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?

https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice/march-2023

usefull stats - 43% of appointments made were seen on the same day.

I think for every patient who turns up at A&E with a problem which could have been diagnosed and dealt with by the GP, the GP surgery should be billed for their A&E treatment.

They are

That's pretty much how it works. There's huge pressure on GPs to reduce hospital attendance.

again, in my area the GPs across many different groups/practices have pooled some of their resources to centrally fund a fantastic out of hours GP service. You see the cars whizzing around evenings and weekends doing home visits/ care home issues and on the rare occasion I've had to use it for a child with an infection I had a video call back within a couple of hours and an antibiotic prescription sent to the nearest open pharmacy immediately after the appointment.

they are based at the minor injuries units across the area and anyone attending for anything GP worthy gets triaged in their direction leaving minor injuries to attend to, minor injuries.

Nope, far longer than that. Both my mother and FIL had cancer and ultimately died in the noughties. Their "care" and treatment by the NHS was utterly crap both times. Late/missed diagnoses from the GPs, slow/cancelled scans, treatments, operations, etc. No sense of urgency at all, despite cancer treatment obviously being time sensitive.

FIL in particular had to wait over a year for his cancer operation as it was cancelled several times and he was stuck in hospital waiting for his op, so inevitably he kept getting hospital acquired infections which meant he wasn't fit enough for other operations. By the time he finally got his operation (some 18 months after first contacting the GP), it was too late and the cancer has spread too far, so he had an operation for nothing! On one of the "cancelled" operation dates, the surgeon was on a training course, but they'd still booked operations in for him!

M ended up dying at a bank holiday weekend because she couldn't get the help/support she needed - GPs were closed, out of hours GP fobbed her off over the phone, McMillan nurses calls just went to answerphone and weren't replied to, oncology dept was on answerphone, 999 wouldn't send an ambulance and just referred her back to out of hours GP, etc. It's really nothing new. The NHS has been crap for a good couple of decades if not more.

Why email/text appointments don't work:

DH got a text message about a hospital appointment - not expected, although he does have a chronic condition so not implausible. 'Follow this link for your letter' etc.

Right, we say, heeding the best practice advised by banks etc. before we click on an unsolicited link, let's just make sure it's not a scam ...

Googled number - 50% results saying genuine, 50% saying THIS IS A SCAM

Inconclusive. We'll phone the hospital ... 'you are number 81 in our queue' ... maybe not, then.

OK, let's pop down the road to the GP surgery and ask them if it's genuine.

DH goes with phone, shows the receptionist - who doesn't know whether it's genuine or not. Their system won't show whether an appointment is scheduled and she can't tell from the number or the wording of the text.

We decide the only solution is for DH to go to the hospital in person to find out if his appointment is genuine.

Then, in the post, thankfully a letter arrives about the appointment.

Why not just have regional primary care centres administered by regional trusts, rather than just hoping that a bunch of private contractors will self-organise to provide key services? Your area has a great out of hours services provided by GPs but many areas don't - why the postcode lottery?

I know that GP surgeries are struggling to get and retain practice partners anyway (because it is effectively two fulltime jobs in one and both are hard - being a GP and running an organisation) - so why not just scrap this outdated model?

I also think that how to access care has become complex and confusing. The NHS seriously expects sick people to figure out exactly where they need to go for care, is it 111, a pharmacy, GP, walk in centre or A&E?

Who do you think works for the out of hours providers? it’s is contracted out to a separate organisation yes but they still have to employ GPs, nurses, etc. Some GPs work full time in out of hours but many work a shift or two a week in out of hours. There isn’t some other magic pool of doctors to work out of hours only - same number of total GPs to cover the work 24/7 however you divide them up. A trainee GP and I work 3 shifts a week in general practice and one in out of hours - including 12.30-24.30 today. My supervisor does the same.

I am of course aware that many many people work more than 36 hours a week. I am simply informing you that the legal definition of full time work is 36 hours. Also it’s quite possible to work 48 hours a week and still only work 4 days (4x12). Do some teaching and some admin and some training (lucky them not having a nursing home allocated - btw they may well do even if there isn’t one that local to your area as all the NH are divided up by the ICB and allocated usually) and it looks like there only offering clinic three days a week and people are accusing them of being part time! (You really don’t want doctors working more than 48hours a week as like HGV drivers and pilots etc they do kill people when they mess up)

I think you’re missing the point about capital investment in GP surgeries. The point I was trying to make is that it isn’t down to the individual GP to renovate/replace a surgery building. That’s way out of their cost bracket. The funding comes from somewhere else not the standard practice income which is for healthcare. I don’t know the ins and outs of it in detail but I do know it’s not as simple as phoning up the town hall and saying - “please can we have a new surgery”. Some GP partnerships own the practice they work in, some rent. The fancy new buildings are often rented/ppfi (as they are funded not by the GP partnership) and the rents can be high. For a partnership in an old but owned building meaning they are financially secure to decide to move to a new rented premises (if they can secure one being built for them) could be financially disastrous.

My own GP (the one I’m a patient at) is in an old unfit for purpose building and has been trying to get the LA to help fund a new one for ages. Two large housing developments projects locally have both undertaken to fund it (and a new primary school) and both have miraculously gone bust just as the houses are built but before the school/surgery is. The council have finally put in a school in portacabins but no surgery. It’s a shit situation locally as the surgery is too small and they can’t get more staff as there is literally no where to put them but it’s not the GP partnerships fault.

conversely the surgery I used to work at was in a fancy big ppfi building that the council had arranged as part of a regeneration project. It was supposed to be a community hub housing the library, citizens advice, several GP surgeries, sure start, community health service (health visitors, district nurses etx), a pharmacy and a community cafe. The ppfi people put the rent up loads and charged stupid money for new lightbulbs etc (classic stuff) two of the GP practices folded, the pharmacy moved to cheaper premises, the community cafe shut down, the tories scrapped sure start, and the library only opens two days a week due to cuts. The one remaining GP surgery partnership is struggling to meet the costs of this massive building - due to the dumb design most of it needs heating and lighting just to open the surgery (clearly they signed a crummy contract but their doctors not property developers/lawyers) and was very near folding when I left. They wanted to be open on some evenings to help with patient access but literally couldn’t afford to pay the extra fees to do so.

If it’s not clear I’d actually love to see all GPs directly employed by community nhs trusts (on the consultant pay scale) and the trusts maintain and fund the buildings and the admin. As a trainee I work in hospitals, in community trusts and in General practice. In hospital/community trusts I have a much better work life balance and much less responsibilities the patients however get a less responsive service and patients will miss the partnership GP a model when it’s gone. Consider HV and midwife’s and district nurses, used to be attached to GP surgeries and knew their local area inside out, care was delivered to the patient near their home in a localised manner, now their with the community trusts and work from a hub somewhere far away and you never see the same one and they don’t know the families or area at all well. GPs actually have (one of system one/emus/vision) functional electronic health record and electronic prescribing because as independent contractor they demanded the private IT providers make something that works. My local big nhs hospital has four different clinical IT systems but still has paper notes and drug charts l because the clinicians are just employees and the managers don’t get it. Get rid of partnership and all GP will become like out of hours care but I’ll work a nice 8-10 hour day and not have to worry about fixing a leaking surgery roof or paying the nurses wages. (Actually I think Australia beckons because I know I wouldn’t be happy providing such care)

@Eleganz

I know that GP surgeries are struggling to get and retain practice partners anyway (because it is effectively two fulltime jobs in one and both are hard - being a GP and running an organisation) - so why not just scrap this outdated model?

Well I agree we should stop the outdated GP model, but not for that reason.

Literally every small business owner has to find ways of doing their "day job" alongside all the admin/bureaucracy/management that comes with it. That's whether they're a GP, dentist, optician, plumber, electrician, solicitor, accountant, etc. If people want the benefits of running their own business, they have to accept the downsides, which is basically either doing all the management outside working hours, or reducing their income-earning hours to do the non income earning admin/management, or pay out of their "earnings" for people to do the admin/management for them! You can't have it all!

@Qazwsxefv just for context - my work (a LA) has loads of developers contributions ready and waiting to be spent on a number of GP practices and the hold up is entirely down to negotiating with the GPs and the CCG (or whatever it is now called).. it's 10x more painful than trying to reach agreement with any other partner body.

Had a message from the hospital this morning to say if I have symptoms of covid not to attend tomorrow that's an improvement on the compulsory covid test in the hospital car park a week before then isolate

Well @Florenz i think the people who say "oh the elderly will just have to learn" should be the ones to teach them.

Id fucking love to watch you try and teach my DM how to do it while i break out the popcorn

I'm not sure if it's the gp's fault or not but the lack of timely appointments is a huge factor. Also less people with supportive experienced relatives who can advise an anxious parent that a baby with a cold/mild group etc doesn't need a and e. And there is more sympathy both in real life and on social media if you call an ambulance for someone with tonsillitus or an ear infection instead of just giving painkillers and going to gp if it gets worse. I 've never called an ambulance for Facebook likes but when me or my dc are ill with something horrible but not life threatening and some one, usually MIL says some scathing remark when I just wanted sympathy then I can sometimes understand why people do that.

Yes, I'd love to see someone try to get my MIL to use the internet or a mobile to book a GP appointment! She can't even work the TV remote anymore and has lost the "art" of recording programs on the TV - she can't even remember doing it. She used to have a simple mobile phone and could text and make calls on it, but she's unable to remember how to do that now too! Even the microwave is a mystery to her!

Older people tend to go backwards, especially if their memory starts to go and ultimately they get dementia. It's something that is going to have to be addressed. Even people in, say their 60s or 70s who are using the internet and smart phones may find themselves unable to use them in a decade or two time. It's going to cost the country a hell of a lot of money if people have to start going into homes and/or getting carers earlier and earlier because they can't cope with the "new normal" of technology!

Yanbu

https://www.theguardian.com/society/2023/apr/22/woman-who-miscarried-fined-by-nhs-for-claiming-free-prescription-while-pregnant