Reply With QuoteDoesn't everyone when they reach the earnings threshold or is medicine different to other university degrees?Originally Posted by casbar
No. And without even a shred of guilt. By the time I hope to not be doing your standard NHS work the NHS would have had nearly a decade of actual blood, sweat and tears from me.
Doesn't everyone when they reach the earnings threshold or is medicine different to other university degrees?
I am not sure what the deal is now but when I was a student if you did medicine the last 2 of your 5 or 6 year degree had the tuition fees paid, I am assuming that is what is being referred to. Don't worry I still have a large student loan.
I'm not worried. I just believe if the state paid for the training, then if you don't give x back, you should repay. Just like Consultants who baulk at doing NHS work in preference to their private work. Like I say, I have the greatest respect for doctors and nurses, but a lot I know are ardent left wingers who think nothing of milking the NHS for as much as they can and then complain about the lack of funding. So for me, the hero worship has run its course. Do the job you get paid for. Bit like years ago when the Bakers went on strike, if you don't want to get up at 4am, don't become a baker and get a different career.
I have some sympathy with that argument, but as the OP pointed out, he will have a big fat student loan to keep paying back at commercial rates of interest for the next couple of decades. I certainly have. At least he is still here rather than emigrating and not paying back a bean.
One of the flaws in your argument though is that the system is set up to encourage 18 year-olds to train to become doctors after their A Levels. This then means they need to make a commitment to choosing those A Levels that are the prerequisites whilst they are sitting their GCSEs. Most 16 year-olds could be forgiven for not realising the implications of a huge postgraduate training pathway on their interpersonal and family commitments well into their 30s. Anyone who thinks otherwise is deluded.
No one wants the hero worship either. The ridiculous pot banging every Thursday last year made many colleagues grimace with embarrassment. We would like for folk to think seriously though about how the NHS and social care should be funded going forwards, because as others have pointed out, we are living longer with more complex and costly conditions, and what we have at the moment is not sufficing I am afraid.
Finally, there are some areas of medicine and surgery where private practice is more common than others. The vast majority, GPs included, do no private work at all. If you have a demanding full-time role as it is, you are unlikely to want to head to the private hospital after work or on a weekend. The craft specialties such as surgery are the exception rather than the rule.
I will also add that junior doctors are mercilessly exploited in their final years, doing incredibly long shifts in stressful conditions for a pittance. I believe that 2 years of that more than refund any fees they may have had paid for.
'Against stupidity, the gods themselves struggle in vain' - Schiller.
I'm not having a go at you, I actually have the greatest respect for doctors, but do you think you maybe chose the wrong profession?
Started out with nothing. Still have most of it left.
Most medics choose their profession at the age of 14, when they make their GCSE choices. From then on the hoops they have to jump through to get in to medical school are unlike those of almost any other profession. What other profession demands on the job experience (a hospital job or working in a GP practice), before you have even submitted a UCAS form? Seems ridiculous to expect a 14 year old to have the maturity and experience to understand what they are letting themselves in for at that age. But by the time you are fully qualified in your late twenties, you have invested nearly 15 years of your life in the pursuit of a medical career. It's pretty tough to just throw all that away and start again.
I don't really think anyone is having a go at me, I started this thread to try and get a better insight into where ill-feeling comes from, I actually think I have done that. It is lack of understanding.
Did I chose the wrong profession? I mean it is an impossible question to answer isn't it and there is little value in looking back to my 16 year old self and wondering if I made a mistake. I was a child after all... The real sad thing is that when I sit in a doctors mess or staff room I see a huge proportion of people that have been absolute battered by their jobs. Bright, intelligent, hard-working, passionate, principled people broken. Broken but trapped by mortgages and school fees a lot of the time. I promised myself I would not become one of those people. If I cannot find a role within medicine that I can be at peace with then I will leave, my life would literally depend on it. Sounds dramatic but I think it is true. I have had two colleagues kill themselves and I will not let myself even venture down that kind of road.
I truly believe being a doctor is a privilege... after my second year as a doctor I thought I would leave medicine, I applied for consultancy firms in London and was doing well in the application process but I withdrew. The more I learnt about the industry the more I realised I couldn't do it. When I have a shit day as a doctor it usually means something, management consultants have shit days too but as far as I could see they were just working to make money by making other people loads of money - when they had shit days nobody was really better off for it. Unfortunately the system just doesn't give a fuck, chews you up and spits you back out. When I spot a cancer early, pull someone back from the brink of suicide or spot a seriously ill child I think maybe it is all worth it but in actual fact it probably isn't... not if it means I am a husk of a man when I come home to my family.
Did I choose the wrong career? I think that depends on the decisions I make going forward. I don't blame the kid that made that decision. I have made friends, saved lives, cut people open, sutured them up, I saw a couple get married on a ward once because the guy was going to die very soon - a privilege - so I can't regret it, I just might not do it forever!
What is all the Paperwork you have to do? Couldn't it be done by an administrator?
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What is all the Paperwork you have to do? Couldn't it be done by an administrator?
Some can, most can’t. Referral letters (can be dictated but that isn’t the time consuming bit), acting on letters from consultants, blood tests, prescriptions, death certificates and cremation forms, dealings with a coroner, and just anything else that gets labelled with “go to your GP”
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Thanks for the reply and being honest. I don’t doubt that it’s a very difficult job and loaded with emotional baggage. It’s not something I would want to take on, which is one of the reasons I respect those who do.
However people are experiencing problems with GP services and it seems quite widespread.
More than one person thinks the addition of a practice manager had a negative effect on the service that was provided. But said managers probably improved the lot of the GPs.
Perhaps we had it too good in the past. Or perhaps we expect too much. But surely standards should improve not diminish. And if they’re diminishing perhaps we need to work out why.
I hope things improve for you.
Started out with nothing. Still have most of it left.
I think we know why, I'm just not sure there is the will amongst the population or politicians to admit it or do anything about it. There has been a collective head in the sand for 20 years, and it is just easier to blame GPs than to admit that the government has got it wrong.
I hate to get personal about it, OOK, but you seem to fall into that category.
Let me put it like this. There is a bus service in a town. Everyone can use it. The population of the town doubles. The number of people who need to use buses increases because they can't use their cars. People need to make more journeys because they have more places they need to visit. The budget for the bus service decreases, so the number of buses in service goes down. The buses are busier, maintenance is not thorough and they break down. The number of drivers decreases because there are people who can't get a seat on the bus and they are unhappy. It becomes harder to man the buses that are in service. So people have to queue. Some will get a seat, some won't. Do you blame the bus driver?
I have nothing but praise for GPs in my experience, but some other members of the NHS I can’t say the same for at all.
Things like hospital units, specialists’ secretaries etc seem to have a huge sense of self importance. They don’t care of the impact to you when not answering the phone for hours on end, you turn up on time and are sat waiting for a long time and that sort of thing.
I'm old enough (unfortunately) to remember the days of solo GP surgeries where you sat and queued for an hour to be seen on the day. In reality, they were the the 'bad old days' when the pace of life was so much slower, and most visits to the GP were either for antibiotics or a sick note. In fact most people were prescribed a 'tonic' which lasted long enough for any minor symptoms to disappear of their own accord.
For years I complained that the medical profession weren't open and honest with patients, now that they are, patients blame the GP for not having a magic wand.
Life is far more fast paced and the consumer is far more demanding in today's era where medicine can do so much more than it could in the last century.
A couple of years ago, I apologised for taking up a GP slot as my symptoms hadn't improved in 3 weeks - the GP said "don't apologise, it needs checking,, we get people ringing the surgery because they started coughing last night".
Basically, it's one of those 'If it walks like a duck...' scenarios - health professionals have been flagging up issues for some years but people bought in to the 'NHS is inefficient' mantra indicating that the people at the coal face were complaining without good cause. Now the public are miffed because it is becoming increasingly problematical to secure an appointment (and all brought to a head by COVID-19).
We were warned, but we listened to the wrong people so now we blame the people we didn't listen to...
I said I respect doctors. I also said "More than one person thinks the addition of a practice manager had a negative effect on the service that was provided." If you read the thread you will find that is true. I think you will find that most of my criticism was levelled at the way GP practices are run, not the GPs themselves.
But since you want to get personal about it, (I won't call you a name), at the end of the day GP partners have the final say about how their practice managers operate the practice. I don't blame the 'bus driver' no. But I blame the partners running the bus company.
So how has the government got it wrong? Are they not paying enough at £155 per patient registered? My GP practice has 14k patients registered. Thats £2,170,066.
In your example about buses, you miss out that the bus service is paid for each person, whether they use the bus or not. And when the population doubles the amount the bus service is paid doubles, whether they use the bus or not.
Also the average paid per registered GP patient rose from £136 in 2013/14 to £152 in 2017/18 to £155 currently.
Started out with nothing. Still have most of it left.
In my analogy the people running the bus company are the government, the bus driver represents the GP, not the way you have put it.
And considering that the rise in what each practice gets per patient barely exceeds inflation, the extra amount of work being asked for by the government year on year is barely covered. If we didn't attract other non-NHS work (research, travel vaccination etc), most practices would be unviable for what they get paid per patient. The service patients receive is subsidised out of other income. We couldn't survive without it and you wouldn't get a service.
So, in your eyes, every practice in the country is adequately funded and simply mismanaged by the GPs. Is that really a realistic view? That only goes to illustrate my point that you/large sections of the population/government are being willfully naive or burying your heads in the sand. I am afraid there is no denying the statistics. The population has gone up, there are fewer GPs doing more work, investment in the infrastructure of general practice has been lacking for the last 10-15 years.
The government has it it wrong by underfunding the whole of health and social care - it is front line services like GP and Emergency Medicine that will bare the brunt of it because we can’t hide from the tidal wave of demand. As I have tried to explain it is no the funding of the actual practices it is the lack of doctors and the lack of funding in the whole system.
It is just so lovely for the government that people don’t often see this and directly blame the people just trying to get on with doing the work.
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And all that suddenly changed in the last year did it?
You say the population has gone up. If a practice has more patients it has more income. So if they managed ok with fewer patients and less income, why not with more patients and more income?
At the end of the day the OP asked for people’s opinions. Many seem to have had similar experiences to mine.
If you want to just say it’s all the governments fault, fine.
Started out with nothing. Still have most of it left.
My GP practice has 14 GPs for 14k patients. How many would they need in your estimation?
Started out with nothing. Still have most of it left.
Enough to meet demand. Your view point that they have 14 GPs therefore this should be enough is massively oversimplified.
There isn't a set number of GPs needed per amount of patients. Some areas have massively complex patients and so they take up way more time and appointments. It isn't just about the number of GPs, as I keep harping on about, it is also about other local services because when they are underfunded and resourced the brunt is felt by the GPs.
I would think the number of GPs required depends a lot on the population it has in its books. The younger, more active the population is, the fewer GPs will be required for the same amount of people.
For a given surgery, this population is going to age so even though they may not take on more patients, the number of GPs needed will increase. As the size of the surgery is limited, the max number of GPs it can host is finite. When you get into this territory is the time appointments are more difficult to get and further into the future.
The solution would then be to have a new surgery covering the area and to redistribute the patients so that all have a balanced share of each age group. But of course that doesn't work if the area is just ageing because the youths are moving away.
Hence my earlier suggestion of paying surgeries not by patient on the books, but by actual appointments.
'Against stupidity, the gods themselves struggle in vain' - Schiller.
I never said 14 was enough. I asked you how many they would need?
Which areas would have ‘massively complex patients’? Are you saying that the service going down is caused by a sudden influx of ‘massively complex patients’?
Started out with nothing. Still have most of it left.
Think that’s pretty good, average is something like 2k patients/GP.
Maybe you’re massively complex!
Last edited by Kingstepper; 4th October 2021 at 08:28.
And I am saying there isn't a specific number. There is only the amount of demand the patients generate vs the resources to handle it.
I obviously don't know your specific surgery but if it is anything like mine the service is going down because covid was the straw on the camels back that has further disrupted mental services, routine operations, mental health provision, patients have sat on problems and then become more ill plus a myriad of other services being stretched. This leads to GPs fire-fighting - dealing with acute and urgent things and routine chronic disease management goes by the wayside leading to chronic diseases becoming more complex and demanding more appointments and time. On top of that this makes the job unbearable so maybe some of those GPs have had to reduce working hours so they don't complete break and have to stop all together - thus making the problem worse.
The government spent £22 billion on private contractors to make a rubbish app that had almost no effect on the pandemic. If that had gone into moving the needle on some of the above problems, the situation would be much better.
Different areas have different levels of patient complexity for lots of reasons. Other services, social adversity, housing, drugs problems etc etc.
GPs haven’t been seeing patients since Covid hit at my surgery. So there would almost certainly be a backlog.
Started out with nothing. Still have most of it left.
I thought that was the case for mine, too, but it isn't. It is just that they have effectively done with the waiting room, and therefore reduced the number of face to face. Patients wait in their cars (it's in the sticks anyway, no one comes by bus) before being called. Less efficient in terms of FtF appointments but they have increased the number of telephone consultations. I am not fond of the e-consult system but I am afraid there will be no going back, quite the opposite.
'Against stupidity, the gods themselves struggle in vain' - Schiller.
I promise you, they have. They have just had to prioritise the ones that really need to be seen because if they saw everyone they'd drown.
Look, it isn't my job to convince you of anything - your mind seems quite made up. I wanted to get an insight into what some people feel and why they feel it. I have done that - I feel most people realise it is not the fault of the actual doctors doing the grunt work on the ground.
Bottom line is I am worried about GP and the NHS as a whole - if change is going to happen then public support will be needed as that is all politicians care about. If you have money - don't worry about it, your care will improve with privatisation and don't worry yourself about the riff raff that can't afford good insurance (talking generally now, not to you). But I do worry about this. The poor will suffer/die, the middle will just about pay for it, the rich won't be arsed. This is sad. The money is there, the government would just prefer to put it elsewhere.
I have spent enough time on this thread now I think!
But actually thank you to everyone that contributed.
And if you want to widen the debate, I work in mental health services and on many of my recent (past 18 months) on-calls we have detained patients under the Mental Health Act to find there are no acute female or male psychiatric beds in our city.
So we look wider and find there are none regionally.
So we look wider and find there are none in the country. That’s both NHS and private hospital providers. Nominally in the low tens of thousands in terms of supposed capacity.
So the patient sits in a completely unsuitable and inappropriate facility for several days until someone, somewhere, is discharged.
Last time that happened a fortnight ago the bed was in Cornwall. The patient was in Sheffield.
If that is not a convincing example of how seriously wrecked the system is, I cannot imagine what would convince some of the doubters here. This has nothing to do with bloated layers of middle management and everything to do with a steady erosion of funding in real terms in my particular corner of the system. These patients are some of the most unwell people in the entire country at that particular crisis point and as a society we are letting them down massively.
Can't help thinking that 50 odd years ago things worked better. So much for progress...
Why close all the hospitals that cared for the mentally sick. Why privatise the elderly care sector. I've no idea
General practice has been an evolving crisis for years, but there has been a slight pandemic, so things have certainly got worse, yes. It has rather highlighted many of the problems we have been talking about for a long time. But suddenly we are all now talking about it as the impact on patient care becomes critical. The government has not listened and now they are surprised at the exodus from the profession?
Your argument that more patients equals more income, so why can't we cope is rather simplistic. As said before, the demands of patients and government have increased as has the complexity of what we do. Investment in infrastructure has been lacking (remember austerity?) and many surgeries need serious updating or replacement. Combine that with a demoralised workforce who are leaving in droves. But I suppose you can always access the magic GP tree (that's the one where you allow other countries to train doctors and then steal them and promise 6000 new GPs just like that).
Recruitment and retention have really started to hit hard. Five years ago we had 11 partners and 5 salaried GPs. We are now down to 7 and 4, with two more leaving within the next year. In spite of five partners leaving/retiring, we have only been able to recruit one partner in the same timeframe. Of my group of close friends, 6 of us, all aged in our mid fifties, only one of us will be a full time GP this time next year, and one other will be part time. The rest of us will all be out. This has not been helped by the introduction of punitive pensions rules which make it not worthwhile continuing to work.
So, yes, I do blame government.
Excuse me, I have 40 or so patients waiting, so I'm going to dip out of this thread too!
"There's none so blind..." Seems to me that some people here are more interested in lashing out at the symptom (availability of F2F consultations). Ergo if they can see a GP F2F then there isn't much wrong with the system?
I actually advocated telephone consultations with my local surgery some 15 years ago as it is far more convenient for me - just for disclosure
The fact so many Drs are retiring early must speak to something?
Maybe that was the case at your GP's, but it certainly wasn't at mine.
Started out with nothing. Still have most of it left.
As you've said, different areas have different levels of patient complexity and so it should be clear that the '£x per patient' will have significant impact on the level of service in different areas, which in turn will affect the publics perception of their GP's.
I've appreciated your first-hand experience and hope you can find time to further contribute to the topic.
R
Ignorance breeds Fear. Fear breeds Hatred. Hatred breeds Ignorance. Break the chain.
Thanks for this Eddie, when I was in Sheffield. One doctor and turn up for an appointment. Get seen and helped.
Now fast forward our Medical Centre has about the same as Eddie says. But you can not get an actual appointment. A telephone call if you’re lucky. I should have had my Blood taken January to check my Thyroid Function. Not Taken. Should have been referred June for an endoscopy for my Barrett’s not happened, however received a letter advising endoscopy will be in December!
WTF are these Doctors doing?? If not seeing patients. Not taking calls, but will if you’re lucky ring you.
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I'm not talking about HSE work in a factory, where most operations are repetitive and fairly easily managed. I'm talking about Construction sites in which tasks are constantly changing and evolving, and where each one can lead to a personal charge of Corporate Manslaughter in addition to the trauma of killing a colleague /or friend, rather than a ticking off from the GMC.
I really don’t think that equates?
I'm not sure how NHS dental practises operate compared with GP surgeries but one seems to work better than the other.
My dentist operates an NHS practice, and they're brilliant and have managed to maintain appointments throughout the pandemic, and have been available for emergency appointments when needed. They've been happy to have their fingers in patients mouths, and obviously work in close proximity. Whereas many haven't been able to get in to the same room as a GP for the past 18 months.
The problem is not with the GPs but with the number of GPs. And that in turn is a reflection of problem with the NHS.
NHS is a wonderful model but sadly it is not sustainable without substantial increase in health care spending. Aging population and more expensive treatments have increased the cost of health care and spending 10% of GDP on healthcare sadly is not going to cut it. GPs and doctors in general need to be paid more to recruit more doctors and keep them in practice. Unless people are prepared to pay more taxes, it is steadily going to get worse.
Quite.
I haven't read all of the posts in this thread, so I apologise if I am repeating what someone has already said, but the OP asked (paraphrased) why are the GPs taking such a kicking at the moment? Because it's your turn. As simple as that. Whilst we are all looking at the attacked, we are not looking at the attackers, or at least those that have their mouthpieces doing the attacking.
A life of a GP has improved when most of them went part time, but it is still no life, and there are much better things that you can be doing with your life as those in charge treat the NHS like building blocks they can keep re-arranging, and the service just gets worse, but people like you try to hold it together, and don't get thanked for it.
Some of the health professionals on here have intimated that the remuneration GPs receive is not enough for the work involved. Given the time and the amount of studying required to become a GP, and the obviously intense nature of the profession, what do you think would be a reasonable salary? Or is it the case that the job has just become too difficult, and the salary isn't the problem?
Started out with nothing. Still have most of it left.
Punitive pension rules. Is this the one where you get "penalised" for having more than £1.25m in your pension pot?
I'll cry you a river after morning surgery. Might be 2pm before I can do that though
As near as I can put it: this. Misdirection, finding another Aunt Sally for the red-tops and their readers to throw sticks at, anything rather than examine the problem, which is clearly that the system is broken. Like so many things in this country, there may have been “just enough” resources to run GP services before Feb 2020, but throw in a pandemic and the concomitant additional degradation of working conditions for medical professionals, it should come as no surprise that the NHS camel’s back is properly broken. As johnbarker has said, it’s not limited to GPs, this sort of issue seems to be cropping up everywhere.
Be suspicious of simple answers to complex questions, folks.
Save your tears, they aren't required. What the Government has done, though, by introducing the lifetime earnings allowance & the annual allowance (with taper, which has gone now thankfully) is remove any incentive to either stay in the NHS or do any extra work or overtime. Hospital consultants refuse to do extra shifts because the effect on their pensions is such that they get taxed more than they earn and GPs, once they reach the pension cap, have no incentive to continue working in the NHS at all, hence retire early.
The Government have created their own perfect storm - they make the job undoable and they remove the financial incentive to do it!
And in answer to another post, further up - I don't think GPs are underpaid or overpaid. It's about more than that, and I don't think the problem will be solved by paying them more.
First off, I need to ask some questions
Is it essential that you get my opinion, can I ask what difference my opinion would make?
Unfortunately, there are no opinions available today
If you call first thing tomorrow morning you may get an opinion and potentially be able to make an appointment for an opinion via telephone at a later date that will be convenient to me but not you (Not that I will make it as I’m typically 2-3 hours later giving opinions)
You may get my point, to sum it up I think the NHS is broken, for emergency care it still seems to function ok but for most everything else its not fit for purpose
Must make it incredibly difficult for those that work in it
Personally I’ve given up on it , I know it wont be there for me like it hasn’t been for my loved ones
The system is going through a death by a thousand cuts. The best way to replace it is to keep breaking it.
I rang my GP 19 times yesterday afternoon. Engaged on each occasion.
Usually you get through to the recorded message and then wait in a queue for, often, a very long time.
I wasn’t expecting to speak to a doctor but assumed a minimum wage receptionist might have a couple of minutes to spare ….
How the other half live!
I rang yesterday to get an appointment for my teenage son.. he had a cough . 53 minutes wait and I get to the receptionist..she said they are only doing phone appointments...that's fine I said but then she added that my son would need a negative pcr test before I could book a phone call back....if that wasn't acceptable go to a&e .
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