41 gp surgeries

I have lived in the same house and been with the same GP practice for 40 years.

I have seen the practice develop from three partners operating from a tiny house to a four-partner, two salaried-doctor practice in a new purpose-built surgery to a modern three-location practice with over 20 doctors and a multitude of different specialists including nurses and advanced nurse practitioners, respiratory specialists, pharmacists, paramedics who do home vists and deal with minor illnesses and infections, physiotherapists and social prescribers.

There’s an online triage system that ensures that a patient is seen by the most appropriate specialist.

I like is this way. I don’t see any problem having medical professionals who work part time so that they can have a better work-life balance.

Yes, I think perhaps you are struggling to move with the times.

I think with 20 gps there’s a chance that you might remember who you saw but 41 is beginning to feel very impersonal?

Interestingly do hospital doctors/surgeons also struggle to work full time? I imagine that working in A&E must be very stressful for the doctors on call. Bit of a mystery ….

Tin Soldier you're very lucky.

Ours now has 9 GPs, some part time, who serve 2 large villages. Since we moved here 30+ years ago there an extra 1200+ houses. We had 5 full time GPs then who served both villages. We now have a 6 week wait for a telephone appointment, followed by 6 week waits for any further appointments for results, etc - was 5 weeks a few months ago. There used to be all sorts of mother/child sessions, prenatal, antenatal, elderly, etc in the afternoons but those have all gone. There is a practice nurse but that's it. Neither of us have ever met a GP, even when we have had health issues.

ronib that sounds like our Practice too. As a child we had one GP in the village. You walked to his house, sat and waited to be seen, no appointment needed. He did everything, surgeries, home visits, delivering babies, prescriptions etc . as far as I remember later on a Nurse went in for a few hours to help out. This little practice covered about 5 villages as well as ours.

Years later it was taken over by a practice in a nearby town. There were about 6 doctors involved, a couple of nurses and one receptionist. Then a new health centre was built and we now have about 15 GPs nearly all part time, a whole team of receptionists, loads of nurses, a pharmacy, physios and a couple of paramedics who help out. Do we get a better service than we did in the 50s and 60s? Definitely not. We now wait a couple of weeks for an appointment and 7 working days for a repeat prescription.

Two of the full time GPs retired not long ago but alongside working there they ran a private cosmetic surgery between them and left their brochures in the waiting rooms which I didn’t think was on at all.

ronib are you sure there are 41 GPs for 33,000 patients, that seems an awful lot? I think the average full time GP has between 2,000 and 2,500 patients on their list, so even with a lot of part time GPs you seem very over-provided?

My GP practice has the same wait issues as most others but I am sure they try their best. It had over 30,000 patients (September 2023) with a mixed catchment ranging from middle-class to a high degree of social deprivation. There is a lot of new housing development too.

I don’t care who I see for ten minutes. With 30,000 plus patients, it’s unlikely a doctor will have anything but a passing memory of what ails a particular patient. My notes are there for any practitioner to read and proceed from.

Maybe the reason some doctors go into general practice is precisely so that they can work flexible hours rather than the punishing schedule that junior hospital doctors are expected to work. The majority of doctors in my local practice are now younger women who may have child care responsibilities

As for hospital doctors, who know what hours they work? Often, we only see them for an outpatients’ clinic that lasts a couple of hours. Many consultants work in both the NHS and private practice.

At least the BMA does now allow junior doctors to have 11 hours rest a day - which means they may work up to 13 hours. I’d rather not see a doctor who may be exhausted after a long shift.

Casdon I have counted the number of partners and salaried gps etc and to my surprise they came to 41! Of course they could be working one or two shifts a week. Over-provided it isn’t with appointments being suspended due to safe working limits. Quite the mystery.

TinSoldier given the huge number of possible human ailments, I would rather have the benefit of a gp who had the fullest experience and expertise rather than see one who had limited exposure due to very limited working hours.

That does seem like an unusual set up ronib. I assume if there are a large number of very part time GPs they are working other hours elsewhere - which could be a strength or a weakness.
If they are splitting their clinics so that, for example, patients who are diabetic attend a clinic run by a GP who specialises in that and works at the local hospital and other practices too, the service for that group will be excellent because he or she will have expertise.

To become a GP you need to complete:

• a degree recognised by the General Medical Council which takes 5 years.

• a foundation course of general training which takes 2 years and

• general practice specialist training which takes 3 years.

If you are seeing a fully-qualified GP who has had ten years of training it really doesn't matter how many hours a day they work.

TinSoldier and as one young gp once said - I don’t stop learning. The idea that ten years of training makes for a fully competent professional is debatable given the changes in medical research and practice.

GPs are generalists ronib. Even in smaller practices they specialise, they always have. I think you’re suffering from a case of the golden glow of the past.

Casdon well yes and no - the golden glow of the past is preferable to misdiagnosis and mistreatment! At least I live to become the subject of a research paper!

Lucky you. 41 Drs for 33,000 patients. We have 10 ( all part time) serving 23,000 patients.
We can usually get an appointment for same day ( or next day)

petranot lucky at all. Wrongly diagnosed for years, fobbed off with exercise sheets and just recovering from major surgery. Thankfully on the mend due to the skill and expertise of robotic surgery plus brilliant surgeon.

Do people have the NHS App and know how to use e-consults? Hope people know they can access lab results, consultation records, medication, vaccination history, documents etc etc etc via their NHS App with a click of a button or (even easier ) using face recognition .. .....
It doesn't solve everything but it is an useful tool.
If there's a problem you want to write to the surgery about, you can use e-consult in the first instance, in England anyway. Not sure about Scotland and Wales.
Triage lists are often run by Advanced Nurse Practitioners who can assess and prescribe and they'll refer to the GP when needed. One thing though.....I think it's vitally important GP practices offer clarity as to who a patient is seeing.....at what level - it's too easy for patients to assume it's a GP when in fact you've seen an ANP (they don't wear nurse uniforms). ANPs are a great asset and work hard, are skilled and committed - but patients should be left in no doubt as to who exactly they are, and introductions should be 100% clear.

ronib

Casdon well yes and no - the golden glow of the past is preferable to misdiagnosis and mistreatment! At least I live to become the subject of a research paper!

One generalist GP serving a local population in the past wasn’t necessarily a better or worse GP than you would see now though ronib, unfortunately there have always been misdiagnoses. In a good general practice the specialisation of GPs now actually means you’ve got a better chance of being diagnosed correctly. I know that is no help when you personally have been misdiagnosed though, and of course not all practices are good.

ronib

Interestingly do hospital doctors/surgeons also struggle to work full time? I imagine that working in A&E must be very stressful for the doctors on call. Bit of a mystery ….

I can answer that question for you. My dd is an A&E medic. She has been working ‘part time’ which in her Trust is considered to mean 38hrs p/w. Most jobs would consider 35/38hrs to be a full time position.

This week she’s worked four 10 hour twilight shifts, back-to-back. Of course, you don’t just walk away as your ten hours ticks up. You carry on dealing with your current patient and then you have your handover, which can be anything from 30mins to an hour. She’s working these so-called reduced hours because working 70+ hours a week during Covid broke her, both physically and mentally.

These sorts of hours are why doctors are leaving. It’s just not compatible with any sort of life outside work. Unless you know exactly how many hours each GP works, the term part time is meaningless. It may be that your GP’s are working 4 days a week, which likely will be 8am-6pm but still counts as part time.

GP’s, too, are under much more pressure nowadays. The population is older, people have more complicated conditions and patients are more demanding. Many of the patients my dd sees, and will be seen by GP’s too, actually have social issues, not physical ones. Poor housing, living on a pittance, addiction problems, lack of community. Few of these would be seen by a doctor 50 years ago but they’re rife in certain areas now.

Casdon but it seemed perfectly obvious to me that gps had their hands tied in my particular case. In order to accurately assess me, I needed an ultrasound and ct scan. My particular surgery doesn’t have this equipment and the default position was a fob off with exercise sheets. Some 4,500 women die each year from ovarian cancer and it’s avoidable.

One thing though.....I think it's vitally important GP practices offer clarity as to who a patient is seeing.....at what level - it's too easy for patients to assume it's a GP...

I went for an appointment at our surgery and was told,
"You'll be seeing Dave today," in a manner that implied he was a good thing.
Dave turned out to be a very pleasant and efficient paramedic practitioner, who I was indeed perfectly happy to see 🙂

ronib

Casdon but it seemed perfectly obvious to me that gps had their hands tied in my particular case. In order to accurately assess me, I needed an ultrasound and ct scan. My particular surgery doesn’t have this equipment and the default position was a fob off with exercise sheets. Some 4,500 women die each year from ovarian cancer and it’s avoidable.

I’m not aware of any GP surgeries having CT scanners? The point I was trying to make is that in a big surgery there would usually be at least one GP specialising in gynaecology, and you would have a better chance of being referred sooner to a consultant because of their specialist knowledge. Obviously this didn’t happen for you, which I’m sorry to hear. I don’t however think the old system with a single GP would necessarily have meant you were seen any sooner by a consultant because referrals from GPs without a special interest are often less detailed and specific about whatever the issue is so patients wait longer to be seen.

The A&E doctor that DD knows worked 72 hour weeks during Covid and all the staff were given counselling to help them deal with what they were doing. It's not a work load you could carry on with indefinitely.

Another thread to complain about GPs.
When you’ve done the job yourself, then complain!