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?

This is not true.

They receive a higher weighting depending on deprivation, but it very much involves ‘doing the work’ to get paid, ask any practice manager about their end of year QOF!

The thresholds are variable but this is the issue - the money isn’t in seeing you or your child for your cough/cold, a referral for a hip replacement or a manky toenail, its seeing you for your long term conditions. It’s seeing you to manage your medication. It’s visiting care homes. It’s reducing your opiates. So, how do you balance all the chronic long term condition management with all the acute requests too?

You get paid a flat rate (not always much either) for simply having patients on books but the £££ is in the work you do. I can honestly tell you that this is a false narrative, it’s just not structured the way you think. Seeing 1 patient 5 times about their bad back essentially is a financial loss to the practice, you have to rely that a lot of your patients do not contact you at all, so you can use that to mitigate the losses.

I've just checked beta company my GP does have a limited company with four others. Interesting there was £467k in the bank

OH has a friend at the marina he said ghost patients were the best ones to have on the books. All the European patients who left after the Brexit stayed registered he said. I guess that helps to cover the cost of the patients who visit regularly

That's going to be challenging for our surgery who have always done this

I feel really sorry for pharmacy. Ours are run off their feet since covid. The Welsh government promoting that we see them and phone them first. So the phone never stops, they're called away to look at a rash etc in what was a walk in cupboard. Many of the staff I've known for years have left. You have to wait minimum 7 days to pick up a repeat. I overheard patients being told that it wasn't in stock, so go back to GP ask for some else or wait and they will order it.

GP practices were always private companies. The fact they are now an LLP is a red herring. That was the way the NHS was designed. As well as general medical practitioners (GPs), general ophthalmic practitioners, general dental practitioners and general pharmaceutical practitioners were all set up as private contractors.

Ten years ago my GP said she didn't expect the NHS to survive more than ten years. I went home and researched and paid for a private plan for myself and son. Husband scoffed and wouldn't join the plan.

I've needed it a couple of times in a decade. Now I need a scan GP wasn't optimistic until I said I had private cover. He actually smiled. I think he's fed up knowing patients referral is a waste of time.

Not all GPs operate like the OP has described.

However as mentioned there is privatisation by stealth happening within the NHS. Services are contracted out to companies with the lowest bid. Unfortunately if it turns out it’s not exactly possible to deliver those services for that cost, said private company will adopt dubious practices.
Dh works as a locum and the company he works for treats all permanent staff appallingly. No break for 8 hours, appointment slots too short to assess the patient properly, double or triple bookings, no admin time given . The attitude from management is suck it up, don’t be nice to patients it takes up too much time, if you haven’t got time to write up notes it’s your problem, don’t criticise the company it reflects badly on us. That’s only the half of it.
No wonder staff leave.

My GP practice is generally awful.
They make you complete an e consult and don't get back to you. Say use the app but no appointments are ever uploaded. Prescribe medication over the phone, say it needs a review then never have an appointment to review it so just prescribe more when you are about to run out.
They expect you to take your own BP.
Never do any proactive health checks.
Have never called me for my smear which was due in January.
I know one of the admin team who says the main two GPS are lazy and avoid face to face consultations as they prefer working from home. They have so few face to face appointments that when you do get one and only use two minutes of your allotted time there's no one else waiting to be seen so they sit and read the paper. My friend has witnessed this.

I wish people would stop repeating this - the BMA have no influence whatsoever over training numbers. That is the GMC and Department of Heslth.

The BMA passing a resolution at its AGM doesn’t have any wider impact - they’ve also voted to ban boxing and fizzy drinks in the past.

Are you in Sheffield? That sounds exactly like my surgery. They ran the vaccination programme for half the city. They shut down the branch surgery which is the only one with adequate disabled parking & access, cut everything else in the surgery to a minimum, even though Covid is over, nothing has restarted, You ring for an appointment & it's press button2, then 1, then *, spend an hour on the phone in a queue & you are still number 40 if you have been lucky enough to get through, the message says book online but they have removed online booking from the website. The whole place is a shitshow, I ordered my prescription 10 days before Easter, when it still hadn't arrived the day before Good Friday I rang the pharmacy who said they hadn't received it, I spent 90 minutes trying to get through to the surgery who hadn't got it signed & sent across, it took until 3.30pm to get it sorted which was too late for the pharmacy to deliver it. Because I'm housebound, I ended up going 4 days with no antidepressants over Easter, tried to complain & goy told we only accept complaints in writing, it's the 21st century, whycan'tI email a complaint.

GP surgeries - in my experience - are not fit for purpose. Our 4yo couldn't get an appointment for 4 weeks. Went to walk in who told us to go to the GP. I find it pretty scary as a parent.

@ForTheSakeOfThePenguin

Having said that, I think it it was the Tories policies and massive budget cutting that forced surgeries to merge.

Nope, like a lot of current NHS problems it started under Blair. Our old GP surgery sold out back in 2003 and formed a "chain" of all the surgeries in our town. Service standards plummeted immediately. Our next nearest town followed a couple of years later. You can no longer go to your nearest surgery nor see the same GP. If you want an appointment you are allocated a random GP in a random surgery. That's been the case for the last 20 years around here.

The others are paid "per piece of work", GPs are paid "per patient". So dentists etc have to actually provide appointments and do things to get paid - the more they do, the more they are paid. Same with opticians, pharmacists. GPs are paid per patient, so there's no incentive for them to do anything more than basic standards required by the contract, hence they do the bare minimum needed to keep their contract.

Three GPs I know are permanently only doing online appointments. One has moved far, far away from the surgery they work at. Ok, this is better than them leaving the professional altogether (though, as far as I know, this was never something any of them intended to do), but it’s not ideal from a patient’s perspective.

Who would be charged? Everyone? Pensioners? (many of whom are very well off), Children? Those on benefits? Basically all those who get free prescriptions?
Or just the poor sods in the middle yet again.

Yep, like Poll tax in the 80s, there'll be so many exemptions that the poor sods in the middle end up paying more.

so your GP practice is solvent…

how much do you think a medium sized company with a large premises to rent and maintain and probably about 60 employees (salaried doctors, receptionists, manager, typists, nurses, pharmacists, HCAs, physio, cleaners) to pay the wages of should have in the bank?

Sorry my above was in reply to this post. Quote function glitchy

Our Gp used to be a great surgery but also became part of a larger group and now it's very difficult to get an appointment

They still don’t pay this directly to themselves, look up how a PCN operates. Their LLC is funded by the work that GP’s do and the contracts they are awarded.

https://www.bma.org.uk/advice-and-support/gp-practices/primary-care-networks/primary-care-network-funding

A good PCN passes back some of the funding to practices, they also invest in other local initiatives to improve access, support GP practices, local population (services you wouldn’t usually get from a GP, like physiotherapy). They can’t sit on this money forever, they have to justify exactly how the £ is spent to the ICB by a deadline. So if they pass it back to the practice the practices have to justify what it was spent on, for what reason and it has to fit into one of the improvement categories

Yes, it does. So that you can cover everyone else. If you live in a fairly nice area, your surgeries will be getting a very low £ per patient. This is why they end up encouraging patient self management, as it’s more cost effective. If you live somewhere like an inner city, it will likely be more £ per patient

If it’s £100 per patient per year, then that is the cost of your visit. Each visit could cost £30-50 for instance (staffing, premises, equipment) so every patient could get 2-3 appts per year. But Mavis with a bad leg needs weekly appts for 3 months. Bob needs a hip replacement and is on a long waiting list so he keeps booking an appt cos he’s in pain. All of their tariff is used up quickly, so you need your young fit healthy population to never visit you. GP’s don’t get paid per contact they get paid per patient and then runs out. They then get paid to manage all the long term conditions and reduce the burden on secondary care. They are asking you to buy your own BP machine because it’s £20, and they assume that people will want to try to take some responsibility for their own health. I am sure you can still book in if you cannot afford a BP machine but those who can, probably should buy one.

We are all also responsible for managing our own health, it is not entirely your GP’s responsibility in the same way it’s not for your child’s school to teach your children absolutely everything about life, it's also you as a parent

If you can afford it I recommend chiropractor for a bad back, osteopath when your hips are painful. They give you the right specific exercises which help so much to do at home daily. It's better than painkillers.

All gps have private companies and are contracted to run nhs services. They can also earn extra money by reaching QOF targets.

Gps also form groups with other local gps to provide extra services, known as PCNs (Primary care networks). The gps run independently from each other. However, the pcns can get extra funding to employ physiotherapists, pharmacists etc. which all the surgeries can use.

The main problem is there’s too much demand and not enough gps to go around. Many employ other disciplines, advanced nurse practitioners , pharmacists etc to ease the pressure.

I agree that some surgeries are badly run, but a lot are hard working, and trying to do their best.

Long queues at pharmacies and you have to say what's wrong on front of the rest of the queue and other shoppers