To wonder why we don't force GPs to work as NHS employees like every other doctor

[OptimismvsRealism]

They're the weak point for the entire health service and they make a fortune while hospital doctors pick up their mess

The issue with GPs isn't that they're money grubbing. It's that too little of the NHS budget is devoted to primary care, relative to how many services it provides. That's why the quality of service is declining.

in Canada, family doctors (GPs) have control over their patient lists. When they close the list that is that. There's no guarantee of access to a family doctor. About 20% of Canadians, iirc (varies by province) are not registered, and you go to a walk in clinic if you get sick. I have a friend (near Montreal, one of the hardest places to get a doctor due to Quebec politics) who spent a full decade on a waiting list before being assigned to one. That's the trade off. In the UK, they just push more patients onto lists, so the doctors work overtime and appointments are hard to get.

My GP friends are hard working, dedicated, overworked and undervalued professionals. I see them on their knees, absolutely exhausted and destroyed by their impossible workload.
Walk a mile in someone’s shoes…

Because pay would likely go up - there was a lot of discussion about this when AfC was first introduced, and the BMA junior doctor committee was in favour. An F1 would be a band 5/6 an F2 would be a band 6, an SHO would be a band 7, an ST4+ would be a band 8. Big jump in money once the extra hours and antisocial pay is applied (doctors are generally contracted for 48hrs a week, AfC is 37.5.

There should be the option for new GPs to work as salaried employees if they wish. Many good doctors aren’t suited to being self employed. It’s the one size fits all approach that is wrong.

I agree fully, for the most part the GP service is completely broken and not working. The number of people I've known, who've been fobbed off and turned away from their gp (usually with a prescription for some basic med or pain relief) is astounding. And then they've ended up in A&E when a serious condition has been overlooked and escalated to critical.

It seems you have to almost harass them into seeing you, nevermind taking your symptoms seriously or referring you to a specialist. Their seems to be a common theme of not listening to the patient properly, not examining them thoroughly and premature diagnosis - just deciding it's the most common trivial ailment and ignoring the possibility of anything more serious.

There was my 20 year old friend who'd been to his gp endless times since he was 17, complaining of hip pain. GP just kept giving him stronger and stronger pain meds. Until he collapsed and went to hospital, where they discovered he'd got a tumor in his hip, but it was too late for anything but palliative care. He just made it to 21. Or my best friend who was fobbed of by GP as having IBS, despite being incredibly ill and passing blood for months. GP never examined her properly or looked at blood test results properly. In the end she got so weak she could barely function. I nagged and nagged her to call 111 and they told her to get straight down to A&E. They discovered advanced ulcerative colitis (normally takes years to progress to that bad), and an immediate colectomy was the only option left that could be done. Thankfully it was successful. She's switched GP since, but the new one seems no better - 6 weeks to get an appointment, and that's just a telephone appointment, forget seeing them face to face.

I know quite a few more horror stories like that unfortunately. I actually think GP surgeries should be shut down - half the GPs moved into pharmacies and the other half put in hospitals. It's tragic, but NHS 111 telephone service seems better than what GP's can offer these days.

Having said all that, my own GP surgery has been absolutely brilliant. They recently came top in my county on patient satisfaction survey, and they totally deserved it.

What do you do for a living, @OptimismvsRealism?
If you’re happy to force somebody else into employment they might not enjoy, then buckle up. You aren’t going to enjoy what’s in store for you.
If only people thought one simple step ahead.

See my earlier post, @DreamTheMoors - you've misunderstood what's being suggested.

That’s very interesting! Thank you for sharing.

If a room is used or has to be cleaned and reset. That costs money. A practice has to cover its operating costs.

I would not move to Canada as a GP, they are screwed here too.

I have to say somthing here, having a chronic health condition, my GP’s are great. If I have a problem I ring they usually solve the problem. Everyone from the receptionists, secretaries, phlebotomists, HCA’s & pharmacists are doing a great job in difficult circumstances in my experience. I know not everyone’s not experiencing the same. I felt the need to put out a positive in a sea of negativity.

I’m a hospital doctor. You could not be more wrong.

Salaried GPs make less than hospital specialty consultants. I would leave medicine before becoming a GP, their job looks awful. They do not have it easy!

This.

Would the OP like to foot the bill for the thousands of GP's surgery buildings across the country?

And why, if being a gp is such a route to undeserved riches, are there only 6,311 surgeries in England when there were 7,484 in 2016?

https://www.statista.com/statistics/996600/gp-practices-in-england/

A HUGE portion of 'part time' GPs are anything but

As well as seeing patients, a GP must deal with an avalanche of correspondence from hospital clinics, laboratories and other clinical sources, reviewing and entering information onto thousands of patients' records, flagging up results requiring further treatment, messaging patients and making clinical decisions based on the results

They must help the practice comply with government imposed targets for ensuring up to date information is held on patients' height, weight, alcohol and drug consumption, prescribing issues, coding, audits and accepting new patients and all the bureaucracy that involves

They've got to make referrals to services

They must go to safeguarding, Prevent, and MARAC meetings, liaise with police, social services and community clinical services, like District Nurses and virtual wards

They must supervise and mentor trainees, reporting back ot hospitals and universities when required

They must continue with their own personal development, paying for training, conferences, memberships and exams

They are part of practice management and must help deal with hiring, firing, budgeting, procurement, security and health & safety

They must act as a duty doctor, dealing with emergencies, acting as a point of contact for admin staff, writing emergency prescriptions and offering advice

Many GPs are also part of OOH rotas, staffing Urgent Treatment Centres or specialist OOH sites

They have stepped outside the clinical career structure, forgone any chance of consultant grade to work in an isolated building with no onsite security, receiving any rando that walks through the office door, hoping the panic button works

It is a thankless, potentially dangerous, job and they are not paid enough

I haven't read the whole thread, but I'm a DGH consultant, and I can tell you that being a GP is the hardest job in healthcare, probably one of the hardest jobs in the country. I would rather eat my own head than be a GP. Whatever they do, no one will be happy. Imagine a job where literally ANYTHING could be your next appointment. Anything of all the huge array of things that can affect the human body. It's frankly impressive that they are mostly right. It's in no way their fault that politicians chose to structure their work the way it is, or that they're not mostly direct contracted NHS employees the way I am - in fact it makes their jobs harder as they also have to be small business owners. I suspect if you tried to figure out what salary to pay a nationalised GP service, it would be completely unaffordable.

Not to mention, one can be a salaried GP under the current structure. I believe I read that fewer GPs now want to be partners, despite the higher income, because the extra pay doesn't compensate for the workload.

British GPs are expected to do more than their equivalents in some other countries, as well. The structure of the NHS and GPs' role in gatekeeping access to secondary care places a significant burden on GPs.

Also as someone who works in an adjacent field (public health), I would never go into general practice to make loads of money (and not just in the UK sadly). Even within medical fields: the way you make money as a doctor in the UK is by making it to consultant in a field where you can also maintain a private practice.

And Gps have to save up, in advance, for their own maternity leave payments. They are like a private business and have to fund many things that employers nomally pay for.

@Gingernaut There are millions of jobs across every sector and industry where people work long hours. in return for higher pay than an average person.

Of course there are lots of additional tasks for a GP to work on as well as just doing appointments, but it's no different than any other job or profession. Your decorator has to go and buy the paint, do her tax return, service the van, not just paint all day. Again, it's a normal part of any career, not a GP specific issue.

If someone chooses of their own volition to take on additional work to earn more money, it doesn't make them a martyr - it just means they decided they'd like to earn some more money.

If person A chooses of their own volition to do a job of work with lower pay, benefits, career progression and so forth than the one person B chose, they're still not a martyr. They just chose which career pathway they felt best suited their needs.

And yeah, GP safety is a big issue, as it is for all medical staff.
It's also an issue for retail staff, hospitality staff, traffic wardens, hairdressers, teachers, and everyone else. Not for one single second am I saying that's right and just, but again it's not a GP specific issue.

This is intended as an attack on your opinion only and not at all on yourself personally - if it comes across as the latter that's down to my lack of communication skill rather than malintent.

I thought that private companies like Symphony are buying up GP prractices then laying off doctors as they are expensive in favour of cheaper PAs.

The people who go to medical school are intelligent, hardworking and are likely to have robust health, a high professional salary and a minimal amount of negative life experiences, save for their rigorous training and ridiculous workload (although that is their choice). Patients tend to have different lives and experiences and being labelled as rude or treated as adversaries when they are in need of assistance is, I believe, a cultural problem that causes resentment to build.

Obviously more GPs are needed to cut down on individual workloads, they need breaks and time to complete admin tasks and they need appreciation for the challenging and important work they do. Patients need to be seen, heard and treated with dignity.

Something that always strikes me as interesting is that it becomes possible for a GP surgery to be open on the weekend when they are being paid to give flu vaccinations. Maybe the NHS should pay GPs a high salary for weekend working and then more patients could be seen?

The problem is that there's not enough GPs to staff more hours. It would shift hours around, but not provide more hours of service.

A production-line of flu jabs is not the same as operating an actual GP service, at all.

Wes Streeting used to think all GPs should be salaried. Til it was pointed out that with all the unpaid work GP Partners do, you'd need at least 3 salaried drs to replace every 2 partners.....

It used to be that if you went to see a GP the problem you had, persistent abdo pain, painful hips etc etc would be diagnosed then referred to a specialist eg orthopedic surgeon at the local hospital whom the GP would write to and you would see them in a week or so. This direct line seems to have been cut and the referral letter goes off to the hospital and you are put on a waiting list of weeks, months or years.
the upshot must be that GPs are constantly seeing sick patients who aren’t or haven’t had the required treatment -through no fault of theirs.
This must be exasperating and soul destroying - complaining patients you can do nothing about.