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 company that runs our surgery group is over 2 million in debt, but they've only been running a few years and they tend to take over financially struggling practices.

I worked in the hospice in Wales and it did happen.

OH friend was part of the committee who reviewed the case and put forward the recommendations.

You're just unpleasant. Not one word is untrue I attended his funeral. The other a family member. Our family is awash with NHS staff. Nurses GPs and two consultants. I worked in a hospice.

It would not have been based on two expected deaths in 24 hours. Something must have been specifically amiss or concerns raised so you cannot extrapolate that to usual practice and to do so is misleading and causes distress to families.

I hate my local GPs with a passion, they withheld scans from my mum stating she couldn't have cancer again after having a hysterectomy when a quick google told me it is very possible. And it did happen. My mum got admitted to hospital eventually and was asked by them there why she hadn't had a scan depsite going to the GPs numerous times.

GPs withhold referrals like they are gods, there are story's every day of them ignoring patients illnesses

Would earlier intervention saved my mum I don't know but she shouldn't have had to wait so long.

I always find it quite “Trumpish” that we have had 5 Tory prime ministers since Labour was last in power but someway it is always Labour’s fault 😁

Pity that those 5 Tory PMs have not done anything for the economy apart of making it far far worse.

So are they going to pay me back when I have to wait past the time for my appointment.

You do realize a lot of hospital appointments are missed due to them being moved multiple times and the patient not informed or letters not reaching in time.

Well if the options are merge or go under then merge is what happens. It’s not really a choice, the merged practice is maybe offering worse care but if the old practice folds then there is no care.

old style GPs are a partnership private business with a contract with the nhs to provide medical care to patients registered with them. The financial risk to the partners is unlimited. The medicolegal risk not just for the Gp partners own work but that of all staff in the practice (nurses/HCAs/receptionists) etcis only partly covered by the nhs (dvla stuff, benefits stuff, sick notes etc are not nhs covered).

if your local hospital owes money no one sends dept collectors round to the chief executives house trying to take his TV to cover the dept. If hospital goes into dept (and most are) it can still pay the wages of its nurses and receptionists as the government bails them out. The GP partner can well have debt collectors after their own stuff, they are responsible for the livelihoods of their staff, many I know when times get hard pay the staff out of their own money. If a nurse makes a mistake and it’s not nhs covered the GP partners are financially responsible for their mistakes.

the media will have you believe that GPs are all earning loads of money but infact recently small practices just keep on being non viable financially - it’s not a desire to sell out to make big money elsewhere it’s that the small practices can’t survive - they can’t pay the rent/wage bill/insurance anymore so they have to sell out or merge. If you can’t pay the staff or the rent you can’t continue.

Imagine an independent coffee shop near you. It’s run by a couple of friends who took out a loan secured on their own houses to set it up. They’ve been doing it for years and did have a loyal local support base, they tried to help out locally by doing free coffees for homeless people and letting groups meet in the shop but now costs have gone up, inflation is high and they want to be good employers so wages are going up, the sanitary inspectors demanding that they have some fancy ultra cleaning machine they can’t afford to keep their 5* hygiene rating and that everyone they employ needs to go on a fancy diversity course, and the customers are all complaining that they don’t have a fancy online ordering app like costa does. They try and innovate and appeal for help from government but are told they that they’re greedy and lazy. Customers seem upset all the time and get shouty with the barista becuase they haven’t heard of a double frozen extra hot no cream frapac-mocha-chino. The friends realise they can no longer break even and have mounting debt. They worry that their staff will all loose their jobs And they will loose their homes. They sadly decide costa to pay off their debts and to ensure their staff continue to have jobs and the people still get coffee.

would you blame the coffee shop owner for being a greedy fat cat who didn’t care about their staff or customers or would you realise that they have tried to make a business work and it has failed and they have made the only choice they have to survive?

General practice is in crisis. The sort of old style GP partnership people seem to want is not viable financially. Yes a GP can make loads of money setting up some sort of mega-corporation but that’s not what most are doing - these mega corporations only have a few CEOs after all. Most GPs are struggling in small practices or if/when that collapses they leave and go work abroad or for a mega-GP-corp not as a boss but as an employee making reasonable not eye watering money (60-80k per year full time) They actually earn less than when in partnership but don’t have to worry about running a business

I've just looked up my GP practice at Companies House. It was 4 separate practices, but they all merged into one big one approx 5 years ago.

The 3 directors applied to have the company struck off on 24 March, and haven't filed accounts since Feb 21. I suspect they may have sold the company to one of these big health providers.

My GPS run 3 practices but only 9 GPS are partners. The others are employed. There’s 9 partners and 17 salaried and registrar gps. Not a single one is available 5 days a week. Not one. Therefore you just see a GP. You have no relationship with any of them. That went out of the window decades ago. Its fair to say it’s not a bad practice.

My DM also has a partnership gp service. It’s atrocious. They are not willing to fund a new surgery. It’s still in an old house with stairs. It’s lit of the dark ages. It hasn’t changed since before the NHS was founded when the house belonged to a doctor. Continual complaints get residents nowhere. Poor care is standard and it upsets a lot of elderly patients who find it unfriendly and uncaring. Every other village and town has a more modern surgery. I find it incredible that they won’t invest when everyone else has.

No exceptions. Everyone pays.

No more letters, they are ridiculously inefficient. All communication to be by text or email.

You didn't answer if they are going to pay me back for being late. Or is their time more important.

I think there'd be a lot less late appointments if people had to pay for them.

So no you aren't answering my question as every gp appointment I've had has been late

A significant number of appointments are taken by the elderly who wouldn’t necessarily be able to access emails or texts

They would have to learn.

If an appointment was very late, maybe a refund would be appropriate. I haven't thought things through that far. I think there'd be a lot fewer appts if people had to pay for them so much less chance of lateness occurring.

It doesn't matter if it's very late if you are fining me for not attending then it works both ways as you said you really haven't thought this through and in reality it doesn't work.

Reasons your GP is not offering a normal clinic appointments all day every day for you to book- they might be doing any of the below that they are also required to do:

1. nursing home ward round (half a day per nursing home once a week)
2. baby check clinics (half a day, once a month)
3. admin session (where the doctor reviews all the blood and imaging results on their patients, reads and writes letters/emails on patients to from specialists, writes reports to dvla/dept work+pensions/coroners/insurance companies etx) (half day twice a week)
4. training session (safeguarding update/prescribing update/BLS update/manual handling update/session on fancy new treatment for something) (half a day once a month)
5. Morning off as have been working in out of hours/hospice (yup GPs staff these) all evening/night and need mandatory rest
6. minor surgery clinic - freezing warts etc (half a day once a month)
7. Home visits to dying patients or dead patients (including having to travel considerable distance to view the deceased after death if they were the last doctor to treat them but the patient then moved to be with family) (maybe half a day every other month)
8. Teaching medical students (because you know we need more GPs)(half a day per week)
9. quality improvement and audit - such as comparing patient outcomes in one area - say diabetes care with national standards - to ensure that the practice is continuously improving and providing safe care
10. if a partner running the business - checking accounts, recruiting, planning cover, organising premises maintaince, etc

add to that the standard day is usually 10-12 hours long so you normally get to full time hours (>36week) in 3-4 days and that people also get annual leave is it any wonder that no GP is doing a “standard” clinic twice a day five days a week (any GP that is is not there keeping up with their mandatory training requirements and would be unsafe

Partnership GP is not appropriately funded for the partners to fund the purchase of land and then the building of a brand new surgery. Have you any idea what that might cost? It’s well beyond the reach of any normal individual - a normal GP in partnership is making between 80-120k - that’s good money yes but not enough to fund the building of a brand new surgery - that would be millions, for a building that you would then worry the government will appropriate (compulsory purchase under cost) at some future nhs reform. Why should your DMs GP borrow 1-2 million (even if they could in todays market) at their own personal risk to provide facilities for the nhs?

These new fancy surgeries are usually built with government grants/bribe money from local housing developments/regeneration money/by a fancy private GP corporation , hardly the individual by GPs fault that the local authority won’t spend the money - moan at the MP. This is why partnerships are folding - patients expect the fancy buildings and websites of some super-corp but with the personal touch of a single handed GP.

36 hours is full time? That’s an issue in itself? Yes. They do have other things to do but 3/5 days, or less, for all of them looks part time.

I know a lot about contributions from developers. They contribute because they are required to. Not a bribe! Why on earth would you think that? DH has worked with GPS on their buildings. Nearly every GP practice here has had one in the last 40 years. Not one is a fancy building. On the other hand they are accessible and the elderly can actually get to a consulting room! Every GP has managed if except DMs. Even ones in hugely expensive areas. It is possible if you want it enough.

https://en.m.wikipedia.org/wiki/Centene_Corporation

Just been down a rabbit hole 🕳️🕳️🕳️🕳️🕳️ or six to find out who are the players in the buying up of our health. Here's a big fish with a chequered history.

From surgeries to hospitals. It's interesting.

A “bribe” as in the developer promises a new GP surgery for the local area to get planning permission (maybe I was a bit too tongue in cheek). Why this particular surgery had not been able to secure funding I don’t know - maybe they don’t write nice enough applications (funding applications for major infrastructure development not covered in medical schools). It sounds like it’s more your DHs field - maybe he should volunteer to arrange funding for them? And before you say he’s not being paid to - neither is the GP!

36 hours being full time is the government definition for all working adults in the uk - nothing specific to healthcare I’m afraid. If you work over 36 hours a week you are working full time. Most GPs do between 40-48 hours a week. You say it looks part time but what bit of the other bits of their job do you want them to stop? Seeing patients in nursing homes? Doing Out of hours care? Visiting the dying? Writing and reading the letters and results? Not a lot of good if the GP spends 12hrs a day seeing patients face to face but then never writes the referal letters for them to be seen in the hospital or looks at the blood results for them.

@Qazwsxefv
Ax I said. It’s not a bribe! It’s a legal requirement that developers contribute to local services. Therefore reads and schools are also included.

Out of hours care? Completely contracted out. None done here and hasn’t been for decades. Calls are diverted to a central out of hours provider. No one else works 36 hours full time that I know. We don’t have a nursing home here. They do train. Hopefully they update their education. They close the surgery at least once a month for training.

What they have done is employ more nurses. That’s not a bad thing and saves them money. Lots of appointments are nurse appointments. It is done so the doctors see fewer people. Let’s at least be honest: with huge pensions they retire early too. So it’s a short working life. Many self employed people work way more then 48 hours a week for many more years. It’s what you do when you are self employed. Doctors retire early because the tax payer is paying a very generous pension most people can only dream about.

I think you are broadly right, though my own personal experience of the NHS dates back several years. Whatever the reason, I am outraged that it is often so difficult to get appointments, because often the patients who need the appointments most aren't pushy enough or do t know the right code words to get seen. And many older people still feel they should just put up with whatever is wrong.

I am really feeling for my MIL who has basically been ignored since Covid - she is frail and has multiple chronic conditions (which aren't going to kill her but the symptoms are severely affecting her). She gets issued with new meds with no idea of what to expect and no follow ups. She feels no one is listening and has talked about wanting to take her own life because her symptoms are intolerable.

However my own experience more than a decade ago was still not good - endometriosis symptoms ignored by my GP and FPC for years, had to move abroad to get a diagnosis, too late to avoid permanent damage. Multiple ankle sprains ignored, including one with talar dome fracture/massive cartilage lesion - have had three surgeries abroad and have needed a complete ankle replacement since my mid-40s.

Some kind of European-style system must be the answer.

In 2019 the government promised an extra 6,000 GPs, but now there are 825 less full time GPs than in 2019. Some areas are reporting that there are 250,000 patients to one GP.