Is the government trying to break the GP service?

There is some logic to extending GP opening hours, if the money is there to pay them and the ancillary staff that would be needed (especially in rural dispensing practices)- but what makes me so cross is the way it seems to be done. Could the government not have sat down with the RCGP and discussed the possibility; and organised some consultation with GPs on the ground. The whole tone of this proposal is threatening and confrontational, which is wholly unnecessary. I am sure that all GPs are keen to offer their patients the best possible service and also want the NHS to thrive. They are being treated like naughty schoolchildren who are not coming up to scratch and this makes me sick.

Interesting to read things from your perspective mumofmadboys.
In our area we can call a private GP to do a 30 minute home visit for £130 before 5 pm and £180 after 5 pm and at weekends. That makes me think my GP at the surgery should be paid at least £400,000 per annum for the hard work he does. I think Jeremy Hunt might have a coronary!

I am married to a retired GP by the way. It was a rural practice and for many years he was on duty every day (with one weekday off), every other night and every other weekend. This worked out that every other week he was on duty from Thursday morning (two surgeries, then visits, finishing at about 8 pm), then on for the whole weekend (day and night) and then did the whole of Monday (two surgeries, then visits and finish at about 8 pm). This was madness and we had no family life at all. In some ways it was worse for me, because I could not move from the house as I had to man the phone when he was called out - at least he got to drive round the lovely countryside a bit!!

So....the new shorter working hours for GPs are a good thing. My OH's health deteriorated rapidly under the stress and he had to retire from the NHS at the age of 42, but continued to do locums and one surgery a week and some work for the benefits agency. I leave you to imagine what this did to his pension!

But how surgeries are going to cover all this extra care I do not know and if this is not properly organised students will be put off GP as a career.

It is to be hoped that the out of hours might appeal to GPs wanting to work part time for whatever reason (family, or running down towards retirement). But, as I said upthread, why does it have to be so confrontational? I am sure there is no lack of goodwill from the GPs to give a good service.

As I have said, ours is a training practice and we often have medical students sitting in with GPs. They will often take a history from you in another room while your are waiting for the doctor to see you. Over the course of the past year, I have seen five of these students, and three out of the five have said that when they have qualified, they will go home to their own countries and practice. Some of them may not have intended to become GPs anyway; they are "covering the ground", so to speak, but given that there are only so many training places available in universities, how many of the ones we are training (whether home grown or not) are leaving these shores to practice elsewhere? Where are the incentives to persuade them to stay?

There is no "of course it will take pressure off A and E" Rosesarered
There are two main categories of Gp appointment - the urgent and the non-urgent.
Urgent are caused by things like ear infections, chest infections etc. They need immediate GP treatment normally, and occasionally referral to hospital. If the need is out of hours then there are out of hours GP services in all areas which will result in the patient seeing the GP at home or in a surgery, within an hour or so.
If you need emergency GP service out of hours, then you call your GP, listen to the answering machine message and call the number as instructed, or go to the drop in centre. If the GP is worried they can send you to A and E.
There are an awful lot of non-urgent things concerns that people take to their GPs - anything from failure to get pregnant, to a funny looking mole, to a verruca. We could all think of dozens of examples. It would be very rare for one of these to result in an emergency admission.
GPs have to manage both of these. People who commute, or who have really busy work diaries would like, ideally, to be able to book an appointment on a Saturday, or first thing in the morning on a day when they can go into work late. People who don't commute are normally happy enough to take an hour off work in my experience.
Bullying GPs and imposing one-size-fits all London-centric solutions is not going to help A and E, but is surely going to alienate even more GPs from this government.

I had a GP appointment on Christmas Eve. Strangely enough, this was the easiest time to get an appointment and it was so quiet that the GP could spend half an hour with me. This seems to give the message that many appointments aren't so urgent after all.

I doubt if many people would see their solicitor or accountant on a Sunday, so I don't see why they expect a GP appointment on a Sunday for something non-urgent.

Ours is a rural practice with a massive geographical spread. Getting appointmentsIs a nightmare but to be fair they are using telephone triage a lot now which is good and effective in my book. Out of hours is a problem with no buses and the nearest walk in centre requires a car to get there. When surgeries are 'closed' there are mountains of paperwork to complete, staff training and so on. Ambulance cover here is sparse to put it politely and a friend recently spent 2 hours on the floor outside with a #nof and no pain relief.

I feel radical action should turn all those away from a/E unit if they are neither an accident or emergency. Drunks should be triaged more effectively even if this involved the judiciary services. I speak from experience of working in A/E over bank holidays when we had to put mattresses on the floor, wear waterproof coverings to our feet and hose the floor down. That's after avoiding all the spitting, fighting, swearing and fists.

This whole subject is a nightmare and it's going to take much more than one political party + or - funds to sort out.

In the small town where I lived, they still have the 'lock up' where drunks were put until they'd sobered up.

Unfortunately the option to turn timewasters away from A&E is not viable in this newly litigious society; and there is the same problem with 111 - their algorithm for each condition errs hugely on the safe side and sends people in to A&E who could have waited till the next day.

Exeter Hospital is triaging patients at the door and sending away non-urgent "timewasters." As you say, * Luckygirl*, this has big flaws. DH was turned away, sent home with very strong painkillers for stomach pains. 24 hours later when the drugs wore off he staggered into the GP who shouted "classic symptons of appendicitis, get yourself to A & E this minute." His appendix was nicrotic, he had to have the strongest antibiotics known to man and took weeks to recover. It could have been fatal.
Not impressed with this idea.

Ooops ... necrotic.

If the need is out of hours then there are out of hours GP services in all areas which will result in the patient seeing the GP at home or in a surgery, within an hour or so.
I don't think that happens in all areas; you can wait a long time for a nurse to phone back, then the nurse may think it is necessary to speak to a doctor resulting in another wait before the doctor phones back and he/she may eventually make a home visit.
A 999 call results in a wait for a nurse to phone back and go through a triage assessment to ascertain if it is urgent (ie heart attack or stroke) and a further wait for an ambulance if it is not considered so urgent (like a broken limb).

My friend's DD did all the GP training before deciding it was absolutely not for her; she preferred to specialise. It was better to make the decision then rather than to struggle on in a job where she was not happy.

There does seem to be great variation in GP practice hours from town to town even practice to practice.
I agree it's unfair to blame GPs for the ills of the NHS ( no pun intended ). There is no joined up thinking between NHS, Social Care, GPs which would surely help. We gave much greater expectations of all these services now so we must be prepared to pay more for them.

When iwasyourage,my daughter had to drive over 20 miles on her own with her 10 day old baby who had breathing difficulties(we were out of the country and she had no one else to go with her as dad stayed with the other kids) THAT cant be right in anyones book.She was worried sick and the advice given ,keep flicking babies feet when her breathing stops ,just made her worse,its not such a simple thing to do on a motorway !!Lots of other professions work shifts I dont see why GP's cant ,their family life isn't any more important than anyone else's

Jalima in that case the out of hours system needs fixing in some areas, not more appointments for non urgent worries and ailments.
There does seem to be a wide variety of out of hours provision - and some of it is presumably, now, being run by private companies.
www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/nhs-out-of-hours-services.aspx

Yes, there is a wide variety of provision. We don't have a 24/7 out-of-hours service apart from 111. I've never used it, but I understand that people are generally advised to go to A & E.

paddyann, If your daughter had a child with breathing difficulties, the right place for the baby was A & E. A GP couldn't have done anything if it was that serious.

Fair enough for GPs to do shifts, but how many hours can they work safely? If they are to cover nights and all weekends, they cannot provide a full service at other times without the money to employ extra doctors, nurses, receptionists and pharmacists (if they're a prescribing practice). I would rather their time were used efficiently with an OOH service covering a number of practices for emergencies.

I think some people forget the responsibility a GP carries. Regardless of how many actual hours they work, they very often take patients' worries home with them at night, for example, I know my cousin has trouble sleeping for worrying about his diagnoses. You may say they knew that when they chose to become a doctor and I agree their family life is no more important than anyone else's, but if a GP ceases to care because he/she is too tired, too frustrated, then we will all be in trouble.
Being a doctor has one of the highest suicide rates compared with other jobs.

Our GP said once that he didnt used to sleep well because of my family[very bad asthmatics at the time]. I was alarmed about him and for him. I tried to reasuure him that if anything did happen, we could and were coping.
[I most certainly did not want our family to affect his care for all his other patients. I hoped my talk did the trick for him at that point].

What a strange thing for a GP to say to a patient...

What a strange post (not you Ana)

Lillie, you are so right in reminding all of us about the responsibility GP's carry. I find it hard to believe but reluctantly have to accept I have chronic and complex health problems. My GP manages the various consultants involved. I am and will remain, eternally grateful to our GP practice for the level of care our family receives from them. The notion they should be given responsibility for operating 7 days a week 12 hours a day in surgery, alongside all their other responsibilities if frankly bonkers. We'll drive our NHS down he drain, in the same way our other public services have been driven.

Yes, we will. Even fewer doctors will want to become GPs and we'll end up paying for all visits. I believe it costs about 40 euros for a vist to a GP in Ireland, unless patients have a means-tested healthcard or are over 70.

How much do plumbers and electricians charge per hour? I suspect GPs will charge more.

There is a private GP practice near me, which charges £85 for a 20 minute appointment. It's not open in the evenings or weekends. All tests and prescriptions are extra. Two of the doctors formerly worked in my practice.

If that's what people want, count me out. I couldn't afford it.

People in the Republic of Ireland delay going to the GP or put if off for a while, because of the GP charge.

My mother remembers the plan they belonged to as children, they paid a local GP a weekly sum as an insurance, I'm not sure how it worked and what would have happened if they needed hospitalisation.

There is only a very small percentage of the population that has access to private health care. Not sure how they are going to sell it to us all, and goodness knows how us ancients could possibly afford it.

The GPs around here formed a consortium and won the bid for the out of hours service. It is housed at Macclesfield General Hospital which means it isn't readily accessible to patients without their own transport, but it is well used and has the advantage of being comprised of GPs who know the locality and each other.

JessM - the out of hours system is variable. Where I live, the call handler usually tells you there's nothing wrong with you. If you make a fuss, you will get a call back from a nurse a couple of hours later, another fuss, and then a call from a GP who, if you're lucky, after several hours wait, will send a prescription to an out of hours pharmacy or tell you can attend their service around 45 minutes away. If it sounds serious to them, they will tell you to call an ambulance. I think they are pointless. The nearest walk in centre is around 1 hour away. The local A&E has an Urgent Care Centre which is really good, which is where I go outside GP hours for urgent care.