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

Hospital doctors pick up their mess?You’ve got it the wrong way round.

GPs are on their knees. GPs are having to manage conditions they have no business doing because hospital waiting lists are so long. GPs are having to support the patients who are waiting years for specialist and appropriate treatment from hospital specialists.

(Not bashing hospital doctors at all - they have an impossible job to do too)

It could be done.
The NHS could set up a surgery paid for by the NHS and staff it with employed GPs paid to work set hours and offer a service the same as our current GP practice.

People could opt to register and join this new GP practice.

So why don't the NHS pilot this method?

I suspect we need to talk about how many people a GP practice should have on the books first though.
And should we rate people so that we get a sensible number per need
eg: old and small children get a higher "person count" than the rest of the population?

So I'd count as 1, but a baby would count as 1.5 and an OAperson could count as 1.2-2 depending on age.

Then you could say (and I'm playing with numbers here) that each GP can have 4000 people points.
So that could be 4000 standard people, or 1500 old and young mixed and 2500 standard people.
With adjustments for those with severe health issues too perhaps to ensure no GP service is overwhelmed.

We know some sections of the population are more vulnerable and may need more urgent or frequent appointments.

We could once we've agreed a figure per GP that is workable, then calculate how many extra GPs we need if we want a fair and accessible service and start training more people up.

lack of pay versus high pay is an unjust reality, not a cliche.

That sounds unnecessarily complicated

@Andthereitis that is an ideal plan. The data is there ready to analyze. it isn’t a particularly complicated model to run, especially if you are just trying to parse people into a few broad categories.

I don’t actually know how the nhs pays a GP for each patient. I know in some countries and in some systems it is a flat rate, regardless of how complicated the particular patient might be. The idea being that patients will average out and it will be ok.

The problem is that doesn’t actually work. Practices often have unbalanced patient loads. that can be geographic as geography and economics are strongly correlated with health. It can also be reputation. When someone with a chronic condition finds the holy grail doctor who actually helps, they share that name in support groups.

I don’t actually know how the nhs pays a GP for each patient. I know in some countries and in some systems it is a flat rate, regardless of how complicated the particular patient might be. The idea being that patients will average out and it will be ok.

That is pretty much what happens. It is a flat rate per patient registered with the practice, with a very small amount of weighting depending on the specific demographics.

Has there been a recent survey of ownership of GP surgeries?

IIRC, many/most are owned by the partnership not the NHS.

So if GPs close to retirement decided they’d prefer to leave at any hint of this as a policy rather than wait to be nationalised; presumably they’d just give notice required by the contract and sell up to highest bidder. Who might be brown/grey field site property developer.

And also IIRC, there are awkward demographics amongst GPs that mean a disproportionate number are close to retirement

Look at the real picture:

Eg. GP practice with 8 partners
15000 patients

Paid £108 per annum per patient under contract.
£1.6 million quid
8 GPs to pay mix of partners and salaried
10 nurses, 5 reception staff and admin staff plus a Practice Manager
A large building to run and maintain.

Not great is it?

OMG @OptimismvsRealism are you for real?

GPs won't agree to this - so the discussion is dead in the water. And you can't make them - because we are not in a communist state. The GP contract needs reform and the tax payer can certainly state what they are willing to pay for their services but cannot force them into servitude.

Some GPs would very much prefer being salaried - and there are advantages including being able to leave your job at the office and not worry about keeping the lights on and paying staff but most simply want a better funding model and to retain autonomy

Someone's already pointed out lots of GPs are set to retire. Have the one ones all employed directly.
Make that the new normal.

People need GP services. Let's discuss waya to improve the current mess which doesn't work.

Additionally many conditions that were managed in hospital previously are now managed by GPs and chronic conditions have increased exponentially.

£10 billion a year is spent on management of diabetes. Almost 6 million people in the UK have diabetes now - much of that increase is lifestyle driven and has added pressure on what may have been the cushy job of a salaried GP described above.

What can we do - as the public - to stop 6 million diabetics becoming 10 million diabetics? Because that is the direction of travel!

New GPs will not sign a contract of servitude unless it is attractive to them. So the discussion should be what conditions improve their lives and prevent burn out - not lose your autonomy and work for us. The BMA and the RCGP will shut that down and it won't get anywhere

Wes Streeting has already announced that more of the NHS budget will be diverted to primary care - that is a start

I’ve had a call at 9pm from my GP and emails on a Sunday.

“ Many times the pay of top hospital consultants”

I’ve no idea where you get your (mis)information from but that’s complete nonsense. GP’s aren’t paid a fortune and as for “running at a profit”, I hate to tell you this but that’s how businesses work!
No profit = bankruptcy!

It won't be a doctor giving the vaccination! That will be given by a nurse, possibly not someone who works for the practice even - the vaccination service will be paying to use the space.
And frankly as a taxpayer I strongly object to having to pay more for routine out of hours services so your employer doesn't have to give you paid time to attend an appointment Mon to Fri.

They have to maximise profits, otherwise there isn’t enough to pay for staff, the overheads and equipment.

Its miserable!

Except they’re not “independent”. Their payments come from the government, fee which are set by the government and they run the practices.

Interesting thanks

I have T2 diabetes - I've had it for 25 years, well controlled. The GP practice get extra funding for "managing" a chronic condition like diabetes.

But they do bugger all to "manage it" for me. There was a time when I'd get two appointments per year with the practice nurse, have my feet checked, have blood tests, blood pressure and weight taken, and maybe a little chit chat about healthy eating.

For the past 3/4 years, all I've had is a once yearly blood test done by a HCA who then asks the same questions from a computer questionnaire but offers no advice or comment on the answers I give - it's clearly to "prove" they're "managing" my condition, but they don't check my feet anymore, ask me to check my own BP in the waiting room and hand them the note with the reading on it, and ask me my weight - they don't even weigh me anymore.

Money for old rope. Just pretending they're "managing" to get the dosh!

If that wasn't bad enough, despite getting a text every year to say my bloods were "OK", I actually saw a GP last year and asked him for the blood sugar readings for the past 3 years. They were steadily increasing, which I wasn't told, and were higher than the recommended readings for a T2 diabetic. He said I'd need increased medication and "lifestyle" advice to get the readings down again and said someone would contact me (Heaven knows why he couldn't add a drug to the regular prescription, he's a GP after all!). A couple of months later, a random nurse phoned me to ask for another blood test. I went in for that. Then radio silence again. I chased and chased, only to be told they had no diabetic nurses ! It took six months to get the new prescription, and then I did another blood test three months later, which I got the usual text saying "OK", so I had to phone to ask for the reading, and it had actually gone up.

"Management" my arse. Mis-management more likely. They're taking the money and not providing the service!

The funding model needs to change. They need to be paid "per consultation", i.e. £x for a GP, £y for a practice nurse £z for a HCA. Then they'd start actually doing the consultations if they were paid for what they do rather than the "per patient per year" where they can do as much or as little as they want and still be paid!

Poor service - but that isn't to do with whether they are salaried or managing it themselves. Also reflects the need for more GPs, nurses etc - as you have nicely demonstrated the reduction in service over the past 5 years.

The number of diabetics (as an example of a chronic disease, there are many more) in the UK has increased by almost 1 million each year. Number of fully qualified GPs decreased by 1% in the same time space. That is why the service provided is demonstrably worse

A GP is called a primary care physician in the U.S. and their income tops out at about $250k annually working 80-90 hours a week. From that income they have to repay at least $500k+ in tuition and training.

In the UK most GPs income tops out at £80k a year. They work about 60 hours a week and have debts of about £50k which is repaid based on their income.

I don’t think GPs are grossly overpaid at all. Their income should top out at £120k a year. It’s extremely difficult for two adults in a family household to work these hours so you need to overcompensate to cover the lower income of the other adult. If you want people to be committed you need to pay them accordingly.

In the U.S. and Canada no medical workers are working unpaid. It’s only the NHS that I know of that where medical staff are working longer than their contracted hours without pay. In the US it’s mandated that anything over 40 hours is 1.5x pay for salaries less than $67k a year. However, most employers pay 1.5x hourly rate for all working more than 40 hours a week because otherwise no one would work the extra shifts.

When I need a doctor I get to see one either same day or next day. What I don’t spend in taxes I spend on medical care. When I lived in a blue state on the east coast with high state income tax, Medicaid was treated the same as private insurance so everyone gets to see the doctor without it bankrupting them.

The NHS system is broken because the system was designed, like everything else, by a single white male who has a wife taking care of them. Visiting the recycling center and traveling through airports I can see the same flaw. They need to ask mothers with 3 children and disabled people to design these processes.

Correct. I earn less than £30 per hour, which for my level of experience is not a huge sum in my opinion. A friend of mine does online tutoring for £50 per hour.