Its also worth pointing out the diabolical pension rules force a lot of GP’s (and hospital consultants) to reduce their working hours. My wife is a GP and works fewer sessions than she could but she has been forced to reduce due to topping out her pension. This sounds lovely, like a great big pension. The reality is that if she breaches the threshold, she will be liable for a bill of many 10’s of thousands. She can’t plan for this as they don’t forecast, they only tell you months after the event. A partner in her practice recently got a £40k bill. So, perversely, working more hours could cost her more money than not working.

You could immediately create capacity in GP and hospitals by reforming the daft pension rules which were designed for the mega rich, not for well paid public servants.

Other things that will help:
– Government and media need to stop talking down tele and video consultations. They are good thing and should be encouraged for the right circumstance.
– ANP’s and other medical staff are ace and should not be viewed as a poor alternative to GP’s. You don’t need to see a consultant level doctor for every minor ailment.
– My wife reckons a local, well resourced, effective and accessible mental health provision could free up around 29% – 30% of her working capacity.
-Sort out the small stuff. My wife’s printer broke and it took local NHS 6 weeks to fix it. Her phone took 2 weeks to fix. GP’s work at pace, silly little things like that have a real life impact.

Incidentally, I took my lad into A&E last week. In, seen, assessed, x-ray, seen again, moon boot supplied and out of the door again within 45 mins. Its not all bad.

When I was little the doctor would come to you.
Now you’re lucky if an ambulance turns up.

Earlier this year I went to a seminar delivered by a senior official from [area redacted – large deprived northern seaside town] who observed that a tiny proprotion of their population – about 200 families – were collectively responsible for a really material percentage of their expenditure on health/social care/policing/flytipping etc.

I’m not sure that’s anything new, there are always certain areas / estates with dysfunctional families who endlessly eat up resources.

When I was little the doctor would come to you.

And why was that a good thing? How many other medical consultants come out to your house?
GP’s still do home visits, but generally for bed bound and end of life care. They are not going to waste their time visiting your house because your throat is a bit sore.

Pharmacist was the first port of call who told us to see the GP for antibiotics. GP receptionist told us not to use 111 due to wait time and to go to local Hospital if we wanted to see someone today. 🤷‍♂️

Fair enough @stuhawk, sorry you’ve not been able to get treatment quicker. Only asked as I think there’s always a few things that could be dealt with elsewhere but some people have the “must see a GP and only face-to-face is good enough” mentality. Hope you get sorted anyway!

@footflaps absolutely not new, it’d just be a helpful problem to solve!

At what age does a doctor who chooses that path become a GP?

Any age TBH… many med students know they want to be GPs…
Medical life goes:
uni – 5/6 years
junior doctor – 2 years
speciality training – 3 years for GP, 5 for other specialities
‘fully qualified specialist’…

I initially did ‘hospital medicine’ then switched to General Practice.. so I’m tecnically DrP BM MRCP MRCGP!

About 8 years ago, many older trainees (like, in their final years as speciality trainees) switched across to general practice. Now, TBH, fewer people are becoming doctors in all walks of life!

RE the home visits – TBH the only person they convenient is the patient, and i’m afraid you’ll jsut have to get over that! I can see 6 people in an hour in the practice.. or maybe 1 or 2 in the same time on visits (and that’s because my practice boundary is tiny!)…. if YOU were in charge of this service, what would YOU suggest we do..
Additionally, things change. I’ve got end of life patients who say “no one has been to see me recently”, when in fact they mean “the GP hasn’t seen me this week”.. they’ve been having 3 times a day visits from teh palliative care nursees, having OT and PT going in… but people still think the GP is the answer to everything (“winks, blows on knuckles and rubs lapel… can you blame ’em..!!”

DrP

@franksinatra Am I right in remembering that the usual suspects (ie. the Daily Mail) was slagging off GPs pre-pandemic for not offering video/remote consultations?

As above home visits are only for those who physically can’t get to the surgery. It’s just not a good use of a limited resource otherwise.

Its ok. The manifesto says “6,000 more doctors in general practice”……. https://www.conservatives.com/our-plan/nhs

Although that promise has been quietly dropped. I say promise.

The manifesto says “6,000 more doctors in general practice”…

Without any actual changes to anything to achieve it.

Didn’t Bojo give us 40 new hospitals?

Am I right in remembering that the usual suspects (ie. the Daily Mail) was slagging off GPs pre-pandemic for not offering video/remote consultations?

Yep, then the Daily Mail and Government starting slagging them off for doing exactly that.

I honestly think most sane people are perfectly happy speaking with Dr on the phone or via video call. I certainly don’t want to hang out in a DR’s waiting room reading crap magazines and sharing air with ill people if all I’ve got is a minor ailment*

*obviously I don’t have to do either as I was smart enough to marry a GP and get my own private GP service, although it is completely devoid of any actual sympathy

System here seems to work, despite our 5 GP practice bring down to 3 GPs.

You ring the receptionist who does a little triage and someone rings you back. Last time I used it I got a call back the same afternoon, bloodiest booked for next day, face to face the week after when the tests rests were back.

When my elderly mum had an issue with a growth on her leg, she rang, was given a face to face within a couple of days, nurse practitioner didn’t know what it was and referred her straight to dermatology.

The system is at breaking point, but it somehow staggers along here. Sadly, I guess my expectations have been lowered as well.

Lucky enough to get a same-day call back here, happy with that. What was more worrying recently was FiL going for an eye test one Tuesday this month, the optician spotting bulges in arteries in his eyes (I think) and saying he needed to to A&E NOW for an MRA, him then waiting 12 hours in A&E for a bed, then having to wait until Friday for the scan and discharge (all clear fortunately).

I can’t conceive of how godawful it must be for the genuine heroes who staff the NHS to be that overwhelmed – my heart goes out to them, it must be horrendous. 🙁

My surgery is a impossible to get through by phone. During Covid they have introduced an online e consultancy thing which is actually pretty good, much to my scepticism.

My solution to the capacity problem. Reduce the financial demands on would be doctors. We need more of them, so maybe even offer grants to get them trainees up.

And, controversial don’t pay them so much that they can work 2 days a week and still be comfortable off, and then choose to take much earlier retirement than the majority of the working population. I have several GP friends who don’t seem to realise that to earn similar amounts to what they do, they would need to be Directors / CEOs of mid sized companies, and believe me they extract their pound of flesh. Most are partners working 2 – 3 days a week, and still on hefty salaries

DT78 – yes they are paid well- but remember they have to buy into the practice which depending where it is could easily be another large mortgage. My pal paid more for his share of the practice than he paid for a posh house in a posh town IIRC

I also doubt most CEOs of mid size companies are paid less net. – and its a highly skilled job with stress hard to imagine and as above 10 years or more of training to gain the skills

I don’t quibble at it is a highly skilled job, but it is very very well paid.

Raise the salary of juniors, recruit more of them, but reduce the salaries of those in mid and senior positions to something sensible so they actually stay in work

I did chuckle about that comment about fte equivalent up there….

Also it’s hard in a lot of other professions to be part time and still earn well well above national average

Also all the doctors I know are from families of doctors, so we’re able to do it because their family funded them. That needs to change so med school is open to everyone able and bright enough, not just those who can afford it, or are willing to be massive saddled with debt

I had the grades for medicine, the cost and time before break even stopped me pursuing it

Starting pay for a gp is 60 grand. After ten years training

Average is under 100 grand and gthats for full time and remember they pay for the buildings out of their own pocket.

Most go part time / retire early because they are broken by the stress.

Most go part time / retire early because they are broken by the stress.

or are forced to through ridiculous pension rules that penalise working too much.

I know the pension issue struggles to get sympathy. This is well worth a read
https://amp.theguardian.com/society/2019/jul/28/growing-number-of-gps-cut-shifts-to-avoid-huge-pension-tax

My view is that like airline pilots I don’t want my doctors thinking “I don’t get paid enough for this shit”

A major part of the stress is overwork / demand

Increasing capacity by making it cheaper or funded to enter the profession would he,o alleviate demand

You wouldn’t need to pay so much if there was lots of resource, and it wouldn’t be so stressful.

Last time I spoke about money with my partner friend she was taking home £60k pa for two (long) days a week. not sure what other jobs are out there that enable you to do that.

This is how it used to be years ago, some from south of the border may struggle with the odd word

DT78. have you ever had to make life or death decisions on a regular basis? To deal with dying people and tell them they are dying. to deal with suicidal folk knowing that not only are you accountable for the decisions you take but if you make a mistake you could be in legal trouble.

respectfully you have no idea the level of stress involved in this sort of work. I have but I could always pass the buck. I too had a place at Uni to do medicine. I didn’t take it because I could not face the ten years of training under utterly appalling conditions ( they have improved since)

Plenty of lower paid staff make life or death decisions, in fact when I look across what medical staff at all levels have to do, GPS seem more insulated from the frontline.

Like I said, can you think of another job where you get 60k for 2 days work a week, and have a pretty stonking pension, and pretty much job security for life?

I can’t.

I have not said it is not a skilled job, or that it has its pressure. But so do many other jobs, medical professionals would also not understand.

make the profession more accessible, increase capacity, reduce stress, redistribute income from those earning huge sums to pay for those to train up.

2 long days 24+ hours so is 60% of FTE so her salary is in line with the average for the profession. she will have had to buy into the practice for that which will have cost a lot and she is responsible for her share of the upkeep of the buildings ( to oversimplfy)

I was a nurse till I retired. Lower paid staff only make life or death decisions with the support of senior staff ( even registrars will have a consultant to refer to)- guess what – those senior staff are paid at similar rates.

go on – name me another job outside of medicine where you have similar levels of responsibility or stress. airplane pilot might come close I guess

Military to start with

Now you answer my question tj

Almost everyone in the military has a senior to pass the buck to. Nothing like the level of stress.

CEOs of medium businesses will earn far more pro rata. My pal who is an accountant earns more pro rata. Two pals who are management consultants earn more pro rata one a heck of a lot more and both work part time

We need more GPs. Please, do the training and become one. There is even a £20k “new to partnership” scheme to attract new doctors in to these highly paid part time positions.
Strangely no one wants to do it.
I’ll post this again. Read the summary then come back and have a conversation about what the problems are (clue- partners earning too much isn’t one)

https://committees.parliament.uk/publications/30383/documents/176291/default/

Almost everyone in the military has a senior to pass the buck to. Nothing like the level of stress

If a doctor ****s up, someone else dies, a bit stressful.
If a soldier ****s up they die, and probably a lot of their pals too.
That’s probably quite stressful.
.
IANADOS

I feel this article might go some ways to answer a couple of the questions…

https://www.theguardian.com/society/2022/nov/27/stress-exhaustion-1000-patients-a-day-english-gp-nhs-collapse

you are focusing on one part of my theory

fund people to train at a decent level
give them a bonus when they sign on if that helps
increase capacity
that will reduce demand and stress
that reduces the need to pay high salaries
lower stress and lower salaries mean gps stay employed longer
capacity is increased

currently it’s in a death spiral of massive financial burden to entry, way too few gps for demand creating too much stress, gps paid so much they can choose to reduce workloads or retire earlier. the whole system needs a revamp.

and TJ you have some lucky friends, accountants I know are on around 60k pa FT. Directors I know are in and around 100k plus bonus their jobs are 24×7 and it would simply not be allowed to be part time. the stress may not be life or death but there is truck loads of stress. it’s just different stress. none of the jobs you mentioned are as job secure as a GP. that is worth a huge amount, only those in roles where they don’t need to worry about it don’t realise how much a benefit that is

and when you think about military. think about what is going on jn ukraine. that’s what they are trained for and will be expected to do when ordered to. imagine that stress. not the same. but still truckloads of stress.

I would suggest with the military when on active service ( and I can only imagine) the stress must be horrendous and far worse than any medical stress. However its not the week in week out stress that is so draining and they have seniors to refer to.

directors? Nothing like it. the stress comes from a totally different source and is not comparable

Edit – I have looked after veteran from WW2 with PTSD ghastly stuff. they were under that stress for years

Our GP is pretty good, the one 2 miles up the valley (so very similar demographic of patients) is poor. Like much of the NHS it’s down to management and staff attitude.

Our local hospitals though are bordering on negligent. Our son has a condition which needs a minor OP. GP identified the problem and sent him straight to A & E who considering the pressure they are under were pretty good. Worst fears didn’t materialise but they wanted him back the next day for further scans. Things went downhill after that, we got an initial diagnosis which given some other issues he’s had from birth needs sorting sooner rather than later. No communication for a fortnight, got hold of the consultants secretary, notes hadn’t been sent over, then there were further admin issues. Another 2 weeks and we were going nowhere, went back to GP who again were great, made a referral themselves this time. Week later letter turned up, great we thought, need to book an online appointment. Started the process, first appointment 107 days, not good but at least we were in the system. Went to the next page no appointments available at all, tried this multiple times over many days. Eventually rang the support number to be told all they could do was book an appointment online using the same website patients use. They tried, had the same issue and told us the hospital was managing their appointments outside of the system. So the the local staff have arbitarily decided to block services to patients. The helpline person messaged the hospital and told us we’d have to wait for the hospital to ring us. Six weeks later and nothing, dead end. Now booked a private appointment. The NHS isnt just under resourced it’s negligent. Under resourced is having to wait for 6 months on a waiting list, not being able to even get on a waiting list is disgusting and effectively disenfranchised people.

Maybe all part of the Torys grand plan but unless the NHS gets it’s act together it will be the last resort for care and anyone that can will get treatment privately, in many respects it’s already there.

Stress is stress TJ doesn’t matter it’s source it’s how it impacts the individual

It’s reading like you are saying GP stress is a special type of more important stress. It’s not. It is still stress. This is the same convo I’ve had with other medical professions. You do a fantastic job, but all have a blinkered view to the rest of the world of work.

I have genuinely and recently looked into medicine again, through wanting to do something more fulfilling Sadly there is no way I can pay for my mortgage and kids whilst training. So for people like me the door is shut. It’s shut for very very many capable and willing people.

Might need to think a bit more on your over simplification of the military and their command structure too. It doesn’t work how you think. Plus, even if it did, do you honestly think having someone more senior erases stresses of a situation? In someways it can make it more stressful to have to defer to others.

My practice is currently running on half the number of GP’s it had a few years ago, they just can’t get replacements in at all. They’re trying to get as many people in as they can but it’s a losing battle for them.

ours is completely the same. you have more chance of winning the lottery than getting an appointment.

I’ve been trying to get an appointment at mine for nearly 5 months to have an asthma review that they invited me for. Every time I get through (I phone after 9am) I get told that all the slots are taken for the next 2 weeks and to call back the next day after 9, same thing the next day etc. I ran out of inhalers last month and as my prescription is out of date I bought some of the weak ones in the local chemist, they are so weak that it takes half of the bloody thing to have any effect!

DT78 with respect its you have no conception of the levels of it. ( same as I don’t really with the military) But I can assure you that “the buck stops here” is a large part of the crushing weight of it.

I worked in a well resourced area. ~The stress nearly broke me and I was able to refer and defer the worst of the decisions

I’m sure you know, but take a look at work related suicide, the aggravating factors, and those professions most likely to die from suicide. As a spoiler. GP does not top the rankings.

Not that it’s a competition or anything, I’m just trying to point out you aren’t able to see other points of view

Anyway as you were

TJ stress is particular to an individual and trying suggest some people have it worse than others is not helpful. It’s how it affects the individual that’s key. Stress got so bad for me in a senior role where it was highly unlikely anyone would get hurt yet alone die that I collapsed and blacked out, ended up being carted off in an abulance to A & E. Then got sacked for the temerity to be unable to cope with the stress (which had really only started with the appointment of an appalling director).

A lot of stress is created by the inability to control your job, not the severity of outcomes if things go wrong.

I have a morbid fascination with these sort of threads. I appreciate and don’t dispute people’s lived experiences about poor GP access, it is a failing and wildly variable service. But when actual GP’s join in to provide their experiences and evidence to go someway to explain the issues it’s largely ignored. Then there are always one or two vocal posters who just bang on about how much GP’s get paid, like all GP’s are somehow mega rich partners.

My wife is a salaried GP, I’m a mid level Civil Engineer, want to guess who earns far more on an (actual hours worked) per hour basis?

Not that salary is a particularly relevant argument anyway, I know no doctor who does it for the money. Why would they? These are incredibly intelligent people who could earn far more in other industries if that’s what drove them.