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?

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

Agree. The system largely seemed to work subject to complaints of long specialist waits five years ago. You phoned your gp and were generally offered an appointment within 3 days for any gp or maybe a wait of a week or two for a gp of your choice. There were always urgent day of appointments.

Then Covid hit. Since then, my practice became one of those everyone must call at 8am for a day of appointment and of course being 47th in the queue at 8:01 meant no appointment. I never understood why it could not go back to the old system. It must have suited the gp’s to do it that way, but why?

Now my practice has moved to the online form request. I’m also assuming the forms are triaged by AI and will wait for the day when all my medical information becomes hacked.

Come up to Scotland my dear, you will be very welcome 😊
Good luck

I'm so sorry to hear this.

My local GP surgery uses advanced nurse practitioners and although I only had 2 or 3 appointments in the last 5 years, it was always a nurse practitioner I saw. I heard it's the same for everyone else, unless you have a really complicated lr specific condition.

With ANPs, PAs and paramedics, I feel a lot of GP roles were replaced to make things cheaper for the government to run.

@BerryTwister Absolutely not disagreeing with having to work additional hours. None of them are full time though, most do 4 sessions & presumably london pays more.

It’s utter madness when trying to get a GP appointment is almost impossible.

There's no care in it or genuine check up on your symptoms. Just bp and weight and off you pop

Whole system is broken to be honest.

It's a target-driven system, that's why. The government likes to measure activity using targets and spreadsheets. The quality of the care will be abysmal, but as long as those boxes are ticked, it doesn't matter.

I'm an ANP and I agree with you.

I'm good (I specialise) and proud of my practice. BUT, I am very aware (and practice daily STAYING aware that I'm not a qualified doctor ) I'm a qualified nurse with additional qualifications and experience in my field. I'm skilled and knowledgeable, BUT : I'm blinkered. I only know what I know. I don't know what I don't know. I'm fantastic at the core diagnosis of my speciality: but when we're talking niche differential diagnosis (and that could include red flags ) I'm not skilled and don't have that depth and breadth of knowledge once you take me off my beaten track. I'm aware of that. We must never ever let ego get in our way.

I see myself as a helpful adjunct to my superiors (drs specialised in my field ) not a replacement or an 'equal'.

This sounds very silly: but it's one of the reasons I will never wear my stethoscope around my neck. I don't want to allude that I'm a doctor. To me : it's an old fashioned mark of a Dr. And patients are easily confused (especially these days ) . I've seen many a physicians associate and paramedic/nurse practitioner happily let a patient assume they're a doctor or get 'offended' when the patient looks perturbed that they're not.

Conclusionally: We're good. In fact, we can be really good. But we must always remember: we don't know what we don't know. And despite not realising it sometimes: we will have blind spots that exist less for people (drs) that have undergone medical training and post grad qualifications. Keep the ego out and respect our drs : I do. Hats off to you all ❤️

1. I think the BMA should be pushing for an additional independent reporting structure outside GPs' normal workplace to submit reports about the appropriateness of AHP reviews at their workplace.

There's a massive conflict of interest where GP partners are considering the financial needs of the business (wanting lower paid staff) and in that small business, reporting substandard practice (other than critical incidents) would be frowned upon and considered as nitpicking with colleagues.

Salaried doctors (who rely on those same GP partners for their livelihoods) are reluctant to report poor practice/delays/inefficient pathways to care, of which there are many.

The current reporting structures mean that decision makers nationally are only hearing about critical incidents but are not about the general picture of missed diagnoses , inefficient pathways, or delays to care due to extending scope of AHPs.

1. I think practice leadership team/ICBs should be held directly responsible (including criminal liability) for failures in care if they are appointing AHPs and allowing them to practice extended scope roles without the background knowledge of a GP.

I'm not talking about chronic disease reviews/pharmacy team monitoring. That's bread and butter work for AHPs and they do it brilliantly. I'm talking about AHP led triage and AHP first contact with acute patients.

'If you hear hooves, think horses not zebras' is the expression you sometimes hear in medicine. However I've seen enough zebras in my career to know that it can be disastrous to assume the likely answer is going to be the right one.

For example - assumptions I have seen from AHP colleagues in various workplaces:

Coughs are viruses (seen a missed asbestosis with that one)
All sore throats can be assessed through online scoring symptoms (seen a missed/untreated scarlet fever with that one),
Back pain is usually caused by strain/slipped disc (missed myeloma).
Muscle aches/tiredness assumed to be a virus (delay to coeliac diagnosis).
Nurse triage - Vomiting caused by d&v illness and advised to rest for 48 hours (vomiting caused by raging sepsis - patient told by hospital team he could have lost his life).
Abdominal pain with suprapubic tenderness and urinary symptoms treated as UTI (missed appendicitis).

The notes and question formulation are not up to scratch to protect these AHP if these cases were investigated and they could be prosecuted. I have a lot more examples but I'll end here.

Our DD was the same. Wanted to study medicine and got the grades but in the end chose a different path. She chose the world of finance instead and will likely earn more than your average GP but without any of the crap. Relieved.

No you are far from being unreasonable. I hope things turn a corner for you soon.
I was absolutely astounded recently when at a GP appt, the doctor told me she would normally book a follow up appt but couldn't because she had been made redundant (specialist derm clinic attached to hospital closing). Never ever thought I'd hear of doctors being made redundant by the NHS.

Absolutely 100% (I'm on the inside of the system so speak from experience) and have used the system myself. It's dire. There's no care.

I'm advanced in my practice (non medical ) but still think the most important part of my job is how i delivery the care. Listening to people, explaining things clearly, treating them as a while human with unique characteristics. I haven't forgotten that after 20 years. But many have. I feel saddened that this is what our healthcare has become. "Tick tick tick- keep ticking the boxes " 🙄

I had a patient irate on the phone the other day complaining she couldn't get into our clinic for 20 weeks (meant to be 4 week wait ) she said it was "ridiculous" (I think she thought I'd argue ) I said "I completely agree with you. It is ridiculous" (she really softened after that and we left on a good note ) my colleagues thought I should have kept the professional barrier up. But I disagree.

about 3 years ago I had a tumour on my thyroid. I could only get an appointment with a nurse practitioner & not a GP. She told me it was a fatty lump, but I will ask a GP to have a quick look. It's a good job she did get the GP as otherwise who knows what could have happened. I'd have been walking round with a tumour thinking it was fine as just a fatty lump. Although in fairness at my GP surgery we do usually manage to see a GP within a few days

The young ones are all nice op!

I don't mean that rudely, more as an acknowledgement that I think it's a tough job year in year out.

I think it's more consultants that are needed. My gps just end up referring on anyway ( well they fob you off first and then refer you in when you come back with the same problem). The practice nurses at least listen.

As a ANP (specialist field) who's proud of my practice : I agree.

MSc are full of waffley written fluff based around research (I learnt nothing bar how to critically analyse research) the real learning is the self directed study I did and the experience in my field etc. MSc taught me very little. They're all the same : MSc in advanced practice MSc in law : you're doing the same MSc ! They don't teach you about your subject. It's all research and critical analysis.

You're right : the pure A&P is self taught (for those of us that are actually interested enough to self study ) whereas doctors training includes hefty chemistry and A&P. So as a very good ANP: yes, I agree! But people don't know what they don't know and we must stay aware of it to be great ANPs.

I’m sorry you can’t get a job op.

to those asking - I get regular appointments from my GP practice.

i’m severely disabled. I get hassled regularly to come in and do the long term condition reviews with the nurse practitioners.

these are government driven targets - eg all patients with asthma should have an annual review to check they are in the right inhalers etc.

so I go in and they do the government checklist with me.

q1 does your asthma stop you walking?

I answer no, never, I can’t walk and use a wheelchair.

at that point the good ones realise the government questionnaire is fucking useless for me and we actually have a conversation and the bad ones just record my literal answers.

they also like to book me gp appointments to try to get me to change my medication, some of which apparently is against NHS guidelines but all of which I have been prescribed by a consultant so I waste the appointment by telling them I have no bloody idea about the meds go argue with the consultant.

However last week I had a bladder infection and so actually wanted to see them for once as it hadn’t gone after a week but I couldn’t get to see them and a helpful pharmacist gave me antibiotics.

OP I hope you find something soon. I think it's horrifying that something as essential as a GP is being outsourced (in a manner of speaking) to Nursing practitioners. Not that I have anything against them - they are all lovely caring people. I agree that they can take the load of the menial jobs for the GPs and I don't menial in that sense but in that they can arrange/do blood tests, COPD clinics, birth control, diabetic clincs etc etc.
But ultimately our GPs are our first line of defence when it comes to consulting them for all manner of illnesses. In our household, we go to the GP when whatever the pharmacist and off the shelf remedies have not worked. By which time, we are a lot more ill than if we had managed to see the GP five days earlier.
On the occasions, that it is felt that an early GP appointment is necessary then we use the e-consult form - which is often quicker than phoning at 8 in the morning for a non-existent appointment. In these cases we are often given a same or next day appointment so the surgeries can be selective in who can have an appointment sooner. But these appointments can often be arranged at an alternative surgery - not ideal if travel is involved but at least you are being seen.

As a fellow ANP - I agree. We absolutely need doctors and GPs 🙏

I'm not surprised, OP, but it must be beyond frustrating.

Last time I had a "GP" appointment I was seen by a physiotherapist. As I wanted the appt for sudden onset excruciating headaches, I was a little surprised. Fair play to them though, they flagged the possibility of giant cell arteritis and I was seen by a rheumatologist 2 working days later.

Could you do locum work, maybe through an agency? There are two f/t GPs in my town who started as locums and got perm jobs as a result.

I mean, actually it makes sense and unfortunately the GPs are reaping what they’ve sewn
Years of refusing to come out and do house visits refusing to work weekends.
They’ve made themselves redundant in general practice.

I agree, a PA salary is usually starting at Band 7, an Advanced Practitioner is the same, so why would they go down the route of no income and an extra student loan to end up with something they could get their employer to pay for whilst studying part time, getting paid study time and on the job mentoring and experience.

So sorry OP this is heartbreaking to read. Studying medicine is a hard path to take and someone who has comitted so much to forge a career that essentially is about helping others should at least be rewarded with a job ay the end of it.
Seeing as noone can get a gp appointment, you would think the country is crying out for doctors who want to be a GP.
It seems we are in a shit storm. I would be taking my qualifications and going to another part of the world. The uk is a pile of shit atm.

@CrispsPlease i would argue that as an ANP you should be aware of what you don't know. It's when you are aware of the things that you don't know you can be aware of your own limitations and scope of practice. If you don't know what you don't know then that ongoing cough and incidental weight loss is just a post viral cough and weight loss from lack of appetite or that specific epigastric pain is just indigestion.

I was just about to say this. Shortage of GPs in small country practices. We would love to have you!!

I'm highly specialized in acute emergency medicine in a particular field. With respect , you don't know me or my role. "You don't know what you don't know " is a 'saying' - look it up.

I'm trying to put the point across that I'm good- I'm excellent actually 😆. But.... I am aware I am not a doctor and respect my medical colleagues. I think I may know everything there is to know about (example but not my actual field ) "pulmonary embolisms " ... But a pulmonologist will know more and in greater depth and breadth.

Do I know more in my field than an GP/fy1/fy2/ general consultant : yup. They come to me for advice.

Do I know more about other diagnoses than them ? No. I haven't had their extensive general training.

Do I know more about my field than a consultant specialised in the same field ? No.

It's staying aware of your limitations. That's what a sensible practitioner does.