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?

Same as happened with High Street Retail, restaurant chains, car dealerships, estate agent chains, pharmacies, opticians, etc.

The "self employed" small business owners have sold out to big chains over the past couple of decades, usually owned/run by financiers/hedge funds, who then take the money but provide the cheapest/crappest service they can get away with!

Nope, the damage goes back a lot longer than 10 years. It was crap in the early 00's - don't you remember Blair "sold" the GP contract (more money for doing less) as his way of "solving the GP crisis"! That worked well didn't it!

Ours have employed more nurses and HCA’s and there is no GP in the surgery they do phone appointments, which are hard to get, I like phone appointments but only if it’s an old complaint not a new one.
Something was picked up at an eye test and I needed a heart check, my GP said they could do it over the phone!
A&E is bursting at the seams bcos no one can’t actually get to see a GP.

The GP issue is only one part of the existing problems. But yes, most of the practices I know are maximising income and minimising patient contact.

I understand they can manage their practices as they choose, but I don't think it should be possible to offer telephone appointments without a specific and reasonable time window, and I don't think telephone appointments should be recharged at the same rate as face to face appointments. The current system incentivises barely adequate care.

The biggest problem with GPs is the way it's funded, i.e. they get paid "per patient" rather than for what they actually do, so there's no incentive for them to actually see patients, they get paid whether they see you or not.

It needs to be changed so that they're paid for what they do, rather than how many patients they have on their books.

Ahhh, this makes sense as to why they doctors group I'm in is advertising for more patients.

ALL GPs are private. They always have been.

GPs are greedy. They are betraying the Hippocratic oath.

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

This is the crux of it, but it's not even just about being good or bad, we have a huge shortage of GPs, being in an area that can recruit enough makes a huge difference. Having decent partners also helps undoubtedly though. I'm not sure how it would be any better run directly by the NHS though, they aren't exactly doing well at retaining enough HCPs or meeting treatment targets.

My surgery used to good before Covid, then most of them retired and I do not know what is happening now. I have not been able to see a GP since before Covid, they put messages on their Facebook page about using econsult, emailing, etc but every time I have needed them, they just go ignored. I just filled an econsult in last week for problem I have been having since August, I received a text asking if I wanted a telephone apt , I said yes but guess what? NOTHING again I am just ignored as always, I give up

I'm aware not all GP surgeries are like mine. I'm also aware that GP surgeries have had to be run as businesses for a long time but it's a bit galling when you can't see/speak to a GP, knowing they are being paid as you are their patient, but they won't see you. The nhs then gives a contract to the GP owned company to see the patients because the GP surgeries are "overwhelmed", and the GP makes a tidy profit without actually face to face seeing a patient, all while closing the smaller surgeries and blaming the patients who get frustrated because they can't get appointments.

Also, let's face it, not everything can be diagnosed over the phone, some things need to be done face to face!
They are now asking patients to buy their own blood pressure machine and tell them the readings instead of running a clinic.

GP surgeries need to be open 7 days a week and on bank holidays. Even if the weekend / holiday opening hours are shorter then Mon-Fri hours this would immediately help with the situation where an and e units get overwhelmed .

They should be open 24/7 at least in large cities.

Where would you find enough GP’s from ? DH was a GP for 25 years but handed back his contract last year - we’ve now left the UK. No one took on his practice so 00’s of patients to find another GP. GP’s are leaving in increasingly large numbers.

Existing gps need to realise they need to work weekends and bank holidays like everyone else is expected to

There's a huge shortage currently, do you think mandating that they have to work weekends and Bank Holidays will entice more people to train?

If it wasn't for Nye Bevan there wouldn't be an NHS. I don't think that today's NHS is quite what he had in mind though.

If you work evenings and weekends you get time off during the week. Where are you going to find enough GP’s to cover all the days/hours?
One in five GP’s under the age of 30 left the profession last year and the numbers overall are dropping each year.

There's a shortage of GPs and nurses. Also, a lot of GP surgeries don't have space for more doctors despite an increase in the number of patients.

GP surgeries get paid for the number of appointments they give, so its hard to lay for more receptionists.

There are restrictions on how many GPs can be trained, and the NHS pays a set amount for an appointment, etc. If more and more go private, then the NHS are not competitive enough, so surely it's the NHS at fault as much as the individual GPs?

I think there is money wasted and some of the issues are blamed on patients when its the NHS inefficiency causing the issue. (missed appointments that patients are unaware of, apt cancelled by patient but not logged so down as a missed apt etc)
However pay, retention and staff shortages cause an awful lot of the problems so its not all about bad management and wasting money. Brexit meant many NHS staff left and a lot of well qualified staff can earn better money or have better working conditions abroad.

The NHS was first set up when
a) the population was smaller
b) life expectancy was shorter
c) people died of (now) treatable conditions...(so now might have 20 years of appointments and treatment instead of dying prematurely from it)

All of those, as well as providing medical procedures that would not have been invented then, mean its a completely different service from when it was invented.

More prescribing power for pharmacists then. They would help massively . A little training and a consultation area in pharmacies and I’m sure that would make a difference

Nurse led out of hours clinics too

The BMA blocked increases in the number of medical school places and a ban on the opening of new medical schools about 10-15 years ago. That's now coming home to roost as we've not got enough coming through training now.

@Parker231

I can't quote your reply but it's spot on

Ok if they force GPs to cover practices 24/7 at weekends etc

So then where are they going to find the GPs to cover during the 'normal' working week?

You do realise there is a shortage of GPs nationally?

So make GPs cover 24/7 but watch the numbers plummet further as those choose to go and work overseas or quit altogether due to poor working conditions

I'm addressing my questions to the OP!