We are watching the demise of the NHS with our eyes wide open.

On average it costs £220,000 to train a doctor over their five-year degree.
Most of the training is paid for by the government but some tuition fees - plus rent and living costs - are paid for by the student.

The article is from 2016. 5 years ago. No doubt it will cost more today but how does 9 grand a year cover it?

Please explain because I'm totally bewildered

I missed a zero! My bad.

BUT surely, the doctors are working for a large part of that time (the 9 years) so surely, although there is a cost ratio, there is also a profit ratio?

Having worked for the NHS with a gap of 30 years in between employment with it, I can say that once they began to run it as a business and employed chief executives with ridiculous salaries , plus their assistants and assistants assistants and making the admin side top heavy, that the troubles began.
I dread to think of the amount of money that has been spent and possibly wasted each time that EOs leave their jobs, for a variety of reasons and they leave with the "golden handshake" of a years plus salary that could have been spent on patient care.
About GPs. In my area several GP surgeries have closed often through the retirement of GPs and other nearby surgeries have taken on the patient list, therefore stretching the resources of that new surgery.
All very well for the government to throw money at the NHS, but they reduced the number of places at medical schools, so the hospitals are short of doctors and a GP must work as a hospital doctor for a number of years before training as a GP - so if there are not enough hospital doctors in the first place, where are the new GPs coming from to replace those that have retired ?
Yet another lack of planning along with the skills of HGV drivers and abattoir workers, skilled agricultural workers that are expected to appear fully qualified from somewhere!

We do indeed have a perfect storm brewing.
Since 2010 the way in which money has been distributed within the health service changed in lots of ways. Maybe the government has injected large amounts of money, but if that goes towards creating new layers of management, it will not be improving waiting lists.
Aneurin Bevan had huge obstacles to face when he wanted to get the NHS started.
Most of the opposition actually came from the GP's, who feared loss of income at the time.
The Tory party has always been annoyed and irritated by the NHS ever since, whilst publicly praising it and this has become more obvious since the start of the pandemic.
The general public still believe that the NHS will always be there and often refuse to see what is happening.
Maybe they expect there to be some sort of announcement to say on a certain date there will no longer be a service providing free care to all at the point of need.
It will not happen this way, it will happen softly and quietly by stealth, to the point where people will just believe it was the result of the pandemic.

Scones

And the Conservatives are still ahead in the polls.

What ever is wrong with us?

I know, WHY?? I can’t understand it!

As a very heavy user of our NHS, I have seen with my own eyes the deliberate underfunding policy of the Tories since 2010, it was just getting to be quite good and then we had that change of government and it had gone downhill rapidly since in the hope that they could flog it off to the US and their mates …. They wanted it to become so bad that we, the ‘great unwashed’ wouldn’t complain when they actually did it as we wanted it to improve. Then came COVID-19 and Boris’s dice with death and the country fell back in love with the NHS and hence it will make it much more difficult for them now, hopefully!

The NHS saved my life 10 years ago. A swift and aggressive cancer. I had great treatment. Yes, long waits for chemo, because the nurses were so overstretched. AND a two month wait for my cancer surgery (agonising wait). And chaos, around the arranging of chemo and radiotherapy.

BUT I lived due to that treatment. A friend in the US with a pay-for system died. My treatment was comprehensive. Hers wasn't.

To think that service won't be there for my DD and DGS is unbearably sad and also very frightening.

N.B. If this is too long a read, just check out the last paragraph. It shows why the NHS is struggling. Also please see the fact regarding GP earnings.

I can't answer all the individual points raised in this thread and would like to stay apolitical but thought that you may like to know some facts. Hard facts.

General background:
General practice has faced a decade of under investment.
Patient consultations are increasing as the population grows.
Patients are living longer with more complex health needs.

Comparison to previous years:
In 2017 the NHS gave 8.1% of the NHS budget to general practice.
This was significantly less than the previous decade (in 2005/6 general practice received 9.6%).
To equate the same figure for 2017/18 the investment should have been just over £12 billion. It was not.

Relationship between investment and GP earnings:
Although GP investment increased each year, GP earnings have decreased.
Example: Between 2012/13 and 2013/14 GP investment increased by 4.7%.
This is because whilst GP investment has been increasing, the total cost of expenses has also increased but at a much faster rate.
Between 2015/16 and 2016/17 GP investment increased by 5.7% whereas total expenses increased by 8.5%.
These steep increases in expenses therefore impact GP income and do not allow increased investment to be translated in to increased earnings.

A significant boost to general practice funding generally is needed.
I repeat: GP earnings decreased by 3%.

Health spending as a share of GDP:
This remains at the lowest level in a decade.
As a share of GDP, spending on health in 2018/19 was roughly the same as in 2011/12 and only marginally above that of 2008/09.
This is as a result of low growth in health spending which has risen by 1.6% a year on average since 2011/12.
This is less than half the long-run trend of growth in health spending which is 3.6% a year in real terms.
In 2018/19 the UK spent around £153 billion on health, at 2019/20 prices.
On average health spending has increased by 3.6% a year over the history of the NHS as a result of growing population, prevalence of chronic conditions and rising cost of delivering care.
However, over the past decade, the spending on health has slowed to just 1.6% a year since 2011/12. At that point health spending was 7.3% of GDP, a drop since its highest level of 7.6% in 2009/10.

Due to low spending growth since then, the NHS has grown at a similar rate to GDP growth and now stands at 7.2% of GDP.

In terms of growth as a percentage of GDP, the nine-year period since 2009/10 is the lowest since the first decade of the NHS.

Yes that absolutely confirms the opinion that th3 Tories are running it into the ground.

We need to invest in more places at medical schools. We need more doctors now and that need is only going to increase in the future.

In the short to medium term we need to allow more doctors to come here. But we also need to train more doctors in this country.

We have many able, well motivated and well qualified school leavers applying to study medicine and being turned away for lack of places and so we have to rely on more foreign trained doctors.

That in turn means depriving other countries - often more in need of doctors, of their own trained people, which makes no sense.

One of our closest friends was our GP for thirty five years, having come here from a third world country. His work has benefitted our country, but at the expense of his home country.

We need more places at UK medical schools, even if it means a reduction .in places for other subject areas.

Thank you Candelle for your extremely informative post. Thank you also for putting a few of the often believed myths about GPs firmly to bed. I mentioned in an earlier post that GP pay has decreased, and I mentioned my daughter whose income fell over the last few years. For some reason the general public are reluctant to believe that the pay of GPs has declined, and I have seen/heard it suggested that the payments for delivering the flu vaccines at GP surgeries is paid directly to the GPs and it’s actually the nurses who do the vaccinations. This has been suggested with great indignation. I have explained that payment for vaccination services is not paid to individual GPs, but to the surgery and along with other funding is used to maintain the buildings, employ staff such as nurses, care assistants, paramedics, Practice Managers, cleaners, maintenance teams etc.

Good post varian.

Thank you for a very informative post, Candelle.

I got into trouble here when I last mentionned this, but here goes again. A huge proportion of GPs work part-time. Now there is nothing wrong with this, and it is a legitimate choice.

However, Government planning and calculations have been done on the basis of GPs working full time. You don't have to be a mathematical wizzard to work out that you need a lot more GPs if a large proportion work part-time. And it cost the same amount to train a doctor who will work full time, or part time.

Totally concur with your viewpoint Kali2.
This is becoming a habit.
I must up my game.

I felt appalled at the treatment my poorly neighbour has received, I saw her today. She is 85 and has just come out of hospital with an inflamed gallbladder and suspected stones. She is now on oral antibiotics, having been on a drip for five days.

On Tuesday she felt so nauseous she couldn't function. She rang our local health centre for a telephone consultation and was told they were all booked, and to ring 999.

She said she was nervous to do that as it wasn't an emergency, but the receptionist said to phone them. When she got through to the emergency call handler she told her off for phoning, but did take a tick list of details.

A few hours later at 5.30 pm she received a call from the doctor, telling her a prescription had been sent to the chemists which closed in 30 minutes. She said she couldn't drive and had no-one to collect it - the doctor told her to 'sip water'. Her daughter lives over an hour away, luckily I was around and able to get them for her.

Poor lady. Where is the compassion these days?

Shandy57 and Urmstongran this is typical of a service that just cannot cope and demonstrates how thin the NHS veneer is.

The lady in question was prioritised (whether you believe it or not) and rung at 5.30 pm as that became her slot: others must have had higher priority (all calls are triaged at a GP surgery).

Urmstongran, although a dreadful situation for this lady, what do you mean by 'where is the compassion these days?' Everyone had done their bit (although not entirely satisfactory - there are not enough GPs) and the problem was the timing.

As to the sipping water instruction, this must have been the best advice. I have had gallstones and know that anything remotely rich could upset them!

Perhaps the lady in question could have rung her chemist and asked them to deliver the medication?

Whatever, compassion did not come into the equation and I hope you didn't mean that the GP should have left her/his surgery, driven to the chemist, probably waited to collect the medication and then have driven to her patient before returning to her other patients at the surgery?

That may have been the case in days gone by but is just not possible now. Had I been the lady, I would have been very upset in her situation but we all have to acknowledge that there are not enough doctors.

Did you know that there is a service run by the Royal Voluntary Service (previously known as the WRVS) named First Responders'. They will act in exactly this situation. Their telephone number is: 0808 196 3382.

Perhaps you could pass on this telephone number to the elderly lady for future use.

According to news reports this week a GP working part-time works 40 hours a week. In most people’s work 40 hours is a full time job.

My hospital-based medic dd regularly works 75+ hours a week. I would not want to be the person rushed into A&E who is then seen by someone on their 75th hour of night shift work.

Thanks for the number Candelle, I'll pass it on, although I wonder if we do have anyone here in Northumberland. I told her I'd always help her as much as I could, but it was the straw that broke the camel's back as she now feels so frightened on her own. She told me yesterday she feels so weak and wants someone on hand to help her, she is going to look at going into a nursing home.

She had already had a carer assessment which starts on Monday, someone is coming for an hour and a half at £22 per hour to help her shower, and hopefully make her lunch, she can't be bothered to feed herself anymore.

I feel really sad for her, she had hoped to live out her days in her family home.

SueDonim

According to news reports this week a GP working part-time works 40 hours a week. In most people’s work 40 hours is a full time job.

My hospital-based medic dd regularly works 75+ hours a week. I would not want to be the person rushed into A&E who is then seen by someone on their 75th hour of night shift work.

Exactly SD. I know my GP of choice (haven't seen him for years, he's very booked up) works part time.

His car is at the surgery by 7am and he's frequently there after 9pm on his working days (I'm not a stalker! I drive past the surgery). He's a very good doctor and I trust him with my life. I'm GLAD he doesn't work more. As it is, in the 10 years he's been there, he has aged a good 20+ years. He was a handsome young doctor when he joined. Now he looks careworn.

How many hours do you think is reasonable for a GP to work Kali? We UK teachers work 60+ and I can assure you THAT isn't reasonable.

UrmstonGran An excellent post?????

Urmstongran

The fact remains most GPs work part time. Huge capacity that we paid to train not being used.

Surely that’s because many GP’s are women and it’s a good way of allowing highly skilled people to have families but still continue with their career. I actually think that telephone consultations are the way forward. GP’s can deal with far more consultations and, in many cases the GP’s role is to decide if a hospital referral is necessary. It’s a pity that so many walk in centres were closed down as they took a lot of pressure off surgeries and A&E.

55% of GPS are female
90% of GPS work part time in general practice.
However, it grates on me that people assume that because they are part time as GPs, they aren’t working elsewhere in the NHS for the remaining time, when most of them are. They keep our community hospitals going, they work as clinical fellows in different specialties in hospitals, they run the out of hours GP services, they train medical students, they operate as GP management support in community frailty services etc. etc. Has it ever occurred to people why they don’t sit in a GP surgery for 10 sessions a week?

My recent experiences of the nhs and care sector have been appalling too. In my area carers are not available even if one is assessed as necessary. I have not been able to get a carer privately either. There are no gp appointments for at least 2 weeks - ever. The district nursing emergency night team take at least 3 hours to arrive from phoning and the 999 call has taken 8 minutes to pick up even. Sometimes telephoning the surgery can take all morning as first one must get onto the telephone queue. Happily during lockdown a caring support group formed for the vulnerable. I have found them invaluable - the way forward I suspect is to form your own community support groups. That would have been useful for shandy57’s elderly neighbour.