Even GPs are exhausted. Credit: Universal Images Group via Getty Images
My first appointment is at 8.30. Our daily meeting is also at 8.30, despite my protestations at the obvious scheduling conflict. There is no room in which to hold it, so we gather in the waiting room. One of the partners begins the meeting by running through staff absences: one doctor is off with stress, another must look after their child, who has Covid. There is a massive backlog of patients waiting to be seen, despite the fact the practice is offering a record number of face-to-face and telephone appointments. It can’t keep up with demand. The days are long and frequently tough; a colleague cracks a quick joke to lighten the mood. The patients already waiting watch us laughing and glance pointedly at the clock.
I hurry to my consulting room and briefly go over my schedule for the day — one morning clinic from 8.30 to 12, an afternoon telephone clinic from 2 to 5, and an hour for admin from 1 to 2. I have two scheduled coffee breaks as well, which I won’t use for coffee: I always try to schedule them after my trickier patients, so that when they inevitably overrun, it is not into another patient’s time. I am a trainee doctor, having qualified from medical school two years ago, so my appointments are 15 minutes long rather than 10 minutes, and I have time at the end of my day to debrief with a supervisor.
At 8.45, I go to the waiting room to call my first patient, Mrs Smith. She is hard of hearing and I don’t know what she looks like, so it takes a minute for her to acknowledge me. It takes a further two minutes for her to walk to the consultation room, because her ankles are swollen and she walks with a stick. By the time she has managed to sit down in the chair and remove her coat, nearly half of the appointment time has gone.
Mrs Smith starts to talk about the weather. I interrupt and remind her we need to keep on topic. As a medical student, I watched qualified doctors talk over patients in this way and thought naively that I would never be so rude. But it only took a few weeks of working in General Practice to realise that being brusque and firm is essential, unless you have hour-long appointment slots. Mrs Smith looks crushed. I suddenly remember that she recently had an appointment with my colleague following a bereavement, and that I am perhaps the only person she will speak to today. I constantly feel pulled in two different directions — forced to choose between doing the best for the patient in front of me, and doing the best for the patients waiting for me.
She eventually tells me that she has come to see me about breathlessness. When I hear that word, a list of potential diagnoses pops into my head: infection, lung disease, fluid overload, cancer, or perhaps a more niche disorder I’ve only seen in a medical school textbook. To determine which seemed more likely would require me, at the very least, to take a 20-minute “history”, but if I want to examine her, that would leave us with around three minutes, not including the time required to write out any prescriptions and refer Mrs Smith, if necessary.
Mrs Smith seems slightly annoyed when I ask about her medical history: “Isn’t it in my notes?” She’s right — it probably is somewhere in her electronic record, but I haven’t had a chance to click through its entirety, and long gone are the days when GPs know each individual patient. On average, there is one qualified GP for every 2087 patients.
This ratio is worsening year on year, partly because the population is increasing, but also because the pool of full-time GPs is shrinking. It’s not surprising. In the UK, the average full-time employee works 35.7 hours a week; 48 is the statutory maximum. General Practice is often seen, even among doctors, as the ‘easy’ way to practice medicine: the equivalent of a 9 to 5. But full-time GPs work 48 hours a week, while “part-time” GPs work 35, not including the unpaid hours when clinics overrun, or the time spent on admin at home.
No amount of time ever seems to be enough, though. I was reluctant, for instance, to examine Mrs Smith on the bed, rather than letting her remain in the chair, because I knew it would take at least five minutes to get her on and off it. But my conscience got the better of me. As I assisted her onto the trolley, I mentally readied myself for complaints about waiting times later in the day. I can deal with angry patients; Mrs Smith’s health cannot deal with a misdiagnosis.
Mrs Smith’s breathlessness, I decide, is most likely related to her heart failure, and that the best course of action would be to increase her diuretic dose to try and get some of the fluid off her lungs. But Mrs Smith has chronic kidney disease — which is common in the elderly — and increasing the diuretic dose might exacerbate it; I want to schedule her a blood test for the next week, to check. She takes out her diary, which I cross check with the phlebotomist’s diary — which feels like a bad use of my time. I find myself becoming frustrated.
As I begin teeing Mrs Smith up to leave, she bursts into tears and says it’s just so hard without her husband. Perhaps, I think guiltily, the breathlessness was just an excuse to talk about her bereavement. But I have seen one patient and I am already running 30 minutes late: I cannot comfort her now but offer a follow-up appointment to talk about how she’s coping generally. I have a free slot in 2 weeks. At the end of this consultation, I don’t feel like a good doctor; I feel like I rushed a grieving old lady with complex health issues. I tell myself to think about it later, when I have time.
By the time Mrs Smith leaves the room, my next three patients are already waiting, but I need to wipe down the chairs, bed and door handle: Covid is still with us after all. My next patient is Luke, a young man I have been seeing regularly due to his deteriorating mental health. He is unemployed, in serious debt and has recently split up with his girlfriend and moved in with his alcoholic father. We are both aware that his low mood and anxiety are mainly down to these circumstances — but I cannot fix them, so I have prescribed him an antidepressant and referred him for counselling.
Today, Luke is agitated. He tells me he is having serious thoughts about driving his car off a bridge. I screen for protective factors — a support network, a hobby, any hope for the future — but find none. Luke accepts my concern and agrees to be referred to the mental health crisis team. The person who answers my call is a trainee and wants to discuss the case with her boss. I am aware that the mental health team is as stretched as we are, but I can’t help but feel frustrated: it takes thirty minutes for her to call back. During this time, I do not feel comfortable asking Luke to leave my room, so we make awkward conversation as my patient list builds up.
When the phone eventually does ring, I speak to a mental health nurse who insists that, because Luke has had previous suicidal ideation that he has not acted on, his latest symptoms don’t constitute an acute change. Luke does not need to be reviewed by their team, she tells me. I need to take responsibility for discharging him. I don’t feel comfortable doing this, so we go back and forth until she eventually agrees to contact Luke later that afternoon. As Luke grunts a thank you and leaves the room with his head down, I am not sure that I have helped him at all.
There is no time to dwell, however: I need to write a detailed entry in Luke’s notes. In theory I am doing this to provide an accurate history of his condition to help him get the best treatment possible from subsequent professionals. In reality, I am doing it to protect myself in court should harm come to him.
Fortunately, the rest of the morning’s cases are simpler: a child with a urine infection, a man with a fungal rash, a woman who wants a repeat prescription of her contraceptive pill. I rush through them, grateful both that I have a chance to catch up and that, if the patients are angry about their wait, they do not show it.
I finish my morning surgery at 1.15, over an hour late. As usual, I will have to eat as I go through my admin. Patients often wonder what I do when I am not actively seeing them. They don’t realise that I have to sign every repeat prescription request, even if the patient has been on the medication for years. I can do this well, or I can do it badly.
If I do it well, I will read through their entire list of repeat medications, making sure that another doctor hasn’t started them on any drugs that might inadvertently interact with the ones they’re already taking. I will check that they haven’t been on a medication for years that should have been stopped after a certain period of time. I will see if any checks are overdue. If any of those things are the case, I need to ‘action’ them — by sending a letter to the patient to ask them to come in for a check-up, or by writing to their specialist consultant about changing their medication.
If I did it badly, I would just sign.
Next on my admin to-do list is to read through letters sent from secondary care. Today, I note that Mrs Jones, who I referred a few weeks ago with a breast lump, has been diagnosed with cancer. I call her to schedule an appointment to talk through everything. Finally, I catch up with my admin from the morning clinic that I didn’t have time to do during the appointment — like sending Mrs Smith’s referral.
The afternoon clinic is a telephone surgery, for which I am grateful. It means that patients won’t be getting agitated in the waiting room if I have another Luke or Mrs Smith, but can instead get on with their days as they wait for my call. I can also choose the order in which I call patients: I scan the afternoon’s list, scheduling simple prescriptions for acne and leaving a young woman with a recurrent sore throat until later in the day. I know that she is becoming fed up with the GP management of her condition and that the phone call is likely to be a difficult one.
Because it’s easier to read the guidelines for a condition during telephone surgery, by the time I phone her I am able to apologetically inform her that she does not meet the referral criteria for a tonsillectomy. The patient is angry. Her affliction is interfering with her job and private life; I know she cannot understand why the people who are meant to help her will not. I understand, but I am also affronted. It would be much easier if I could pass her on to the hospital, instead of prescribing another packet of throat lozenges, but I know that the referral will be instantly rejected. Of course, this is as much to do with the risks of surgery as the pressures on secondary care, but the patient does not care about that. As her anger dies down and she says goodbye, I find myself hoping she will eventually get fed up of calling. I admonish myself and decide to refer the patient anyway. At least then I can tell her I tried my best.
My final phone call of the day is with a patient who has some sort of pain somewhere, but it’s hard to work out where because there is a significant language barrier. I get put on to someone — a nephew, I think — who tries to explain, in slightly less broken English. In the end, I make the patient a face-to-face out-of-hours appointment with a colleague, and add a warning in her notes that it is not suitable to offer her a telephone appointment in the future.
Before I leave, I have a debrief with one of the GP partners. I hover outside his door, listening for a gap between his phone patients. When I eventually enter, he has his head in his hands, but quickly springs to attention when he sees me — he is keen to train more doctors after all, and tries his best to shield me from the pressures, and focus on the positive aspects of a job he once loved.
But I know that he has stayed late each night this week and that in his spare time he obsesses over the — increasingly negative — Google reviews of the practice. I don’t want to take up his time, but if something goes wrong with one of my patients after I had chosen not to discuss their case with a senior, I could end up in hot water legally. So I rattle through my day while he nods and occasionally interjects with suggestions.
Once I get home, I try to relax, but thoughts continually flash into my head: didn’t you rush those “easy” patients a bit? Are you sure the diagnoses weren’t actually urosepsis and a malignant rash? If harm comes to them, they will blame me, and I will blame myself.
My phone buzzes with messages from colleagues from my previous rotation, a surgical job. They joke that I am living the dream, working 9 to 5 — that I spend most of my time sitting down and refer any real problems onto the hospital. I turn off my phone and head to bed. I have decided not to apply for GP training.
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SubscribeWe in the west have been very successful in keeping people alive for many more years, something not predicted when the NHS was set up. Millions of older people means millions of illnesses, both mental and physical. Not all of these older people are capable of thinking things through themselves or of using the Internet to self-diagnose.
Recently, because of the lockdown, I had to speak to the doctor in the new way (by telephone) and it worked well – the conversion took 5 minutes at the most and I had prepared what I was going to say, in the name of efficiency.
However, the NHS system does not do one important thing – it does not measure ‘Wellness’. If you are old and live alone and you just don’t feel well (obviously this is a mental or physical issue), you need reassurance at least annually that you are OK. This is an important and often overlooked feature of the NHS.
I suggest that trained nurses could hold annual discussions with patients, over-75 perhaps, to discuss just how they feel about life and perhaps measure blood pressure, weight, height and offer advice on how to live better. This could relieve the GPs of some work.
Great to see constructive solutions offered.
Of course the more GP’s diagnose by phone/online there is an increasing likelihood their role will be overtaken by Artificial Intelligence.
Can’t give a reference but 10 years or so ago there was a large trial in the USA involving several thousand patients. They compared the accuracy of a computer diagnosis system to that of older, experienced doctors. The computer system won easily but the patients still wanted the real thing.
This trial was intended to show that older doctors just couldn’t keep up with innovations in the medical world. The result is not surprising but it shows that patients don’t just want diagnoses but they also want reassurance from someone they trust.
Well, it’s interesting, isn’t it.
Great to learn that at least some doctors, in Jane Smith’s practice at least, are apparently doing their best.
Meanwhile, back in the experience of my family and friends and acquaintances, most medical practices seem pretty devoid of patients and cars (other than a few doctor’s or staff’s cars). I’m not sure I’d now recognise my doctor if he stood up in my soup.
Yesterday I had to visit the surgery to drop off a urine sample for testing (all arranged by post / text / online). As the box to receive samples had been shifted (presumably a plague risk), I had to wait ten minutes to hand it in to a bored receptionist. I had just neen treated to listening to an obviously anxious patient trying (and failing) to persuade her to allocate a telephone consultation before 22 October.
I could give another dozen examples off the top of my head. And some friends report even worse.
I’m certain may GPs are super dedicated. But I fear some are not. Just as, when I had to complain about a serious problem to an officer of my Unitary Authority during strict Lockdown, I mysteriously got a response which clearly had been sent from a computer in Iceland, I wonder if anyone succeeding in actually talking to their GP can hear waves on a beach and someone singing a calypso.
Just as with nervous teachers who claim feel at imminent risk from contact with their class children, I rather think a few P45s being issued, might concentrate minds and provide encouragement.
How long will it be until the Treasury points out that we’ve managed without many GPs and teachers for the thick end of two years now, so why not just buy a few more computers?
A few p45s indeed… 🙂
Or the engaged tone on the phone which is what lots of people seem to get when they ring up the GPS.
Over 75s are exactly the sort of people who won’t take being ‘fobbed off’ by seeing a nurse instead of a Doctor….the 75s are the sort of people that think the pavements and shopping aisles are priority lanes for their electric buggies..
…I declare an interest: I’ve been clipped more than once by the electric buggies driven by Oldsters.
I think you are incorrect. In my previous GP ‘s practice, they employed several practice nurses and a specialist diabetic nurse. Most patients, particularly the elderly were more than happy to have regular appointments and minor procedures with the nurses; there was a feeling that they were maybe less time pressured and ‘important ‘ than the doctors, so the appointments were less pressurised from both sides.
By the way, I was nearly run down on the pavement by a Pidcock wannabe on his bike yesterday, but I didn’t become convinced that people under twenty-five were going to be stroppy at the Doctors.
Allan / Niobe
Well, I am diabetic as it happens and am supposed to get an annual check up with a diabetic nurse (+ a specialist optical scan checking for eye damage). Needless to say that went straight out the window in 2020.
Old or not, I have no problem in being examined by a trained nurse. Most of the things they are trained to check (blood pressure, condition of feet, weight, general fitness, results of blood & urine tests) are well within their capability and there’s normally (ho-ho) a Doctor they can check with, if they are unsure or thing medication needs adjusting.)
When I eventually got an appointment, it turned out that this would be by phone, thus significantly reducing the scope of the ‘check-up’.
The young nurse who rang seemed pleasant enough, but I was nonplussed, when I queried something, that she told me that she was sorry but she was “only a trainee nurse and knew next to nothing about diabetes.”
I rest my case, other than to note that it wasn’t me (or the trainee) on that occasion, who was taking the piss.
Yes, of course I was referring to the NHS pre Covid, when it was possible to see and be seen by a living human being. And the practice was voted the best in Oxfordshire.
my husband recently tried to get a follow up appointment, as instructed by a call from a nurse from our new practice ( of course, she couldn’t make the appointment, that would have been too simple). He called as instructed to be ‘held in a queue’ for 37 minutes, being assured every two minutes that he was patient number one in said queue. After 37 minutes , he gave up. What were they doing for 37 minutes at 2pm? Because I can’t believe it took 37 minutes to make an appointment for another patient. Was there actually anyone there? Or were they all sitting down with a donut, as their figures would suggest ( I did actually see the receptionists once pre Covid).
Our receptionists are working flat out. Sorry….
If a nurse specialises, for example in diabetes, s/he is likely to have more experience than a GP. We are used to having our children delivered by a midwife!
I’d make bike riders who hit people on a pavement, get a punishment beasting. I’ve seen stroppy U-25s… 🙂
Very few Oldsters drive buggies.
For one thing, most Oldsters can’t afford them.
Not many? Hmm, that doesn’t chime with my experience.
I don’t know where you are Allan, but in England the electric buggies tend to be concentrated in certain areas, for example there are far more in Biulwell near Nottingham than in other areas of the city.
I’ve often thought a regular ‘wellwoman’ or ‘wellman’ clinic every 3 years over 35 and every year over 65 would be far more beneficial AND cost effective than the current scattergun approach. Personalised, thorough and preventative.
Wonderful plan..almost more difficult to get practice nurse than it is to employ a gp!
In South Africa you can still get really quality private care for a reasonable amount of money.
Granted, this doesn’t include the poor, but there is reasonably good care at a lot of the state hospitals and clinics and that is free. This can be very very good care, if you are at a country hospital in the Western Cape. Given that a huge percentage of the population live on welfare (supported by a sliver of tax payers) and given the exploding population, I guess that is better than a lot of other countries.
A regular private appointment for a specialist would be as low as £40 and I recently had an hour and a half appointment with a specialist cardiologist professor for £17 – the appointment was 90 minutes long.
My last experience with the NHS was very poor (I paid for this experience) and it looks like it is steadily getting worse. I don’t know what the cheering is all about. Make people pay something and see things improve.
I think the Dutch / German system is the healthcare model the UK should be moving towards.
Correct – patients all have insurance services are largely private.
So doctors see patients as an income and want to see them.
The services are nominally private, in reality, shed loads of spending is delivered by the state to keep the costs on individuals down. 🙂
Perhaps they see them as clients with money to follow and that changes the emphasis. In a past lifetime GP’s were on call over the weekends, so their workload was much higher.
No, your patients can’t ‘get on with their day’ while they wait for your telephone call. They are stuck at home, distracted from any other business, reluctant even to go the the toilet in case the phone rings and wondering how the hell a doctor can be relied upon to make an accurate diagnosis without a physical examination.
Have you looked at other professions? Like many of my colleagues at the Bar I was usually at my desk by 7.30 a.m. and not infrequently worked until midnight. And a work-free weekend was a rare luxury.
I would have imagined your own experience of overworking would have made you more sympathetic let alone the dangers of overwork on the human brain affecting legal thinking or medical intervention.
This idea of being super-hard working is not for the majority of people. It is for the type of person who reads UnHerd, rather than the Daily Mail. I can’t imagine many medical doctors would give time to read UnHerd.
I do!!
Ahh, yes, the extremely well paid Bar.
Some barristers make a fortune; others can hardly make ends meet. Believe me, there’s an extraordinary spectrum of earnings. (I never hit the big time.)
If you can’t make a living without working around the clock, try something else ?
Then you should have seen a doctor about your severe case of workaholicism.
You’re probably right. But I enjoyed it.
We are paying the price for Lockdown. If you terrify a population into avoiding all contact, and use the NHS as the National Covid Service, then there is an unavoidable price to be paid.
You don’t just have a year’s worth of patients to catch up on. All their conditions will have worsened from what they would have otherwise been with intervention. That health impact has already happened, trying to compensate for it seems impossible.
Presumably a large number of patients that would be presenting with complex medical needs, many elderly, are not around anymore due to Covid. The situation should stabilise eventually. Solution of allowing private GP practices to operate alongside the NHS seems worth a try. It does work in education to relieve pressure on state schools but undoubtedly breeds resentment among those that can’t afford it.
See my comment above, all NHS GP’s practices are already private. They have never been nationalised.
GPs were part of the NHS from its inception, and free to use.
No. It breeds resentment among those who can easily afford it but want it provided by other people’s taxes. At least that’s how people in the UK seem to react. The rest of the world just think a free-at-the-point-of-delivery system is ridiculous.
This is totally correct!
I can’t understand why some of the time-wasting admin chores are undertaken by the most highly qualified and paid members of the medical practice.
In the above account a repeat prescription for the contraceptive pill is given to the GP to sign. Surely a nurse practitioner should be able to do this? Ditto acne pills.
In my own case I will need thyroid tablets for the rest of my life but instead of giving me three months’ supply I get 28 days’ worth and have to then request a repeat. This has to be signed by the GP. My blood is supposed to be tested every six months. So nothing is checked during the six months’ interval that could cause the doctor to refuse to sign a repeat prescription yet we go through this palaver every damned month. I could live for another 35 years!
Doctors have refused to accept advanced practitioner roles for nurses and are sniffy about pharmacists. They cling to their professional status as if nobody else could do their job or any part of it. They are wrong and now the chickens are coming home to roost.
My sister in Holland gets 3 months of her prescriptions at a time. Regular checkups for her diabetes by a nurse- doctor involved if any concerns. Doctors and dentists continued normal face to face treatments throughout the COVID period and now.
Omg we would love more.pharmacists and nurse practitioners and in fact our outgoing partner was a nurse practionter although profit sharing no cheaper of course as a partner. But. There’s a lot pharmacists don’t or can’t do so we still need enough doctors to be on call. But all.useful. trouble is pharmacists are extra rather than instead of until you achieve an economy of size
Nurses have to be prescribing…
Heal thy self.
It’s not always possible but it IS possible to keep oneself as healthy as one’s life schedule would allow. Which means being mindful of how you spend your free time and what you eat. It doesn’t require much time nor money but it does require a lot of will power.
Most of the health info is available online too but not everyone has the time, knowledge and capability to search for the answers. Also in many cases we are impatient to get better without actively trying to get better ourselves. Chained to a system that does little. Surface healthcare with drugs upon drugs to solve one problem while creating another.
I try and avoid hospitals and doctors and hope that if and when I need them, either it will be quick or I will go quickly. This is what I pray for.
You forgot genes. Make sure you choose parents who give you good genes, or you’ll be sorry.
And buy a scale and weigh yourself every morning. Amazing how that focuses your will power. In fact scales should be given to every British citizen by the NHS – money well spent.
I weigh every morning but I would add a caveat to your suggestion – you also need to record your weight for ever so that you pick up short-term and long-term trends. My old tutor used to say that to measure something without recording the result is a waste of time.
So, you need a slightly up-market scale which keeps records for you.
I generally don’t allow more than a 1 kg weight difference and if I go higher I adjust lifestyle for a while.
Or a diary.
I know from experience that daily weighing is obsessive and does more harm than good. Daily fluctuations are not very informative, but a monthly weigh-in is good enough to show the trend over time. I weigh myself (and my dog) on the first of every month and write the numbers on the wall calendar, seen daily, as an exercise in self-awareness. This type of habit should be feasible for anyone.
I agree with you for myself but not for millions of people in the world. People should be responsible for their own health but it would probably be necessary to remove the safety net of the NHS in order to force the issue – and that will not happen.
As long as the NHS exists people will refuse to consider their own responsibility.
Or just invest in some classic but unforgiving tailoring … one’s wardrobe does function as a record-keeper (those trousers looked great when I was working out regularly, this is my Dumpy Suit, for podgy times, and these are the usual…ooh, the usual a bit snug, a regime of broths and veg is urgent!)
And of course you’d need to come up with another system.
One would think that this is obvious ! – But then I look at the obesity etc stats and must conclude that many people are functionally stupid and mightily prone to ‘magic thinking’. Many people seem to be aghast that medical science cant just magically fix them. I beleive this type of thi nking is caused by political and medical messages that personal responsibility is no longer required because if you vote for us we will look after you , and in the case of the medical profession because it is no longer permissable to assign personal responsibiity for irresponsible health practices – in case anyone might be ‘made’ to feel ‘bad’. Gawd how did it come to this pathetic state ………………..
This shambles is entirely the medical professions fault . You have clung to the NHS model which can never work. Your profession has resisted having a modern service -a la most European countries. The one where the state doesnt run it -the state provides universal insurance -and the services are essentially private. Works far better than the NHS monopoly state run service model. Doctors can see the patients for as long as they professionally choose.
So why do doctors resist it ? its better for patients, better for doctors and has far better health outcomes. Why do doctors love the huge state monopoly model ? The only other country that has the UK NHS model is Cuba.
The Europeans pay more for healthcare (and have done for decades) and don’t continually run their systems continually close to capacity.
That is totally totally irrelevant.
Why is it irrelevant? A bigger budget would allow for more doctors and nurses, beds and capacity, like they have in Europe. The European model wouldn’t work without vast amounts of taxpayer money
And Brazil, where the speed of service is similar
If the NHS budget in terms of GDP was on par with those European nations then we wouldn’t have half the problems we do
How do you know?
Hmm, GPs whinin’ about (a) huge patient lists, GPs complaining about (b) the vast amount of time wasted when patients can’t speak English…
…andbGPs supporting (c) Open Borders…
…I wonder if there might be a connection between (a), (b) and (c).
Strikes me you can have a welfare state or mass immigration but you can’t have both.
‘I note that Mrs Jones, who I referred a few weeks ago with a breast lump has been diagnosed with cancer.’
A few weeks ago? And how many weeks will she have to wait for treatment? Is this the NHS which is ‘the envy of the world’?
This is such a sad article. Here in the States things are not much better.
Profit, of course, drives US medical practice. There’s a shrinking number of primary care physicians (US equivalent of GPs) because of the heavy workload and because they make substantially less money than specialists, so most new doctors specialize. The interim solution in the US is nurse practitioners. These are experienced nurses who’ve passed an additional exam and provide primary medical care. That system seems to work reasonably well but they’re not the same as physicians, in my experience.
At least in the UK both physicians and the system they work for view you as a patient. In the US, physicians might want to view you as a human being but the system views you as a profit source and the more services a physician provides the more you (or your insurance) is billed. Overtreatment is a real and dangerous problem in the US system.
I don’t know the answer to these issues. The average age of the population increases, along with medical problems, and we all expect near perfect outcomes and the very latest technology.
My own solution is to avoid the medical system wherever possible and if I develop a problem I think will require more than a primary care physician can offer I go straight to a specialist. That’s possible in the US under many health insurance plans but I know you need a referral in the UK.
I like (in a jaded, cynical way) the old joke about the Republican party’s healthcare policy: don’t get sick, and if you do get sick die quickly. Many a true word is said in jest.
When I returned here, within a short time I needed carpal tunnel surgery and a knee replacement which I paid for. The cost of those two things cost the same as a year’s health insurance premiums.
My God! Either your insurance cost a bomb or you got the cheapest knee replacement ever. What was the annual premium on your US health insurance?
$23,800 total inc deductible. ($1,400 a month $7,000 deductible)
Carpal tunnel was £2000, knee replacement £13,000
So not quite a years insurance premiums but not far off.
Anything else?
I think a lot of this problem is the ongoing turf war, physicians fighting tooth and nail not to let go of anything. I’m almost 60 years old and the best, most thorough physical exam I ever got was from a nurse practitioner. Physician assistants are at the same level, graduate school work, above an R.N. but below a doctor. These people can handle the vast majority of patients who do not have complex issues. In the clinic where I work each department always has at least one doctor, the “resource” person, available for any questions or concerns the lower level providers may have. This system works well.
I am surprised at the level of busy work the GP in this article has to do. The provider is responsible for documenting the encounter, but in most modern systems this is dictated quickly instead of being written out laboriously. My clinic has a staff of medical assistants (several months of vocational training, lower than a nurse), whose entire job is processing prescription refill requests. If a particular case requires a doctor’s attention, that one is kicked up the ladder.
I’m most surprised that we do not have entire clinics, or at least separate departments, specifically for elderly patients to be seen by qualified geriatricians. We know these patients can’t see or hear well, they move very slowly, their appointments are going to take much more time, they have special needs, and very often those needs include social support as they are lonely and the medical appointment may be their major outing for that day, or the week, or the month. Quit trying to wedge them in with everyone else and then being surprised by how long they take. It’s unfair to everyone involved.
Financially, our system in the U.S. is still barbaric, and I don’t understand why people are being allowed to go broke over medical bills, with bankruptcy as the only way out. This is not civilized. We don’t need medical care to be free, we just need it to be affordable. I have no objection to everyone having skin in the game, but there should be a limit. Why not a flat percentage of taxable income as your premium, doled out to private insurers and care providers in the way that Medicare Advantage programs are done? What’s so hard about that? Children and people who don’t make enough money to pay taxes will get free care, everyone else will pay something manageable. Price gouging is a major issue to be addressed. Why does a hospital get to claim that an MRI costs $27,000 (this was an actual bill sent to an uninsured man in his 20s), when another place in the same town can do it for a small fraction of that amount? Something isn’t right here.
I’m not a socialist, but health care should not be seen as a product, like a Tesla or a vacation house at the beach, that’s only for those people who can afford to buy it.
How is this pressure causing you to “betray your parents”. Or maybe the sub-editors are “betraying your patients”?
So glad I’m not the only one who noticed the subheading…I read through the whole thing waiting to see how the parents were betrayed.
Yup. So much to say here really. I’m a GP. We ate utterly hammered by demand now. It’s totally unsustainable and awful for patients having to battle the system. But good primary care is hugely cost effective and wonderfulness you can manage continuity of care. I’m lucky enough to have been in my practice nearly 17 years so know many well. Add to the trainees list being a partner and coping with the ever greater list of box ticking we must achieve to get paid (taking us away from patient care) which we were gloriously spared during early covid but could have managed then (not now) and we have a perfect storm
More private medicine will not help the majority of people in this country and private GPS are already available if desired. I want to look after a glorious mix of all of our population not those wealthy enough to but lots of my time…
Struggling for immediate solutions but if certain newspapers could stop bashing us for being lazy without understanding the position currently (eg can’t fill waiting rooms with infected patients next to immunosuppressed and elderly patoents) then morale might be a little improved…
But I love my work and my patients and will keep on running round the hamster wheel until I fall off. Or retire early. Which is what most of our GPS are doing and is why we don’t have enough!!
The pool of full time GPs is shrinking in large part due to more women becoming GPs and choosing to work part-time. As told to me by a female Paediatrician, “the more women doctors you have in your health system the more doctors you need.”
Back in the Good Old Days junior doctors could expect to work 90 to 100 hours a week. Not any longer. The effect of applying the EU working directive has been to approximately double the number of junior doctors needed to do the same amount of work.
Around 25% of UK medical school graduates do not stay with the NHS but move overseas. This is shocking given that we all know our NHS is the envy of the world. Why would newly qualified doctors not wish to work in the world’s greatest healthcare system? Given that they have direct experience of working with the wonderful NHS it is beyond my comprehension that any of them would wish to move to Australia or Canada.
Bottom line: the UK’s Marxist education system fails to train sufficient doctors for the UK’s Marxist healthcare system which compounds the problem by failing to retain the doctors and doesn’t work them hard enough.
‘The good old days?’ Please dear god let me not be seen by that Doctor who is working his/her 99th hour of the shift. As a veterinary surgeon who works consecutive days, nights, and weekends I know, full well, what that feels like. Burn out is a real phenomenon!
I totally agree with those comments who mention the inefficiency of the system. The repeat prescriptions, getting patients to their consulting room, and so on. So much more could be done, but the GPs who manage the practices are almost certainly too tired to spend time thinking about and instigating these things.
I understand that junior doctors used to work 99 hours a week. Not 99 hours without a single break. You would have to be on some serious narcotics to work 99 hours without sleeping.
There is an issue with burnout and the potential for mistakes to be made when people are working very long hours. But several professions are structured in a way that junior employees are required to work long hours in order for them to learn by experience and to weed out the non-hackers including the legal profession. The military operate along the same lines. If you want to be selected for an elite unit you are going to be put through the wringer. Ditto professional sports.
According to NHS England, 90% of GPs work part-time. That is not sustainable, especially given that the cost of putting someone through medical school is so high that student loans only cover about 30% of the total cost. The taxpayer picks up the remainder.
https://www.pulsetoday.co.uk/news/workload/nhs-england-says-almost-90-of-gps-work-part-time-in-response-to-pulse-survey/
Yes of course, 99 hour ‘week’. My mistake. However may I say that it tends to feel like a continuous shift since the breaks in between leaving and arriving are so woeful.
In certain professions sorting the wood from the trees approach by pushing people to their limits is an excellent method of selection. When one is dealing with an animal or person who needs an emergency intervention, whether surgery or medicine, and the clinician is seeing double due to severe fatigue then this is not only incredibly dangerous for the patient, but also for the clinician who has to drive home. I believe fatigue affects the ability to drive in a similar way to being intoxicated.
I wholly appreciate your comments about part- time GPs. However, I wonder why so many feel the need to choose to do this? We have come full circle I think!
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No, HMG effectively limits the number of doctor training slots it wishes to pay for, encouraging instead, the NHS to recruit cheaper doctors from overseas…
That is typical government thinking; the Treasury restrict the budget to save money, creating stresses harder to quantify elsewhere. I understand the numbers have now been increased, but probably not by enough.
Most of the Uk trained doctors moving overseas are not going to Australia, Canada or the Us. It is very difficult to get such a position in these countries, for various reasons ( bonds in the US, Australians first policy etc). Even before Brexit, it was hard for British doctors to work in the more prosperous EU nations, because the language skills required were high.
however, the NHS trains a significant number of doctors from ethnic minorities. The skills acquired are in high demand in countries where the doctors have familial or other connections.
https://advancemed.com.au/blog/uk-doctors-australia/
I’d rather have the UK system, even if you describe it as Marxist, than the US system anyway. Also I’m glad junior doctors no longer work 100 hour weeks, as I’d hate to be the patient he sees on his 100th hour. On the rare occasions I’ve pulled in those hours in the past I was good for naff all by the end of it, productivity was non existent and mistakes galore which isn’t something I want from my doctor
Do you have any evidence that the adoption of the 48 hour working directive and subsequent reduction in junior doctors’ hours reduced medical mistakes within the NHS?
If you want to spend your days trying to prove that working excessively long hours doesn’t lead to fatigue, less productivity and more mistakes be my guest
Fair enough. It’s only £200 billion of taxpayers’ money that we are talking about wasting so we might as well manage that trifling amount on the basis of gut feel and what sounds nice.
The choice doesn’t have to be between the UK and the US systems. It could be based on the French, German Dutch, Danish, Australian,…………………………………..systems.
Those systems only work because of a vast healthcare subsidy from the taxpayer. Their budget in terms of GDP from the treasury is much more than the UK spends on the NHS, with very little difference in terms of outcomes
One way forward might be to
allowhave small independent private practices again, ie, similar to dentists and physiotherapists. Fully qualified medical doctors who found working in the NHS too stressful could run their own private practice, either alone or in pairs. They could then arrange their surgery hours to suit themselves. This would mean their expensive training was less likely to be wasted and it would relieve some of the pressure on the NHS. Perhaps on the understanding that 10% of their patients paid nothing.I think many practices in the UK are already private; the one I use is.
There are indeed a few but they are not generally available. It’s 30 miles to my nearest.
It is my understanding that all GPS are private practitioners. Most contact their services to the NHS. Those that don’t are “private” and charge their patients for their services.
The problem is that if you are diagnosed with a chronic condition by a private practitioner, you are landed with the ongoing costs of treatment and medication, which are horrendous. Of course , in an insurance contribution system this is less problematic, although it can still be difficult. I suffered with a mysterious ( eventually diagnosed) condition some years ago, and my employer sent me to a private GP who referred me to a consultant, also on his private list. This man told me that as my condition was going to require a lot of tests , he was going to re- interview me in his NHS clinic, as then he could prescribe as much as was necessary.
i am devoutly thankful for his pragmatism and kindness.
Yes I can imagine, however a local independent private doctor could still be in the first line of dealing with problems, many of which would turn out to be minor. The more serious could perhaps, by arrangement, be passed on to be treated by the NHS.
All existing NHS GP’s are already private contractors. This has not changed since the NHS was first established, as it was the only way to bring GP’s on board, who didn’t want to lose their more lucrative private practices (although I’m not sure how lucrative those same practices are now).
Sort of, but private practice in the form I have described, as a small independent business, hardly exists. I’m suggesting that it could be helpful (to doctors who find the NHS too stressful) if it became much more prevalent and an accepted part of our health system, rather than the exclusive rarity that it is today.
Considering the NHS was founded 80 odd years ago I doubt that any of “those same practices” even exist.
This really makes no sense. We already have exclusively ‘private’ GP’s and we’re already paying for NHS private GP’s, so how would adding a third tier of private GP’s help the situation? Far better to look at the far more successful French/ German healthcare systems.
GPs are technically self-employed but they are paid by the NHS. Our local surgeries in cities, towns and villages are run by the NHS, they come under it’s jurisdiction.
They are not “private” in the way you suggest.
Brilliant idea! And it’s already working half a world away! Here’s a straw in the wind – in a 12 doctor general practice in suburban Sydney, my GP is one of four in their early thirties trained in the UK.
No doubt GPs work hard but are they being effective? My experience of GPs are they act as gate keepers for NHS rather than advocates for the patient. If a person has complications I found GP not very helpful. I am no longer sure whether human GPs are any better than automated Bots as the first port of call when one falls ill? Why do GPs needed to be incentivised to do what is right? Whether it be vaccinations or any other preventative actions? They should be recast as Well Being Advocates and success measures changed from inputs to outcomes.
That is certainly a rationalizable conclusion.
A standard bit of economic theory would be: There are two ways ration demand: by price or by imposing waiting lines. Or some combination.
If we give out stuff for free, then folks line up for it. We put some in place to manage the line, the gatekeeper. Folks who don’t want to wait in line can pay out of pocket for care from private providers. That might be very expensive, but those are the options: “free” but wait in line or expensive but get immediate access.
Wait in line is all very well for electives and luxuries. Many health conditions, alas, are only worsened with time…which drives up the cost of their treatment, while reducing the odds for a good outcome.
I’ve never understood why the doctors have to come out and get the patients themselves, why can’t they just call you in on intercom, or get a receptionist to do it. Then they could have a moments pause in their office between patients. And if there was a numbering system which showed you where you were in the waiting list, you could get ready when you were the next number, instead of being called ( usually at a distance, hard to hear), put down your magazine, gather up your stuff, all of which wastes time and flusters you.
it must be some bizarre tradition left over from private practice.
Perhaps they like the exercise, I know I would.
It strikes me on reading this ( and as a result of conversations with GPS) that one of the problems is that we as a society are expecting the doctors to medicate conditions outside the remit of first referral medicine . If people are lonely or grieving, that is not the province of the doctor. If people are suffering because of their living conditions, that is not the province of the doctor – but one reads continually advice in newspaper for almost any problem with the vaguest connection to health (including sadness) to consult the GP.
Add to these unrealistic expectations the burden of patients with multiple conditions , usually as a result of old age, which can never be cured, and sometimes scarcely alleviated – and you have a very unattractive profession.
A private company operating in this way would not have any customers. Socialism always fails.
A while back, Circle Health, a private health provider, were given the keys to a major UK hospital and paid by the SoS Health to ‘get on with it’.
Circle soon handed back the keys, whining they couldn’t make any money because they had to maintain an eye wateringly expensive A&E dept. and ICU whilst providing a service to all comers.
The capitalist model in the States costs the taxpayer more per head of population than the UK model does. Capitalism doesn’t work without some form of the state behind it either
An Airline looked at how the NHS worked and said if they ran their service like that they would crash a plane every week.
Airlines get to cancel flights and only those that pay get a seat….the paying directly for a seat being the important bit.
A friend of mine, who is extremely impatient, just told me about his experience with his doctor. After nearly dying of a unique Covid variant, my friend asked his doctor if he can stop using the oxygen mask.
The doctor looked at him and said, “You are like the person who ignores the low oil light that appears on your car’s dashboard. You also ignore the check engine light when that pops on. You continue to drive the car until the engine blows and then you ask the mechanic if the car can be fixed today?”
We eat whatever we want, drink like fish, smoke, lay on the couch, binge watch stupid and idiotic shows and then dump on a poor doctor when the “$@%#” hits the fan physically or mentally.
Indeed. But our system does not encourage or reward health. It rewards those who don’t look after themselves. And who generally don’t pay for it either.
Smokers, boozers and fat bastads more than pay for their healthcare via taxation on the booze, smokes ‘n’ nosh they consume plus o’ course SBNFBs, tend to die earlier leading to pensions savings.
Very droll!
Most professional jobs have become more pressurised in recent decades. Ask any profession and there is a good chance they will tell you they would not encourage their children to follow in their footsteps.
However, medicine has always carried an extra emotional load. My father was pleased to get out of hospital medicine and become a pathologist precisely for this reason and that was pre-war.
AI will certainly assist in future. Incompatible and excessively prolonged prescriptions are prime candidates to be sorted out by AI rather than a GP over their lunch break. AI could certainly provide a basic triage service once people got used to describing their symptoms to a computer.
However, the use of volunteers to take some of the pressure off GP would assist. There are large numbers of perfectly capable individuals both old and unemployed who would be happy to volunteer some time to assisting doctors follow up phlebotomy appointments etc or lend a sympathetic ear to the lonely and mentally troubled while the GP got on with strictly medical issues. I have certainly been happy to be served by volunteer vendors at hospital and receive a cup of tea from a 90 year old volunteer after my cataract operation who would have been a sympathetic listener if I needed one. It would help the GPs and the Volunteers themselves. If the GP could prescribe a dose of volunteering it would be a win win for all.
That’s true about professional jobs. One might have expected ever improving tech to be reducing said preasure, but it doesn’t seem to be working out that way. As for GPs linking up lonely patients with volunteers, that’s has been increasingly a thing since 2018. It’s called ‘Social prescribing’. In practice it doesnt always work out as well as one might expect. Being lonely often correlates with being less trusting of others – some lonely people trust their doctor but less so volunteers.
At least pathologists don’t have to put up with wibbling patients and I doubt there’s many rush jobs involving chopping up the, err, deceased.
You’ve been watching too much Silent Witness. A large part of Pathology is analysing tests on the living.
Absolutely true. I enjoyed my profession when I started, but it has steadily become more and more ‘regulated’, by which I mean the self-respect one started with as a professional is replaced by an ever-increasing requirement to comply with ‘procedures’, the design and checking of which is almost entirely by non-professionals.
These procedures are introduced to avoid the risk of things going wrong, which it is hard to argue with, and yet one knows that in the end, they will not improve your judgement and knowledge, and of course, year by year, that is borne out. Meanwhile, they consume a great deal of time, and are unutterably boring.
It would help to know if general practice, today, still works for patients in terms of a satisfactory outcome. If it does, continue, train more doctors etc. However, the article is about the distress of doctors and that obviously needs addressing, for what it’s worth I’ve put my suggestion in another comment.
Startling figure, that. One GP serves 2000 + patients. The NHS pays practices just over £150 per patient per year.
Doesn’t that ignore that probably 80% of those 2000+ patients don’t create much if any demand at all? The NHS strikes me as a service where 20% of users account for 80% of demand….in line with Pareto law. It wouldn’t surprise me if it was higher…getting on for 90/10.
80/20 is probably a fair description of the demand. The problem with primary care is that scattered in the 80% are a large number of patients you need to ‘catch’: cancers, suicides, many other irreversible conditions where timing is critical. So even when a small number of patients dominate one GPs attention, there are a large number to remain vigilant for.
And 90% of that 20% will be old people and people who have ‘mental health issues’.
Blimey, lots of guesses here without statistics.
And a lot of those (like my old au pair) left the UK years ago never to come back but didn’t delist and can’t be delisted. Nice work for them that can get it.
A very wise decision, Jane. I have seen first hand at the toll this job can take, not only on the GP themselves, but their family too.
42 years and counting….
Much better than wiping the furniture down would be opening the windows. Why doesn’t evidence-based medicine play any part in the NHS’s Covid-19 strategy?
“Junior doctor discovers that not everyone in the real world is as nice as her privately-educated friends while questioning if the salary three times the national average is worth it” shocker.
That is £300,000 – maybe a second GP could be afforded to help out?
They do have to pay rent, service costs, all those blocking receptionists, practice nurses, etc, etc. But it is not a bad salary even after all that
Covid has obviously sent the whole of the NHS into chaos.
The question is: How long will it take for the NHS to recover ?
Many of us fear that it never will and thus that the NHS as we’ve known it is over.
Probably to be replaced by a quick-diagnosis & emergency service only.
In March 2020 the illustrious Matthew Hancock announced that a giant shed in East London normally used to sell tanks and fighter planes would be repurposed as a hospital with up to 5,000 beds. 1,000 of these were to be intensive care beds.
This splendid achievement is our way out of all of the NHS’s problems. As the giant shed won’t be needed to cope with Black Death levels of COVID-19 mortality why don’t we use it to eliminate waiting lists? This quarter we can do hip replacements. Next quarter we can do eye operations. The following quarter we do knees, etc.
Mr Hancock’s ability to build in two weeks a 5,000 bed hospital and find the people to staff it is an example to all of us. We should do it more often.
Except the sheds weren’t staffed….
Interesting. I had a great uncle who was a doctor in India (IMS) at the end of the nineteenth century/beginning of the twentieth, and he would periodically tour the countryside doing nothing except cataract operations, as being the best method of fulfilling a huge demand.
OML. What are you all taking about. The NHS is a crock of shit by any international standard. Get!a grip people, it’s their NHS not ours. It’s all about their needs not the needs of patients or pregnant women, FYI there’re not patients. Stop giving this entitled bunch of sub contractors any air time. They are not NHS workers. Would the RCGP care to comment. FYI they are not part of the NHS.. They are private contractors. Perhaps some will see the irony.
Soon the Goverment will tell us that the only way to fix all this is privatisation: https://www.youtube.com/watch?v=Www0cHLQulw
And fundamentally, they will be right. What is free is always in demand. But what the practical acceptable solution is, who knows?
However we’ll never know unless we try. Perhaps in a geographically ringfenced area, possibly in a relatively remote area.
No, it should be done in an area of the highest demand with ID cards brought in to confirm that those demanding healthcare have a right to it.
And chopping all translation services might save a few quid as well.
The German solution. They’ve been working on it for years but seem to have got the links between health and social care finally into a decent set-up, though of course Germans pay more for healthcare than we do.
It is perhaps begging the question to ask that people take more responsibility for their own wellbeing?
The increasing mean age of the population will mean there is less qualified care to go round.
All I needed, last week was a repeat of a topical, which, because I can’t purchase antibiotic ointment without a script, had me spending 196 minutes on the phone, trying to get through to the surgery, a total failure.
OK my time-waste is superfluous.
It would help if the practice had either a text, e-mail or website, saving my time as well as delivering a better service.
Challenged the weak rejoinder is that many are atechnophobe and so all must suffer the waste of time.
Perhaps the law makes idiots of us all.
In the last 18 months I have seen a number of elderly friends and relatives die of heart conditions, respiratory problems and/or cancers, with little medical treatment prior to imminent death. This includes my seemingly fit and healthy ex-Royal Marine 84 year old father who took himself to bed feeling unwell in September last year. My Mother tried to get a home visit from his GP who declined, but offered to speak to my father by telephone, his considered opinion was that my father needed to get up and do some exercise. He was in fact admitted to hospital two weeks later and dead of multiple cancers within 5.
It has been pointed out to me enough that he was old and ‘due’ to die soon anyway, so what’s the point in giving the old expensive treatment. Another year or two wouldn’t make much difference would it? So my mother and I can console ourselves with the notion that he helped save the NHS, and indeed my mother tells me she does not intend or expect any different for herself.
We smiled at the award of the George Cross, and my mother suggested that they could have my dad’s medals as he doesn’t need them anymore and they would make a nice bar.
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But why aren’t there enough GPs? Surely it’s not because their Royal College and the teaching organisations restrict the available supply (for example, by the number of places at university, or the requirement for a trillion grade A’s)? Nope, it has to be that they aren’t paid enough. Wait a minute…
As a grumpy old Canadian doc, I sympathize with so much of this article.
The solution? Go back to the old direct-pay system.
In a socialist system like here in Canada, patients feel entitled to your time, tests, surgeries because they pay tax, and our system is “free” for them. In the US those with insurance feel entitled to care because they pay their premiums and besides the co-pay, it’s “free”.
A client might want to sit with a lawyer for 2 hours and chat in detail about life, the universe, and everything. They can but will get charged per hour. If patients directly paid for a given amount of time with a doctor, it would solve the run-on appointments issue.
Many docs in Canada protested vehemently when we changed from a patient-pay model to a socialist model in the late 60’s. They knew it would ruin healthcare. Their timeframe was off but their prediction was correct. Now a full 50% of our (massive) provincial tax bill goes to healthcare, and a chunk of our (also massive) federal taxes go to healthcare. We pay top dollar for a healthcare system that is bloated, top-heavy with bureaucrats, and inaccessible to the non-rich-and-famous.
Our system in Canada is imploding. Here in my home province almost 10% of the population is on the “Need a Family Doctor” list. And those are just the ones who bothered to wait on hold to put their name on the list. Most of us (my wife and I are both docs and have no family physician) don’t bother, as we know it’s a charade.
PJ O’Rourke: “If you think healthcare is expensive now, just wait and see how much it costs once it’s free”.
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The application of systems theory to GP practices might produce some interesting results.
https://bjgp.org/content/66/646/e362
I believe that the model described in this 2-page article would revolutionise British primary care.
What? No tictoc dance breaks? No insta or FB update breaks? Man … you should switch jobs. What about lorry driver? Or maybe circus clown. There’s shortage of clowns I’ve heard
Unfortunately, the Conservatives have been slowly running the NHS into the ground. When you compare the funding per person to European countries like France and Scandinavia we are way way behind. The NHS needs a Labour government but sadly people seem more upset by Schrodinger’s immigrant. One that simultaneously takes our jobs and claims benefit. Every election it’s the same old magic trick. And the people that need the NHS vote in their droves for projects like Brexit. Yes the NHS has flaws but non of them will be overcome by deliberate and ideological underfunding. It was on life support before COVID. A failing NHS is easier to privatize. Who will get the contracts? The Etonian chums of Tory Ministers.
I have tremendous sympathy for the challenging tasks that are being faced by GP’s on a daily basis.
At the risk of causing a storm I would like to make the following factual statements:
According to Fullfact.org in Dec 2019 we had approximately 35,000 FTE GP’s in England. https://fullfact.org/health/gp-numbers-or-down/
According to the timetable provided by the Author, the daily number of appointments expected to be undertaken by a trainee doctor is 14 Face to Face and 12 telephone appointments – a total of 26 appointments per day. For a qualified GP those figures are 21, 18 and 39 respectively.
According to NHS Digital there were 25.5 million GP practice appointments in August 2021 of which 12.252 million were undertaken by GPs. https://files.digital.nhs.uk/DD/3257F2/GP_APPT_Publication_August_2021.xlsx
From the above facts I would deduce the following:
35,000 fully qualified GP’s are scheduled to carry out 1,365,000 appointments per day.
The August appointments should take 9 working days to complete.
DISCUSS
If you are quoting FTEs then productivity is far less than 39 each day. However I would say you needed to factor in two things – vacancy rate, and August as a holiday month when some doctors are absent. Instead of using the 35,000 figure, this needs to be adjusted to actual.
I concede that there may be fewer than 35,000 FTE GP’s in August but 50% less?
FTE’s is Full Time Equivalents – the 39 appointments is for a full days work. Fullfact estimates the total number of GP’s at 45,000. I do not see any reason to factor for this.
Glued to the story as I am, I feel a certain frustration. It’s all narrative. One other piece of anecdotal evidence is: ‘The first thing you learn is you always have to wait’. GP consultations always overrun, if only to ensure that GPs never waste time by having a break. Having had a career in essentially operational and mathematical analysis and modelling, my first thought is ‘Where are the data?’ With the data, one can look for patterns, relate length of consultations, chronic re-prescription etc, to age, circumstances and seriousness and treatability of condition, characterise the urgency of conditions and the effectiveness of interventions. If this leads to triage and sounds a bit like Qualys revisited, so be it. In the end it is the outcome that matters, and that should be something physical (if depression and mental illness had no physical consequences they wouldn’t matter). I don’t know whether it still takes seven years to qualify, but GPs should not have to be social workers. They should have the space to focus on what they can do most effectively. Another small personal anecdote. My last of happily infrequent GP consultations concerned an unpleasant sinus condition following a heavy cold, that produced a taste of fish. This could readily be traced on the web to Streptococcus infection. The GP on duty (not ‘my GP’ any more) took well under 15 minutes to prescribe Amoxycillin with a separate adjuvant to suppress resistance. It cleared it overnight. So sometimes, things can work, and work efficiently. (PS I DID still follow the whole week course, though today the need for that is being questioned)