I plead guilty! I am a retired GP, 31 years in the same practice, now enjoying my RPI indexed pension. You could qualify for a full NHS pension after 40 years of service but there used to be an ability to make additional voluntary contributions to add years to your service. In my last years (part-time) I was making an additional 8K+ contribution to my pension pot so that when I retired I am indeed well provided for - but that was my choice.
Out of hours services used to be based on a 1930-40's model of care. I did over 20 years of on-call, which meant in the week working a full day, then an overnight until 8AM and then another full day until collapse at 7PM. In that time I would have made potentially life threatening decisions (the patient's - not mine) whilst exhausted. There is nothing more debilitating than getting out of bed 3 or 4 times to treat emergencies and then cracking on the next day. Weekends were no fun for the family, bound to the house as my wife acted as unpaid receptionist. At least we only did 24 hours on-call but I have worked all Sunday and not slept more than a few hours before Monday morning. It simply was not safe, even if it gave the illusion of continuity and care. The Co-operative movement which began a few years before I gave up out-of -hours was great. Defined shift, worked your socks off, but it was only 8 hours. Some nights continuous visits, but at least we had a call centre, drivers and good equipment. Didn't come cheap though, it cost me personally £3000 a year to be a member of the Co-op, as it did every other member. When the last Govt offered the chance to give all this up for £6K we bit their hands off. The civil servants who negotiated this with the BMA did not have a clue how expensive the service that we had been subsidising for years was - they soon found out.
Our new contract was largely imposed by a centralist government with political ideas who wanted more central control over issues such as 'quality'. Because quality is something ill-defined, especially in General Practice, they chose targets which where somewhat evidence based but largely things that could be counted easily, such as weight, BP etc. The quality framework has led to a lot more data and has improved the general health of the population. If a random middle aged man, who may only come in very infrequently, has his BP measured because the protocol says it should be done to meet your 'targets' the intervention is intrusive and not the reason he attended (which should take priority). However if it is raised, and a large number were, and we intervene by getting him to lose weight, take exercise, stop smoking and maybe after monitoring treat with medication then statistically we can show that he should live longer and healthier. No fun to have a stroke or heart attack in your 50's from preventable disease.
Our practice always met its targets. It was not easy but we had been doing most of it for years anyway. The money was not extra, it was part of the package of our general remuneration but throwing away that money would have been bad management. We invested heavily (hundreds of thousands) in computers, staff, training and professional management, because we wanted to do a good professional job and that requires resources and planning as well as team work, from every member of the practice team. Did it work? Our mortality figures for example heart attacks has fallen constantly over the 30 years, some of that is better drugs, some is better interventions and monitoring. The danger is that you chase targets and avoid the individual need and that has occurred.
The other gripe I have is that the patient has no idea how difficult General Practice is as a discipline. Sure there is lots of training and after 10 years you hope to become a GP. It is much more difficult now to become a partner (more responsibility but a share in the profits of the risks and opportunities of the business) so more young GPs are now employed as Assistants - less pay and less chance of progression. There is no average day but when I was working the bulk was routine (BP, asthma, general elderly medicine, depression, anxiety, cancer monitoring, diabetes etc. etc - you get the picture). However you had to be aware that every patient had potential not to be routine. The truly suicidal, the cancer symptoms picked up early enough, the incipient stroke. Occasionally you made decisions that were immediately life saving, which gives you a buzz, but you also had the satisfaction of stopping a 30 year old smoking, by constant nagging, and extending their potential lifespan into retirement. So a morning surgery, say 12-15 patients, maybe 30 problems to deal with. Some 45 minutes admin, results, letters etc. Visits - variable but usually necessary, maybe a lunchtime managerial meeting, more admin, signing up to 60 prescriptions (and reviewing the medication), evening surgery - similar to the morning. Input data on each consultation as it happens, whilst talking, trying to be empathic and not missing the dreaded target reminders, and all in 12.5 minutes (I started GP at 7.5 mins and it is now 12.5 because of the increasing burden of data logging and the complications of an ageing population). Do this every day and don't miss anything.
I'm quite glad I'm retired.
