GP Appointments.

pretty much yeah. We can book minor injuries for the same day, but again a queue system to get on.

Yes, same here. Just waited 3 days to get a phone appointment for Jnr. I can’t get one.

Welcome to modern Britain, where we are told to "simply pop in and see your GP" on tv adverts.

I'm scared of getting properly ill, I haven't been able to access a GP appointment for quite literally several years for a variety of minor ailments I've ultimately chosen to ignore instead.
(Sheffield)

All systems normal here. No problem getting an appointment if it is genuinely required, but the vetting process is a lot more stringent

Does your surgery have a duty doctor that will do a call-back if you call the reception after the initial rush? That's what we do if it is something we are particularly concerned about and we usually get to speak to / see someone.

Is this similar at other GP practices?

We can have similar. Our receptionists are either brilliant or a 'challenge' in really pushing about how important your need to prioritise is - but then for me that can stray into making medical decisions as a filter.

Agreed that the local community hospital now seems to be the GP provision for pressing concerns.

Can anyone explain why the (lets be honest, privately owned practice) GP can in effect 'push away' the more pressing patients and allow the (still directly NHS Owned and run) local hospital to pick up the excess?

I was astonished ( and not a little worried) that I phoned my GP at 1pm, described my symptoms and got an appointment for 1630 the same day!
I queried it with the GP and said I wasn't sure to be happy with the excellent service or concerned that they thought it was necessary to see me so quickly. He just said it's how they work and normal 🤷‍♂️
My old practice it was a 2 week wait for a telephone appt

Johndoh
Phone and face to face appointments fall under the same rules for booking unfortunately.
Feel a fraud sat in a hospital waiting to see someone when it’s not an emergency, I think a lot of the people sat here are in the same boat as us and can’t get to see their GP. The NHS seems to be on the verge of breakdown, I wonder how long it can last like this, or maybe it’s always been this way.

I’m very sorry that the system I am part of is broken.
The recent report, chaired by our latest chancellor, explains what the problems are. Have a read of the summary.
https://committees.parliament.uk/publications/30383/documents/176291/default

Summary 3
1 Access to general practice 7
Demand in general practice is rising 7 The NHS does not have enough GPs 8 Patients face poor access 9 GP workloads are unsustainable

Is this similar at other GP practices?

Yup, the same as mine, and then it's only phone consultation. You don't even get a specific time for the phone consultation, though last time it was narrowed down to the afternoon 🙄

Sorry if this comes across as unhelpful, but did you try any of the other services - direct to Pharmacy, NHS 111 online/call etc first? Sometimes they can at least eliminate some of the other variables or help with a referral/fast-track in to a Practice or elsewhere.

I work in IT supporting GP Practices and the whole system is absolutely slammed at the moment - backlog from Covid, usual winter flu/coughs/colds, Covid booster jabs still going on amongst other things. We've had a number of GPs across the city leave, retire, or just sack it off as they're getting a lot of abuse from patients and politicians alike, which only makes the lack-of-appointments problem worse.

I've never not been seen or had a call same-day. It's usually an early-morning call to be added to a list and then a call-back.TBH I'm rarely in need of a GP but I do wonder/worry about what happens when I'm more in need.

A friend of mine is a GP receptionist and the abuse she receives daily is horrific.

Click here for the answer

GP practices across the country are experiencing significant and growing strain with declining GP numbers, rising demand, struggles to recruit and retain staff and knock-on effects for patients.

They have been at the forefront of the NHS's response to the COVID-19 outbreak, delivering vaccines whilst maintaining non-COVID care for patients throughout.

as of October 2022 (latest data) we actually now have the equivalent of 1,896 fewer fully qualified full-time GPs compared to the September 2015 baseline (when the current collection method began).

With over one in 10 (16%) of respondents to a BMA survey telling us they plan to leave the NHS altogether after the pandemic, these losses are set to continue further if the Government does not take appropriate action.

GPs (hi) and other primary care staff are a finite resource. I have a limited capacity to deliver safe healthcare every day.
Once that capacity is reached, you can wither accept unsafe healthcare for all, or seek healthcare elsewhere.
I get tired. My staff get tired. My job is actally pretty difficult, and I need to be alert, aware, and entheused to carry it out well. I can only acheive this up to a certain point.
If you pile more workload onto me, I can't do it safely.
I am not alone in this.

Unless one of 2 things happen:
1 - less people seek input for their healthcare matters from GP surgeries/expect less
or
2 - there are more GPs and other primary care staff

The system will spiral down further.

DrP

Similar in so far as it's call at 8 and see what you can get, but they have a queuing system and I have without fail always got an appointment same day, though sometimes have to call back at 1pm for the later in the day slots. In recent years they have started to triage more to give telephone appointments where appropriate in the first instance.
This is city centre Edinburgh in an incredibly stretched practice, but they seem to make it work and I'm very grateful.

@revs1972 Welcome to modern England.

I live in Scotland, our GP practice has an e-consult service where you can submit requests for advice, etc on-line. You'll get reply within 24hrs offering either an in-person or telephone consultation with the practice nurse, phlebotomist or GP.
If you can't or don't want to use that they still have receptionists that you can phone. My experience over the last 9 years is that they are excellent at triaging and the kids have often been seen the same day.

Not at my GPs. If you contact them by phone before 9.30 you get an appointment that day. Used to be a turn up and be seen but reverted to phone during covid. Never once have I not been seen that day if I wanted to be. sometimes its a bit of a wait. There is a phone queuing system and a phone back system. they do phone triage as well. these emergency appointments are unlimited.

They are a bit of an outlier tho I recognise but they have put huge investment ( staff and buildings) in and I think all the GPs are part time. ( which will reduce pressures on individual GPs)

While what DrP states is true and its also variable around the country IMO part of the issue is their status as independent practitioners. I'm sure my local practice have ended up taking less money for themselves out of the business to fund the infrastructure improvements and extra staff. Not all GP practices go this extra mile - they are not being paid to do so.

Just as bad at my surgeries. Son tried for days to get an appointment for a sick note - yes they insisted he come in with Covid. Even explaining he had Covid he still had to go and see someone. Madness

Matt - its because of their status that they can do this. District nurses for example cannot.

My wife currently has a chest infection following Covid about 6 weeks ago. She's given up hope of seeing a GP for anti-biotics.

I recently mangled my arm in a bike crash - nasty wound. Given the state of A&E/GP's I just patched it up - probably needed stitching but I've a nice bright purple scar now.

So far always been able to arrange a phone appointment the same day, if it's something that can be photographed I'll get a text prior to the appointment asking me to upload a photo of the offending body part 😀
A couple of times it's been serious enough to be called straight in for a face to face (same day both times) other times I've spoken to either a doctor or nurse over the phone and advice/prescription given.
Had cause to use the NHS 111 service to this year and it worked well.

Edit: we can book appointments using patient access online.

Can anyone remember back in the day when the doctor would come to your house to see you (I grew up in the 70s).

ours is completely the same. you have more chance of winning the lottery than getting an appointment.

Can anyone remember back in the day when the doctor would come to your house to see you (I grew up in the 70s).

I can beat that. I can remember the doctor visiting me when I was about 13-14. It was a nasty case of tonsillitis or similar. A short while later an ambulance arrived to haul me off to hospital because the doc had been concerned about my temperature. A doctor and an ambulance to the house in the same day, something not seen since the 80s. 😀

(Actually, full disclosure, the GP didn't contact my parents before asking for an ambulance and I was at my gran's when it arrived, about half a mile away. The ambulance had gone to my home address and not got an answer so had checked with neighbours and tracked me down. What a service!)

johndo - yes and they still will if needed and even then they only did house calls if the patient couldn't get to the GPs However the same GP that I used then also had no appointment system - it was turn up and wait and the wait could be hours and no preventative medicine system, no counselor or practice nurse etc etc

Edit - When Julie was ill we had multiple home visits

Pyro
Pharmacist was the first port of call who told us to see the GP for antibiotics. GP receptionist told us not to use 111 due to wait time and to go to local
Hospital if we wanted to see someone today. 🤷‍♂️

It's hugely variable. There aren't nearly enough doctors, not enough money, and we're seeing way more patients than ever before.  I manage a inner city GP practice, and I've never seen it this crazy for this long There are practices that I think are probably unsafe, pray for a mild winter.

Doctor's visits and Panini Football Sticker albums have, for me, always been inextricably linked.

part of the issue is their status as independent practitioners. I’m sure my local practice have ended up taking less money for themselves out of the business to fund the infrastructure improvements and extra staff. Not all GP practices go this extra mile – they are not being paid to do so.

TJ - I appreciate you work(ed) in healthcare, but I get the impression you don't fully understand the current GP position in England... how we work, how funding works etc.
We all receive extra funding for infrastructure and extra staff (google "PCN ARRS" or look here )... it's just that often this isn't even enough! Our PCN's physio has just quit to set up a private practice..he has offered for us to pay more him to see our NHS patients however...how kind of him!

Also, you frequently refer to the status of independant contractor - what exactly do you think this means? That we can do whatever we want? Cos it's simply not so! We are (well, partners are) self employed as a partnership, commissioned to deliver NHS care.
It's like saying you'll open up a Subway franchise but **** it..."I'll sell BigMacs and KFC..." we are governed by a contract.
The interesting part is... and you won't believe it... we USED to do LOADS of stuff that wasn't part of our contract but as teh workload has increased we're saying "NO" to the extra, unfunded stuff... For example..

I recently mangled my arm in a bike crash – nasty wound.

THis isn't GP workload at all. Trauma and injury is not in our contract. Simply put. It's not our job. So yeah, by all means moan about your GP not being able to see you for a broken foot, in the same way you'd moan about your hairdresser for not changing your car oil whilst you get a perm,...it's not their job. It never was!

DrP

Yep, it's the same here. I don't doubt that GPs are working hard - I've had a telephone consultation at 7pm before now.

It's the same across the NHS. I was referred to a rheumatologist, and finally had my appointment yesterday - 13 months after the referral! The letter said "expect to spend 4 hours at the hospital, as further investigation/treatment may be required". During the consultation, she says "I'm going to request an urgent physio appointment for you". So I said "when will it be - today?". And she goes "Sorry, no, it'll probably be early next year".

****ing tories 😡

The interesting part is… and you won’t believe it… we USED to do LOADS of stuff that wasn’t part of our contract but as teh workload has increased we’re saying “NO” to the extra, unfunded stuff… For example..

Oh I know this. A mate is a GP. Not intended to be a slur in any way and yes I don't know the details

I guess my point is that because of their unique status withing the NHS variability is built in to some extent and even locally the variability is huge. One local practice still has steps up to the door and a normal front door. Mine is level access with a wide door

It seems to me ( and maybe I am wrong) that because of their status as independent contractors its harder to enforce standards or are the minimum standards too low?

Stuff like not having a queueing system for the phones as some have detailed or the access issue as above That sort of infrastructure issues

Its the system we have and it aint gonna be changed but IME the variability amongst GPs is far greater than in other parts of the system

we are governed by a contract.

...And the contract pays us assuming that the "average" pat will come to the GP about 3 times a year. I can pull the stats from EMIS (the pat management system we use), but it's about;

about 5% never come

about 20% come about 3 times a year

about 30% come between 4-6 times

about another 30% come 7-10 a year

about another 10% come over 10 times a year

and the really growing part of our patients,  an admittedly teeny amount or so come about 15-30 times a year. This group take up huge amounts of time and effort to manage. To put numbers on it for out practice that last two groups is about 850 patients. We're doing vast amounts of unfunded work for this small group of very highly demanding patients, often at the expense of folks who don't come that often.

Trauma and injury is not in our contract

I'm getting very bored of telling my patients who are angry with my receptionists that we're not an emergency/urgent service.

Mine got to the point where you could make an appointment for a few days time, or do the first-thing-in-the-morning roulette. Then the bookable appointments got further and further away, and now they barely exist so it's all "call up and hope". It's not like it creates any extra appointment space so I'm not even sure why it happened? Is it just that you get less no-shows? Or is it because they only know the availability on the day?

Not blaming anyone for it, the practice are fantastic and they basically keep me going despite all my best efforts, but it seems weird- you'd kind of expect that under a strained system, efficient booking ahead would be the big thing and getting an appointment right away would be harder, not the other way round

It seems to me ( and maybe I am wrong) that because of their status as independent contractors its harder to enforce standards or are the minimum standards too low?

I think you ARE right there... but efforts are being made to improve things with the introduction of PCNs (essentially, groups of smaller practices 'pooling resources' to provide care at a wider level, with more 'standards'/less inequality.)

I'll put my hand up...our phone system is shite and unfair! We've been trying for MONTHS to get a new contract with 'in cloud queuing" as I completely agree that not having a queue is unfair... it's like anything though... getting someone in to do it, amongst all the other work going on (we've recently had a slope and electric door added for access) is a hassle...
On the subject - that slope/door cost "our surgery" about 18 grand. Seeing as I'm 66% of "our surgery" it cost me PERSONALLY 12 grand...! Yet people still moan the door is too slow... or opens the wrong way etc!!

DrP

At what age does a doctor who chooses that path become a GP? After medical school, junior doctor, etc?
I'm 32. I was friends with a number of medical students at university of approximately my age. Not all of them, and I'd guess that those I was friends with were the more outgoing and adventurous type.

I'd guess 50% of them, based on facebook, are now living and working in Aus/NZ.

Combine that with the pensions issue meaning that many towards the end of their career are taking part time hours or early retirement as it makes financial sense.

And there is a lack of GP's to go around.

I don't blame either group for acting in their own self interest.

On the subject – that slope/door cost “our surgery” about 18 grand. Seeing as I’m 66% of “our surgery” it cost me PERSONALLY 12 grand…

This just shows the madness of the system IMO. I'd much prefer GPs were all directly employed in NHS owned buildings.

The building my GPs are in was bought and converted in the last 10 years. That will have cost them a couple of million at a guess.

You will get your 12 grand back tho when you retire and sell the business will you not? 😉

At what age does a doctor who chooses that path become a GP?

26 / 27 I think assuming they progress thru the training without delay. Then to become a partner you have to buy into the business which is not at all cheap

and the really growing part of our patients, an admittedly teeny amount or so come about 15-30 times a year. This group take up huge amounts of time and effort to manage. To put numbers on it for out practice that last two groups is about 850 patients. We’re doing vast amounts of unfunded work for this small group of very highly demanding patients, often at the expense of folks who don’t come that often

That issue goes wider than health for sure.

Earlier this year I went to a seminar delivered by a senior official from [area redacted - large deprived northern seaside town] who observed that a tiny proprotion of their population - about 200 families - were collectively responsible for a really material percentage of their expenditure on health/social care/policing/flytipping etc.

Did anyone suggest hitting up Therese Coffey and seeing if she's got any pills your lad could have?

Its also worth pointing out the diabolical pension rules force a lot of GP's (and hospital consultants) to reduce their working hours. My wife is a GP and works fewer sessions than she could but she has been forced to reduce due to topping out her pension. This sounds lovely, like a great big pension. The reality is that if she breaches the threshold, she will be liable for a bill of many 10's of thousands. She can't plan for this as they don't forecast, they only tell you months after the event. A partner in her practice recently got a £40k bill. So, perversely, working more hours could cost her more money than not working.

You could immediately create capacity in GP and hospitals by reforming the daft pension rules which were designed for the mega rich, not for well paid public servants.

Other things that will help:
- Government and media need to stop talking down tele and video consultations. They are good thing and should be encouraged for the right circumstance.
- ANP's and other medical staff are ace and should not be viewed as a poor alternative to GP's. You don't need to see a consultant level doctor for every minor ailment.
- My wife reckons a local, well resourced, effective and accessible mental health provision could free up around 29% - 30% of her working capacity.
-Sort out the small stuff. My wife's printer broke and it took local NHS 6 weeks to fix it. Her phone took 2 weeks to fix. GP's work at pace, silly little things like that have a real life impact.

Incidentally, I took my lad into A&E last week. In, seen, assessed, x-ray, seen again, moon boot supplied and out of the door again within 45 mins. Its not all bad.

When I was little the doctor would come to you.
Now you're lucky if an ambulance turns up.

Earlier this year I went to a seminar delivered by a senior official from [area redacted – large deprived northern seaside town] who observed that a tiny proprotion of their population – about 200 families – were collectively responsible for a really material percentage of their expenditure on health/social care/policing/flytipping etc.

I'm not sure that's anything new, there are always certain areas / estates with dysfunctional families who endlessly eat up resources.

When I was little the doctor would come to you.

And why was that a good thing? How many other medical consultants come out to your house?
GP's still do home visits, but generally for bed bound and end of life care. They are not going to waste their time visiting your house because your throat is a bit sore.

Pharmacist was the first port of call who told us to see the GP for antibiotics. GP receptionist told us not to use 111 due to wait time and to go to local Hospital if we wanted to see someone today. 🤷‍♂️

Fair enough @stuhawk, sorry you've not been able to get treatment quicker. Only asked as I think there's always a few things that could be dealt with elsewhere but some people have the "must see a GP and only face-to-face is good enough" mentality. Hope you get sorted anyway!

@footflaps absolutely not new, it'd just be a helpful problem to solve!

At what age does a doctor who chooses that path become a GP?

Any age TBH... many med students know they want to be GPs...
Medical life goes:
uni - 5/6 years
junior doctor - 2 years
speciality training - 3 years for GP, 5 for other specialities
'fully qualified specialist'...

I initially did 'hospital medicine' then switched to General Practice.. so I'm tecnically DrP BM MRCP MRCGP!

About 8 years ago, many older trainees (like, in their final years as speciality trainees) switched across to general practice. Now, TBH, fewer people are becoming doctors in all walks of life!

RE the home visits - TBH the only person they convenient is the patient, and i'm afraid you'll jsut have to get over that! I can see 6 people in an hour in the practice.. or maybe 1 or 2 in the same time on visits (and that's because my practice boundary is tiny!).... if YOU were in charge of this service, what would YOU suggest we do..
Additionally, things change. I've got end of life patients who say "no one has been to see me recently", when in fact they mean "the GP hasn't seen me this week".. they've been having 3 times a day visits from teh palliative care nursees, having OT and PT going in... but people still think the GP is the answer to everything ("winks, blows on knuckles and rubs lapel... can you blame 'em..!!"

DrP

@franksinatra Am I right in remembering that the usual suspects (ie. the Daily Mail) was slagging off GPs pre-pandemic for not offering video/remote consultations?

As above home visits are only for those who physically can’t get to the surgery. It’s just not a good use of a limited resource otherwise.

Its ok. The manifesto says "6,000 more doctors in general practice"....... https://www.conservatives.com/our-plan/nhs

Although that promise has been quietly dropped. I say promise.

The manifesto says “6,000 more doctors in general practice”…

Without any actual changes to anything to achieve it.

Didn't Bojo give us 40 new hospitals?

Am I right in remembering that the usual suspects (ie. the Daily Mail) was slagging off GPs pre-pandemic for not offering video/remote consultations?

Yep, then the Daily Mail and Government starting slagging them off for doing exactly that.

I honestly think most sane people are perfectly happy speaking with Dr on the phone or via video call. I certainly don't want to hang out in a DR's waiting room reading crap magazines and sharing air with ill people if all I've got is a minor ailment*

*obviously I don't have to do either as I was smart enough to marry a GP and get my own private GP service, although it is completely devoid of any actual sympathy

System here seems to work, despite our 5 GP practice bring down to 3 GPs.

You ring the receptionist who does a little triage and someone rings you back. Last time I used it I got a call back the same afternoon, bloodiest booked for next day, face to face the week after when the tests rests were back.

When my elderly mum had an issue with a growth on her leg, she rang, was given a face to face within a couple of days, nurse practitioner didn't know what it was and referred her straight to dermatology.

The system is at breaking point, but it somehow staggers along here. Sadly, I guess my expectations have been lowered as well.

Lucky enough to get a same-day call back here, happy with that. What was more worrying recently was FiL going for an eye test one Tuesday this month, the optician spotting bulges in arteries in his eyes (I think) and saying he needed to to A&E NOW for an MRA, him then waiting 12 hours in A&E for a bed, then having to wait until Friday for the scan and discharge (all clear fortunately).

I can't conceive of how godawful it must be for the genuine heroes who staff the NHS to be that overwhelmed - my heart goes out to them, it must be horrendous. 🙁

My surgery is a impossible to get through by phone. During Covid they have introduced an online e consultancy thing which is actually pretty good, much to my scepticism.

My solution to the capacity problem. Reduce the financial demands on would be doctors. We need more of them, so maybe even offer grants to get them trainees up.

And, controversial don’t pay them so much that they can work 2 days a week and still be comfortable off, and then choose to take much earlier retirement than the majority of the working population. I have several GP friends who don’t seem to realise that to earn similar amounts to what they do, they would need to be Directors / CEOs of mid sized companies, and believe me they extract their pound of flesh. Most are partners working 2 - 3 days a week, and still on hefty salaries

DT78 - yes they are paid well- but remember they have to buy into the practice which depending where it is could easily be another large mortgage. My pal paid more for his share of the practice than he paid for a posh house in a posh town IIRC

I also doubt most CEOs of mid size companies are paid less net. - and its a highly skilled job with stress hard to imagine and as above 10 years or more of training to gain the skills

I don’t quibble at it is a highly skilled job, but it is very very well paid.

Raise the salary of juniors, recruit more of them, but reduce the salaries of those in mid and senior positions to something sensible so they actually stay in work

I did chuckle about that comment about fte equivalent up there….

Also it’s hard in a lot of other professions to be part time and still earn well well above national average

Also all the doctors I know are from families of doctors, so we’re able to do it because their family funded them. That needs to change so med school is open to everyone able and bright enough, not just those who can afford it, or are willing to be massive saddled with debt

I had the grades for medicine, the cost and time before break even stopped me pursuing it

Starting pay for a gp is 60 grand. After ten years training

Average is under 100 grand and gthats for full time and remember they pay for the buildings out of their own pocket.

Most go part time / retire early because they are broken by the stress.

Most go part time / retire early because they are broken by the stress.

or are forced to through ridiculous pension rules that penalise working too much.

I know the pension issue struggles to get sympathy. This is well worth a read
https://amp.theguardian.com/society/2019/jul/28/growing-number-of-gps-cut-shifts-to-avoid-huge-pension-tax

My view is that like airline pilots I don't want my doctors thinking "I don't get paid enough for this shit"

A major part of the stress is overwork / demand

Increasing capacity by making it cheaper or funded to enter the profession would he,o alleviate demand

You wouldn’t need to pay so much if there was lots of resource, and it wouldn’t be so stressful.

Last time I spoke about money with my partner friend she was taking home £60k pa for two (long) days a week. not sure what other jobs are out there that enable you to do that.

This is how it used to be years ago, some from south of the border may struggle with the odd word

DT78. have you ever had to make life or death decisions on a regular basis? To deal with dying people and tell them they are dying. to deal with suicidal folk knowing that not only are you accountable for the decisions you take but if you make a mistake you could be in legal trouble.

respectfully you have no idea the level of stress involved in this sort of work. I have but I could always pass the buck. I too had a place at Uni to do medicine. I didn't take it because I could not face the ten years of training under utterly appalling conditions ( they have improved since)

Plenty of lower paid staff make life or death decisions, in fact when I look across what medical staff at all levels have to do, GPS seem more insulated from the frontline.

Like I said, can you think of another job where you get 60k for 2 days work a week, and have a pretty stonking pension, and pretty much job security for life?

I can’t.

I have not said it is not a skilled job, or that it has its pressure. But so do many other jobs, medical professionals would also not understand.

make the profession more accessible, increase capacity, reduce stress, redistribute income from those earning huge sums to pay for those to train up.

2 long days 24+ hours so is 60% of FTE so her salary is in line with the average for the profession. she will have had to buy into the practice for that which will have cost a lot and she is responsible for her share of the upkeep of the buildings ( to oversimplfy)

I was a nurse till I retired. Lower paid staff only make life or death decisions with the support of senior staff ( even registrars will have a consultant to refer to)- guess what - those senior staff are paid at similar rates.

go on - name me another job outside of medicine where you have similar levels of responsibility or stress. airplane pilot might come close I guess

Military to start with

Now you answer my question tj

Almost everyone in the military has a senior to pass the buck to. Nothing like the level of stress.

CEOs of medium businesses will earn far more pro rata. My pal who is an accountant earns more pro rata. Two pals who are management consultants earn more pro rata one a heck of a lot more and both work part time

We need more GPs. Please, do the training and become one. There is even a £20k “new to partnership” scheme to attract new doctors in to these highly paid part time positions.
Strangely no one wants to do it.
I’ll post this again. Read the summary then come back and have a conversation about what the problems are (clue- partners earning too much isn’t one)

https://committees.parliament.uk/publications/30383/documents/176291/default/

Almost everyone in the military has a senior to pass the buck to. Nothing like the level of stress

If a doctor *s up, someone else dies, a bit stressful.
If a soldier *s up they die, and probably a lot of their pals too.
That's probably quite stressful.
.
IANADOS

I feel this article might go some ways to answer a couple of the questions...

https://www.theguardian.com/society/2022/nov/27/stress-exhaustion-1000-patients-a-day-english-gp-nhs-collapse

you are focusing on one part of my theory

fund people to train at a decent level
give them a bonus when they sign on if that helps
increase capacity
that will reduce demand and stress
that reduces the need to pay high salaries
lower stress and lower salaries mean gps stay employed longer
capacity is increased

currently it's in a death spiral of massive financial burden to entry, way too few gps for demand creating too much stress, gps paid so much they can choose to reduce workloads or retire earlier. the whole system needs a revamp.

and TJ you have some lucky friends, accountants I know are on around 60k pa FT. Directors I know are in and around 100k plus bonus their jobs are 24x7 and it would simply not be allowed to be part time. the stress may not be life or death but there is truck loads of stress. it's just different stress. none of the jobs you mentioned are as job secure as a GP. that is worth a huge amount, only those in roles where they don't need to worry about it don't realise how much a benefit that is

and when you think about military. think about what is going on jn ukraine. that's what they are trained for and will be expected to do when ordered to. imagine that stress. not the same. but still truckloads of stress.

I would suggest with the military when on active service ( and I can only imagine) the stress must be horrendous and far worse than any medical stress. However its not the week in week out stress that is so draining and they have seniors to refer to.

directors? Nothing like it. the stress comes from a totally different source and is not comparable

Edit - I have looked after veteran from WW2 with PTSD ghastly stuff. they were under that stress for years

Our GP is pretty good, the one 2 miles up the valley (so very similar demographic of patients) is poor. Like much of the NHS it's down to management and staff attitude.

Our local hospitals though are bordering on negligent. Our son has a condition which needs a minor OP. GP identified the problem and sent him straight to A & E who considering the pressure they are under were pretty good. Worst fears didn't materialise but they wanted him back the next day for further scans. Things went downhill after that, we got an initial diagnosis which given some other issues he's had from birth needs sorting sooner rather than later. No communication for a fortnight, got hold of the consultants secretary, notes hadn't been sent over, then there were further admin issues. Another 2 weeks and we were going nowhere, went back to GP who again were great, made a referral themselves this time. Week later letter turned up, great we thought, need to book an online appointment. Started the process, first appointment 107 days, not good but at least we were in the system. Went to the next page no appointments available at all, tried this multiple times over many days. Eventually rang the support number to be told all they could do was book an appointment online using the same website patients use. They tried, had the same issue and told us the hospital was managing their appointments outside of the system. So the the local staff have arbitarily decided to block services to patients. The helpline person messaged the hospital and told us we'd have to wait for the hospital to ring us. Six weeks later and nothing, dead end. Now booked a private appointment. The NHS isnt just under resourced it's negligent. Under resourced is having to wait for 6 months on a waiting list, not being able to even get on a waiting list is disgusting and effectively disenfranchised people.

Maybe all part of the Torys grand plan but unless the NHS gets it's act together it will be the last resort for care and anyone that can will get treatment privately, in many respects it's already there.

Stress is stress TJ doesn’t matter it’s source it’s how it impacts the individual

It’s reading like you are saying GP stress is a special type of more important stress. It’s not. It is still stress. This is the same convo I’ve had with other medical professions. You do a fantastic job, but all have a blinkered view to the rest of the world of work.

I have genuinely and recently looked into medicine again, through wanting to do something more fulfilling Sadly there is no way I can pay for my mortgage and kids whilst training. So for people like me the door is shut. It’s shut for very very many capable and willing people.

Might need to think a bit more on your over simplification of the military and their command structure too. It doesn’t work how you think. Plus, even if it did, do you honestly think having someone more senior erases stresses of a situation? In someways it can make it more stressful to have to defer to others.

My practice is currently running on half the number of GP's it had a few years ago, they just can't get replacements in at all. They're trying to get as many people in as they can but it's a losing battle for them.

ours is completely the same. you have more chance of winning the lottery than getting an appointment.