as much than if same patient had just managed to see GP in own surgery.
So am I being unreasonable to think that GPs are partially to blame?

No you are not. They are maximizing income for minimum work. They have a limited company, as opposed to a partnership, to limit the tax each GP (director) pays. They also seem to be sitting on a lot of taxpayers’ money. This is really a result of the contract arrangements for GP services. It’s not in our interests.

Do you know this is how all GPs work? They’re never employed by the NHS and always contracted?

I suspect this is driven by the NHS and not the GPs themselves though.

I’m more interested that it’s a plc though, that seems a peculiar choice for the GPs.

Care to name them?

Yes.

"Stuffed their mouths with gold" moment?

Points if you can place the quote.

Thank Bevan for the NHS 😀

I think your example is at the extreme end of the spectrum though.

where I live my GP Surgery is a village GP surgery with 3 GPs serving around 3000 patients from one larger village and about 10 smaller ones. You can usually get a same day telephone appointment and a same week face to face appointment if needed. They even do minor surgery such as cyst removals etc.

You can't lump them in with what your GPs have done and say 'all GPs are bad and the downfall of the NHS' because that wouldn't be fair and my GP surgery offers excellent value for money to the NHS as far as I can tell.

Like pastabest our local GP is the same, formed a limited company and they provide incredible service, I know that’s the exception though 😞

Lots of gps surgeries are now owned by private healthcare groups. They are running surgeries and dictating how and when you see a dr. These private healthcare companies are making a fortune out of the NHS. You are seeing profit over health.

Nope. That has happened a few places. My go surgery runs as it has always run.

You're not wrong. They're also paying physician's assistants to see patients with one central GP available to take phone calls if they need to consult (but they're discouraged to do so) at another location. It's not all GPs but it is shameful.

my gp surgery has been swallowed up by a another 8 miles away
and now i have to ring the other surgery, which is a real shame as my surgery is excellent.
just finances though op

My local GP practice is also excellent. They are not all equal. Twenty years ago I was hospitalised twice with tonsillitis which would of been easily cleared with antibiotics had I been able to get a timely appointment. It’s not a new thing.

GP’s have always run businesses and been paid by the NHS to do so. In my opinion this means that the service they provide is very dependent on the GP’s running the practice some good some bad. The problem is the health and care system today is becoming an integrated system and the way that GP’s are separate services and this just complicates things and doesn’t meet the needs of the many older people we have now. I think GP’s should be salaried and work in local NHS teams along with nurses, physios, occupational therapist etc.

GP’s obviously do work with other professionals but we would all benefit from properly integrated local services.

For example, District Nurses are directly employed by NHS although based in GP practices. The nurses can’t become partners but the GP’s can. The physios sit in the local small hospital and cover many GP practices. The out of hours doctors are run by a separate organisation again. There are no specialist doctors at the local hospital, the nurses run the wards with input from the local GP practice. Anything over a minor injury needs to go to the larger hospital miles away. There are different teams for mental health, continence care, palliative care, home from hospital, reablement, emergency response. These all sit separately to social work teams. The population is actually the same for many of these teams, by that I mean, generally the people needing support are the same people but can you get help on a Friday at 5pm for someone who is elderly and has had a fall and could stay at home. No, they wait hours for an ambulance and get sent to A&E because there isn’t a proper 24 hour service.

I agree that the stealth privatisation of the NHS is a problem. My optometrist identified a potential retina problem and asked my GP to refer me to a specialist. Our whole area now uses a US owned service as "triage" for eye problems - impossible to be referred direct to the eye hospital. I wasted 4 months on 2 appointments with this "service" (arranging the appointments was a whole other drama) before they admitted they couldn't deal with me and referred me to the eye hospital. To cap it off, after being discharged by these clowns, it took 7 weeks for them to refer me (which is an online system so would have taken a few minutes) and they only did it because I chased them. So now I'm finally in the queue for the eye hospital 6 months after the problem was identified. Total shambles.

I think you’re right and I’m not surprised many are adopting this model based on the fact I’ve always felt GPs were the weakest link in terms of doctors.

My current one is brilliant but far too many of them have done the bare minimum for a long time and have a too relaxed attitude to work.

I remember being turned away by several when I was clearly severely ill for 3 weeks and it turned out to be pneumonia. If I’d ended up with sepsis I’d have sued.

Our GP hasn’t made a limited company and hasn’t outsourced the admin, but I do agree that since covid it’s been terrible.

I booked a telephone appointment at mine (can’t do face to face) and had to wait three weeks for it.

The doctor never called instead sent a message saying they’d tried to call… my phone was on loud all day and I rearranged work meetings etc. around it.

I then had to ring back (took 40 mins to get through) to be asked if it was an emergency. I said they definitely didn’t ring but I still wanted an appointment that day because I waited three weeks for it.

I was told it would be any time after 2:30pm so I then spent the rest of the day on tenterhooks, anxious if my phone would ring (I had a train journey home which was awful as I was paranoid they’d ring then).

Eventually they rang at 7:30pm and the doctor was awful to me. She said if it wasn’t urgent she didn’t want to know, I explained it was in place of a routine appointment because the earlier doctor did not ring. In the end I felt I couldn’t speak to her about my issue as she was so shirty with me.

That night I actually ended up in A&E so all in all it was a nightmare.

The next day I then had my appointment with the third GP I’d had an appointment with.

But essentially where I’m going with this is all of this could’ve been resolved quickly under one appointment if the appointments were face to face!!!!

It’s also on red frustrating that GP telephone appointments don’t have a fixed time… at our surgery we are told afternoon or morning so you’re left all day on a state of anxiety wondering if they’ll ring at an inappropriate time etc.

Yea we have these big conglomerates too. If it turns out you do need an appointment some guy rings you and asks if you can come in with like half an hour's notice to one of the practices way across town. I mean most people can't do that. But as far as they're concerned they've offered you an appointment and fuck you if you say no. It's barely a service at all. Mostly I just fill in an online form and get a phone call about it two months later. Pretty sure it's costing a fortune too. It's frustrating because GPs are the gateway to everything so if you can't access a GP you can't access the health service, such as it is.

They are also generally quite shit at their job.

Well yes that too. And yea random phone calls when they feel like it instead of actual appointments. What the fuck is that about?

Yes it's shit.

But not really surprising when the payment per year per patient, is less than cost of insuring a pet hamster 🤷🏻

Labour are planning to tear up contracts and make GPs salaried NHS employees which should stop the rot.
Our GP is outstanding and community focussed but even they have outsourced triage and have now closed their books.

Look at that, another drop-and-run anti-NHS/anti-GP post from a 'first time poster'.

Something drastic needs to be done. The NHS has been "on its knees" so to speak, for decades, one of the problems is that many GPs now work part time which doesn't help with the backlog of patients needing appointments.
It's not shortage of money that is the problem, it's bad management and waste.
My SIL works in an NHS setting and she and others never fail to be flabbergasted at the amount of money that is wasted, when all it needs is decent management to cut it all out

No, it's been "on its knees" for about ten years.

Ten years.