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

They ran perfectly well for years before the switch. It was an ideologically motivated change. And it significantly decreased the focus of the practices. The influence of GPs on commissioning is also of concern - MH services will continue to be cut. I will continue to say what I have observed.

Yes, they'll continue to be cut because there's no funding to pay for it. It wouldn't matter whether GPs were in charge of commissioning or not. They've cut to the bone already.

I also have type 2 diabetes and live in the USA. Statistically, the UK has traditionally done better than the USA for diabetes outcomes (overall; the US has really variable results). This is not simply about the insurance system but about a number of social determinants of health, but the UK having a strong primary care based approach was superior. Based on comparing the care I get with what other people with diabetes report in the UK, I am not so sure these days and await updated statistics. And T1s don't seem to be doing better, with the NHS being restrictive about access to tech.

(I see my primary doctor every 3 months, get regular blood work, get eye exams yearly, have a CGM, and get yearly foot checks. I wish I could tell you everyone in the USA gets this level of care but for various reasons they don't. Outcomes in the South particularly are really poor.)

You are correct - diabetes care in the US is very variable. The NHS has a world leading diabetic eye screening programme for instance - every single diabetic has an annual eye exam with retinal imaging. But this is funded and administered via centrally and GPs simply refer into it once the patient is diagnosed and it runs with a large team of graders and linked data.

CGM uptake is also restricted but there has been a massive programme of work and engagement with industry. - 70% of type 1 diabetics and it is NICE recommended for young Type 2s as well.

The NHS has promise - it is difficult to have the level of universal coverage we have for some things without such a system. But there are gaping holes - that are getting wider.....

I think it's very unreasonable to suggest this about all GPs, to be honest. Our local surgery have been absolutely fantastic and always proactive. I also have two GP friends (not at my practice) who are run ragged trying to fit in as many people as possible, while also trying to ensure their appointments aren't rushed and that nothing is missed. I appreciate that not everyone has the same experience as I've had, obviously, but I think it's unfair to suggest that all GPs are a 'weak point'.

Who in their right mind would go and see a private GP? For what? To google symptoms privately? Seriously?

Proof please? Because this is nonsense.

Absolutely! The very idea is obscene - GP practices run like capitalist for-profit partnerships and they are paid for by the taxpayer like in socialist countries? Really? This is madness. And for those who would say - our GPs will go private or go and work abroad if they are forced to be salaried - wake up - nobody in the UK would pay to see a private GP - a private specialist, yes, for their skills. But to pay somebody to google symptoms? Seriously? Nobody in the UK would go to a private GP. And if you think UK GPs are in high demand abroad, what with their marvellous language skills and superb (not) training? What a joke.

There are over 2,000 private GPs in the UK, so clearly some people do pay to see them.

So why on earth would people become doctors in the first place if they dont want to do what you think they should be forced to do? would there be not less doctors overall then?

regardless have you actually thought the idea through properly?

You clearly don't know much about how practices work & what the major problems are. The key issue is rising patient demand & falling full time equivalent GP numbers. There's a huge amount of info & analysis on the problems- do some reading then maybe you can tell us how to solve the problems

https://assets.publishing.service.gov.uk/governm

Any doctor who was qualified when the NHS was established 75 years ago is most definitely retired and pushing 100 so trotting out the 'GPs were against the NHS' line is very outdated.
Most parents & teachers used corporal punishment 75 years ago, but that's not relevant to modern discussion on the subject.

If I call our local private GP I can see them on Thurs afternoon & get a prescription & reassurance from a Dr I have a relationship with who I like and trust. They know me & my medical history.

Our NHS GP has one doctor I rate who I can never see as so in demand. Locums otherwise & different ones every time. Two week wait plus. As a child we had a trusted family Doctor we could see when needed who knew us.

This could be made more efficient still if all of the gatekeeping was eliminated completely and patients able to directly book appointments with the relevant specialists themselves .... as is possible in some European countries, such as Germany, Switzerland & Belgium

And how would that deal with the "worried well", and the neurotic mentally ill people who are convinced every twinge or sensation they have must be indicates of cancer? The gatekeeping is there so that people see the most appropriate specialist, and there are NICE checklists to go through and pathways of which more-likely conditions to eliminate before you get to the waiting list for the expensive diagnostic appointments requiring the big sophisticated machineries. In the UK the GP administers that and the treatment is free to all NHS patients. I am not familiar with the system in these other countries but I suspect there may be gatekeeping of another kind - yes you can make the appointment youself but perhaps does your insurance provider have similar checklists in place so that they don't have to pay for a specialist oncology appointment for the batshit person who thinks "it must be stomach cancer" whenever she gets indigestion? If you have to pay out yourself if your insurance won't cover your irrational conclusions then that works as a way to moderate the demand for each specialist's time, but I don't see how a system with no gatekeeping and no financial impact to the patient who makes inappropriate appointments could possibly work. Or do those countries have fewer neurotic hypochondriacs than we do?

UK trained GPs are in fact in high demand abroad . and have a much more pleasant working life .

I’m glad we don’t force them. They are already bad enough. All they do is give you pills and send you on your way.

If you think all a GP does is google symptoms then I don't know how to convince you of anything.

You mean why don’t we force them to work for American finance houses and provide a shit service , these days?

@theduchessofspork
i think you are misinformed. Not all Dr’s are employees of the NHS. Junior Dr’s in training are employed by the NHS trust they work for (there is also some funding from the training programme deaneries towards costs of training). Consultants, however, are contractors to the NHS and not employees. GP’s are independent contractors- the practices have a contract with the NHS trust to provide general medical services.

you are also factually incorrect on the rest of your statement. I’m a Dr and not a GP. If GP’s were paid a fortune and had an easy job then they would not have the shortage of GP’s that we have. Most GP’s are not paid more than hospital consultants. They also face significant impact of rising costs of running a practice (cost of equipment, heating and staffing) which we in secondary care are entirely insulated from. Many practices are giving back their contracts as they are no longer financially viable. There are some large consortiums forming, where the “head GP’s” are earning a lot of money, but their salaried GP’s really aren’t. There is also a reasonable amount of evidence that NHS run GP practices do not have better outcomes than those run by partnerships- and they cost more to run. There are undoubtedly practices who are poorly run (this is also true of NHS trusts or even individual departments), and individual GP’s who are either lazy or incompetent (also true of every profession) BUT I don’t think is true of the majority. Many of the issues within general practice are systemic and long-term. Bashing GP’s is not going to improve any of these issues. Nor will trying to force them to become NHS employees.

I agree there are problems within general practice- the causes are long-term and complex but include (but not limited to): chronic lack of funding to match increasing workload; a rise in the aging population placing greater demands on community health and social care services; a significant shortage of GP’s; issues within provision of resources within community services (both health and social care); longer waiting times for hospital are also impacting GP’s (we have a lot of evidence that this is feeding back into increasing demand for GP appointments); and a rise in “worried well”.

Because we abolished slavery about 200 years ago?

Im sick of seeing all these anti-doctor posts from posters who know fuck all about the whole subject. It’s pathetic.

I wouldn't want the NHS to be running GP practices, they would be even worse than they are now.
I am so lucky to have a good GP practice. I know some are awful, but this is what the CQC is for and they need to get tougher. We really need to be looking at the community funding bodies. In my day it was Clinical commissioning groups, I think it is something else now. These are the people who need to be heavily scrutinised because IME these are the people who control the money and service provision. When I was running a service in GP, we had completely unqualified people making huge decisions about services and funding. It was very frustrating and dangerous.

Are they? There seems to be rather a abundance of doctors that can’t get full-time contracts within the NHS at the moment. Perhaps they might consider primary care as an option versus driving an Uber.

Ah yes because the rest of the NHS is functioning so well. The GP model works well when the government isn't fucking it up, like giving pots of money for unqualified staff in lieu of actual doctors.

General Practice is generally the most value for money part of the NHS. And very few GPs are on significantly more than senior NHS consultants. And I’m an NHS consultant.