GPs under pressure
The most effective treatments for many patients is the face-to-face reassurance that only a good GP can deliver. But, in today’s NHS, this is disappearing fast. I have been struggling for days putting together this article. It is about GP surgeries run by people that I have idolised all of my life. GP doctors in the NHS have become far too overloaded. They become demotivated and leave. There is a shortage of GPs in Kent to staff all the surgeries.
Layers of administration
Some small surgeries have survived but many are under pressure to join together in the name of efficiency. These large merged surgeries have become fortresses with layers of admin, call handlers and complex web based forms between the patient and the doctor. Each of these hurdles has to be cleared before patients can contact a doctor, and then it is mainly via a phone call. And Covid has made eye-to-eye contact such a rarity for many.
Old people can easily give up. They often have little experience of modern communications, smart phones, and screens full of *required fields. They do not understand the intricacy of the hierarchical structures within the practices, And sometimes they will die alone.
For others, the difficulty in getting appointments results in patients experiencing delays. Some become impatient and even the conscientious caring doctors receive abuse.
Fragmentation and privatisation of the NHS
I am not questioning the integrity nor the caring nature of our doctors. What really concerns me, is the restructuring of the NHS into large clinical commissioning groups (CCGs). Each CCG controls a bunch of GP surgeries, and an average of 226 000 patients. I am suspicious of the fact that their administration is sub-let to vast American-style admin groups like Virgin Care, which is a private company providing services paid for by public funds. So close to a privatised Primary Care in our NHS!
I also remember the rather cynical quote attributed to Aneurin Bevan, the founder of the NHS. When Attlee reputedly asked him how he was going to convince the doctors to join the NHS, he replied, “I’ll just cross their palms with silver, that should do it,” and it did.
GPs are not in fact NHS employees but independent business managers running their own operations. But many financial decisions are not under their control. Such as the per-patient NHS payment to the practice, the drugs they are allowed to prescribe, the services and treatments they commission for patients.
If your doctor is staring at the computer screen for most of your appointment time, it is because he is looking at all these parameters. There is a huge NHS database (NHS digital) which is used to formulate the parameters laid down by the CCGs. There is a national body, NICE (The National Institute for Health and Care Excellence), which makes decisions about the most cost-effective medicines.
Rating Our GP Care
I would rate my own surgery as “not good enough”. The rating on Google gives it a star rating of 1.7 out of 5 and I think that is generous. It has 27 000 patients and the average waiting time is four weeks for those lucky enough to break through the barriers to get an appointment. It has accumulated this vast number of patients over a number of years by taking over or merging with several smaller surgeries.
These very large CCGs are like limited companies. My own group has another similar group of the same name in Maidstone, Kent, 50 miles away, run by Vine Medical.
CCGs have “partner doctors” whose salaries are self-regulated and paid out of the funding allocated to the surgery. They also have “salaried doctors” who are junior in rank and employees of the CCG but paid in accordance with rates set by the NHS. The Vine Surgery in Maidstone has three partner GPs and 13 part-timers, all in a timetable of working hours available on their website. On average they receive a pre-tax pay of £60 000 per year.
Further restructuring also involves Primary Care networks (PCNs) set up since 2019, designed to link GP surgeries to specialist professionals for mental health, adult social care and so on within each locality, or the area the CCG covers.
Brexit, the pandemic, and a severe shortage of NHS staff
A lot of NHS staff, including doctors, left the country thanks to Brexit. And there is definitely a severe shortage of doctors, as was evident during the height of the Covid pandemic, when old, retired doctors were asked to help. Are they still working? Are they now part of the Johnson “increases in NHS staff”?
Being a doctor can be a physically draining job and is being done excellently by many truly good people while people like me may be guilty of over-exaggerating their deficiencies. I just don’t know and I hate to think the worst of people.
Doctors are regulated by the General Medical Council (GMC), a panel of doctors, who control the register of those who are allowed to practise clinical medicine in the UK. GP surgeries are inspected by the Care Quality Commission (CQC) teams, who use the criteria of “safe, effective, caring, well-led, responsive.” The CQC rates my local surgery as “Good”.
I only know that I would not be a doctor myself for twice the money they get and I also know that what we have today is significantly worse than it was only 11 years ago. Worse for doctors and worse for many patients like me.
