The pension tax matter is misunderstood and sensationalized by the press. Whilst the charges can appear large, there is the ability to be paid via the scheme in exchange for a relatively small reduction in benefits. Cutting hours to avoid the charge is nonsensical in financial terms.

These are incredibly intelligent people who could earn far more in other industries if that’s what drove them.

My onlyfans carreer is on the verge of making it BIIIIG…then I’m gonna be rollin’ in the big bucks…

DrP

The pension tax matter is misunderstood and sensationalized by the press. Whilst the charges can appear large, there is the ability to be paid via the scheme in exchange for a relatively small reduction in benefits. Cutting hours to avoid the charge is nonsensical in financial terms.

and yet..

A survey of doctors by the Royal College of Physicians (RCP), the Royal College of Physicians of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow has revealed that almost half (45%) have decided to retire at a younger age than previously planned, with 86% of them citing pension concerns as one of their reasons for this decision

zippykona

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

My Dad had a heart attack a few weeks ago. The people with him was told an ambulance would take 2-3 hours to get to him.

They phoned me, and I got him to the the hospital in under 15 minutes in the car. He crashed pretty much as soon as we got in the door. Thankfully, amazing people and magic happened in A&E, and then in surgery and he’s now making a good recovery.

But when I got to A&E I found two things – one was where every ambulance in the West Midlands was. Sat outside the hospital because they couldn’t off-load into A&E. Two – there was a queue of 40-50 people out the door of A&E. This got ignored by me, and by the brilliant staff in A&E, otherwise Dad would be dead. If you can stand in a queue for A&E for several hours, you don’t need A&E.

I really don’t know what the answer to this is. I’m not wholly convinced more money is the answer, although it certainly is part of it. Either way, something needs to be done to get these people out of A&E and back in GPs where they should be being treated.

But when I got to A&E I found two things – one was where every ambulance in the West Midlands was. Sat outside the hospital because they couldn’t off-load into A&E

Because there are no beds to put people in to get them out of A&E, because there are few care home beds and huge shortages in care at home because tory policy makes sure that care work is so underpaid that they can’t get staff and anyway all the EU staff that used to do this for a pittance have gone home because brexit

My local surgery was as bad as the OPs before i left the UK, so that’s more than a decade and a half ago.

The senior partner was still taking appointments (i had a few with him) while he was dealing with his own cancer and the fall out from his sons suicide because he didn’t want to let patients down. He was actually treating me after my own unsuccessful attempt to do the same thing. So certainly going above and beyond.

The practice closed down when he retired, having had three or four GPs and supporting staff when i was there and still being snowed under.

It’s been reopened under new management but with much lower staffing and a larger catchment. Must be far worse.

I know the pension issue struggles to get sympathy. This is well worth a read

How is this different from other well paid people, who will reduce their pension contributions appropriately? (someone once told me that it is, but I’ve forgotten the details.

It is different for a number of reasons, the main one being they can’t reduce their contributions. All they can do is exit the scheme for a fixed time (and lose death in service benefits) or reduce income by working less. There is not an option to pay lower contributions.

This is then compounded by not having any live data or forecasts. They are only told about breaches after the event.

In our local area the Health Board are desperate for GP’s to cover the out of hours service, they really need local GP’s to put in extra (paid) shifts at weekend. My wife would happily do this, she quite likes out of hours work. But the likely tax bill for overpaying her pension will be far higher than any income for the work. So, like all of her colleagues, she has to say no. Same story from a friend of mine who is an anaesthetist. They want to run extra weekend planned surgery but they cannot pull together a surgical team as they would all risk having pay money to go to work. They want to do it, but are not prepared to pay out of their own pocket to do so.

A mates mum recently needed hospital. They would have taken her by car, but she was confused and refused to go. 13 hours later one turned up. She’s potentially had a stroke ! Really should have just taken her by car as 13 hours is a long time without treatment for a stroke.

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 know where you are trying to come from with this, but it is not the same. I work in hospital management in a stressful job. My wife is a surgeon (different hospital) and has a stressful job. My stresses to hers are on a different level. Her stress is about making the right diagnosis, doing the right thing that doesnt harm / kill a person, mine is just management b@llocks. The same with GP’s massive through put, limited time to see patients, less access to diagnostics, more complex patients. All results in very high stress levels again about will a patient come to harm from their intervention.

You could argue that other that other professions have that sole responsibility for life/death of a person, maybe a pilot, but the fact is they have a back up pilot and computer to support them. Although doctors do have multi disciplinary teams and colleagues to bounce concerns off, unfortunately it is much more of a sole practitioner approach and the buck does stop with the individual clinician.

This is then compounded by not having any live data or forecasts. They are only told about breaches after the event.

Its awful. Mrs FD is being asked to do additional work to clear back logs. She has just been hit by a tax bill that is taking roughly £400 per month net from her take home pay. Makes it pointless doing any extra hours. In fact she is seriously considering reducing her contracted hours down to avoid this situation in future. We know the bill for the next financial year will be higher, but thats just a guess and we cannot even plan for what it will be.

Back to OP – did you get an appointment? Unfortunately, now triage does have to happen, and you have to be ‘ill’ to be seen by a doc. Buy Pulse Oximeter. If your sons oxygen saturation rate is lowered, they will take notice.

The whole system is broken, and its around staffing (NHS and Social Care) and bed capacity in social care. A series of governments have reduced training posts (not just conservative), wages are low in NHS and Social care, and there are not enough Social Care beds.

Acute Care hospitals ‘appear’ to be the pressure points as that is the easily accessible part of the process. They are the one place where historically the doors have never been closed to inappropriate use

We have given up with our GP. Luckily we dont get ill. Sport injuries yes. Luckily we have private medical which we have now topped up and have a GP part included. Other than that we have a drop-in-centre locally.

I noticed the other day that the local FB page mentioned the Police were called after a full on situation with a miffed customer. The rottweilers on reception pushed some dude to the system that you can log into to say you are in, but it didnt work and he missed his appointment. He was told to go away and re-book and try again another day. Not right but I do feel for the customer.

This place has been terrible ever since we have lived here.

I do wonder if we have it wrong. A mate who lives in France said they pay for small issues and help, and then if you have something big its free. I am not 100% this is correct. Sounds a good idea to me, last time I was in A&E with my son with head injury, that the on-line help told us to go it, it was full of people with colds etc

Luckily we have private medical which we have now topped up and have a GP part included.

I think you will find though that there are issues in private land too.

Your ‘GP’ in private land might not actually be qualified and almost certainly not know your local health economy

Also capacity is increasingly limited in private secondary care, their weighting times are going up too

Sounds a good idea to me, last time I was in A&E with my son with head injury, that the on-line help told us to go it, it was full of people with colds etc

The problem with this sort of observation is that you don’t actually know why those other people are there, and they are looking at you and your son and wondering why you are there with no obvious problem.

When I have the misfortune to attend A&E though, I have wondered why it’s a full family trip for some people – children, both parents and grandparents.

The Tories have finally broken the NHS; it’s clearly beyond repair.
I think we are now entering a transitional phase where many more NHS employees will leave, services will have to be withdrawn, and many people will not be able to access adequate healthcare or, at least, not to a standard we may hope for or have become accustomed to.
Probably several years before an alternative system becomes established. It’s not like there are that many private alternatives at present, even if you can afford them.

Observer, patient and NHS occupational therapist fwiw.

Your ‘GP’ in private land might not actually be qualified and almost certainly not know your local health economy

What do you mean by ‘local health economy’? If I used an online GP it would be for the same questions that I might use AskMyGP at my surgery – the things where I don’t want to bother a GP fully, but are a bit more than I want to talk to the pharmacist and not enough for A&E. (eg a dislocated finger which I put back into place when it happened but had gradually stopped working. Sorted via AskMyGP, who sent me for an X-Ray at Minor Injuries, who arranged a quick visit to a physio.)

Its not beyond repair.

1) fund social care properly including decent pay for staff.  Frees up all those blocked beds.  This could be done quite quickly and increases beds available by 20% ish IIRC.  this then puts ambulances back on the street thus ending the shortage of ambulances

2) General practice is a little trickier  Personally I would bring all GPs into direct emplyed however that would be both slow and meet a lot of resistance.  Other than that I am not sure.

3) Remove all privatistion as at matter of urgency.  Save huge sums

4) end the stupidity of the splintered set up in England – remove massive amounts of bureaucracy and save around 10% of the acute care budget

5) go back to the bursary for nurses or even better pay them to train

6) in the short term make it easier for EU nurses to come to the UK.  ~~There is a huge oversupply of trained nurses in Spain

However the main issue is the tories want the NHS to fail so they can divert money to the folk that they have been bribed to look after and for ideological reasons

Remember tory MPs are bribed by private healthcare providers to divert money to the private sector

Sorted via AskMyGP, who sent me for an X-Ray at Minor Injuries, who arranged a quick visit to a physio.)

Or you could have just gone straight to minor injuries yourself.  That is precisely the sort of issue they are there for

Sorted via AskMyGP, who sent me for an X-Ray at Minor Injuries, who arranged a quick visit to a physio.)

Or you could have just gone straight to minor injuries yourself. That is precisely the sort of issue they are there for

Fair comment. I’m now questioning why I thought the GP was the first choice. Maybe because the injury had happened several months before and I knew that it was unlikely to be broken.

Remember tory MPs are bribed by private healthcare providers to divert money to the private sector

I can’t do the fancy crops through thing on my phone. It should have read.

Remember ALL MP’s are bribed by private healthcare providers

And Scotland are looking at going for a 2 Tier healthcare system

the main one being they can’t reduce their contributions. All they can do is exit the scheme for a fixed time (and lose death in service benefits) or reduce income by working less. There is not an option to pay lower contributions.

Given the problems this is causing it should be a relatively easy change to pay lower contributions. In my scheme you just went into an online portal to change your contribution %.

Remember ALL MP’s are bribed by private healthcare providers

Perhaps but IIRC nothing like the same extent in other parties

And Scotland are looking at going for a 2 Tier healthcare system

source?  I did read some criticisms around an idea floated but beyond that I do not know.

Edit – genuinely interested in your source for that because it would be a huge vote loser IMO

I do wonder if we have it wrong. A mate who lives in France said they pay for small issues and help, and then if you have something big its free. I am not 100% this is correct. Sounds a good idea to me

It’s pretty much what we have in sweden.
Until you’re 20 everything is free. Dental, GP, MRI, surgery everything.

From 20 it costs, but, it’s usually an admin fee sized payment, varies from about 8 quid to 20 quid depending on complexity and time, there are regional variations. So to see the practice nurse for my basic asthma appointment was 15 quid (half an hour including testing). Back issue was 10 minutes with a doctor (8 quid), then 30 mins with neurologist (15), Physio (10) then MRI (15, yes, 15 quid for an MRI, and only a 3 week wait) and so on. It’s mainly to make sure that you turn up, because if you book and then don’t turn up, you still have to pay, they’ll send the debt to the baliffs.
The sleep issue i’ve mentioned in my thread, cost me 10 quid to get the initial consultation and referral from the GP, then 20 quid for the sleep study and it’ll cost another 20 quid for the set up of the CPAP, the machine itself is free and i can keep it for ever, once i’m in the system with the CPAP, all the follow ups and replacement facemasks etc will either be free or be on the the lowest rate.

Prescriptions are charged in the same way, free under 20 and certain medications are cheaper because you’ll die if you don’t have them (insulin for example). Also, you have a cap of 200 quids worth of medical a year, after that, it’s free. And the more you spend on medicine the cheaper it gets as well…
So my FiLs replacement knee surgery cost him his 20 quid, and that included all the outpatient and physio follow ups too. His medication that keeps him alive costs 12 quid for 3 months supply. My inhalers on the other hand are about 14 quid each, because it’s in a different category.

Dentistry is charged at a subsidised rate. Similar to what the UK dentists were ~20 years ago. You also get 60 quids worth of dentistry per year for free (which is a general check and about half a clean.)

It all sounds complicated, but because everyone is on the same system, and the same page, it works.

I think the Two Tier thing in Scotland was put forward as an option and very quickly dismissed. I don’t think it was actually given serious consideration, just classic options appraisal type approach where you lay out all options, even the silly ones.

When I have the misfortune to attend A&E though, I have wondered why it’s a full family trip for some people – children, both parents and grandparents

I can answer that. I had to take my partner to A&E some years ago with a suspected leg DVT. The toddler daughter was left in the care of my mum and dad so they went out for lunch. Whereupon my dad got a massive fishbone lodged in his throat which required a trip to A&E… 🤦‍♂️

And Scotland are looking at going for a 2 Tier healthcare system

I suspect that was part of a blue sky thinking discussion in a future planning meeting that got leaked and blown out of proportion for political gain. It got shut down very quickly after being reported.

edit – too slow!

My plan to relive pressure on GPs is pretty straightforwrd

1. fund GPs at the levels of patient care that they’re experiencing, not at the level the GP contract suggests. There was a study that suggested that for every 5 years the population gets older; you need to double the healthcare provision – does that sound like it’s happening to anybody? edit: I don’t necessarily need to pay my existing GPs more, but I do need to recruit more GPs, I can’t currently afford to do that, and I’m suppossed to offer an 8am-8pm service, with the GPs I have, that means that they sometimes working extended hours or I don’t have say: An on-call GP in the morning, but I do have one in the afternoon or evening. It put everyone on just another bit of stree that they have to deal with. One of my GPs has stayed on an extra couple of hours to sign off the over 200 prescriptions that need looking at just today

2. Reduce the mindless bureaucracy and “quality measuring re-assurance” bullshit that plagues our working days. I’ve spent the last 3 days filling in a 10 page 40 question document for my CCG/ICB (whatever they’re calling themselves today) for safeguarding that required me to download policies and included training records for all my staff, not just the clinicians . I have to do this every year. Part of my funding provision requires me to do a year long “digital enhancement project” to make sure that my website attracts traffic from vulnerable patients. This has so far required two multi stage project updates; with another to come, four zoom meetings and counting and three project collaboration meetings (and counting)

3. Stop funding by micro management (IE QOF and IIF), let GPs decide locally what’s best for their patients – ie treat doctors like the professionals they actually are.

4. Once Parliament has done all that ; leave us the **** alone to get on with the job.

Nickc – given the variability in provision and standards in GPs how do you manage that?  Good GPs clearly don’t need  this stuff but clearly some are much less effective than others?

I totally get what you mean about meaningless paperwork tho – I used to get it as well.  One of the questions I would ask is ” How will this improve care” and if it didn’t then I refused to do it.  When pressed I would then ask” which of the tasks I am doing would you like me to drop to do this?”  IIRC tho al lot of this ties into your funding so that option is not there for you unless it was co-ordinated nationally as industrial action

I think the CQC has been an overall “good” @tjagain, and that effort has largely weeded out the chaff (not to mix my metaphors) , it’s really hard nowadays to be a badly run or unsafe GP

Yeah I think the NHS is overall really bad for admin crap. I try to keep lots of it at arms length or pushback, but when they have you over a barrel for money…You just end up caving in a complying like a good automaton…

A growing population in many areas is almost certainly adding to the problem. New housing being thrown up with no provision given to how all those extra people are going to get access to healthcare, etc – those ‘300,000 new houses every year’ that the developers, sorry the government insists are necessary are magically going to have extra doctors, nurses and other health workers and professionals appear to share the load? Within less than a mile of where I live, another 2500 or so homes are being built between the A4/A350, the local hospital and doctors surgery nearest to them are where I go, and the surgery in particular are excellent, they’re very proactive, I get text updates about any necessary services like flu jabs that I’m eligible for, and the last time I needed to see a doctor, last October, when I had an issue with my arm that kept me awake for 48 hours, I got an appointment within five days.
A follow up after a month when the course of treatment I was given proved ineffective long-term I got a phone consultation with a different doctor which, with some further input from me diagnosed a carpal tunnel issue, and a suggestion I should get a wrist brace to sleep with, and that has worked really well, but I just cannot see how the existing surgeries in town, and our small hospital will be able to cope with this continuing expansion of the town’s population, because there’s no added infrastructure being built within these estates to provide healthcare local to them – a huge expansion along the town’s western bypass, which promised local services failed to provide them, because the developers ‘had no money available to build them’. 🤬

According to the 2021 census, the population of Chippenham was 36,548, in 1991 it was 25,376; when I was a kid, early 60’s it was around 15,000! At the current rate of growth, it’s going to be above 40,000 within five years

By comparison, Salisbury has a population of 41,820; what’s the likelihood of the small market town that I call home ever getting the range of services that the city of Salisbury, has, with a population almost the same size, and probably greater than, within a very short time.

In a similar theam.
Son yesterday fainted just as I was going to work, in the past he’s had two lots of open heat surgery.
He stopped with his mum and she has taken regular blood pressure readings, there at the low end of normal.

We can’t get any response from anyone Its not bad enough for A&E but are not convinced sending back to school before he’s at least seen a doctor

@bigdean thread diversion- I’d maybe ring hospital had surgery see if have a specialist nurse associated with consultant or ring surgeon secretary. No point pissing about if can’t get into GP, they may speak/ see direct, always worth a punt.

Thought I’d come back to this after a busy “duty day” <span style=”font-size: 0.8rem;”>yesterday. Data is collected on gp appointments for public access- the daily heil has already used this for click bait to bash us with.
Yesterday was pretty full on. However the appointment book only shows 19 patients for me. Nhs England says up to 25 a day is safe.
I got my PM to run a search on patient records I had accessed yesterday and she sent me a big spreadsheet this morning.
I’ve had a “day off” today and I have dug into it a bit.
It shows that I accessed the records of 304 different patients yesterday. About 175 of those were just to click ok to issue their repeat prescription. About 45 minutes work. As I said there were 19 appointments in the book. 7 were face to face and 5 of those had a phone call first the rest were phone calls. Call that 2 3/4 hours work for ease of maths.
That leaves 7 hours and 110ish patients’ looked at records for some reason or another- basically to make a decision about.
I think that is a decision about every 4 minutes non stop.
We talk about decision fatigue in GPs. It’s real. I hope the decisions I was making at 6pm were as good as the ones I was making at 8am.
I must be mad to do this and I can see why very few newly minted doctors want to follow in my footsteps (remember those ones who went on strike in 2016 for a better contract- they don’t want to do this work).
We need a new contract that actually addresses the workload involved.
To use DrP’s analogy from earlier in the thread, we have a contract to run a MacDonalds franchise that says we have to give everybody as many Big Macs as they want, which was costed when everyone was happy with 4 a year. Now everyone wants 8 and a whopper with cheese which have no way of delivering as well.

Edit. I bet I can predict the response to the suggestion above about contacting secondary care direct… contact your gp 🤷🏼‍♂️

double post thingy

Well you can’t be that busy if you’ve got time to type out all that twice…

Edit – that refresh thing is annoying, really spoiled my hilarious joke.

repeat scripts.  I am on a lifetime script for statins.  Its an utter pain to get a repeat.  its not automatic, I can’t request over the phone, I can ask my pharmacy to get it for me tho and I can only get a month at a time.

thats a huge waste of peoples time

Ask for repeat dispensing TJ. You can have 6 or 12 months at a time issued and left at the pharmacy of your choice. You’ll still have to collect monthly though cos the treasury needs your money. Oh no I forgot you have free scripts north of the border now.
I’m leaving this thread alone now.

Ah,I can do my repeat prescriptions online and upto 5 repeats, before they need to go to the GP though the meds I am on I get 2 months worth at time.

I’m supposed to have 3 months some of chemo tablets arrive by courier tomorrow and a text should’ve been sent to me today with a 2 hour time slot so I know to keep an ear out for the door.

No text and I think I’ll be bloody lucky if they turn up tomorrow.

The prescription is handled by a company called Alcura and delivered by DPD I think.😐

This is the third script for the drugs and it’s been a complete ball ache to get them each time so far.

I have not heard a single good word from people all over the world regarding GP appointment in the UK, from EU to far east. My German friends were particularly surprised how difficult it is to get an appointment to see GP and then being referred etc. Happened to him so he experienced it.

I have endured a chronic sinus problem since last year without being able to breathe properly through my nostrils as they were 90% blocked all the time. However, the past two months were particularly bad to the point that they were 100% block even when I was sitting down. I normally sleep sitting for the past two years because my nostrils would be blocked if I lay flat.

Took me several attempts to get get an appointment to see the GP. The GP took a look and said it was bad and gave me some nose drops. Applied it for 3 days. Bad move. The problem escalated to the point not only the medication caused 100% blockage but also created intense pressure on my ear resulted in muffled hearing. It was so unbearable I tried to go back to get an appointment immediately but even after 3 attempts were not successful.

Finally, at 3.30am in the morning two weeks ago I could not longer bear it as my throat was very dry to due breathing through my mouth only, I rang 111. The person over the phone tried to get me an appointment to no avail and immediately told me to go to the nearest 24/7 walk-in GP. Took taxi there and the emergency GP said the drop was not suitable for everyone and the side effect might be worst for some people. Gave me strong course of antibiotics. The problem subsided a bit and I could breathe a little better now (40%) but my taste buds are completely gone until now and although my hearing is less muffled, it has started ringing loudly at times.

Although I have been referred to ENT since 19 Oct, I have to wait until 14 December. In the meantime I just have to wait. While waiting I have called friends all over the world to see if they had alternative medication that perhaps could cure the situation such as traditional herbal remedies. Well, so far another friend is also facing the same problem and has suggested trying something that perhaps might reduce the swelling inside the nose. Not going to say what it is until I have tried it as the ingredient is a fruit you can buy from supermarket. The application however require some preparation. i.e. drying the skin of the fruit etc. If it is successful I will reveal the “remedy”. Try it at your own risks.

I have to take the risk because relying on GP in the UK is a very long process unless you are dying. At one point my sinus was so bad last month, I would rather be dead then to suffer the feeling of constant “waterboarding” 24hr a day.

The common knowledge amongst friends from all over the world who are in UK is try to avoid getting into serious health condition. The GP gatekeeper appointment is a hit or a miss. If you are lucky you get to your problem sorted quickly, otherwise you have to be half dead to be seen.

oh ya … without being able to breathe properly sometimes it also felt like pressure is being put on the heart. i.e. like holding your breath until you use your mouth to breathe.

Not read all of this but involved in healthcare so took an interest in thread and OPs post.

Definately NHS pretty broken and that is a political issue re tax levels, aging population, brexit/staff levels and a long term sensible strategy that doesn’t move the goalposts and bury GPs in local management bureaucracy. Also get the most out of the healthcare professionals that are available as a resource.

Re OP it sort of depends on the chest infection. If the child was in severe discomfort or had breathing difficulties then a GP appointment and possibly A-biotics might be the way forward. But if more of a lumpy chesty cough then advice or seeing a more available HCP is more sensible. This route is not commonly taken as patient education or relevant easy pathways (111 that is so risk averse it ends with recommendation for GP / hospital (disaster in terms of cost and use of resources for anything like the OPs issue).

One potential area is to use local pharmacists more – NHS commissioned services for (relatively) minor but important stuff but where a F2F or video appointment is wanted by the patient. Pharmacists have a decent level of clinical training and are now coming out of degrees qualified to prescribe. Automate the mundane repeat medicines dispensing to free up their time. Pharmacy First service is funded in Scotland and v successful for taking appointments away from GPs, but not in England…..