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Post by bracknellboy on Oct 29, 2023 8:28:42 GMT
This is yet another disaster in the making. GPs are not perfect but overall they provided a service of which by and large the public approved. Now they are effectively being removed from front line duties to back office to be replaced with others who are not anywhere near as well trained or experienced. Yes, and no. In my view we should stop trying to look at the current NHS through the lens of what we were accustomed to or the shape we "expect" the NHS to be. We should be looking abroad at successful health systems which provide a much better service than our at times sclerotic, dysfunctional semi crippled NHS. GP services are just one of those. GPs are 'gatekeepers' to pretty much the entire rest of the NHS and health services in general. Do they really need to be ? How much of their time is spent doing an inspection of the person in front of them and then shuffling them off to a speciality which the person in question could have referred themselves ? Or that first inspection could have been done by a lower qualified and much cheaper person ? In other countries, it is not abnormal to go straight to the specialisation (as I understand) or to perhaps have a short telephone or video consult before being shunted on. By their very nature, GPs are not specialists in many areas that are still the function of primary health care to deal with. So why should we be consuming their very expensive time dealing with those things ? Many surgeries are of course already starting to deal with things that way as much as the constraints they have allow them to. None of which is to say that there aren't GP headcount/resource issues. There are. And you can probably point to a multitude of factors. Including Brown's generous pay settlements coupled with generous pension arrangements, coupled with built in disincentives to continue working when your generous pension hits limits relatively early, coupled with a consummate failure to credibly forward manpower plan for the NHS in general. The latter can only be laid at the feet of the current incumbents of power, since they have been there for 13 years. Whatever previous failings there may have been.
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michaelc
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Post by michaelc on Oct 29, 2023 15:18:12 GMT
The governments plan is to replace doctors with non doctors who have far less training, knowledge and experience. They are cheaper though. I do wish governments would have a mature discussion with the population about what the NHS can provide for current levels of funding. Is it just about funding though? And no I'm not going to launch into a daft "efficiencies" argument. I'm talking about foresight. Compared to the entire cost of running the NHS, building a few more med schools a few years ago is relatively small beer and would have meant there'd be no shortage of doctors. Nor would we be "stealing" them from other countries.
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hazellend
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Post by hazellend on Oct 29, 2023 19:43:35 GMT
This is yet another disaster in the making. GPs are not perfect but overall they provided a service of which by and large the public approved. Now they are effectively being removed from front line duties to back office to be replaced with others who are not anywhere near as well trained or experienced. Yes, and no. In my view we should stop trying to look at the current NHS through the lens of what we were accustomed to or the shape we "expect" the NHS to be. We should be looking abroad at successful health systems which provide a much better service than our at times sclerotic, dysfunctional semi crippled NHS. GP services are just one of those. GPs are 'gatekeepers' to pretty much the entire rest of the NHS and health services in general. Do they really need to be ? How much of their time is spent doing an inspection of the person in front of them and then shuffling them off to a speciality which the person in question could have referred themselves ? Or that first inspection could have been done by a lower qualified and much cheaper person ? In other countries, it is not abnormal to go straight to the specialisation (as I understand) or to perhaps have a short telephone or video consult before being shunted on. By their very nature, GPs are not specialists in many areas that are still the function of primary health care to deal with. So why should we be consuming their very expensive time dealing with those things ? Many surgeries are of course already starting to deal with things that way as much as the constraints they have allow them to. None of which is to say that there aren't GP headcount/resource issues. There are. And you can probably point to a multitude of factors. Including Brown's generous pay settlements coupled with generous pension arrangements, coupled with built in disincentives to continue working when your generous pension hits limits relatively early, coupled with a consummate failure to credibly forward manpower plan for the NHS in general. The latter can only be laid at the feet of the current incumbents of power, since they have been there for 13 years. Whatever previous failings there may have been. Without sensible gatekeepers secondary care waiting lists would sky rocket. GPs are excellent value for money in this country, but primary care will probably end up being privatised.
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hazellend
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Post by hazellend on Oct 29, 2023 19:49:13 GMT
The governments plan is to replace doctors with non doctors who have far less training, knowledge and experience. They are cheaper though. I do wish governments would have a mature discussion with the population about what the NHS can provide for current levels of funding. Is it just about funding though? And no I'm not going to launch into a daft "efficiencies" argument. I'm talking about foresight. Compared to the entire cost of running the NHS, building a few more med schools a few years ago is relatively small beer and would have meant there'd be no shortage of doctors. Nor would we be "stealing" them from other countries. The whole thing is ridiculously planned. Some current examples: - massive shortage of consultant anaesthetists with a bottleneck of trainees due up no training posts - massive shortage of GPs, but very little locum work available as practices get funding for non doctors to do GP lite work, but not for locums. I’ve never felt so negative about the NHS since starting my career in 2001. It really isn’t that difficult to sort, either keeping it free with more centrally funded tax money, or copying one of many other global NHS systems that are better.
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Post by bracknellboy on Oct 29, 2023 21:10:04 GMT
Is it just about funding though? And no I'm not going to launch into a daft "efficiencies" argument. I'm talking about foresight. Compared to the entire cost of running the NHS, building a few more med schools a few years ago is relatively small beer and would have meant there'd be no shortage of doctors. Nor would we be "stealing" them from other countries. Some current examples: - massive shortage of consultant anaesthetists with a bottleneck of trainees due up no training posts - massive shortage of GPs, but very little locum work available as practices get funding for non doctors to do GP lite work, but not for locums. I’ve never felt so negative about the NHS since starting my career in 2001. It really isn’t that difficult to sort, either keeping it free with more centrally funded tax money, or copying one of many other global NHS systems that are better. I may misunderstand your meaning, but my sense it that it is ridiculously unplanned. You might have meant the same. Or you might have meant that it is deliberately ridiculously planned.
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Post by bracknellboy on Oct 29, 2023 21:38:57 GMT
Yes, and no. In my view we should stop trying to look at the current NHS through the lens of what we were accustomed to or the shape we "expect" the NHS to be. We should be looking abroad at successful health systems which provide a much better service than our at times sclerotic, dysfunctional semi crippled NHS. GP services are just one of those. GPs are 'gatekeepers' to pretty much the entire rest of the NHS and health services in general. Do they really need to be ? How much of their time is spent doing an inspection of the person in front of them and then shuffling them off to a speciality which the person in question could have referred themselves ? Or that first inspection could have been done by a lower qualified and much cheaper person ? In other countries, it is not abnormal to go straight to the specialisation (as I understand) or to perhaps have a short telephone or video consult before being shunted on. By their very nature, GPs are not specialists in many areas that are still the function of primary health care to deal with. So why should we be consuming their very expensive time dealing with those things ? Many surgeries are of course already starting to deal with things that way as much as the constraints they have allow them to. None of which is to say that there aren't GP headcount/resource issues. There are. And you can probably point to a multitude of factors. Including Brown's generous pay settlements coupled with generous pension arrangements, coupled with built in disincentives to continue working when your generous pension hits limits relatively early, coupled with a consummate failure to credibly forward manpower plan for the NHS in general. The latter can only be laid at the feet of the current incumbents of power, since they have been there for 13 years. Whatever previous failings there may have been. Without sensible gatekeepers secondary care waiting lists would sky rocket. GPs are excellent value for money in this country, but primary care will probably end up being privatised. GP's are almost without exception extremely hard working, caring, and excellent health practitioners. But whether they - meaning not the individuals but the activities they actually do within the system they operate - are excellent value for money is a more complex statement, and at the very least demands the question: based on what measurements and set of system level objectives ? If they spend even only 15% or 20% of their time doing things that could be effectively and safely done by a lower cost practitioner, then self evidently they are not as "good value for money" as they could be. Far better to have them dedicating their time to where it is best utilised. We have a significant problem in this country in that we put the NHS and its workings on a pedestal. And any criticism is then figuratively lynched with a 'i want to privatise the NHS' placard hung round its neck. With the only solution to any problems then being 'feed the machine with more money'. Not 'are we doing the right things'. For probably at least 20 years, the result is that proper assessment of whether a 75 year old institution is fit for purpose and actually delivers value for money gets smashed on the head in righteous indignation. The reality is that at least in the last one to two decades, many other health systems provide better 'customer experience' and better health outcomes, while still providing an essentially 'universal health care system'. We should be recognising that and seeing what we can learn from elsewhere.
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michaelc
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Post by michaelc on Oct 29, 2023 22:02:52 GMT
Without sensible gatekeepers secondary care waiting lists would sky rocket. GPs are excellent value for money in this country, but primary care will probably end up being privatised. GP's are almost without exception extremely hard working, caring, and excellent health practitioners. But whether they - meaning not the individuals but the activities they actually do within the system they operate - are excellent value for money is a more complex statement, and at the very least demands the question: based on what measurements and set of system level objectives ? If they spend even only 15% or 20% of their time doing things that could be effectively and safely done by a lower cost practitioner, then self evidently they are not as "good value for money" as they could be. Far better to have them dedicating their time to where it is best utilised. We have a significant problem in this country in that we put the NHS and its workings on a pedestal. And any criticism is then figuratively lynched with a 'i want to privatise the NHS' placard hung round its neck. With the only solution to any problems then being 'feed the machine with more money'. Not 'are we doing the right things'. For probably at least 20 years, the result is that proper assessment of whether a 75 year old institution is fit for purpose and actually delivers value for money gets smashed on the head in righteous indignation. The reality is that at least in the last one to two decades, many other health systems provide better 'customer experience' and better health outcomes, while still providing an essentially 'universal health care system'. We should be recognising that and seeing what we can learn from elsewhere. I would agree with that. I would add (and no doubt you and Hazellend will disagree), that GPs are overpaid due to there not being enough of them and because various Tory governments have allowed many of them to work as quasi independent businesses. £163,900 average for your typical GP partner but can be a lot more than that. www.nuffieldtrust.org.uk/resource/exploring-the-earnings-of-nhs-doctors-in-englandI do agree with Hazellend however, that we should move towards one of the many better systems that are in operation across Europe and beyond (I don't include the US in that list due to so many people being excluded from decent healthcare).
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Post by bracknellboy on Oct 30, 2023 8:42:56 GMT
Is it just about funding though? And no I'm not going to launch into a daft "efficiencies" argument. I'm talking about foresight. Compared to the entire cost of running the NHS, building a few more med schools a few years ago is relatively small beer and would have meant there'd be no shortage of doctors. Nor would we be "stealing" them from other countries. The whole thing is ridiculously planned. Some current examples: - massive shortage of consultant anaesthetists with a bottleneck of trainees due up no training posts - massive shortage of GPs, but very little locum work available as practices get funding for non doctors to do GP lite work, but not for locums. I’ve never felt so negative about the NHS since starting my career in 2001. It really isn’t that difficult to sort, either keeping it free with more centrally funded tax money, or copying one of many other global NHS systems that are better.My original response had picked up on your first part but my eyes had skipped over the second. I can fully understand why you would feel so -ve about the NHS. I also fully agree - as I think I've probably boringly made clear on many occasions - that we should at the very least be looking outward at other successful health care system around the world, but particularly Europe. I say Europe because I know there are a good few instances of well functioning health systems that are 'social health care provision' in nature. I'm not sure I agree with the 'it really isn't that difficult to sort' statement though. Because I simply do not believe it is as simple as a funding issue. If it were you could increase the amount of GDP spent on healthcare and increase the money given to the NHS and voila its fixed. But it won't be. There is simply far too much that is wrong and broken about the current system both at the macro level and the micro level. Moving to a new health care system will be painful and difficult because of the legacy we have in place. But it needs to be done. I've had the "privilege" over the last couple of years of hearing about my siblings experience of both the BE and NL health care systems. Comparing/contrasting with some experiences here in the UK is eye opening.
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adrianc
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Post by adrianc on Oct 30, 2023 9:44:50 GMT
...and because various Tory governments have allowed many of them to work as quasi independent businesses. GP surgeries, pharmacies, opticians, dentists have ALWAYS been private businesses contracted to the NHS, right from the very start. Ironically, there's probably more NHS-internal GP surgeries now than there have ever been, as many are run directly by trusts.
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Greenwood2
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Post by Greenwood2 on Oct 30, 2023 9:55:03 GMT
GP's are almost without exception extremely hard working, caring, and excellent health practitioners. But whether they - meaning not the individuals but the activities they actually do within the system they operate - are excellent value for money is a more complex statement, and at the very least demands the question: based on what measurements and set of system level objectives ? If they spend even only 15% or 20% of their time doing things that could be effectively and safely done by a lower cost practitioner, then self evidently they are not as "good value for money" as they could be. Far better to have them dedicating their time to where it is best utilised. We have a significant problem in this country in that we put the NHS and its workings on a pedestal. And any criticism is then figuratively lynched with a 'i want to privatise the NHS' placard hung round its neck. With the only solution to any problems then being 'feed the machine with more money'. Not 'are we doing the right things'. For probably at least 20 years, the result is that proper assessment of whether a 75 year old institution is fit for purpose and actually delivers value for money gets smashed on the head in righteous indignation. The reality is that at least in the last one to two decades, many other health systems provide better 'customer experience' and better health outcomes, while still providing an essentially 'universal health care system'. We should be recognising that and seeing what we can learn from elsewhere. I would agree with that. I would add (and no doubt you and Hazellend will disagree), that GPs are overpaid due to there not being enough of them and because various Tory governments have allowed many of them to work as quasi independent businesses. £163,900 average for your typical GP partner but can be a lot more than that. www.nuffieldtrust.org.uk/resource/exploring-the-earnings-of-nhs-doctors-in-englandI do agree with Hazellend however, that we should move towards one of the many better systems that are in operation across Europe and beyond (I don't include the US in that list due to so many people being excluded from decent healthcare). My GP can't get any new partners, two recently retired, and he can only get locums they don't want to have the responsibility of being partners and all the admin that goes with it. I don't know exactly what they do, but the locums can also get tax advantages by setting up a company for themselves. I don't know if our GP practice will survive, the sole remaining partner is not that young, the locums like to work mainly from home doing phone consults and don't want to do unsocial hours, so even finding a GP on the premises is quite unlikely.
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hazellend
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Post by hazellend on Oct 30, 2023 12:48:18 GMT
I would agree with that. I would add (and no doubt you and Hazellend will disagree), that GPs are overpaid due to there not being enough of them and because various Tory governments have allowed many of them to work as quasi independent businesses. £163,900 average for your typical GP partner but can be a lot more than that. www.nuffieldtrust.org.uk/resource/exploring-the-earnings-of-nhs-doctors-in-englandI do agree with Hazellend however, that we should move towards one of the many better systems that are in operation across Europe and beyond (I don't include the US in that list due to so many people being excluded from decent healthcare). My GP can't get any new partners, two recently retired, and he can only get locums they don't want to have the responsibility of being partners and all the admin that goes with it. I don't know exactly what they do, but the locums can also get tax advantages by setting up a company for themselves. I don't know if our GP practice will survive, the sole remaining partner is not that young, the locums like to work mainly from home doing phone consults and don't want to do unsocial hours, so even finding a GP on the premises is quite unlikely. Exactly. GP in its current state is not sustainable. It may look well paid, but there’s a reason nobody wants to do it in the U.K. for these rates. Doctor pay has dropped 30 - 40% in real terms over 10 years., whilst working conditions worsened. If we want to have doctors as part of our medical workforce in this country (trust me, we do) then pay and conditions will have to improve.
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keitha
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Post by keitha on Oct 30, 2023 13:32:42 GMT
Ditto Pharmacists, my OH didn't have an increase for 14 years, and she recently saw that the rate currently being offered to Locums is less than she was getting in 2008.
Had a letter from GP this morning dated 3rd October, postmarked the 25th !
When I asked whilst arranging appointment, apparently the franking machine was out of action for a month. So no-one thought to take them to the post office and put stamps on.
Because they sent so many letters out on the 25th they have opened up extra appointment slots in the future, I have an appointment a week on Friday ! This will of course mean people trying to get appointments will be pushed back.
I mentioned the pre covid self booking system. that would save me an hour on the phone, It's been discontinued and won't be coming back as some patients abused, booking the urgent appointment slots, for minor issues, or for things they don't need to see GP for. I suppose the issue is if I have a minor issue and can't get an appointment after several weeks of trying I will grab an urgent slot.
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michaelc
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Post by michaelc on Oct 30, 2023 13:57:10 GMT
My GP can't get any new partners, two recently retired, and he can only get locums they don't want to have the responsibility of being partners and all the admin that goes with it. I don't know exactly what they do, but the locums can also get tax advantages by setting up a company for themselves. I don't know if our GP practice will survive, the sole remaining partner is not that young, the locums like to work mainly from home doing phone consults and don't want to do unsocial hours, so even finding a GP on the premises is quite unlikely. Exactly. GP in its current state is not sustainable. It may look well paid, but there’s a reason nobody wants to do it in the U.K. for these rates. Doctor pay has dropped 30 - 40% in real terms over 10 years., whilst working conditions worsened. If we want to have doctors as part of our medical workforce in this country (trust me, we do) then pay and conditions will have to improve. Except that they do. 3 times more applicants than places in 2022. Tell the care workers who have to clean elderly behinds for a living that £163,000 is not enough for GPs. www.ft.com/content/3f8c35ed-e7b6-4f96-b965-a2b97bee45cc
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IFISAcava
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Post by IFISAcava on Oct 30, 2023 14:56:44 GMT
Exactly. GP in its current state is not sustainable. It may look well paid, but there’s a reason nobody wants to do it in the U.K. for these rates. Doctor pay has dropped 30 - 40% in real terms over 10 years., whilst working conditions worsened. If we want to have doctors as part of our medical workforce in this country (trust me, we do) then pay and conditions will have to improve. Except that they do. 3 times more applicants than places in 2022. Tell the care workers who have to clean elderly behinds for a living that £163,000 is not enough for GPs. www.ft.com/content/3f8c35ed-e7b6-4f96-b965-a2b97bee45cc1. Medicine at university is less oversubscribed than it used to be relative to other subjects. 2. A far higher proportion of people qualifying in medicine do not stay in UK clinical medicine than ever before. 3. I know many GPs. None earn that figure. Salaried GPs (which is an increasing proportion) are on less than half that. A GP partner is running a business and may or may not get that figure a) if they work full time (50-60 hours/week), which many do not b) if they can fill posts in their practice on the reimbursed rates, which many can't and c) if they can make the financial sums add up, with the result that d) they often end up with much less profit and much higher than full time work to make the business function. 4. Experienced doctors are retiring early. That is slightly better now since they belatedly changed the pension rules, but they already haemorrhaged plenty of doctors by waiting too long to do it. 5. Doctors are highly qualified and have options. You may think they receive a high salary and it is "enough", but real terms salaries in NHS medicine are down much more than comparable professions, and if the NHS working environment is sh*t and the market will pay them more elsewhere (different country or different work setting) then they won't stay. They aren't staying. Recruitment is a nightmare in many places. 6. It is obvious where this is going: medicine is becoming a devalued profession, the NHS is becoming a second rate service, people will increasingly opt for private healthcare as a top up to the NHS. As long as you are happy with that, then fine. If not - you can't just beat doctors up emotionally, financially and verbally - you have to work to retain them and that includes improved NHS T&Cs (and a proper pay review system). Oh, and 7) none of this is relevant to care workers, who are underpaid and deserve every penny they get for difficult and draining work.
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michaelc
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Post by michaelc on Oct 30, 2023 16:06:39 GMT
1. Medicine at university is less oversubscribed than it used to be relative to other subjects. 2. A far higher proportion of people qualifying in medicine do not stay in UK clinical medicine than ever before. 3. I know many GPs. None earn that figure. Salaried GPs (which is an increasing proportion) are on less than half that. A GP partner is running a business and may or may not get that figure a) if they work full time (50-60 hours/week), which many do not b) if they can fill posts in their practice on the reimbursed rates, which many can't and c) if they can make the financial sums add up, with the result that d) they often end up with much less profit and much higher than full time work to make the business function. 4. Experienced doctors are retiring early. That is slightly better now since they belatedly changed the pension rules, but they already haemorrhaged plenty of doctors by waiting too long to do it. 5. Doctors are highly qualified and have options. You may think they receive a high salary and it is "enough", but real terms salaries in NHS medicine are down much more than comparable professions, and if the NHS working environment is sh*t and the market will pay them more elsewhere (different country or different work setting) then they won't stay. They aren't staying. Recruitment is a nightmare in many places. 6. It is obvious where this is going: medicine is becoming a devalued profession, the NHS is becoming a second rate service, people will increasingly opt for private healthcare as a top up to the NHS. As long as you are happy with that, then fine. If not - you can't just beat doctors up emotionally, financially and verbally - you have to work to retain them and that includes improved NHS T&Cs (and a proper pay review system). Oh, and 7) none of this is relevant to care workers, who are underpaid and deserve every penny they get for difficult and draining work. Lets hope so as that would imply we have enough doctors. In countries I have been to where there are enough doctors, they are valued just like many other professionals are also valued. This is actually the fundamental problem that has been in existence for many decades. The BMA have ensured that we don't train enough doctors in order to keep the profession exclusive. Now we have large numbers trained abroad and as I said the AVERAGE salary is £163,900 meaning some earn less and some more. Any more doctors want to come here and say GPs need paying more and we should keep the profession exclusive ?
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