To think this budget will finish us off

[BurnoutGP]

I am a GP Partner of over 20 years. I am now senior partner for the last few years. We have seen year on year below inflation funding increase. With an explosion in demand and massive shift of work from secondary care. We have issues wirh recruitment.
Our partner income is shrinking year on year. We are now always overdrawn and this gets worse every month.
We just cannot soak up the MLW and NI without adequate resource uplift.
I think we will be done. I'm so very tired of the constant battle and the demand and anger while working "part time" 60hr weeks.
We will have to hand back our contract. And we wont be the only one. That will leave one surviving practice in my area.
I'm done.

Yeah but all the self enrichment paperwork would be gone

@BlossomToLeaves
If you really worked in hospitals for decades, you would know how utterly inefficient their management structure and procurement departments are. They are far, far less efficient than in general practice. Ditto the IT systems. Ditto the medical staffing. And of course you will also know that Consultants are very much involved with management too, although not to the extent the GPs are because they are not responsible for running an SME.

You may not be able to imagine what GP partners do. The things already listed are some of them but they also mop up all the additional clinical work so they take lots of paperwork home and check blood test results, hospital correspondence, medication requests, etc, they take on additional management of complicated patients that they know well, they take charge of teaching of medical students and other staff, whom they mentor. Theoretically, running the whole business and managing the staff doesn't need to be done by a GP but the other clinical things do (plus insurance reports which require a GP and would take time away from NHS work) and if you imagine that employing several managers is bound to help, like in the hospital, you are very likely to be mistaken.
If all GPs became salaried, there would not be Partners anymore picking up the extra 2 or 3 hours or work a day; that would need to be paid at a sessional rate, then you would need more managers employed. Salaried GPs, who are currently loyal to the GP Partners, would also expect to actually do the hours they are paid to do (they do an awful lots of extra hours too).

I certainly don’t think the NHS should start paying GPs to do this.

There are salaried GP (2C) practices in Scotland that work very well. There was a lot of upset at one I know of, because the health board wanted it to become independent again. The GPs who work there provided a very professional service, no ‘working to rule’. The patients preferred it too (especially as most of the GPs left because they didn’t want to become independent contractors again).

I’m not Blossomtoleaves! And I’m afraid none of that convinces me for a second. GP is a specialty and no good will ever come of wasting expensive clinical time on a gamut of admin. Your opinion of hospital management is very different to mine. I’ve seen first hand what happened when a doctor was appointed to run a hospital. It didn’t end well. And most GP practices aren’t serving patients well. It’s almost impossible to get an appointment now. It’s an outdated model which may have worked in the past but it doesn’t any more. Time to move on.

They would do it in their own time. The point is that it would then take them away from their NHS activities.

Those two sentences directly contradict each other.

The things already listed are some of them but they also mop up all the additional clinical work so they take lots of paperwork home

plus insurance reports which require a GP and would take time away from NHS work

Presumably if they didn’t spend time in the day earning extra by doing private reports, they would have more time to do the NHS work they are contracted to do and won’t need to take so much paperwork (I hope not patient files!) home.

GP partners don’t actually run the payroll or mend the leaking taps themselves…. They generally have practice managers. They have a leadership role in coordinating and steering the practise that ideally requires someone who “knows the business” to do effectively and efficiently, much in the same way it is recognised that a headteacher needs to be a qualified teacher.

”Nationalising” GPs and placing them under some overbearing NHS bureaucracy devoid of medical expertise, whilst they simply focussed on medical activity whilst exercising no leadership would be disastrous in my opinion, in the same way as abolishing headteacher/deputy head posts and putting schools under the control of a “National Education Service” headed by non-specialist managers in distant offices and expecting that to lead to good outcomes.

Going down this route feels somewhat similar to the Soviet and Maoist collectivisation of the 20th Century… and that didn’t end well!

There are two Blossoms I see!
To be honest, it just sounds as if you think you know and understand more about a job that you have never done than the people actually doing the job. That's more than a bit arrogant. You've also just ignored what I said about all the additional clinical tasks which is convenient.
Were you actually a hospital manager or something completely different? I have a pretty good account of what goes on in at least one hospital department as regards management currently and it is very poor. Multi layers of managers have simply increased cost and increase inefficiency. The same has happened in the USA.
All GPs and other staff working in general practices are more than aware that the waiting times are far too high and that the overall service is not of the standard that they want to provide. GPs and their families are also patients so see this from both sides, a unique position. It does not therefore follow that making all GPs salaried who suddenly cut waiting times, lead to a better quality of service AND be cheaper. That is highly unlikely, in fact. It is exactly the incorrect assumption that was made over the OOH care, which it turned out was actually being delivered much more cheaply by the GPs. Since then, the governments and the media have sought to tear down the profession. They've been chipping away for nearly 20 years. The reasons why it's 'impossible to get an appointment' (difficult, yes, impossible, no) are multi factorial. I would list them but, as you clearly have no intention of listening, I won't waste my time.

Err. How exactly? I'm not sure what you are struggling with here.
If a GP does half a day a week doing insurance reports, they will have less time to spend seeing patients for the NHS. Time is finite, you know.

But you agreed they’d be doing them “in their own time”, ie time outside patient contact time.

If a GP spends half a day doing private work then the NHS can use the money saved from him being part time (90% wte) to employ another GP.

So you think private work should be unpaid? Is that what happens in the private sector? If GPs don't do these private tasks, who exactly do you think will do them?
Don't worry, records have been computerised and password protected for many years in General Practice. That is one way in which they have long been far more efficient than hospitals, where that side of things is a bit of a shambles at times.

When you get you hair cut, who pays? When you get your car serviced, who pays? Do you think it is unpaid?

Are you being deliberately obtuse? This is a simplification, but let's say a GP chooses to work 4 days in total a week. If they spend half a day doing insurance reports (paid privately and in their own time or however you like to describe it), they only have 3.5 to deliver clinical care and do NHS clinical related paperwork.

I would say that you have sussed out the PP pretty well - because you know what you are talking about, clearly.

Respect.

Do you think the new GP will be employed for free?!
Obviously, I know that private work is paid. You appeared to be resentful of the fact that GPs actually get paid for doing private work.

Thanks, I appreciate that. I'm pretty sure a GP married to a hospital Consultant with lots of medical friends knows a lot more about how general practice than a random member of the public. No GP would pretend that everything is running brilliantly in the NHS because it isn't but I do object to some people thinking they know the job far better than someone actually doing the job currently. I certainly wouldn't lecture my builder or electrician on how to do their job but it seems that GPs are fair game.

I am quite happy for GPs to get paid for private work - being writing insurance reports, providing haircuts or servicing my car. But that is in their own time not paid for by the NHS! The fact that a GP by choosing to take time away from his NHS work in the day to do his private work means he has to do the work the NHS has paid for him to do in the evenings is a decision he has made concerning how to organise his time. (Or her time).

Better ask the Govt?

They changed the law so GPs have to spend a great deal of time researching a persons medical history in order to get or renew a shotgun or firearms certificate.... and it is a great deal of time too, there is a great deal riding on the GP getting it right......

The Police forces then even insist the GP/or Practice spends time sending the finished report to the Firearms dept.

There are approx 100,000 renewals every year for shotguns, excluding firearms which require even greater scrutiny.

Not really sure how you get round this or ins medical reports.

But would you expect to continue to pay your electrician or plumber for the hours they took out of the day whilst installing your new heating system, to worked on your neighbours house?

Personally, they’ve till the next election. That’s the deal. If, by that time, things have got worse then I’ll look at voting for someone else.

However, that vote is still unlikely to go to the Tories unless they can offer something a) more than culture wars and b) different to the Tufton Street driven idealogy that landed us in this mess in the first place (I mean, sure, it’s great if you’re Michele Mone, not so much for the rest of the population and unfortunately there’s more of them who vote).

As they say “Insanity is doing the same thing over and over again and expecting different results.” This is what you’ve got to understand: for many voters it’s not so much it’s “Tories” but these particular Tories doing these particular Tory things. If a gardener sells me a “miracle grow” fertiliser and it kills all my plants, then I certainly won’t be buying any more of it, even if the next one I try isn’t any better. Certainly not because they complain “well how long are you going to leave it till you try my product again then?? How long till we draw a line??”

I don't think that even merits a response but I will try to explain once more!
The GP will get paid for their NHS work by the NHS. If they decide to do some private work, they will bill for this privately. Because time is finite, they will do less NHS work as a result, so the NHS will need to pay another doctor for the additional time. No one is getting paid twice here.

I'm sure GPs would be absolutely thrilled to get rid of these tasks but rules are rule at present.