I’m a GP

[WutheringBites]

here’s the thing; I can’t get a job. And lots of us who completed training in the past two years can’t either. It’s a national problem (well, at least across England) and there’s thousands of us in the same boat.
I didn’t expect to earn millions as a doctor, but I did think there would always be work for a nice GP. AIBU?

Not that odd, the PCN COO explained that there was a lot of learning and training needed and staff would reflect. Nothing odd about the behemoth piddling money up the wall to provide crapocracy whilst the blob of patients don't get essential clinical care.

no GP works 9-5. Some do earn £100k , but they will be working 60+ hours per week. I’m winding down to retirement so I only work 35 hours a week, and I earn £48.

Where are you @BerryTwister? I have GP family and they do earn well. Maybe 18k plus a session and obviously partners have the potential to earn more.

@RosesAndHellebores Odd that you were flagged as a high user.

Also a GP although not that close to retirement… I think the use of ‘non-GPs’ will eventually fade out because although they’re cheaper they are nowhere near as efficient or effective as a GP. Of course, this kind of realisation takes time to filter through to the otters that be, but patients now are having to see three or four people (all in separate appointments) to do something that 15 years ago a GP would have done in ten minutes. All these individuals are good at their jobs - a first-contact physio, a clinical pharmacist, a paramedic ACP maybe - but none of them have the overall depth and breadth as @BerryTwister says.

At our surgery we now have very few ACPs precisely because of this - too narrow a scope of practice (even with prescribing qualifications) to be genuinely useful and ended up needing a lot of supervision from GPs (which took us away from seeing patients). I think things are changing now that surgeries can spend their ARRS funding on doctors - previously this was forbidden and they could only employ ‘other’ roles with it.

It’s a miserable situation OP and makes no sense given the shortage patients continue to experience on the front line. It might be worth you contacting surgeries proactively as many will have given up advertising and recruiting even if they have empty posts. The other thing is to look at OOH work as they generally have a GP supervising even if it’s mainly ACPs seeing patients. Or as someone else mentioned maybe online/remote working for national chains (not the same as f2f work but it pays the bills and gets you some experience).

I know all of this is hard when you’re balancing home life and possibly a doctor husband with shifts/on calls to consider as well. It’s madness on a national scale and not at all fair. I think it will change in time but I’m sending you all the best while it gets sorted out.

Tell that to Emily Chesterton and Richard Peters

AHPs have a great role in chronic disease management, but someone needs to decide what that chronic disease actually is and send them to the right AHP. And that person absolutely should be a doctor. Otherwise you end up with tragic misdiagnoses like in the above cases

Wasn't suggesting it would work for you, just replying to the person who said you couldn't leave your family.
It's more often primary age.

The skills of AHP are useful and important but not comparable to a doctor. I saw an AHP in ED when my daughter had a head injury, and he glued it without asking about vomiting, neurological symptoms, LOC... Basically any of the indications for a CT to exclude a brain bleed were not asked about and I didn't get a head injury advice leaflet.

I needed to go home, perform a full neurological exam and fundoscopy for her myself. Luckily I'm educated enough to do this myself but if I were not in the role I am, my daughter could have gone to sleep and not woken up.

Our practice had already started seeing missed sepsis and delayed presentations of other conditions I would want to see with more urgency due to patients being fully triaged by nurses. Luckily no harm YET but I think doctors need to submit critical incident reports for any events in practice where there have been delays/poor diagnosis or other potential damage to patients caused by them being seen by an inappropriate professional and this should be recognised as a separate category for reporting on whichever online system is used.

Doctors may want to protect their colleagues and may be reluctant to report but once healthcare professionals start treating healthcare more like the airline industry and reporting these kinds of poor care, it will be clear that subbing doctors with differently qualified colleagues is inappropriate. Our practice returned to doctor triage after several critical incidents involving AHPs.

I dread to think how many genetic, endocrine, metabolic and dysautonomic conditions, reactive arthritis etc. will be missed because AHPs do not have the training of doctors. I myself have had delayed diagnosis of leukaemia at our practice as the patient was seen by nurses who diagnosed chest infections without considering the underlying aetiology.

It's pretty scary.
REPORT, REPORT, REPORT or patient care will get to an even scarier place.

I’ve worked with a lot of different HCPs and most are fab; but it’s taken years and years of study, training and learning on the job for me to be competent to see all the different GP patients who present. I don’t think you can simply replace all that knowledge and experience; and more than that, it’s risky for patients and for the HCPs who they see.

I don't mean there isn't much that GPs can do. I mean there isn't that much of a workload left for GPs to do.
At my surgery, with a big team of nurses doing all the chronic disease management and prescribing, and the PPs/ANPs doing all the minor illness/urgent care and prescribing, and an outside team coming in and managing patient mental health needs, CKD, hypertension and lipid management clinics being run by nurse prescriber, the quantity of workload left for GPs to manage is vastly smaller than it was 20 years ago when they were doing much more of the above.
You can't argue with that.
The GPs I work with say this themselves.

I’ve been saying this recently. Our GP now runs a system where you can’t get an appointment without completing an online form on an app. (Apparently people who don’t have / know how to use an app on a phone don’t exist because they had a 93 year old test it).

Once you’ve done that you wait up to three days for a response, which might be an appointment but might not.

Im pretty sure the place is now run by chat GPT

In the meantime you can see a pharmacist- my experience is that you go in and tell them what you think the issue is and they agree without even examining you.

Hospital departments don’t even see you, they read a referral and write a letter of advice which in future letters they describe as a consultation.

Private GPs can’t really do a great deal as they’re not your GP so you are advised to speak to your GP.

The only way to see someone is A&E which for most people is entirely inappropriate and adds to the ridiculous waiting times for people who do actually need to be there.

Its all gone to shit in a relatively short space of time.

Can you not accept that I am not. I have explained that their data search parameters were incorrect. I don't live alone either but they assumed I did because dh is registered at a different surgery. Even if I did go to the GP more than once a year, and lived alone, the patronising tone of the communication that assumed the blob was pig thick was wholly inappropriate. Every individual who touched this initiative was incompetent.

This was what I was getting at. I have well over 30 years experience in front line nursing, I am a prescriber, I have a master's in my specialist field plus many other credentials. I work in an advanced practice role and do many of the tasks traditionally done only by doctors.
Would I want to see undifferentiated patients? Hell no! Am I arrogant enough to think that my experience and base profession qualification somehow makes me equivalent to someone who has studied medicine again hell NO.
I work with PAs on a daily basis and frankly most of them scare me. They mostly have zero idea of how little they know and an abundance of confidence. They can't prescribe or order ionising radiation. They have zero pharmacology training and yet are recommending medication strategies for the GP to simply sign off without having seen the patients themselves.
How a degree in zoology and a two year master's , followed by an exam so pathetically easy that no one ever fails it, qualifies them to replace my GP I have no idea.
Nurse and paramedic practitioner jobs used to be taken by those with decades of experience. Increasingly however they are being filled by people with less than 5 years of real experience. Fight for our doctors now, because the alternative is terrifying.

Quite honestly at this point in time you may as well set yourself up as the local Wise Woman and risk getting burned at the stake as a witch.
It seems to be what things are coming to.

You are confusing Physician Assistants with Advanced practice roles. But I don't think advanced practitioners should be seeing undifferentiated patients in GP or acute settings either.
Managing chronic diagnosed conditions like asthma and diabetes is the bread and butter of advanced practitioners they forge excellent relationships with their patients and have enormous knowledge of the conditions, but they also work closely with medical consultants.

@RosesAndHellebores Why do you think I can't accept it? I'm agreeing with you that it's bizarre!

Can you do any out of hours shifts, or ambulance service shifts (most ambulances services have GPs in the control room for remote support).

It's a shame you can't travel. Where i am in Wales we've had spells over the last few years of entire GP practices without a single GP employed. Could you do blocks of locum work over here to keep your hand in?

Do ED departments employ GPs where you are? Could you staff grade at a lower grade in a different speciality for a bit, is that allowed?

At my GP surgery, two receptionists went on a “course” and now take blood samples.
One of them once took her gloves off because she couldn’t find a vein with them on.
It makes me really nervous having someone I’ve known for years as a receptionist suddenly using a needle on me.

@YellowisMellow that'll be for the hours they spend seeing patients. I would estimate that about half of my working hours are spent seeing patients. The rest of the time I’m doing patient related admin. GP partners will also have non patient related admin too. If you add up all the hours a GP works, including the lunch breaks they don’t have, the early starts, the 9pm finishes, and the work from home at weekends, the hourly rate is considerably less than £75 per hour. You might have friends who are GPs, but I’ve been a GP for 30 years so I am very familiar with the workload and pay.

Same. I’m now conditioned to not seek health care for ’minor’ issues but neither was I able to access appropriate health care when I needed it the most. What would the NHS look like if it was free from the constant changes driven by politicians and over paid consultants?

I'm hearing the same about nurses. Newly qualified but unable to get jobs due to not having enough experience. I hope you find something soon

@padso I’m in the midlands. I was a partner for 27 years, and now, as I move towards retirement, I’m part time salaried. Even as a salaried GP I do many hours of work from home on my days off, as well as working long days when I’m at work. All my colleagues do the same. I would say that most GPs do this, and if your family members add up the actual number of hours they work in a week, they’ll realise their pay isn’t quite so high after all. If they’re not putting in a lot of hours outside of their surgery times, then I’m afraid to say they’re not doing the job properly.

Op are you able to set up your own practice? Because getting a GP is horrendous.

Or you move as a family it make no sense you can't get a job.

Have you written to your local MP? I think your story is shocking.

@Onlyinthrees taking your gloves off to take bloods puts her more at risk than you.

This post nails it. GPs are too expensive vs other healthcare staff who can do the same for cheaper

The elephant in the room is that some GPs (partners) are the ones shafting other GPs (non partner salaried ones). GP practices are small businesses run for profit. The GP partners are not employing other GPs because they say they can’t afford to.

ICBs are all staffed by GPs too so whatever initiatives are coming from there I am afraid GPs are also responsible.

In this context I am amazed that the BMA is encouraging Drs to go on strike over pay. When there is an oversupply of labour wages fall they don’t rise.