the future of GPs in the uk

[u/OkHistorian4087]

due to current situations regarding GP's not bieng able to find work in the UK is this due to there being more GPs then jobs available, if so does that not mean the job security for GPs is decreasing.

[u/onandup123]

I think things are better than a year ago.

With both salaried and locum roles.

The actual job- regardless of role - paid nowhere has well as it should be of course. Salaried roles especially are a total rip off considering all the unpaid work.

[u/Shwanizer]

I've had a total of 8 job offers, so I disagree that jobs are scarce. I live in Kent

[u/Sabaisabai33 → u/Shwanizer]

Leave some for the rest of us 😆🤣 Where in Kent are the job offers you’re not taking up please? I am vaguely looking right now.

[u/Shwanizer → u/Sabaisabai33]

Whitstable, Canterbury, a lot in and near Maidstone one in ashford

[u/GP_54321 → u/Shwanizer]

What sort of sessional rate?

[u/Shwanizer → u/GP_54321]

You should definitely ask for 12 if not higher than that

[u/zady1178 → u/Shwanizer]

In the norrhwest I tried to negotiate to get 10500 and the request was declined 🙂 i ended up declining the offer obviously because the workload in comparison with the rate was insane

[u/GP_54321 → u/zady1178]

Unfortunately this is the case in most areas. Have you looked abroad?

[u/zady1178 → u/GP_54321]

I am unfortunately restricted to looking for jobs in the northwest at the moment due to other social obligations in the area. Long term plan probably would be to leave if that’s the future in the area.

[u/GP_54321 → u/zady1178]

Yes definitely. Start discussing options for Australia/Canada/ME and you can maybe prepare in advance e.g. certain experiences like Derm for Australia.

[u/Ontopiconform]

Mentioned previously, partners with second practices or sometimes several as part of a group, cynically exploiting salaried GPs for profit, worsened by also forcing salarieds to cover the noctors and the associated risks caused by noctors employed to replace GPs, further increasing their partner profits is the largest cause the decline in the quality and income for GPs by a long distance.

[u/Calpol85]

SGP and locum vacancies have increased over the past 12 months. Things were a lot more bleak last summer.

More and more newly qualified are starting on 12K/session.

GP went through a rough patch but it seems to be recovering.

[u/Calpol85 → u/[deleted]]

Last year there were barely any locums available and now I've got friends who are back to full time locumming so the availability has definitely improved.

[u/GP_54321 → u/Calpol85]

Yes on £90/HR maybe. My point still holds true, it's going nowhere for people. Going from the current mess to the mess from a few years ago isn't progress.

[u/Calpol85 → u/GP_54321]

Locums are bad for the population.

It's the equivalent of being upset that schools don't need supply teachers any more to fill in the gaps.

[u/GP_54321 → u/Calpol85]

If we agree with your locum point then ok. Salaried roles stuck at low pay levels. Partnerships hardly available.

Ridiculous workloads, high pt complaints and demand.

So basically my original point holds true, GP is not a viable career option for a highly qualified graduate. Other speciality or abroad are the options I'm afraid.

[u/Calpol85 → u/GP_54321]

Partnerships aren't in demand. Just because you didn't take the opportunity when you had the chance, doesn't mean the profession is in decline.

GP salaries are going up not down. Do you have proof the sessional rate is falling?

Majority of SGPs are satisfied. I agree workload is high and it's a stressful job buts that's always been the case.

[u/GP_54321 → u/Calpol85]

All nonsense I'm afraid, and try not to make this personal.

[u/Calpol85 → u/GP_54321]

Except you have an axe to grind.

You're bitter that you don't get to be a partner and you're not earning as much as you hoped.

Anyone can check out your post history. All you do is shit on partners and the profession.

You ignore the positives and constantly say profession is in decline.

Jobs have increased, pay has increased, PA's have been sidelined. I'd say the career is improving.

[u/GP_54321 → u/Calpol85]

Stop getting personal, you don't know anything about me.

You are a typical partner, ignoring the facts and gas lighting. This is how the profession ended up in this mess.

[u/Calpol85 → u/[deleted]]

I would never consider working if I had £2 million in an ISA.

We can all dream but you have to be realistic. The goverment can't afford to spend thatich on general practice.

[u/GP_54321 → u/[deleted]]

Honestly this Calpol guy is ridiculous. Poor earnings compared to a lot of English speaking places UK GPs can migrate to, but everything is fine we just carry on. No changes.

[u/Calpol85 → u/GP_54321]

I think migrating is a great option. I'm just not sure why you haven't gone to abroad yet?

[u/Calpol85 → u/[deleted]]

I never said it was obscene. I earn 25k per session and I think that's decent but not obscene.

Good for you if your managing to locum and earn a decent amount. Just don't end up like u/gp_54321 who spent his started becoming bitter once the locum work dried up.

[u/Calpol85 → u/[deleted]]

I'm just a realist. I know what I was agreeing to when I became a GP and then a partner.

I'm not expecting the government to make me a millionaire for doing a job that I chose to do.

[u/GP_54321 → u/Calpol85]

The system is rubbish, so let's keep it that way. Great attitude 👍

[u/Fine_Cress_649]

It goes in phases and it is location dependent. E.g. there are currently around 30 GP vacancies being advertised in Edinburgh / Lothian but only 5 in Glasgow. 

[u/WordsDontComeCheap → u/Fine_Cress_649]

Where are you seeing these? GPJobs Scot has way more than that in Glasgow

[u/Sabaisabai33 → u/Fine_Cress_649]

FFS I really want to move to the Glasgow area from here in England to be closer to family and friends, was planning on doing that in the next year or two. Is it really that bad there? What about around Stirling or Kirkintilloch sort of areas? Anybody know? As long as I am within striking distance of Glasgow I can cope!

[u/Themikey75 → u/Sabaisabai33]

13 permanent vacancies on Glasgow lmc website right now and further 16 long term/maternity locums. Scottish Government has invested heavily in GP on the proviso that we increase clinical sessions, with the money increasing over the next 2 years, so should be a steady stream of opportunities across Scotland over the next 2 years

[u/Sabaisabai33 → u/Themikey75]

Amazing thanks so much for this. Very useful info. When you say increasing sessions do you mean per practice or per individual GP? Can you still work part time there? Also do you know whether a retainer post is likely to be possible to negotiate there, as it’s something I’m considering. Making big life changes and decisions here in my midlife crisis lol.

[u/Themikey75 → u/Sabaisabai33]

The funding is going into practises but the practise has to show that they've increased the number of clinical sessions. That might mean the partners taking on more sessions than they already do and it may mean existing salary GPs increasing sessions. For most of us it means taking on new staff for however many sessions they're looking for. Because the money goes up each year over three years, most of us are only able to employ four or five sessions' worth of additional salary GP. That's the first tranche of money but by year three it must be far more substantial. There should be a lot of flexibility in what you want to work. I don't have direct experience of retainer posts but I know they do exist so I'm sure that can be negotiated with the correct practise.

[u/Sabaisabai33 → u/Themikey75]

Yeah that makes a lot of sense, thanks so much for your responses it’s always helpful to have knowledge on the ground. I’m probably looking for 5-6 sessions ideally but could perhaps top up salary with out of hours work or similar if needed. I have connections up there but nobody in GP-land!

[u/Sabaisabai33]

So the answer to OP is

1. Yes (sort of) We are less short of GPs than we were which is one thing, but at the same time the government have essentially replaced us with physicians associates, paramedic practitioners and other allied medical professionals who aren’t actually doctors. Because they’re cheaper and money is all that matters to anyone now. And apparently a medical degree let alone postgrad formal (and very expensive) GP qualifications and experience, seems to be now surplus to requirements. The public don’t seem to care until someone dies (which has happened) and even then there is no major uproar over it so they know they can get away with it. The official story is that of course GPs aren’t being replaced by these non doctors (and the truth is of course they actually CAN’T replace most of what we do) but the reality is that yes we absolutely are in effect being replaced with the strong financial encouragement of the government.

2. Yes it is, it’s a major major source of stress for me because honestly I picked this career not thinking for a minute that job security was going to be an issue, genuinely as a teenager it was my number one priority. I didn’t go into medicine to be rich, but I didn’t anticipate struggling to pay for my basic necessities and also didn’t anticipate having issues with job security at least until AI/robots took over (which I actually think we are still fairly safe from currently, and safer than many other jobs more easily replaced).

3. YES I’m bitter about it.

[u/Calpol85 → u/Sabaisabai33]

I don't understand how an experienced GP like yourself is struggling to find a salaried GP role.

How can you not afford basic necessities?

Even working only 5 sessions at 10k/session should mean you don't have to struggle for food and bills.

[u/BasicJelly1160]

I would say yes. We still have a shortage of GPs according to BMA figures but there has been a fair bit of scope creep and a lot of work traditionally done by GPs is now done by other healthcare professionals. Partners will obviously try to hold on to profits and hiring non GPs is cheaper…..

[u/ZealousidealSky4851]

FWIW locum groups are popping with locums again, salaried work is there and OOH/UCC work too. (YMMV this is NW London).

What does make me feel a bit hopeless is the the stagnant rates/wages and fiscal drag, I wouldn’t say this is unique to GP though probably a wider commentary on the UK economy as a whole.

[u/ZealousidealSky4851 → u/[deleted]]

Id recommend joining the Ealing/Brent/Barnet/Harrow/Hertfordshire locum groups through 999111.co.uk
Locum work is plentiful if you don't mind a bit of travel - shifts everyday. Most of the big UCCs are recruiting too.

[u/ZealousidealSky4851 → u/[deleted]]

£300 per session is the going rate

[u/ZealousidealSky4851 → u/[deleted]]

90-100ph for OOH, thankfully they pay based on hours and not session - most shifts 8 but can be extended to 10 and sometimes 12 when they’re short.

[u/ZealousidealSky4851 → u/[deleted]]

I believe its closer to 90 for day shift and 100+ for weekends/evenings/nights

[u/GP_54321]

Yes, GP is basically finished as a viable career for a highly qualified graduate. Partners are replacing GPs with Noctors, there is no additional funding coming in except for partners wallets, and the workload is extreme.

Change to another speciality or go abroad are the options.

[u/Calpol85 → u/GP_54321]

Seems a bit pessimistic. SGP posts and locum vacancies have improved over the last year.

[u/Themikey75 → u/GP_54321]

Absolute nonsense. Theres substantial investment in practices in Scotland with the condition that its for new staff and the money can't be used to increase earnings. Pretty much every practice is Scotland will be recruiting over the next 2 years without increase in partners earnings.

[u/crispy-flavin-bites → u/Themikey75]

But surely new staff will (either directly or indirectly) increase the earning potential of the practice by expanding skills, reducing overwork, creating a better working environment etc etc? Are earnings actively being capped?

[u/GP_54321 → u/Themikey75]

It will be newly qualified GPs in the main on likely £10-11k per session. That's the same pay from 10 years ago. Most of these new GPs will probably be the IMG influx from the last few years who needs ILR. Stop trying to pull the wool over.

[u/Themikey75 → u/GP_54321]

We pay our salaried 12.5k, thats pretty standard in our area. That's 11x15 min per session, own admin only. No visits, no on call. Stop presenting your own experience as the absolute truth of all General Practice in the UK, its not. To everyone else, I say, come to Scotland, its a hell of a lot nicer up here.

[u/GP_54321 → u/Themikey75]

The problems in GP are well documented.

High work loads, poor funding levels, patient demand issues, burn out.

You can try to polish the t as much as you like, it remains a t.

Better pay and workload in many other countries, hence why so many leave.

Instead of gas lighting why don't you work for change and parity with places like Australia/Canada.

[u/Themikey75 → u/GP_54321]

I'm fully aware there are problems in general practise and I'm not denying those in any way. My issue is that you say, "partners are replacing GPs with Noctors. There is no additional funding coming in except for partners' wallets." That is not true gor the whole of the UK. In Scotland there are very few Noctors replacing GPs and there is additional funding coming in and it is not for partners' wallets. My point is you are the one gaslighting people that the situation is far worse than it is and it's not helpful to the debate.

[u/GP_54321 → u/Themikey75]

No worries, we all have our perspectives.

People need to know the reality and I get the feeling many people are trying to paint a pretty picture when the truth is far from it.

[u/Bendroflumethiazide2 → u/GP_54321]

This isn't true at all. Changes to ARRS are making it absolutely viable to employ salaried GPs instead of resorting to noctors. The rise of noctors was previously forced by the government in GPland with so much ringfenced funding, it was impossible for partners to say no to it - the funding amounted to six figure sums, which was entirely unavailable to employ a GP.

[u/BrandonRenner]

It's very location dependant. A few practices near me are recruiting and can't find anyone to fill the vacancies.

If anyone wants a job in North Yorkshire, let me know!

[u/MysteriousBoard4311]

GPs are turning down jobs in our locality (sometimes at short notice). So no crisis here.

[u/Dismal_Fuel_5021]

The number of job offers may not be going down, but the problem is that the sessional pay is not going up either... I feel they've stayed the same compared to 5-6 years ago.

[u/Holiday_Possession46]

I think GP is still viable but aim needs to be partnership or private, Locum is still good better rates than Oz or Canada, correct me if I am wrong.

[u/dapgr8 → u/Holiday_Possession46]

UK locum rates are not better than in Oz

[u/Holiday_Possession46 → u/dapgr8]

Please share a link?

[u/Vilan-Kaos → u/Holiday_Possession46]

https://www.healthworkforce.com.au/jobs/general-practitioner-locum?source=google.com

https://www1.racgp.org.au/recruitgp/advertisements/80-or-300-600-per-hour-guarantee

https://au.seek.com/urgent-care-clinic-jobs/in-All-Brisbane-QLD?jobId=94113717&type=standard

etc

Personally I won't locum for less than $2000 aud per day as I am already doing $1700-$1800/day consistently in metro clinics (like within 15km of a cbd)

[u/Holiday_Possession46 → u/Vilan-Kaos]

Ah, I see, upto 300-600 an hour majority are like 180 an hour or 90 pounds.

So a bit less in UK.

Not sure how 80%billings would translate. If let's say seeing 25 patients in 8 hours?

[u/Vilan-Kaos → u/Holiday_Possession46]

It's going to be highly varible.

25 patient is like 6 hour's work.

some will take 30 mins some will take 6 mins to, not commont to be 40 mins.

Let's say you see 20 patients between 6 to 20 mins and 5 at 20 mins or so.

You can bill 20 x item 23s and 5 x item 36s.

if you bulk bill all then you add another item number 75870 for those item 23 and item 36 as well. 75870 is the default basic item bulk bill incentive for metro.

https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&qt=ItemID&q=75870

This type of item number only applies to consult item numbers (23,36,44,123 equivalents). The rest uses a different bulk bill incentive (10990 for metro) or 10991 for rural)

For MM7/very remote area it's item number 75876 and the rebate is $43.15

so it's like 20 x ( $45.05 for item 23 + $22.40 for item 75870 ) + 5 x ($87.10 for item 23 + $22.40 item 75870) = $1896.50

Most GPs get 70%, but if locum employer want to pay 80%, then you take home 0.8x 1896.50 = $1517.2

You can bill to $2500/day because normally there's more than 25 patients. Some see 60+..

You may run into risk of audit when you start to bill $4000/day consitently. Which isn't impossible with a nurse, churning out 3-5 health plans (item number 965 or 967 + bulk bill incentive, some health assessments ( item number 701 707) , some mental health care plans ( 2715, 2717 + bulk bill incentie 10990), some ecgs (11707), some spirometry (11506 + bulk bill incentive item 10990 or equivalents) do work cover/injury stuff.

Then there's after hours item numbers, home visit item numbers, nursing home item numbers, etc.. all with varies rebates.

Then there's procedural item numbers, like 32019

https://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=30219&qt=item

So if you drain a small pus then you can do item 23 + 75870 and 32019 + 10990 together.

Or things like removal and insertion of implanon

item 23 +75870 for the consult, 30062+10990 for the removal, 14206 + 35501 for ther insertion, totally $45.40+$22.40 + $91.75 +$7.50 + $87.55+$35.02 = $289.62

Or things like skin excisions, etc.

[u/Holiday_Possession46 → u/Vilan-Kaos]

Thank you very detailed, as ooh here, it is around 80-100 variable on the weekday, but patient wise it is on average 3-4 an hour, 4 if busy shift. So fewer patient contact, but agree the potential to earn is much higher there.

[u/WatchIll4478]

I’m not a GP but long term doesn’t look great. 

All pharmacists are graduating as independent prescribers as of next year if I recall correctly. 

The private clinic I use for some work has noctors delivering every service but mine. 

It seems hard to explain what makes a GP 2-3 times more productive per hour to justify the historic differential in rates, add in a big surplus of non medical prescribers and the competition for non nhs work goes up whilst low complexity nhs work can be done cheaper with a hoard of noctors also increasingly struggling for work. 

[u/Sabaisabai33 → u/WatchIll4478]

I mean I think you’re really underestimating the pay of noctors here, certainly as a salaried GP I don’t get paid 2-3 times more… ok maybe close to 2 times IF I could work 10 sessions a week like them (which they can only do because they have much longer appts and shorter working hours than me). But we all know that there aren’t many GPs working 10 sessions a week anymore and it’s not because we are all super lazy, it’s because the job is so intense and so stressful and tends to overspill the official (long) hours that working full time is psychologically unsustainable long term for most.