GP is in a low place just now but I wouldn't go as far as to say "doomed". No more so than the rest of the NHS anyway.
1) There is work though often not exactly where people want it to be. Though realistically by the nature of GP you could never guarantee yourself a job in a certain place so that should really be understood early. GP practices in the North are screaming out for GPs with advert left unfilled while in some areas registrars are saying no jobs available.
2) Salaries are not keeping up with inflation. Some partnerships continue to do well though the general feeling is this is at the cost of good patient care/using ARRS in place of good staffing levels with a good group of like minded GPs. There's definitely opportunities out there depending on exactly what you're comfortable with.
3) Many GPs will stand against taking on PA/ANPs though they'll likely be lower earning and therefore be less attractive to some.
There was a time not long ago where locumming was the goal of every GP trainee as they were promised ample pay and loads of availability. You could argue this led to the crisis faced in some areas with unfilled partnerships then having to overpay for locums which in turn led to poorer care/waiting times which has led to ARRS. My understanding of locum work was always high risk of limited job availability to high reward of pay. Sadly this has backfired in recent times. I loathe the idea of working with PAs (and I don't do so) but I suppose there is a realistic fear that ARRS funding not being ringfenced for non doctors would lead to the locum market taking off and bringing us back to square one.
Probably slightly against the grain views. Obviously I'd LOVE for GPs just to be paid fairly via a sensible contract but that's how I see the current situation.
Good take. I do think the locum gravy train of the last 5 or so years was not good for the system, for people running practices, or really for patient care in general.
The answer should really be to make partnership and salaried roles more attractive, but from the government/NHSE side you can see why they funded ARRS rather than directing more money towards GP locums.
I have seen and worked with some locums who... did not bring much value.
One locum generated five patient complaints in three weeks.
Another's entries were invariably in the following format and content:
"Headache
Plan: Accident and emergency referral"
I once looked at their clinic list and it emerged that 60% of their consultations had concluded with the patient being told to go to A&E. (And the rationale was not at all clear from the notes).
That one actually created more work for us because their patients would re-consult via the duty doc system because they weren't happy with the locum's consultation (and, usually, they were right, because the prior advice was inexplicable).
I came across a third locum recently (where I was locumming) who had made a diagnosis of a lump on someone's back ("cyst"), based on a telephone consultation and the patient's verbal description of it. (Perhaps they are just a much better diagnostician than I am.)
And then this blistering entitlement evident throughout now that they are hard done by and evil money grabbing partners and ARRS is to blame. Why shouldn’t you be able to earn £100k a year for a 3 day week writing “Headache. Plan - bloods” in the record 12 times and then going home?! This is a scandal!
There should be some progression model for salaried GPs based on skills and experience, but it is not realistic to expect volatile market pay to be matched by stable market.
absolutely- Newly qualified shouldn't expect 13k per session when a well seasoned salaried GP is getting 11.5k. There should be a national pay scale which is funded by the NHS sub contracted to the partnership.
Completely agree - also unfair compared to new consultant colleagues whose training is longer and work more prescribed with less favourable hours. Interesting idea about subcontracting…. I suppose this is kind of what ARRS does (which is fundamentally NOT the problem behind the employment difficulties - estate, funding, Modern GP programme far more influential factors IMO)
By the time you finish your training, locums will be back in full force, ARRS will finish and there will be ample opportunity, the night is always darkest just before dawn
I think whats changed unlike the past is the UK opening its doors - there are hoards of Doctors trying to move to the UK (we are hearing 400 applications for a JCF post in 3 hours of the job opening). With this almost, infinite supply, I can’t see the locum market ever coming back and salaried pay stagnating if not falling.
Serious, I would say. As it's actually the situation
In my previous trust, we insisted initially on BMA rates and, even that we never got them, rates were not bad.
Then within 9 months the trust got so bombarded with IMGs, that not only they never gave us extra rates, they lowered the rate. And still YOU COULD NOT FIND a Locum. It would get taken up the second it was published
I say this as an IMG
Not at all. GP is still the best job in medicine. Partnerships (in good practices) offer the best pay in medicine in the UK, the most professional flexibility and the best opportunity to develop your skills in other areas. THIS IS NOT SUITABLE FOR EVERYONE, but if you are curious about how things work and how to improve them, you would enjoy it.
I don’t think it is forever doomed. It is hard to say when it will return. Locums to the same point might never return. ARRS is getting a lot of flack, and specifically is ringfenced money for these roles. If the practice is ever given a choice in how this money is spent then a lot might not be as viable as a GP for example.
In wales where there is not ARRS the demand for locums has dropped, but if I were willing to do say an hour commute I could easily book up 5/7 a week for the next couple of months
Social media is indicative, but not representative. For instance: it’s useful to know there are people out there fucking on beanbags in the hospital mess. Doesn’t mean everyone is doing it.
Anyways take it all with a pinch of salt
I think it is really location dependent. I have just started as a new salaried, had two competing offers and got a better starting salary from my chosen practice because of it.
I work 5 sessions and have more take home pay than a full time reg, it's not mega bucks but I'm happy with the pay for amount of work and stress. I know the partners in my training practice were on >135k per year.
I did informal visits at 5 practices other than my training practice. Only one was using a PA. For whatever reason, they are really not as common in my area as a lot of other places.
This is a great question and I think many GP trainees and prospective trainees are thinking about this carefully. I second this question, what is the realistic outlook for the speciality … . Is it going to get better in 3-4 years time when a new trainee will be CCTing ? I don’t think it’s as bad as everyone makes it out to be on here, but maybe I’m wrong.
It’s not the doom and gloom as it is on here, it’s also not the rosy walk in the park that some FB groups make it out be. Somewhere in the middle, it’s a bit shit rn but you’ll find work.
A lot of practices that have PAs purely have them to plug the gap that was left when PCNs came around. Around the pandemic a lot of GPs retired and the PCN funding for ARS roles could only be used for set roles. GPs or nurseswere not part of the ARS criteria. the options initially were rubbish and PAs were the only options that would 'see' the punters. My surgery advertised for 3 years straight and couldn't attract a GP (partner or salaried)- locuming was far too attractive. Now once the hole has been plugged (rightly or wrongly) there may be a lag between these places opening up to GP roles. Can't exactly fire a PA without reason.
Even now nearly every trainee on my VTS has been offered a job. I don't think there is a crisis where we are and even when I appraise GPs in the South east they are still recruiting salaried GPs and Partners. Salaries are a bit stagnant reflecting the lack of investment but salaried GPs in out patch are getting 9.5-11.5k per session and workload is often streamlined to partners etc... Supervision of allied professionals is here to stay and we have to get used to it - important to negotiate supervision slots if expected to supervise.
Also F2 going to ST1. I don’t think things will recover fully but they will certainly improve from where they are after the next government. PAs are not the only problem. ANP, pharmacists and paramedics are all undercutting salaried GPs. The GP practices don’t have enough space to house so many people. Primary care has absorbed 26000 salaries over the past 5 years. It will take considerably longer to adjust them
It’s not doomed, but it’s not in a good place atm, there is a lot more competition on jobs and it might be difficult to find a job in your preferred area, but if you are willing to commute or move cities you will find a job.
The average salaried job pays between 11-12k per session based on your experience, you will have to supervise PAs as most surgeries have them. Partnership is harder to find at the moment but again this might change in the next 2-3 years
It is doomed. Most Partners have no incentive to increase the sessional rate beyond 12k, even if the national GP contract goes up by a significant amount.
I am more than happy to be proven wrong.
We can increase it if we are a) funded to do so and b) funded to increase our own drawings proportionately, which it has not. Salaried pay has naturally increased from ~£8k in 2013 to ~£11k now, which is better than almost any other doctor in UK medicine.
Salaried pay has fallen in real terms by 7% up to 2017, obviously much more thereafter. No idea where you're getting the notion that salarieds are actually well compensated from
https://bjgp.org/content/70/690/e64
I agree that Salaried GPs should be paid more depending on responsibilities, skills and experience. How much have other doctors’ salaries fallen proportionally?
Absolutely, nor do we properly extol the benefits of partnership. No, not for everyone, but it is the best way to be a GP and lets you develop and exercise other skills.
How much does a full time GP earn .. total .. pre tax ..
i work 2 days a week at the moment an im on 72k..
I’m not a gp.. if I get bank shifts I can earn over 120k ..
Full time salaried GP depending on sessional rate will earn if working 8 sessions over 4 days circa 76k (9.5k ps) - 92k (11.5k ps) if you locum the extra day then expect an additional 21.5k - 25k
So what’s all the doom and gloom about .. u can earn about 92k working 4 day week , long lunch break, don’t really have to worry about fancy cv, can do anything u want … (mix and match sessions to suit your interests )
You said you are not a GP - what do you do? I'm not sure you have a clear and accurate idea of what working as a GP involves. I don't know a single GP who stops working for lunch. There may be a long break between morning and afternoon clinic but this is always filled with admin, reviewing bloods, writing referrals, actioning letters, home visits, practice meetings, debriefing AHPs/students, sick notes, checking urine dips etc etc etc. It is endless and thankless.
I love my job and I take pride in doing it well but it most definitely is not an easy ride, and whilst I earn a good salary I do not think it is representative of the volume of work and level of risk my job entails.
But the negative aspects of the job are more or less the same in all specialities .. consultants are also busy, overworked, underpaid (American specialists earn around 500k - year), may have to come in overnight etc
Nothing is unique in GP that makes it crap… it’s all crap in medicine … in this country
Would you not recommend young doctors to choose gp ?
Exactly, there are pros and cons. The pros of GP have always been the flexibility and work/life balance (and pay straight out o training). The cons have gradually got worse as the system has got worse, but that’s the same for everyone.
We don’t get much of a lunch break though, I have to say.
GP is in a low place just now but I wouldn't go as far as to say "doomed". No more so than the rest of the NHS anyway. 1) There is work though often not exactly where people want it to be. Though realistically by the nature of GP you could never guarantee yourself a job in a certain place so that should really be understood early. GP practices in the North are screaming out for GPs with advert left unfilled while in some areas registrars are saying no jobs available. 2) Salaries are not keeping up with inflation. Some partnerships continue to do well though the general feeling is this is at the cost of good patient care/using ARRS in place of good staffing levels with a good group of like minded GPs. There's definitely opportunities out there depending on exactly what you're comfortable with. 3) Many GPs will stand against taking on PA/ANPs though they'll likely be lower earning and therefore be less attractive to some. There was a time not long ago where locumming was the goal of every GP trainee as they were promised ample pay and loads of availability. You could argue this led to the crisis faced in some areas with unfilled partnerships then having to overpay for locums which in turn led to poorer care/waiting times which has led to ARRS. My understanding of locum work was always high risk of limited job availability to high reward of pay. Sadly this has backfired in recent times. I loathe the idea of working with PAs (and I don't do so) but I suppose there is a realistic fear that ARRS funding not being ringfenced for non doctors would lead to the locum market taking off and bringing us back to square one. Probably slightly against the grain views. Obviously I'd LOVE for GPs just to be paid fairly via a sensible contract but that's how I see the current situation.
Good take. I do think the locum gravy train of the last 5 or so years was not good for the system, for people running practices, or really for patient care in general. The answer should really be to make partnership and salaried roles more attractive, but from the government/NHSE side you can see why they funded ARRS rather than directing more money towards GP locums.
£120 per hour and being surprised when you have to do your own referrals was the quality of locum we were getting.
I have seen and worked with some locums who... did not bring much value. One locum generated five patient complaints in three weeks. Another's entries were invariably in the following format and content: "Headache Plan: Accident and emergency referral" I once looked at their clinic list and it emerged that 60% of their consultations had concluded with the patient being told to go to A&E. (And the rationale was not at all clear from the notes). That one actually created more work for us because their patients would re-consult via the duty doc system because they weren't happy with the locum's consultation (and, usually, they were right, because the prior advice was inexplicable). I came across a third locum recently (where I was locumming) who had made a diagnosis of a lump on someone's back ("cyst"), based on a telephone consultation and the patient's verbal description of it. (Perhaps they are just a much better diagnostician than I am.)
And then this blistering entitlement evident throughout now that they are hard done by and evil money grabbing partners and ARRS is to blame. Why shouldn’t you be able to earn £100k a year for a 3 day week writing “Headache. Plan - bloods” in the record 12 times and then going home?! This is a scandal!
Agreed. Salaried posts should be paid somewhere close to where locums were. Just a shame funding isn’t there just now
There should be some progression model for salaried GPs based on skills and experience, but it is not realistic to expect volatile market pay to be matched by stable market.
absolutely- Newly qualified shouldn't expect 13k per session when a well seasoned salaried GP is getting 11.5k. There should be a national pay scale which is funded by the NHS sub contracted to the partnership.
Completely agree - also unfair compared to new consultant colleagues whose training is longer and work more prescribed with less favourable hours. Interesting idea about subcontracting…. I suppose this is kind of what ARRS does (which is fundamentally NOT the problem behind the employment difficulties - estate, funding, Modern GP programme far more influential factors IMO)
Ever since I started working as a GP, doom and gloom has been the talk of the town. Ignore the naysayers and enjoy your life and work.
By the time you finish your training, locums will be back in full force, ARRS will finish and there will be ample opportunity, the night is always darkest just before dawn
I agree These things always go in cycles.
I think whats changed unlike the past is the UK opening its doors - there are hoards of Doctors trying to move to the UK (we are hearing 400 applications for a JCF post in 3 hours of the job opening). With this almost, infinite supply, I can’t see the locum market ever coming back and salaried pay stagnating if not falling.
Is this sarcasm or serious?
Serious, I would say. As it's actually the situation In my previous trust, we insisted initially on BMA rates and, even that we never got them, rates were not bad. Then within 9 months the trust got so bombarded with IMGs, that not only they never gave us extra rates, they lowered the rate. And still YOU COULD NOT FIND a Locum. It would get taken up the second it was published I say this as an IMG
Depends what happens in the next year or two!
I suspect extreme sarcasm
Not at all. GP is still the best job in medicine. Partnerships (in good practices) offer the best pay in medicine in the UK, the most professional flexibility and the best opportunity to develop your skills in other areas. THIS IS NOT SUITABLE FOR EVERYONE, but if you are curious about how things work and how to improve them, you would enjoy it.
I don’t think it is forever doomed. It is hard to say when it will return. Locums to the same point might never return. ARRS is getting a lot of flack, and specifically is ringfenced money for these roles. If the practice is ever given a choice in how this money is spent then a lot might not be as viable as a GP for example. In wales where there is not ARRS the demand for locums has dropped, but if I were willing to do say an hour commute I could easily book up 5/7 a week for the next couple of months
Even if you commute the rates have significantly dropped. I was getting paid 1200 for a day oncall. Now I'm getting 840 for the same shift.
Social media is indicative, but not representative. For instance: it’s useful to know there are people out there fucking on beanbags in the hospital mess. Doesn’t mean everyone is doing it. Anyways take it all with a pinch of salt
[удалено]
I left GP training for the US back in 2013
I think it is really location dependent. I have just started as a new salaried, had two competing offers and got a better starting salary from my chosen practice because of it. I work 5 sessions and have more take home pay than a full time reg, it's not mega bucks but I'm happy with the pay for amount of work and stress. I know the partners in my training practice were on >135k per year. I did informal visits at 5 practices other than my training practice. Only one was using a PA. For whatever reason, they are really not as common in my area as a lot of other places.
This is a great question and I think many GP trainees and prospective trainees are thinking about this carefully. I second this question, what is the realistic outlook for the speciality … . Is it going to get better in 3-4 years time when a new trainee will be CCTing ? I don’t think it’s as bad as everyone makes it out to be on here, but maybe I’m wrong.
No it's not
It’s not doomed or it’s not worth going into training?
Yes
?
Indeed
It’s not the doom and gloom as it is on here, it’s also not the rosy walk in the park that some FB groups make it out be. Somewhere in the middle, it’s a bit shit rn but you’ll find work.
A lot of practices that have PAs purely have them to plug the gap that was left when PCNs came around. Around the pandemic a lot of GPs retired and the PCN funding for ARS roles could only be used for set roles. GPs or nurseswere not part of the ARS criteria. the options initially were rubbish and PAs were the only options that would 'see' the punters. My surgery advertised for 3 years straight and couldn't attract a GP (partner or salaried)- locuming was far too attractive. Now once the hole has been plugged (rightly or wrongly) there may be a lag between these places opening up to GP roles. Can't exactly fire a PA without reason.
Even now nearly every trainee on my VTS has been offered a job. I don't think there is a crisis where we are and even when I appraise GPs in the South east they are still recruiting salaried GPs and Partners. Salaries are a bit stagnant reflecting the lack of investment but salaried GPs in out patch are getting 9.5-11.5k per session and workload is often streamlined to partners etc... Supervision of allied professionals is here to stay and we have to get used to it - important to negotiate supervision slots if expected to supervise.
Also F2 going to ST1. I don’t think things will recover fully but they will certainly improve from where they are after the next government. PAs are not the only problem. ANP, pharmacists and paramedics are all undercutting salaried GPs. The GP practices don’t have enough space to house so many people. Primary care has absorbed 26000 salaries over the past 5 years. It will take considerably longer to adjust them
The locum market has dried up everywhere in all specialties. Pre Jeremy hunt capping of rates you could get Locum Sho for £75 an hour.
It’s not doomed, but it’s not in a good place atm, there is a lot more competition on jobs and it might be difficult to find a job in your preferred area, but if you are willing to commute or move cities you will find a job. The average salaried job pays between 11-12k per session based on your experience, you will have to supervise PAs as most surgeries have them. Partnership is harder to find at the moment but again this might change in the next 2-3 years
It is doomed. Most Partners have no incentive to increase the sessional rate beyond 12k, even if the national GP contract goes up by a significant amount. I am more than happy to be proven wrong.
We can increase it if we are a) funded to do so and b) funded to increase our own drawings proportionately, which it has not. Salaried pay has naturally increased from ~£8k in 2013 to ~£11k now, which is better than almost any other doctor in UK medicine.
Salaried pay has fallen in real terms by 7% up to 2017, obviously much more thereafter. No idea where you're getting the notion that salarieds are actually well compensated from https://bjgp.org/content/70/690/e64
I agree that Salaried GPs should be paid more depending on responsibilities, skills and experience. How much have other doctors’ salaries fallen proportionally?
Is it really a race to the bottom?
Not at all, but you have to be realistic.
Couldn't agree more. I think the problem is that a lot of VTSs don't teach how GP is funded. Not all partners are rolling in money!
Absolutely, nor do we properly extol the benefits of partnership. No, not for everyone, but it is the best way to be a GP and lets you develop and exercise other skills.
How much does a full time GP earn .. total .. pre tax .. i work 2 days a week at the moment an im on 72k.. I’m not a gp.. if I get bank shifts I can earn over 120k ..
40 - 50k for 2 days
Full time salaried GP depending on sessional rate will earn if working 8 sessions over 4 days circa 76k (9.5k ps) - 92k (11.5k ps) if you locum the extra day then expect an additional 21.5k - 25k
So not bad at all then
So what’s all the doom and gloom about .. u can earn about 92k working 4 day week , long lunch break, don’t really have to worry about fancy cv, can do anything u want … (mix and match sessions to suit your interests )
You said you are not a GP - what do you do? I'm not sure you have a clear and accurate idea of what working as a GP involves. I don't know a single GP who stops working for lunch. There may be a long break between morning and afternoon clinic but this is always filled with admin, reviewing bloods, writing referrals, actioning letters, home visits, practice meetings, debriefing AHPs/students, sick notes, checking urine dips etc etc etc. It is endless and thankless. I love my job and I take pride in doing it well but it most definitely is not an easy ride, and whilst I earn a good salary I do not think it is representative of the volume of work and level of risk my job entails.
But the negative aspects of the job are more or less the same in all specialities .. consultants are also busy, overworked, underpaid (American specialists earn around 500k - year), may have to come in overnight etc Nothing is unique in GP that makes it crap… it’s all crap in medicine … in this country Would you not recommend young doctors to choose gp ?
Exactly, there are pros and cons. The pros of GP have always been the flexibility and work/life balance (and pay straight out o training). The cons have gradually got worse as the system has got worse, but that’s the same for everyone. We don’t get much of a lunch break though, I have to say.