I am interested - what do you think of GPs in this country? (long read)

[pugster]

And yet GP practices will still be being paid on the basis of the number of patients on their list. For not providing the services they are getting paid for.

... and is my biggest bugbear of late , everyone i know in my area (west mids) is having major problems accessing a GP -yet there are still signs outside every practice saying 'taking new patients' - when they cant deal with the ones they already have.

[Kingstepper]

I am really not trying to get away with anything.

It is because the complex consequences of covid within the healthcare system has seen a huge increase in demand for GP appointments. As an example - the surgery I work in used to have one duty doctor a day who would have to deal with perhaps 40 consults in a day. Now they need 2 or 3 duty doctors - sometimes the amount of consults can be 60-70 in one day, for one doctor. As you say, same number of patients. But there is a huge increase in demand.

I probably do need to harden up I guess, it is just quite sad to see someone feel that GPs are unwilling to do the work when in actual fact we have never been so overstretched and so many are leaving the profession due to the unsustainability of the workload.

You clearly don't believe me when I say that GPs have never been doing more work. All I can say is that it just is true.


I think this is what I was wanting to find out about to be honest, are there people that genuinely hold these opinions, which clearly there are, but again it seems to be as I have seen in practice that most people realise what is going on and don't blame the actual GP.

Why is that?

[oldoakknives]

The reason you can’t get an appointment is because all the appointment slots are full… do you also not believe that? Not in an accusatory way, I am just curious. I am trying to understand where the ill-feeling in the vocal minority is coming from.

Is it that you think we are turning patients away when we are sat doing naff all?

My day at the surgery looks like this:
8am - look through tasks, letters, labs and morning list
8.30 - 11 - phone calls
12- 1 - face to face appts
1-2.30 home visits and try and eat something
2.30 - 4 - phone calls
4-6 face to face
6-7 - admin, catch up and review day with my trainer

I am a trainee so I am protected from the worst of it. But that is what I do.

Also - as an aside, most patients actually want a remote consultation as it is far more convenient for them. Like I said, I prefer to see face to face as I don't like being on the phone and staring at screen all day, but most people do actually want the convenience of a phone call.

Sent from my iPhone using Tapatalk

How many GPs work at the surgery?

How many are working on a normal day?

How many patients are registered at the surgery?

[gerrudd]

I haven't been to a GP practice in about 5 year. I've had two online consultancy in the interim, using the GP service provided by my health insurance. I've found that the majority of GP's to be helpful, pleasant and knowledgable. I'm had a few exceptions, I tore my calf muscle - this was about 10 years ago - and I knew more about the injury than the GP did. But they were exception. My experience of GP practices is less positive and one of ether reasons I now avoid going. Lots of hold time on the phone, lots of repetitive questions, difficulty in getting appointment etc.

To the OP, I think some of the ill feeling comes from the sense that practices are creating an artificial shortage. GP practices are businesses, run for the benefit of their business owners, the GP partners. They have been since the inception of the NHS. I'm fine with that. But they have a single customer, the NHS, to whom they are accountable. The mix of private and public is rarely ideal. I would like to see the practices much more transparent and accountable to their patients.

[oldoakknives]

... and is my biggest bugbear of late , everyone i know in my area (west mids) is having major problems accessing a GP -yet there are still signs outside every practice saying 'taking new patients' - when they cant deal with the ones they already have.

Thing is, if they register you with their practice they get paid for having you registered with them.

Whether they see you or not.

So it's in their interest to register more patients. That means more income. They aren't paid by the number of patients they actually see.

[oldoakknives]

The reason you can’t get an appointment is because all the appointment slots are full… do you also not believe that? Not in an accusatory way, I am just curious. I am trying to understand where the ill-feeling in the vocal minority is coming from.

Is it that you think we are turning patients away when we are sat doing naff all?

My day at the surgery looks like this:
8am - look through tasks, letters, labs and morning list
8.30 - 11 - phone calls
12- 1 - face to face appts
1-2.30 home visits and try and eat something
2.30 - 4 - phone calls
4-6 face to face
6-7 - admin, catch up and review day with my trainer

I am a trainee so I am protected from the worst of it. But that is what I do.

Also - as an aside, most patients actually want a remote consultation as it is far more convenient for them. Like I said, I prefer to see face to face as I don't like being on the phone and staring at screen all day, but most people do actually want the convenience of a phone call.

Sent from my iPhone using Tapatalk

The thing is you asked for peoples opinions, and experiences, and thats what you got. Then you say they don't understand and say they're mistaken.

You may not be turning patients away, but most people I speak to have the same experience in that it's hard work to try to get any kind of appointment within 2 weeks, phone or in person. It's akin to an endurance test at my surgery.

This is the experience more and more people are talking about.

Just saying 'under investment' and 'under paid' just doesn't cut it, sorry.

This is the experience of more and more people.................

Pre-COVID our local practice was fine. Phone for an appointment in the morning and you’d always get an appointment if it was urgent and within a few days otherwise. Since the pandemic started, you have to use a ridiculous online triage system which invariably just tells you to phone the practice and make an appointment which now takes much longer. It’s now harder to actually see a doctor although phone consultations are reasonably available.

What really annoys me is being in the waiting room listening to phone ring without being answered for five minutes while the office staff chat about TV, holidays and whatever else. I’ve absolutely no problem with the the doctors but unfortunately for them they are the public face of the practice so will invariably be the ones who get it in the neck from the public. No different from any organisation really.

One thing that has been a big improvement is the ordering of repeat prescriptions via the NHS app.

[watchstudent]

It is very hard for a GP practice to be allowed to not accept new patients. They have to apply, be assessed and it is dependent on how it would impact neighbouring surgeries so if they are also struggling you probably won't be allowed to. If you are allowed to close the list it is usually only for a maximum of one year.

[pugster]

Thing is, if they register you with their practice they get paid for having you registered with them.

Whether they see you or not.

So it's in their interest to register more patients. That means more income. They aren't paid by the number of patients they actually see.

yes i know, the problem comes though when that massive amount of patients they signed on suddenly decides to turn up :) , i'd like to think someone has worked out a maximum load level per practice but i doubt it.
imo the NHS is now run like the UK's politics - where a few have their hands in the pie with everyone else grubbing round them for their share.

[Ethos]

I've got some frustrations with the GP surgery - particularly how many attempts on the phone it takes to get an appointment. But the GPs themselves are fantastic. I much prefer a telephonic to start with - going into the surgery only if needed.

For people upset with their GP, have you tried changing? We are fortunate to have quite a bit of choice. There is a very modern surgery with everything done by app and there are others with archaic processes.

Re the whole debate about GP's hours / pay - I'd actually like my GP to be extremely well paid. A doctor couple are good friends of ours. She's a GP Partner and I see her constantly stressed with work. He quit being a doctor and is making 8 times as much in the Finance world. They have both strongly discouraged their kids from becoming doctors.

[watchstudent]

The thing is you asked for peoples opinions, and experiences, and thats what you got. Then you say they don't understand and say they're mistaken.

You may not be turning patients away, but most people I speak to have the same experience in that it's hard work to try to get any kind of appointment within 2 weeks, phone or in person. It's akin to an endurance test at my surgery.

This is the experience more and more people are talking about.

Just saying 'under investment' and 'under paid' just doesn't cut it, sorry.

I did, it is what I am after - I think I can say they're mistaken when it comes to saying that GPs aren't working... I am not rejecting your struggles to get an appointment, I sympathise. Nobody is enjoying this.

I don't feel I am "just saying". There has been under investment, not just in GP but in all areas which has a knock on effect.

What would "cut it"? Again, trying really hard not to be confrontational here, I just want to your opinion and I am glad to hear it. What do you feel needs to happen? You have alluded to GPs just getting on with the job that we are paid to do. I think that is a given and again all I can do is promise you that we are trying our best - to the extent that many are leaving because they can't cope - making the issue worse for those of us that remain.

You are entitled to feel angry at whoever you want to - I am just proposing that I think a lot peoples anger is not directed at the root of the problem.

[oldoakknives]

I did, it is what I am after - I think I can say they're mistaken when it comes to saying that GPs aren't working... I am not rejecting your struggles to get an appointment, I sympathise. Nobody is enjoying this.

I don't feel I am "just saying". There has been under investment, not just in GP but in all areas which has a knock on effect.

What would "cut it"? Again, trying really hard not to be confrontational here, I just want to your opinion and I am glad to hear it. What do you feel needs to happen? You have alluded to GPs just getting on with the job that we are paid to do. I think that is a given and again all I can do is promise you that we are trying our best - to the extent that many are leaving because they can't cope - making the issue worse for those of us that remain.

You are entitled to feel angry at whoever you want to - I am just proposing that I think a lot peoples anger is not directed at the root of the problem.

GP surgeries are paid c£155 per patient. My GP surgery has 14k patients according to the NHS website. Thats £2,170,000 they get paid. Is that underfunded? For that I would expect to be able to see a doctor or get a phone consultation quicker than 7-10 days.

If many can't cope then perhaps they chose the wrong profession. I don't remember it being a problem in the past.

[joe narvey]

I’ve lived where I do now for 14years. Never met the person that is supposedly my GP as I’ve never been able to get an appointment and now routinely go private.

Last time I requested an appointment it was a 9 week delay before an appointment.
The practice has been in special measures ( whatever that means) for along time.

I’ve recently had 2 texts and 2 emails notifying me the doctor is retiring and do I want to sign his leaving card or attend a leaving presentation.

What do I think ? The concept sounds nice but in practice it’s a commercial business now and I’d rather go private, have their attention for 20min and leave with a solution.

[watchstudent]

GP surgeries are paid c£155 per patient. My GP surgery has 14k patients according to the NHS website. Thats £2,170,000 they get paid. Is that underfunded? For that I would expect to be able to see a doctor or get a phone consultation quicker than 7-10 days.

If many can't cope then perhaps they chose the wrong profession. I don't remember it being a problem in the past.

You are right, it was less of a problem in the past - because demand wasn't so high and funding was better across the board. Maybe they did choose the wrong profession, can we afford to lose all the doctors that feel this way? I can tell you the answer to that is no...

14 GPs, reception, nurses, HCAs, equipment, building repairs, secretaries, practice manager - I would say that your practice is probably struggling on £2.1mil

Ok - I mean there are just so many variables. Social care is underfunded so the older and more complex patient don't get the social support they need leading to more demand on GP services. ED departments are likely at breaking point meaning that acute problems can't be seen and so they end up trying to seek a GP when they would have previously gone to ED. Hospitals are full to the brim and sometimes patients we admit are coming out more sick than when they went in, plus they are being discharged too soon and so that places demand on GPs. Mental health has no staff or funding which means they go to the GP and are very time consuming. People aren't getting their operations - so they need to see the GP more. Many people tried very hard to stay away from hospitals and doctors during the pandemic out of fear of covid and so have saved up a lot of problems that have gotten worse and so are more time consuming to handle. It is not so much the individual practice not receiving enough money (although in areas with higher poverty I think that is true), sorry to use that word you hate... it is the whole "system". It doesn't really matter what that individual practice is paid, if they don't have the slots and doctors available to meet the insane demand then that's it.

Ultimately, you are right, you should be able to see a doctor sooner than that. The doctors wish you could see a doctor sooner than that.

[watchstudent]

It is such a shame... We should have a system where your NHS GP can spend 20mins with you and not feel they have made themselves even more late than they already are.

I worry that this private creep will continue until we lose what we have completely. Then the poorest will suffer the most, the middle class will be shafted financially if they get expensively ill and the rich won't care.

I’ve lived where I do now for 14years. Never met the person that is supposedly my GP as I’ve never been able to get an appointment and now routinely go private.

Last time I requested an appointment it was a 9 week delay before an appointment.
The practice has been in special measures ( whatever that means) for along time.

I’ve recently had 2 texts and 2 emails nothing me the doctor is retiring and do I want to sign his leaving card or attend a leaving presentation.

What do I think ? The concept sounds nice but in practice it’s a commercial business now and I’d rather go private, have their attention for 20min and leave with a solution.

[David_D]

They have both strongly discouraged their kids from becoming doctors.

A number of medical families I know are creating dynasties! One of them is into the third generation. And they used every trick in the book to shoe the clearly untalented child/grandchild into medical school at the Nth attempt.

[Saint-Just]

£115 per patients per year is both a lot (for those who do not "use" the service) and very little (for those who need it more).
Why not change to paying surgeries by actual patients? With a rate for consultations over the phone, and another for face to face, with targets in terms of time for appointments?
If surgeries are working so hard they will be better rewarded...

[oldoakknives]

You are right, it was less of a problem in the past - because demand wasn't so high and funding was better across the board. Maybe they did choose the wrong profession, can we afford to lose all the doctors that feel this way? I can tell you the answer to that is no...

14 GPs, reception, nurses, HCAs, equipment, building repairs, secretaries, practice manager - I would say that your practice is probably struggling on £2.1mil

Ok - I mean there are just so many variables. Social care is underfunded so the older and more complex patient don't get the social support they need leading to more demand on GP services. ED departments are likely at breaking point meaning that acute problems can't be seen and so they end up trying to seek a GP when they would have previously gone to ED. Hospitals are full to the brim and sometimes patients we admit are coming out more sick than when they went in, plus they are being discharged too soon and so that places demand on GPs. Mental health has no staff or funding which means they go to the GP and are very time consuming. People aren't getting their operations - so they need to see the GP more. Many people tried very hard to stay away from hospitals and doctors during the pandemic out of fear of covid and so have saved up a lot of problems that have gotten worse and so are more time consuming to handle. It is not so much the individual practice not receiving enough money (although in areas with higher poverty I think that is true), sorry to use that word you hate... it is the whole "system". It doesn't really matter what that individual practice is paid, if they don't have the slots and doctors available to meet the insane demand then that's it.

Ultimately, you are right, you should be able to see a doctor sooner than that. The doctors wish you could see a doctor sooner than that.

Why do they need a 'practice manager', secretaries ?


It is not so much the individual practice not receiving enough money (although in areas with higher poverty I think that is true), sorry to use that word you hate... it is the whole "system".

Surely the fact it's an area with higher poverty is irrelevant. It's still £155 per patient.

It doesn't really matter what that individual practice is paid, if they don't have the slots and doctors available to meet the insane demand then that's it.

But that's the whole point. If they are being paid at these rates they should be able to have enough doctors available. Like I said my doctors have 14 GPs on their books. How many appointments does that equate to?

[j0hnbarker]

Why do they need a 'practice manager', secretaries ?


It is not so much the individual practice not receiving enough money (although in areas with higher poverty I think that is true), sorry to use that word you hate... it is the whole "system".

Surely the fact it's an area with higher poverty is irrelevant. It's still £155 per patient.

It doesn't really matter what that individual practice is paid, if they don't have the slots and doctors available to meet the insane demand then that's it.

But that's the whole point. If they are being paid at these rates they should be able to have enough doctors available. Like I said my doctors have 14 GPs on their books. How many appointments does that equate to?

Understandably, you are clearly ignorant of how a small business (which is what a GP practice is) works.

The practice manager is responsible for the admin team (receptionists, secretaries, cleaners) and performs most of the HR functions. They will also be involved in the commercial and NHS supply chain side of the business. Add to that ensuring staff compliance with training, building maintenance, etc. I could go on and on.

What did/do you do for a living? It might be helpful to understand where your experience is derived from, i.e commercial or private sector and so on. You seem to get drawn into arguments that expose you taking an argument for the sake of it position, without necessarily knowing much about what you are taking about.

[prexelor]

My experience has been the GPs have been fine but the receptionists are really hard work. I ring at 8.00am to be told sorry no appointments, ring at 2.00pm. I ring at 2.00pm, sorry no appointments, ring 8.00am tomorrow. And repeat.

As the appointments were for my children, my patience was somewhat lacking. Right you are full, no problems. I will pop in at 2.00pm and when the buzzer goes and no one gets up, I am going in. You cannot do that the receptionist says. I can and I will. Ok, let me put you through to the doctor. I speak to the doctor who gives an appointment for 4.45pm for the same day!

The strange thing is, whenever I visited the surgery with my wife for regular pregnancy check ups etc, the surgery was always empty, which prompted my aforementioned reaction.

I do have real respect for GPs, nurses and hospital staff. (I did have to raise my voice once at my mom’s GP who failed to diagnose or medicate an issue for months and months. It felt inappropriate but I had say I don’t think you know what you are doing. I will be going to the specialist at the local hospital with or without your approval or your letter. The referral letter was then quickly written.)

I have called the out of hours GP surgery for emergency issues which cannot wait for a GP appointment but are not A&E appropriate. What a fantastic service. However, you then see members of the public with coughs and colds taking up valuable appointments.

All the above is prior to the pandemic.

[Passenger]

It is such a shame... We should have a system where your NHS GP can spend 20mins with you and not feel they have made themselves even more late than they already are.

I worry that this private creep will continue until we lose what we have completely. Then the poorest will suffer the most, the middle class will be shafted financially if they get expensively ill and the rich won't care.

I think you' ve nailed it in the 2nd paragraph...every new crisis/disaster an opportunity, Test and Trace for example.

[Chinnock]

Shame Doctors aren’t trained in prevention rather than selling.


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[watchstudent]

Why do they need a 'practice manager', secretaries ?


It is not so much the individual practice not receiving enough money (although in areas with higher poverty I think that is true), sorry to use that word you hate... it is the whole "system".

Surely the fact it's an area with higher poverty is irrelevant. It's still £155 per patient.

It doesn't really matter what that individual practice is paid, if they don't have the slots and doctors available to meet the insane demand then that's it.

But that's the whole point. If they are being paid at these rates they should be able to have enough doctors available. Like I said my doctors have 14 GPs on their books. How many appointments does that equate to?

The problem is that patients in poorer areas are more unwell and so will generate more work, so they are paid the same per patient despite each patient obviously not being equal.

They “should have enough doctors available”? Of course there should! But like there isn’t a magic money tree there also isn’t a magic doctor tree. Fund the NHS properly = being a doctor is more appealing = enough doctors and vice versa.

It equates to clearly not enough appointments to meet demand if you have to wait for 2 weeks…


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[number2]

If the NHS wasn't underfunded that bloody red bus wouldn't have resounded with so many people, we have a growing aging population at the same time as the NHS is being intentionally starved, it's evident from this thread that as per usual many would sooner blame those at the sharp end rather than those creating the problem.
In all likelihood the NHS is doomed not because the 'front line' don't care, but because so many would sooner "clap for the NHS" whilst continuing to make excuses for voting for the status quo.
As for the OP, I have immense respect for his / her chosen career, I and my family continue to receive excellent health care during these incredibly trying times.

[j0hnbarker]

Shame Doctors aren’t trained in prevention rather than selling.


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Absolute nonsense.

There is a branch of medicine for that called public health. Funnily enough, they’ have been in the news a lot recently.

[watchstudent]

Absolute nonsense.

There is a branch of medicine for that called public health. Funnily enough, they’ have been in the news a lot recently.

Indeed, preventing disease is public health and in actual fact far more about socioeconomic factors than healthcare. The stuff that isn’t socioeconomic is about education and lifestyle - diet, exercise, sleep and stress management in a nutshell.

[Chinnock]

Absolute nonsense.

There is a branch of medicine for that called public health. Funnily enough, they’ have been in the news a lot recently.

Indeed, preventing disease is public health and in actual fact far more about socioeconomic factors than healthcare. The stuff that isn’t socioeconomic is about education and lifestyle - diet, exercise, sleep and stress management in a nutshell.

Amazing how doctors still advocate a diet based on a food pyramid that supports inflammatory disease relating to heart, cancer and diabetes.

Still, ensures the pharmaceutical industry isn’t out of pocket.

[watchstudent]

Don’t tar all doctors with the same brush. I have a special interest in exactly this and just came back from a conference looking at the dietary inflammatory index of diets and how they relate to cardiovascular disease, cancer and mental health issues. That food pyramid is clearly crap. Ancel Keys and his Seven Countries study is rubbish and has a lot to answer for.

My own personal mission as a doctor is safe deprescribing and promoting lifestyles not pills to prevent disease.

I find it equal measures amusing and insulting how “gurus” who act like they have discovered the benefits with lower carb or anti-inflammatory, basically pretend that they are opposed to all doctors as a way of marketing themselves. Those darn evil doctors! Check out Dr Unwin’s work to see how proper doctors are using these diets.

So, with all due respect, pull the other one! :)

Amazing how doctors still advocate a diet based on a food pyramid that supports inflammatory disease relating to heart, cancer and diabetes.

Still, ensures the pharmaceutical industry isn’t out of pocket.

[Chris_in_the_UK]

Amazing how doctors still advocate a diet based on a food pyramid that supports inflammatory disease relating to heart, cancer and diabetes.

Still, ensures the pharmaceutical industry isn’t out of pocket.

Where on earth have you plucked that nonsense from?.

[Chinnock]

Don’t tar all doctors with the same brush. I have a special interest in exactly this and just came back from a conference looking at the dietary inflammatory index of diets and how they relate to cardiovascular disease, cancer and mental health issues. That food pyramid is clearly crap. Ancel Keys and his Seven Countries study is rubbish and has a lot to answer for.

My own personal mission as a doctor is safe deprescribing and promoting lifestyles not pills to prevent disease.

So, with all due respect, pull the other one! :)

If we agree Ancel Keys was wrong and John Yudkin was wrongly vilified, not sure how I’m “pulling the other one?”

Feel free to liberally pass on your knowledge to those that can make a difference. There’s plenty out there.

As far as I’m concerned, if a doctor isn’t actively de-prescribing medication, he isn’t doing his job.

- - - Updated - - -

Where on earth have you plucked that nonsense from?.

Do your homework on nutrition.

[watchstudent]

If we agree Ancel Keys was wrong and John Yudkin was wrongly vilified, not sure how I’m “pulling the other one?”

Feel free to liberally pass on your knowledge to those that can make a difference. There’s plenty out there.

As far as I’m concerned, if a doctor isn’t actively de-prescribing medication, he isn’t doing his job.

- - - Updated - - -



Do your homework.

Pull the over one in terms of stating that “doctors” all follow outdated dietary advice. People love to say that all doctors do is sell drugs, drugs can be useful, of course, but as far as I’m concerned big food and big pharma can suck it. Have seen many a lifestyle guru market themselves by saying they are opposed to what “doctors” say, like they know a secret truth we are trying to keep from you.

[Chinnock]

Pull the over one in terms of stating that “doctors” all follow outdated dietary advice. People love to say that all doctors do is sell drugs, drugs can be useful, of course, but as far as I’m concerned big food and big pharma can suck it. Have seen many a lifestyle guru market themselves by saying they are opposed to what “doctors” say, like they know a secret truth we are trying to keep from you.

I’m not disagreeing with the need for medical intervention and drugs per se. Sadly all the doctors I know have little knowledge of giving the right dietary advice. Hospital food proves this does it not?

[Chris_in_the_UK]

Do your homework on nutrition.

I have - many years ago.

I will mention one name - Mark Sisson.

Now do one.

[watchstudent]

I’m not disagreeing with the need for medical intervention and drugs per se. Sadly all the doctors I know have little knowledge of giving the right dietary advice. Hospital food proves this does it not?

No, it doesn’t. Do you think doctors have any say at all about what is served to patients? That is all outsourced by hospital paper pushers to private companies serving cheap crap food.

[Chris_in_the_UK]

I’m not disagreeing with the need for medical intervention and drugs per se. Sadly all the doctors I know have little knowledge of giving the right dietary advice. Hospital food proves this does it not?

Why on earth would you correlate the food served in a hospital being down to doctors/medical staff?.

[Chinnock]

I have - many years ago.

I will mention one name - Mark Sisson.

Now do one.

So we agree, yet you state my comments are nonsense?

[Chinnock]

Why on earth would you correlate the food served in a hospital being down to doctors/medical staff?.

Because it proves prevention is not on the agenda.

Person has a heart attack, survives thanks to medical intervention, yet is told and served food in hospital that will not be in his best long term interests.

He goes home assuming what he has been fed ‘ advised will make him better.

Is there not a fundamental flaw here?

[Chris_in_the_UK]

So we agree, yet you state my comments are nonsense?

The context is nonsense.

[Chris_in_the_UK]

Because it proves prevention is not on the agenda.

No it does not, the medical provision in hospital is nothing to do with the catering.

It's like me attacking you for making a living out of an industry trade publication related to bulk transport and the associated damage to the environment.

You are not worthy of an attack (neither are the medical profession), your publication will promote best practice, innovation and breaking news plus other stuff - does it make you guilty by association? Maybe, but it certainly does not set the agenda nor does it set you up for getting a hard time for trying.

[robert75]

OK you asked so I will give my honest opinion

My family surgery were great for many years but I have nothing but contempt for the current "person" in charge. Horrible obnoxious, toxic individual who I have little to no trust in. Decent doctors who work there dont seem to last long and the good doctors who were there have either retired or left. The staff and just about everyone there seem run down he will be remembered for all the wrong reasons and only has himself to blame.

[Chinnock]

No it does not, the medical provision in hospital is nothing to do with the catering.

It's like me attacking you for making a living out of an industry trade publication related to bulk transport and the associated damage to the environment.

Yet you buy everything that my industry provides, from the food on your table, the house you live in, the car you drive and the energy you consume.

[watchstudent]

Because it proves prevention is not on the agenda.

Person has a heart attack, survives thanks to medical intervention, yet is told and served food in hospital that will not be in his best long term interests.

He goes home assuming what he has been fed ‘ advised will make him better.

Is there not a fundamental flaw here?

I really wish it did mean what you think it means. Because that would imply doctors had a hand in the decisions, when in fact it is all so underfunded that the cheapest bidder gets to feed the patient, and that is it. It proves absolutely nothing about the attitudes of doctors to disease prevention.

[Chris_in_the_UK]

Yet you buy everything that my industry provides, from the food on your table, the house you live in, the car you drive and the energy you consume.

As does the world - do you have an alternative?

I see little choice other than do, or do not.

[Chinnock]

I really wish it did mean what you think it means. Because that would imply doctors had a hand in the decisions, when in fact it is all so underfunded that the cheapest bidder gets to feed the patient, and that is it. It proves absolutely nothing about the attitudes of doctors to disease prevention.

We fundamentally agree, we are just coming from different perspectives.

- - - Updated - - -

As does the world - do you have an alternative?

Just like Greta, No!

[Chris_in_the_UK]

We fundamentally agree, we are just coming from different perspectives.

Just like Greta, No!

Perhaps, but as in anything, we have to work with what we have and try and improve.

Throwing stones at a perceived problem fixes nothing.

[oldoakknives]

Understandably, you are clearly ignorant of how a small business (which is what a GP practice is) works.

The practice manager is responsible for the admin team (receptionists, secretaries, cleaners) and performs most of the HR functions. They will also be involved in the commercial and NHS supply chain side of the business. Add to that ensuring staff compliance with training, building maintenance, etc. I could go on and on.

What did/do you do for a living? It might be helpful to understand where your experience is derived from, i.e commercial or private sector and so on. You seem to get drawn into arguments that expose you taking an argument for the sake of it position, without necessarily knowing much about what you are taking about.

What I'm not ignorant of, is how middle management are sucking money out of the NHS which could be better spent on doctors and nurses.

For example we have an NHS paying top dollar for most of it's supplies, the economies of scale should be enormous, instead they are exactly the opposite.

As for practice managers, the reason I asked is that I don't think they necessarily put systems in place which put the patients interests first. I was with the same GP practice for the first 50 odd years of my life. It was an excellent surgery throughout that time, with excellent doctors, until a practice manager appeared. From there on it became gradually more difficult to get an appointment to see a doctor. It went from usually getting an appointment within a couple of days, to being lucky if it was within 10 days. When I asked once why I couldn't get an appointment any quicker I was told if it was an emergency I could go to A&E. I said I didn't think it was an emergency but it was something I was worried about, she said I would have to to speak to the triage nurse to get anything any quicker. So I did. She asked me why I wanted to see a doctor, so I told her what I was worried about. She said I obviously needed to see a doctor about that, why did I ask to speak to her? When I said I was told it was the only way to get an earlier appointment she said that wasn't true and nobody would have said that. She said I would have to speak to the practice manager. The practice manager insisted that there were always appointments held in reserve for people who requested an earlier appointment. When I said the earliest I had just been offered was over nine days away, and said I was told I had to speak to a triage nurse to get anything any quicker he said that just wouldn't happen! I was put on hold for quite a while, and then he said he would transfer me back to a receptionist who would make an appointment. This he did, and the appointment was made for two days time but with a doctor I'd never seen before. Her first words to me after I sat down were to question why I had tried to misuse the new triage system they were trialling.

I registered with a new surgery the next morning, who asked if I needed to see a doctor that day! This was the case for the next few years, and the doctors were excellent, until covid hit and it became almost impossible to see a doctor.


This is very similar to my experience, you could be describing the very same surgery!

OK you asked so I will give my honest opinion

My family surgery were great for many years but I have nothing but contempt for the current "person" in charge. Horrible obnoxious, toxic individual who I have little to no trust in. Decent doctors who work there dont seem to last long and the good doctors who were there have either retired or left. The staff and just about everyone there seem run down he will be remembered for all the wrong reasons and only has himself to blame.

[Chinnock]

Perhaps, but as in anything, we have to work with what we have and try and improve.

Throwing stones at a perceived problem fixes nothing.

I think you are confusing "throwing stones" will observational reality. We base much in western society on "scientific proof" and we become slaves to that which is "proven". In relationship to nutrition, too much is reliant on what we subsequently think has been "proven", when in reality pressure from Big Agriculture, who generally underpin most nutritional research, skews the reality of what has been "proven" beneficial, due to bias outcome.

I have consciously gone against mainstream guidance and questioned the science, and in the process have become aware in the shortcomings of "scientific proof". I now prefer to give "observational reality" the credibility it deserves, especially when it comes to health and personal nutritional choices.


Sadly many people don't want responsibility for their own health and just assume they can carry on regardless, as the NHS will pick up the bill when they get sick.

I believe it is fundamental for the medical profession to take responsibility in preventative measures, and encourage independent nutritional research, and lift the veil for more people to have clarity in making the right choices. Whilst the advice given through the medical profession and MSM is contradictory, people will continue to get sick, which for our own NHS will have a large bearing on how effectively they can provide and be run in the future.

We can't keep throwing money at a service whose patients will continue to rise. Unless we stem the flow of sickness at the source with the "correct" nutritional advice, the NHS will not survive as it currently stands.

[ryanb741]

[Dr Wolff]

What I'm not ignorant of, is how middle management are sucking money out of the NHS which could be better spent on doctors and nurses.

For example we have an NHS paying top dollar for most of it's supplies, the economies of scale should be enormous, instead they are exactly the opposite.

As for practice managers, the reason I asked is that I don't think they necessarily put systems in place which put the patients interests first. I was with the same GP practice for the first 50 odd years of my life. It was an excellent surgery throughout that time, with excellent doctors, until a practice manager appeared. From there on it became gradually more difficult to get an appointment to see a doctor. It went from usually getting an appointment within a couple of days, to being lucky if it was within 10 days. When I asked once why I couldn't get an appointment any quicker I was told if it was an emergency I could go to A&E. I said I didn't think it was an emergency but it was something I was worried about, she said I would have to to speak to the triage nurse to get anything any quicker. So I did. She asked me why I wanted to see a doctor, so I told her what I was worried about. She said I obviously needed to see a doctor about that, why did I ask to speak to her? When I said I was told it was the only way to get an earlier appointment she said that wasn't true and nobody would have said that. She said I would have to speak to the practice manager. The practice manager insisted that there were always appointments held in reserve for people who requested an earlier appointment. When I said the earliest I had just been offered was over nine days away, and said I was told I had to speak to a triage nurse to get anything any quicker he said that just wouldn't happen! I was put on hold for quite a while, and then he said he would transfer me back to a receptionist who would make an appointment. This he did, and the appointment was made for two days time but with a doctor I'd never seen before. Her first words to me after I sat down were to question why I had tried to misuse the new triage system they were trialling.

I registered with a new surgery the next morning, who asked if I needed to see a doctor that day! This was the case for the next few years, and the doctors were excellent, until covid hit and it became almost impossible to see a doctor.


This is very similar to my experience, you could be describing the very same surgery!

The arrival of the practice manager at a time when services were changing does not suggest that he/she was the cause of it. It is much more likely that as demands increased on the GP partners, they became unable to cope with the management side, which has become increasingly demanding, and got a professional manager in so that they could concentrate on what they're good at i.e. providing medical care.
Your logic is flawed.

[oldoakknives]

The arrival of the practice manager at a time when services were changing does not suggest that he/she was the cause of it. It is much more likely that as demands increased on the GP partners, they became unable to cope with the management side, which has become increasingly demanding, and got a professional manager in so that they could concentrate on what they're good at i.e. providing medical care.
Your logic is flawed.

It's not logic old chap, it's personal experience. In my opinion it was the arrival of the practice manager that prompted the changes, not vice versa.

[wileeeeeey]

It's not logic old chap, it's experience.

You are literally talking to a doctor OOK.

Simmer down.