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

Before i worked at a gp practice I had the impression that they didn't work all day.

I worked for a 3 gp practice with over 5k patients.
Gp 1 male worked every hour they could.
8am to 6.30pm. During that time they saw patients, sorted out blood tests and other investigations. Read over 500 letters/results and requested further tests per week.
Gp 2female as above but on part time hours.
8-3pm but sometimes didn't finish until 5pm.
Gp3female as above but did all home visits before 3pm.
Gp1 had a heart attack from the stress died just before retirement. He was the gp everyone wanted cared and looked out for his patients.
3 years later and we are struggling to fill his place.
Most want to be a locum no stress but no relationship with the patients.

The original reasons for GPs not being NHS staff are still relevant today: GP partnerships own their own businesses and premises, and the government doesn't want to stump up to buy them out.

AIUI there's a general movement in the direction of having all GPs as employees anyway, as being a partner is nothing like as attractive financially as it used to be. Every year the money paid to practices through their NHS contracts falls further behind the amounts they have to pay their staff (salaried GPs, practice nurses, healthcare assistants, receptionists, clerical staff...), and partners are left with less and less money.

There is now minimal if any incentive to become a partner, bearing in mind the need to 'buy in' to the practice. Much simpler to work as a salaried GP or more flexibly as a locum.

Let's not forget when a previous government decided to take over GP out of hours cover, because they thought they could do it more cheaply. Ended up costing the taxpayer a fortune, because they couldn't.

This government wants as many underqualified people as possible to go and work in General Practice because it is cheaper. The fact that people are dying doesn't matter.

5 years ago I would have disagreed thoroughly with you. We had a fantastic doctor. Did home visits, never failed to slot someone in. Checked up on you later if they were concerned. Even offered to drive a friend to A&E (and look after their dc) when they needed urgently getting there.

Then our GP surgery was taken over.

In the last 18 months, these are the contacts I had with the GP:

1. Requested GP appointment for ds who was not able to even sit up without going dizzy. Given appointment for 8 days time. Result: ds ended up in hospital on drip 5 days later.
2. Left (written) message asking to speak to a dr re counselling saying I was struggling mentally: Received text with link to a group that didn't do the sort of counselling I had asked about (in fact only did the type of counselling I had specifically said I didn't want)
3. Left message explaining that ds' medication now was prescription only for under 18s, and the pharmacist had said he needed to get a prescription: Received text saying: "Ask your pharmacy"
4. Tried to get an online appointment for me (how they want you to book appointments). Online says it's urgent, phone GP for an appointment today. Receptionist says there aren't any appointments, so I ask to go on the phone triage. Receive text telling me to book via online application (you know, the one that wouldn't book me on earlier)
5. Asked for a GP appointment for ds with something they have seen him for before. Needs basically checking and potentially medication, but needs to be checked before decision on medication. Can make things much worse by leaving. Received text: "Go to A&E" (who said it was, as I knew, a GP matter. They were not impressed when I showed the text.)

According to our local FB chat, anyone who goes to the doctor is singing their praises because it's so easy. Apparently there's no one else there. Can't imagine why.

A&E was absolutely heaving, there was a queue to sit down. Many of the people I spoke to had been sent by the GP. Many of them either would have been able to be treated by the GP, or had been put off by the GP and so had got worse.

Except it is cheaper. That fact is born out when you compare health board run practises with GP partner run ones.

If it was cheaper, any time a partner run practise offered to hand in their contract the health board would bite their hand off.

Yes, some GPs are paid more than some consultants. But they’re generally more widely qualified and do more. A partner run GP practise does all its own staff recruitment, pay setting and management, patient administration, payroll, records etc. A health board one uses non clinical staff at the health board to do all that, and as we know the corporate administration side of the nhs is wildly inefficient.

I'm a qualified GP with 10 years experience.
I haven't worked as a GP for over a year now. Because it's a nightmare. I don't have enough time to see my patients properly. There's so much demand it's very difficult to get any continuity. I was seeing 18 patients in the morning and 18 patients in the afternoon and 2 or 3 home visits up to 7 miles away. Also looking at 40 or so blood results, 10-15 hospital letters and another 10 or 15 tasks. I was permanently exhausted, late home from work, terrified of missing something. And I didn't have the continuity and ability to care holistically for patients that attracted me to work in primary care in the first place.
I had a salary of around £75000 for 40 hours over 4 days per week. Now working as a speciality doctor in secondary care for around £10000 less but feeling much better. Primary care certainly needs changing but you won't solve the problem by ending GP partnerships, you'll probably generate new problems because then you'll lose those people's work running small businesses.

It was probably taken over by the health board which is what the OP was suggesting. I have a friend who's practice was taken over and it was unbelievably badly managed.

Doh 😩
the surgeries are money focused as they have to balance the books !
it is not about lining the pockets of the GP’s !!
GPs are precious, worked to the bone, and seemingly thought so poorly of by the general public -
the lived experience of ex-GP’s on this thread tell us why the whole system in collapsing -

They can't magic appointments out of their arse, the funding they receive and the terms of the NHS contract hasn't kept up with the increased demand on their services. Or do you believe they're just all suddenly useless for a laugh or because they can't be bothered anymore?

This.

(Although the previous government brought most of the new roles in.)

I remember working for a commisioner and going to a meeting with a hospital because our GPs were refusing to do pre chemo blood tests. Why? Because they weren't paid to do it and so were having to find ways to stretch practice resources further. It was one of 100s of little extras they were doing for free as goodwill. GPs crying in our office was common. It was also unsafe because they were expected to interpret the results but were not experts.

The hospital were incredibly receptive - why would we say no, it's £112 per test.

The nhs is stretched everywhere. The job of a gp is... not fun.

Probably as people are reliant on actually getting an appointment as you can't bypass them to see anyone else

Exactly, they're the gatekeepers, so everything has to go through them.

Go back a few decades and they did a lot more themselves, i.e. minor surgery, attending emergencies, etc., but it's morphed into an "admin" role but they're still the gatekeepers controlling access to everything else.

That works if they are good at diagnosing and sign posting, but a lot aren't, hence the sheer number of "fob offs", misdiagnoses, etc.

And the time and experience of highly trained professionals is being wasted on trivial stuff where people should be able to self-refer, i.e. physiotherapy, podiatry, audiology, etc. It's madness that you need a GP examination and referral for a hearing aid or an ingrown toe nail. If you have hearing problems, you should be able to go straight to audiology, in the same way you go straight to a dentist with tooth problems or an optician with eye problems.

It happened when I first needed a hearing aid, six months of farting around with the GP, getting appointments, them saying I had wax which needed removal first, then another appointment to check they were clear, then they forgot to send the referral, then a few months later, after I'd chased, they needed another appointment to check the ears again to do the referral as the time had passed, etc. Complete stupidity and waste of time.

Same with our son with his ingrown toe nail. Farted around with the GP surgery for about six months again, numerous appointments with GP and practice nurses, all with different treatments, but none worked, so finally and reluctantly referred to podiatry. Finally, the toe nail was off and healing within 2 weeks of the referral, after 6 months of pain farting around with the GP surgery!

They cause a lot of their workload by not diagnosing properly in the first place, not providing the right treatments, and delaying referrals to the specialists.

The problem is that this isn't GPs fault as much as you think. Someone higher up in the NHS has made a cost-benefit decision to require referrals. This is all very deliberate. Referrals are used to restrict access to manage system throughput and capacity. There's insufficient capacity in secondary and tertiary care, so it becomes the job of primary care to keep people from accessing them. If they permitted people to access allied health services (as in your examples) without referrals, then demand would rise with insufficient capacity to serve it.

It also makes work miserable for GPs. They are under pressure not to refer.

The NHS has always had a very tight referral system. They're not unique in having them, but other countries are often more generous. For example, referrals may be more open (eg you effectively can see any gynecologist for 3 years), some specialties may not require a referral, or GPs don't have any pressure to refuse and the referral system is mainly to prevent the worst abuses and hypochondriacs. (In the USA, many insurers do not require primary care referrals and I have seen some real doozies.)

Read the history of the NHS to marshal a chorent argument. Yes, GPs have always been an exception, but so have dentists and pharmacists, so an understanding of how it is why it is and how it all hangs together would enable those who crticise, offer alternative, considered options.
And hospital doctors do not juust 'pick up their mess'

But that doesn't excuse sending irrelevant texts

What do you think a business manager is for if not to maximise the profits of the business? That is literally in her job title!

Not to maximise profits, but to keep their heads above water - rising costs and increase d demands and underfunding …. They aren’t out to MAKE money for profit !!!! It’s to survive. For all our sakes - doh

I would hope that there would be some consideration of the people using the service not just the money they represent. Because the Hippocratic oath is not about maximizing profits,at least last time I checked.

But when we as the community they serve find we can't get an appointment and when we do are palmed off,.misdiagnosed etc what can we do?

Business managers don’t take the Hippocratic oath…

It's a sign of a system that is too overwhelmed to function.

Even just sending a sensible text takes time and energy, needing to look over previous appointments, records, etc. Utterly burnt out people just stop even thinking.

Erm probably because the current model for primary care doesn't allow it.... it's not about forcing GPs, it's the system. The dept of health or the NHS has allowed GP practices to be standalone and not sit directly under the remit of the NHS. If they changed this then the NHS would be solely responsible for every aspect of a GP practice (more burden) and GPs would sit with them or leave as is their perogative. But this model doesn't exist so it's a moot point to say why aren't GPs forced, the better question to ask is why doesn't primary care sit fully under the NHS.