Mark Steggles
@msteggy
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Pinned Tweet
Do you want 8,000 more GPs?
Here’s how
#TeamGP
:
A Blueprint for a sustainable General Practice.
@DrFJameel
@ClareGerada
@Parody_RCGP
@DrSimonHodes
@DrSelvarajah
@BMA_GP
@rcgp
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They burned out, worked longer & faster to increase capacity, they struggled to cope with increasing workloads, they retired early rather than limp on, they left for better lives & whilst working harder than ever they were continually berated by your paper
Does that cover it?
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NHS not on the edge?!! I tried to refer patient with 7 hours sudden onset central chest pain and new RBBB to medics yesterday-was initially told they couldn’t see him until the next day and that there were 80 people waiting in A&E. Had to push for review. It’s past the edge! 🤬
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Utterly shocked and disgusted by
@wesstreeting
attack on doctors and their union.
@Keir_Starmer
@AngelaRayner
Anything to add?
As a staunch Labour supporter and member (up until this morning) I can no longer give you my support or vote with rhetoric like this. Shameful.
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So salaried GPs are getting a real terms pay cut & the partners that employ them get no extra funding to meet the 4.5%, therefore they get a pay cut. And 2% for GP trainees?! Anyone in this government that says their aim is more GPs for patients is not being honest.
#TeamGP
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Two weeks in to locuming and I’m loving it.
15 minute appointments capped at 14 patients per session I’ve found being a GP enjoyable again.
Gone from only being able to manage 3 days previously to working 5 days a week.
General practice can be made enjoyable again.
#TeamGP
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Tried to chase up what happened to a referral made for a patient in June 2021 to gynaecology - assumed there’d been an admin error somewhere.
No - Wait time…73 weeks 🤯
This is the healthcare our government are willing to provide us with and it is utterly unacceptable.
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One of the most disturbing parts of
#ThisIsGoingToHurt
is the all too realistic depiction of how healthcare workers, when burnt out and exploited, rapidly lose empathy for patients and colleagues alike. Broken systems break people.
#TeamGP
#NHS
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The two most impactful changes that could be made to free up GPs & increase efficiency:
Fund every practice to employ a triaging clinician and a home visit clinician.
Rather than tear down the current GP model this simple change, I believe, would have a huge impact.
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This PA job description may as well read:
Attempt to do the job of a GP without the necessary training or qualifications.
Not replacing doctors? My ARRS!
Live General Practice PA job advert. I find this 🤯🤯- reads like an experienced GP role. If this is allowed with 2yrs training - what's the point of a medical degree & GP training (VTS)? How have we got to this?😢
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The future of being a GP in the NHS?
A role supervising teams of allied health professionals who provide direct patient care in large, impersonal organisations.
Detached
Deskilled
Distant
Not what I signed up for.
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When a ‘GP appointment’ no longer means an appointment with a GP.
GP retention schemes scrapped
Real-terms cuts to funding to employ more GPs
GPs being offered redundancy and struggling to find jobs due to inadequate funding.
Only 40.4% of appts in Nov 23 actually with a GP
Accessing GP appointments is a priority for the public.
And thanks to the brilliant work of our GPs, practice nurses, physios, pharmacists and others we’re making progress.
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Anyone labouring under the illusion that ARRS were intended to ‘supplement’ GPs should abandon any doubt.
GPs are being replaced.
Patients may be ‘seen’, it’s increasingly less likely they’ll be seen by a GP.
A new low for the profession & the NHS.
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RCGP jobs website
Number of NHS GP job adverts based across the entire UK? 🇬🇧
🚨‼️Only 223 ‼️ 🚨
Across 9085 practices ‼️
= <2.5%
Where on earth are 4000 GPs qualifying each year going to find work?
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It’s clear - GPs are being replaced. NAO report.
Unconscionable.
Taking a sledge hammer to the foundations of the NHS
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The choices GPs face:
Partnership - huge liabilities, dwindling income, unviable contracts, unmanageable workloads.
Salaried - unmanageable workloads, on average working 25% above hours unpaid, pay erosion, increasing risk of redundancy.
Locum - unemployment.
Leave.
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💥 Mythbuster💥
When it is said that GPs are ‘working part time’, what is actually happening is that GPs are paid a part time salary for full time hours.
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We have a shortage of GPs and we have patients struggling to access GP care.
At the same time we have GPs struggling to find work 🤯
This should be a national scandal!
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We are losing more GPs daily
Immediate changes that would stem the loss:
Cap clinics to safe no - 25
Abolish duty sessions
15 min appts
Admin sessions
Then sort out pensions/pay and funding.
Can’t continue with current No of consultations and not lose more GPs.
#TeamGP
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Duplicitous Hunt.
Awful health secretary
Years on the back benches playing the bleeding heart re NHS
Gets back into a position to make improvements and abandons it all.
Believe them the first time.
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GPs cannot find NHS jobs
Patients are struggling to see GPs
NHSE/DHSC refuse to do anything about it
Plenty of money ploughed in to the recruitment/training of ‘additional’ roles
There can be no doubt - GPs are being replaced.
Unbelievable & so so scary to be a
#GPST3
😱
79 applicants for one GP job in just over 2 weeks?
How did we get to this ?
@DrSteveTaylor
@Parody_RCGP
@KamilaRCGP
@JanjuaAdam
@dave_dlt
@axelheitmueller
@CraigNikolic
@rcgp
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Someone working within their scope of practice doesn’t require supervision.
If supervision is required then they are working beyond their scope of practice.
Why do ARRS roles require supervision if they are working within their scope?
#illogical
#paradox
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One thing GPs used to be able to rely on was job security.
Emerging reports of redundancies & locum unemployment - seems not the case anymore.
Yet another factor that will inevitably drive GPs away from NHS
What an utterly preventable mess. Patients will suffer as a result.
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GPs out of work. There are fewer GP opportunities in the NHS - despite of a shortage of GPs 🤯
GPs in work are expected to supervise and shoulder the liability for those being used to replace GPs 😳
They think anyone can do our jobs 🤦♂️
They are dangerously wrong.
#BackGPs
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‘Same-day Hubs’ - a bit like your GP practice but with fewer GPs, a team you don’t know and probably further way than your practice.
Totally unnecessary & inefficient if your practice had better funding & more GPs.
They could invest in your local practice instead.
#BackGPs
GP - the recognised front door to the NHS.
Rather than ensure resources are there to meet patient’s needs, the plan is to fragment & divert people away from their GP.
Introducing inefficiencies & being bounced between more unnavigable services is the plan.
#BackGPs
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We can’t allow this to continue.
We can’t be complicit in the erosion of patient care in GP.
We can’t allow our profession to be devalued and displaced anymore.
GPs will soon need to take a stand & reject this path we are being forced down.
Enough is Enough.
#TeamGP
“We’re creating PAs to support NOT replace GPs” IS A COMPLETE LIE!
The practice I locum in have now replaced me with a PA 😞
I’ve been a GP for 10 years & can’t get work?!
My GP colleagues CANNOT GET work!
We ARE being replaced, by significantly less qualified people?!
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It’s naive & reckless to allow someone with 2 years of training to perform any of the duties of a GP.
Even with supervision - likely a cursory debrief with a stretched & overloaded GP - potential for patient harm is huge.
There’s a reason being a GP takes 10 years of training.
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There needs to be a reset in expectation of the care the NHS can provide to you.
The new norm is difficulty getting GP appointments, no dentists, dangerous waits for ambulances & A&E, months/years for specialists.
You get the healthcare your government’s willing to provide.
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🚨What this means for patients🚨
Even harder to get appointment ✅
Less likely to be able to see a GP ✅
More likely your practice will close ✅
What this means for GPs
Huge slap in the face
Your work isn’t valued
They’re not listening to you
Time for action 🦀
BREAKING: NHS England will increase funding for general practice to 2% as part of what it calls 'final arrangements' for the 2024/25 GP contract
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What level of supervision should someone with 2 years training receive when seeing patients with undifferentiated conditions in General Practice?
In the absence of any actual guidance I’ll make a suggestion:
1-1, every patient at least discussed if not re-examined/seen by a GP
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Pharmacist partner in GP espousing the ‘benefits’ of replacing GPs with ARRS, but the idea of additional funding to employ GPs is ‘ridiculous’
‘We’ve put a lot of effort into training non-medical staff to take on those roles.’
Shocking!
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Can I suggest that doctors who find themselves in a position of influence use that influence to promote measures that support their colleague’s aims of ensuring sustainable and safe working conditions which are vital for safe and timely patient care. 1/2
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They think anyone can do our jobs.
They also expect GPs to employ and bear the liability for this.
Damaging to the profession and patients.
We can’t be complicit in the wholesale replacement of GPs.
#TeamGP
#BackGPs
This PA job description may as well read:
Attempt to do the job of a GP without the necessary training or qualifications.
Not replacing doctors? My ARRS!
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They’ve effectively signed the Do Not Resuscitate order on NHS General Practice
The consequences for patients and the rest of the ailing NHS will be devastating.
BREAKING: NHS England will DECREASE funding for general practice by an additional 3% in real terms as part of what it calls 'final arrangements' for the 2024/25 Funeral of General Practice
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Bad news for ALL GPs and their patients.
Our entire profession is being devalued on every front and replaced.
#EnoughIsEnough
#TeamGP
🦀
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NHSE do not value GPs.
Their answer to GP shortages?
‘One of the most significant examples of workforce substitution’ - National Audit Office.
They think anyone can do our jobs.
They think patients won’t care who they see.
#TeamGP
you are not valued as you should be. 🦀
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The shortage of GPs isn’t a natural occurring phenomenon.
It’s a deliberately engineered consequence of years of government underfunding & exploitation of good will.
We’ve arrived at a place where AHPs are working beyond their remits as a result with inadequate supervision 1/x
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💯
The idea you can fragment Primary Care into simple/complex, acute/chronic & that anyone can safely do the job of GPs is the deeply flawed premise that is driving policy.
What’s ‘simple’ for GPs is only so because of the expertise & experience gained over years of training.
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It seems commissioners have decided NHS GP care is unaffordable.
Rather than try to resolve causes of GP attrition they’ve opted to abandon standards of training required to provide care & push for recruitment of non-GP roles.
GPs care is not too expensive - it is VALUABLE.
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Should GPs accept liability for clinical assessments & decisions made by people with 2 years of training?
Should GPs prescribe/request medical ionising radiation on the basis of their assessments?
Or should GPs decline & insist that something is done to reverse the loss of GPs?
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What test would someone refer themselves for for internal bleeding? FIT? Bloods? CT? US? Gastroscopy? Colonoscopy? Cystoscopy?
How urgently? 🙄
Asking patients to be their own GP 😲 - Nuts. Didn’t realise there was all this spare specialist capacity to do it.
Laughable.
"One of things we've put forward.. self referrals so individuals dont have to go to a dr in order to get referred to specialist help.. if youve got internal bleeding & you just need a test there ought to be a way that doesn't involve going to see a GP"
Keir Starmer on
#BBCLauraK
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Unacceptable ambulance response times.
Tens of thousands of patients waiting more than 12 hours in A&E.
Months/years wait to see specialist.
Hundreds of thousands of patients losing their GPs per month.
The NHS is collapsing. Not a good time to be a patient.
#NHSCrisisNow
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My GP is struggling.
As a GP I understand why.
I’ve received excellent timely support from them but this is only achieved by them working dangerous hours & undertaking unsafe level of consultations which inevitably is burning them out.
I’m worried I will lose my GP.
#TeamGP
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#TeamGP
🦀
33.5% pay erosion for salaried GPs
Expected to supervise and train up our replacements whilst shouldering the liability
Unmanageable, unsafe workloads
Unviable contracts
They do not value GPs. They are not listening.
@NHSEngland
@VictoriaAtkins
@andrealeadsom
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@pritipatel
Your party reduced police numbers. Correcting your own mistakes is not something you should be lauding yourself for. You should be apologising for reducing them in the first place.
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#TeamGP
This needs to happen NOW!
1) Cap your clinician’s capacity
2) Give them 15 minute appointments
3) Give them admin sessions
If we don’t make this change NOW:
⬆️ exodus of GPs
⬇️ quality of care
⬆️ risk of litigation
#IAmPhilipMitchell
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#TeamGP
Fundamental issue with GP workload is lack of allocation of protected admin time.
BMA safe working guidance 15 min appts, no more than 3 hours consulting = 12 appts/session, leaving 1 hour 10 mins for clinical admin (letters/results/scripts/tasks/referrals).
1/3
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Looking through twitter this evening and trying to decide which unwarranted bashing I should try to refute. Where to start?! Losing the will to try.
If you listen very carefully you may hear the quiet rumble of 1000s more patients losing their demoralised GPs.
#TeamGP
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There’s growing evidence that GPs are being replaced by ARRS. As a profession, we need to be acutely aware that we are being driven to employ, supervise & train our replacements & we need to reject this erosion in the quality/standards of patient care.
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Things that enable me to work sustainably as an 8-10 session/week GP:
25-28 consults/day
Adequate admin time
15 minute appts
No duty sessions
6 months ago was struggling to manage 6 sessions/week and planning on leaving GP.
It should be like this for everyone.
#TeamGP
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Many GPs will be waking up today, having seen the insulting 2% contract offer from NHSE for this year, will be firming up their exit plans.
The last glimmers of hope for recovery have been well and truly extinguished.
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There can be no doubt that GPs are being replaced.
The government have eroded funding and eroded the standards of care patients are receiving.
Molesey and Thames Ditton GP redundancies due to 'new ways of working'
➡️ 11 Salaried GPs received letters of voluntary redundancy
➡️ The New Primary Care Model - Cheap & Cheerful
➡️ This is a side effect of Primary Care Networks (PCNs)
Mr Todd said he appreciated any
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@wesstreeting
The current state of the NHS is terrible. That’s a given. Suggesting it’s because of doctors is utterly insulting and a totally incomprehensible conclusion to have come to. Utter nonsense. Hugely disappointing.
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When did GP get reduced to a production line where primary output is appointments, no matter who they’re with?
With dwindling chance that u might get some remote Dr input in ur care & only when ur health has deteriorated to such degree ur deemed worthy of direct care from a GP.
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More GP consultations than ever before with fewer GPs and more leaving, yet still patient satisfaction is plummeting.
When will we learn that maximising capacity at all costs isn’t working for anyone.
Rapid, rushed, unsafe consulting is damaging to all.
#TeamGP
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RETENTION, RETENTION, RETENTION.
GPs are working well beyond what is safe and sustainable.
Salaried GPs are working, on average, 25% above their contracted hours - unpaid. Add in pay erosion of around 30%.
Burnt out and devalued. It’s no wonder we are losing GPs.
#TeamGP
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BMJ careers website.
Number of GP job adverts based in a practice across the entire UK? 🇬🇧
🚨‼️Only 45 jobs ‼️ 🚨
Across 9085 practices ‼️
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If the NHS is run for the benefit of doctors now, with them leaving, burning out and planning strikes and all, I can’t begin to imagine how awful things will be under Wes’s control if this is his warped perception.
Utterly bizarre rhetoric.
EXC
The NHS is too often run for the benefit of doctors, not of patients, Wes Streeting warns in
@theipaper
interview alongside Rachel Reeves.
He promises a decade-long reform programme to empower patients to take control of their own care.
Story:
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If locum GPs can’t find work in core NHS general practice, as we are hearing, they will find alternative work outside the NHS.
Patients and the profession cannot afford to lose more GPs from the NHS workforce.
Urgent funding desperately needed to prevent a further loss of GPs.
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When you consistently devalue the medical profession for over a decade, erode standards of patient care in the NHS & repeatedly fail to listen to reason there are consequences.
Solidarity with our colleagues who have had the courage to oppose it.
Growing anger amongst GPs too.
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A shortage of GPs yet fully qualified GPs locums are struggling to find work?! 🤯
It is utterly perverse.
Access is being prioritised over safe, effective and quality care.
A very worrying future for GPs and patients alike.
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If you do nothing to halt/reverse the ongoing loss of GPs but instead choose to plough millions of £££s into recruiting non-GP additional roles you are not seeking to supplement GPs, you are actively replacing them.
Worrying for GPs and patients alike.
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@NHSBartsHealth
@TomStocks1982
@mdstbarts
Don’t think the video is the problem here. It’s the disparity it reveals.
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PCNs: A summary.
NHSE: Look GPs, here’s a carrot. It’s the only new carrot around and there won’t be anymore carrots coming your way.
*GPs desperately grab carrot
GPs: This carrot is rotten
NHSE: You’ve taken the carrot now and you need to work harder for that rotten carrot.
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I really don’t understand this fallacy that is popping up in plans for future General Practice that you can separate acute vs chronic care. Pts with chronic problems often present with acute issues, those who don’t have chronic conditions often start by presenting with recurrent
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Worrying lack of opportunity for woefully inadequate number of GPs we have in the NHS.
Choices are poor:
Partner - unlimited liability/workload, inadequate investment/unviable contracts
Salaried - unsustainable/unsafe workloads, 33% pay erosion
Locum - risk of unemployment
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The dire and ever worsening state of NHS General Practice:
GPs are being devalued and replaced.
Partner income reducing
Salaried GPs 33% pay erosion
Locums struggling to find work/having to reduce rates, reduced opportunities/increased competition
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Tip for politicians - listen carefully to people who have the expertise, experience and training working in the industries you’re hoping to improve rather than spurting out your unworkable/detrimental nonsense ideas. It might make you look credible, informed and inspire trust.
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Let’s explore solutions to the GP shortage by means of a Bandersnatch-esc choose your own adventure tweet.
There is a shortage of GPs. Patients are struggling to get appointments: do you
a) complain that GPs are lazy & overpaid?
Go to 2
b) try to understand the causes?
Go to 3
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Is capping patient consultations per doctor, increasing appointments to 15 minutes and allocating admin sessions to GPs impossible with the current GMS contract? Would argue it is not and is the necessary change required to improve retention/recruitment & reduce burnout.
#TeamGP
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Let’s call it what it is:
A means to replace GPs and remove required standards of training rather than take adequate and necessary action to retain/recruit more GPs.
#TeamGP
The GMC has proposed a radical solution to the GP recruitment crisis – removing restrictions on secondary care doctors working in primary care. Editor
@jkaffash
looks at the implications
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@waldvogel63
@wesstreeting
@Keir_Starmer
@AngelaRayner
Think you must have missed the part of the article where he accuses ‘hostile’ unions of holding the NHS back and GPs of not having the best interests of patients at heart.
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A saturated NHS GP job market - with woefully low number of GPs - is a dire state to be in.
Terrible for patients who so desperately want/need GP care, terrible for GPs wanting to work/provide care.
Governments need to wake up to this deepening crisis & back General Practice.
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GP - the recognised front door to the NHS.
Rather than ensure resources are there to meet patient’s needs, the plan is to fragment & divert people away from their GP.
Introducing inefficiencies & being bounced between more unnavigable services is the plan.
#BackGPs
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Got a shortage of GPs?
Abandoning the standards of training required to undertake the role of a qualified GP won’t work.
It exploits PAs, it devalues GPs and it is not what patients deserve.
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Governments are failing to recognise/tackle the fundamental problem in General Practice.
Problem: Not enough GPs.
Their solution: Spend millions recruiting non-GPs
Prioritising access over safe/quality care is not working.
Complaints ⬆️ despite record number of appts, GPs ⬇️
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With the expansion of ARRS - roles that require GP supervision:
Have salaried/employed GPs just been expected to do this?
Who should bear the responsibility and personal risk of supervising such roles?
Ultimately it’s your licence on the line if something goes wrong.
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#TeamGP
A reduction in GP capacity is inevitable.
We have a choice:
Allow it to happen, continuing as we are, losing more GPs to burnout
or
implement safe working restrictions so the long-standing trend of workforce loss might be reversed.
Seems like an easy choice.
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If a patient is seeing a clinician for a problem that requires a prescription should they be seen by someone trained, qualified and able to prescribe?
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Let’s start being honest & more reflective of reality with our words.
Let’s stop talking about intentions & start talking about what’s actually happening.
Addition Roles Reimbursement Scheme❌
GP replacement Incentive Scheme ✅
Physician’s Associate ❌
Doctor substitute ✅
1/n
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NHS teams have had enough.
Enough of poor conditions
Enough of pay erosion
Enough of watching their colleagues leave
Enough of worsening care for patients
I stand with our Nursing and Ambulance colleagues. Thank you for taking a stand.
No doubt more will follow your lead
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@thetimes
@wesstreeting
Another disappointing glimpse into the worrying lack of understanding of the problems in General Practice from the shadow health secretary. And an increasingly oppositional/derogatory rhetoric towards GPs with every statement.
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@DamianFog
Not clear what your point is. If you had had a bed you would have admitted but you didn’t so you’re going to see them in OP? The best way to feed back is to speak to the clinican directly not a tweet that feeds into the false narrative that GPs are to blame for long A&E waits.
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And even back in 2018 - when there were 1800 patients per GP - it was still unmanageable.
Governments mindlessly plough on with trying to make it work with fewer GPs and real terms funding cuts.
It’s not working for patients, it certainly isn’t working for GPs.
Just
#BackGPs
GP CRISIS🔥
500⬆️more patients per GP (2300) compared 2018 (1800)
2000⬇️GPs
20%⬇️ £/patient/year (Total £165compared 2016 £152)
Half population consult GP practices/month (31million)
Govt solution 2024/25 - just £3/patient/year (2%)
Blame MPs not GPs
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Identifying and recognising complexity in an otherwise seemingly ‘straightforward’ 10 minute consultation is precisely why GPs undergo 10 yrs of training.
It is a skill developed over time, with the application of the vast experience & knowledge those 10 yrs provide.
Ooo. That’s a very selective quote. Listen to the whole thing. “When they’re complex they should be escalated”. That’s the very next line. And isn’t that the point? I regret this debate in the Lords because it denigrates the contribution of AAs and PAs, instead of celebrating
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