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?

The difference now is they are merging into large groups and being bought by private companies. The same is happening with vets. To make profits we are charged more for animal care. They can't do that with the NHS so instead are making profits via poorer service.

I get so fed up by these threads.

Absolutely services in primary care are not great in many places- some however are brilliant and that if anything fuels the fire of the ones not getting a good service

BUT it’s all the comments from people who know absolutely nothing about how these things are funded and organised, the historical situations and the complex contracts that are in place.

Of course some GPs are maximising income ahead of other things and of course some are more service driven. They are human and as variable as we all are.

But it doesn’t help arguments to improve things when so much bollocks gets spouted by people who claim to know all about it and have clearly just informed themselves via the local FB page and the Daily Mail.

The Tory agenda is to dismantle primary care. Everyone is currently suffering both those within in and those using it. I can assure you that the private outcome that will be with us in a few years will be much much worse.

As an example- the often thrown about accusation that GPs take in money from hitting QOF targets.

those targets are set nationally from evidence of work that improves outcomes for patients eg checking the feet of people with diabetes. Basic annual funding per patient is so small that it cannot cover additional work. Such work costs money-running clinics with trained nurses, documenting contact, running search lists and sending letters or phone calls to book people in etc.
so there is a financial reward attached to achieving the target. If you don’t do the work (properly) you don’t get paid it. If the payment is made then the public are getting the evidence based service.

Yet then people slag off GPs for making QOF money like they are robbing banks! Would you rather the care isn’t offered or should they be doing it for free?

The Tory agenda is to dismantle primary care. Everyone is currently suffering both those within in and those using it. I can assure you that the private outcome that will be with us in a few years will be much much worse.

I get so fed up of these threads that spout ‘Tory Agenda is to make primary care private’ but ignore the fact it has always been private

This.

This has been happening for well over a decade and is the direct result of making it increasingly financially risky to be a partner in a practice.

I have a number of friends who were GP’s. Within the space of 7 years they have all either emigrated to Oz or taken early retirement. Huge conglomerate super surgeries were forced on them as contracts predicted this was the only feasible ways of working. None of them wanted to work this way and it impacted in their mental well-being. There was a huge exodus from all their surgeries as they felt frustration at the restrictions placed upon them.

there is now a shortage of GP’s and surgeries are unable to staff.

Personally, I blame the years of underfunding from the Tory government, not the GP’s who studied many years to practice.

There might be evidence that if you pay people extra to do something then they are more likely to do it. But there is also evidence that targets distort service delivery negatively as well. The problem is the targets become the focus of care and the underlying contract/service gets neglected in favour of meeting targets. This isn’t just an issue in primary care, it is the same in the acute sector too, and in non-medical sectors.

Presumably it was ‘forced on them’ by the other GPs in the partnership?

the reason why they are merging is to share risks, the GP population is ageing out so they are worried about small practices being left with last partner standing. You can’t run a surgery on one partner easily. It circled back to the exact same issue, not enough GP’s and certainly not enough who want to be a partner and take on all the risk, liability and work.

the fault here lies with the government. I work in the NHS. Newly qualified nurses start on a lower salary than most other public sector workers. Newly qualified doctors start on £14 an hour. Expected on average to work a 50 hour week.
GP surgeries are struggling to retain GP's. They are all either leaving the profession or going abroad for less abuse and more pay.

Many services have already been outsourced to private companies. Near where I live, the sexual health services and anticoagulant service are both run by private companies not an NHS trust.
Many mental heath services for years have been outsourced to tender to the private companies.

it is going to get worse!

No it’s driven by contract changes. They are merging to share risk, smaller practices cannot cope with some of the contract changes and GP’s are teaching retirement age. It’s meant to be for protective reasons not for ££ reasons. The only feasible way of working now is at scale, hence PCN’s. I work at a big practice so we are managing, but smaller ones are struggling and we are all in a PCN, and without it we would be much worse off

Part of the problem now is that the public often assume that private services will be better than public. They probably think outsourcing to private companies is going to give them a better service- ahem… I’m afraid it’s often worse. I know lot of the outsourcing is hidden from the public, but it’s amazing how many mumsnetters often seem in favour of privatisation.

so yes then. GPs are making commercial decisions to merge.

@Menora has explained it perfectly as my friends described. Financially they couldn’t survive as stand alone practices.

But GPs have always been private

the main complainants of this issue are from two categories:

1. those who rarely use or need healthcare but when they do, are frustrated by not being able to access it quickly enough
2. Those who do use it regularly and feel frustrated that things have changed from how it used to be

what everyone seems to expect is fast reactive service to an immediate (acute) need, forgetting about the huge amount of work that has to go into everyone who has a long term condition that needs management all year round, as these are the national targets GP’s don’t choose to do but it’s their main source of income. You cannot survive as a practice without achieving these targets.

The narrative is that people pay their tax so they are entitled to care, but don’t forget, you are actually paying for everyone else’s care now who has more need than you. The young are paying for the elderly care now, not really for themselves, this is how society ends up working. I am also worried about the future, we can no longer view our tax as a long term investment into our own future needs.

When you are acutely unwell or in pain all you want is medical care, understandably, but the reason services aren’t as reactive as people would like is the burden of the elderly and LTC every day, almost hidden work and lack of qualified staff to carry it out.

The point of LTC work is to reduce the strain on hospitals (secondary care) by keeping people well at home for longer. If I could I would have our prescribing nurses seeing all the minor illness all day long and free up some time for GP’s, but I cannot as the nurses need to manage diabetes, asthma, family planning, wound care, injections etc. I also have limited space, so I cannot suddenly recruit more staff as there is nowhere for them to work.

Your GP (partner) will be spending many hours of their day not just seeing patients but they will be: signing prescriptions, writing referrals, talking to consultants, reporting investigation results, reading hospital documents (and adjusting records accordingly), training and supervising staff, managing the business finances, dealing with significant events, working on QOF and essentially dealing with anything complex. they are not hiding at home, they are productive but they are swamped with this hidden work.

Driven by contract changes, GP’s don’t set their own contract

Sympathies to you OP.

I feel fortunate my GP is on the whole very good, if you raise a request you will get a call back same day at the very least. Face to face appointments are hard to get but apart from things like smears, vaccinations etc I've always been fine with a phone consultation... never had an issue getting a script, referral etc from a phone consultation. Keeping the in person appointments for those who really need it is fine & my gp seems to get the balance right

Only complaint is they used to not let you book nurse appointments online (like vaccinations etc) but now they do let us!

Years ago my GP had a heart attack in his thirties. It was the workload, home visit, nighttime call outs plus normal surgery.

Another one who did this was burnt out early, retired died in his sixties.

The paperwork is horrendous Harold Shipman added an extra layer. If our hospice loses two patients in a 24 hour period the police visit.

The NHS with chronic conditions reaches a point where they can't do any more for a patient. My GP said it would save the NHS money if they block booked hotels for some patients in the winter in warmer climates

This. I work for one that was a traditional partnership model when I started, but because they put patients first and didn't care about the money, they weren't really making any and couldn't get new partners. They sold the business to a fairly new Primary Care company that is apparently non-profit (but pays an awful lot of managers to sit around in virtual meetings working on 'transformation') and they have really changed the environment. Half our salaried GPs have left to join partnerships elsewhere. We can't get new GPs because no one wants to work for the company when they can work in a traditional practice and maybe be partner one day.

To big fanfare an old primary school was transformed into a surgery minor operation unit. three surgeries merged. It all fell apart the GPs argued and left. It's now run by the health board using locums and isn't open some days. The principal idea was good was but GPs banging heads wasn't

Menora agree with your pp.
And a large % of practice nurses will be retiring in the next few years. We had two go in February (early) and had two applicants in total who we've had to take on.
One a paramedic who is completely out his depth and an ex district nurse. Myself and my colleague will be well retired before she's fully trained up.

Sorry I was referring more to the contracting out of other NHS services.

But actually I remember the “new” GP contract when it came into force and I foresaw a lot of problems then.

The police do not visit a hospice because two patients die in a 24 hour period. That is a ridiculous comment and totally untrue. Honestly why make up stuff like that?

Harold Shipman impacted regulation mainly in the form of appraisal.

Stories like those from Gosport thankfully made clinicians More aware of the issues of anticipatory prescribing and overall the medical examiner service has increased workload but will no doubt have benefits on better documentation and feedback of issues.

Was replying to this load of rubbish