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Post by Daft H'a'porth A'peth A'pith on Apr 15, 2021 19:30:16 GMT
If there is a shortage of GPs how come the saleries are not higher than in more competative areas, as a true market of supply and demand should dictate. Most are self employed, or employed by the practice, which is a standalone business that bids for NHS work from its local Commissioning Care Group, and so sets its own pay levels, but the basics are: “There are two contractual options for GPs. They can be: 1) independent contractors who are in charge of running their own practices as business either alone or in partnerships. They have autonomy in how services are delivered according to their contract with the Clinical Commissioning Group. In England, these GPs have increasing responsibility for the commissioning of hospital services for the community 2) salaried GPs who are employees of independent contractor practices or directly employed by primary care organisations. From 1 April 2020, the pay range for salaried GPs is £60,455 to £91,228.”
But if there's shortage those pay rates should be more than hospital specialists in competative fields, bet they aren't, hence a market that isn't a market and doctors going where they are less needed. Don't e tell me many doctors choice won't be influenced by the amount they can earn.
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timmullen1
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Post by timmullen1 on Apr 15, 2021 22:31:19 GMT
Most are self employed, or employed by the practice, which is a standalone business that bids for NHS work from its local Commissioning Care Group, and so sets its own pay levels, but the basics are: “There are two contractual options for GPs. They can be: 1) independent contractors who are in charge of running their own practices as business either alone or in partnerships. They have autonomy in how services are delivered according to their contract with the Clinical Commissioning Group. In England, these GPs have increasing responsibility for the commissioning of hospital services for the community 2) salaried GPs who are employees of independent contractor practices or directly employed by primary care organisations. From 1 April 2020, the pay range for salaried GPs is £60,455 to £91,228.”
But if there's shortage those pay rates should be more than hospital specialists in competative fields, bet they aren't, hence a market that isn't a market and doctors going where they are less needed. Don't e tell me many doctors choice won't be influenced by the amount they can earn.
Most GP surgeries are run as a profit making (or at best non loss making) concern, so, as everywhere in the private sector can only pay based on the services they provide. You might have a pretty large practice like the one I’m under with five GPs, plus a financial link to get students from Keele med school, who can bid for and secure contracts hand over fist, thus presumably paying themselves pretty comfortably, or you can have the husband and wife practice nearby, where both Doctors are in their 70’s and have signalled their desire to retire but can’t get anyone to take over from them, so are just doing the bare minimum and therefore presumably pay themselves less because the practice income is less. My practice is actually a Company Limited by guarantee and the five GPs are actually shareholders I assume paying themselves an annual dividend. There’s also the issue of GPs practices now selling out to an American chain; another cousin recently retired as a Practice Manager in York after it was sold because she wasn’t prepared to work under the ethos of the new owners (and she’s a pretty right of centre Conservative). But from having a lot of contact with the medical profession it genuinely isn’t all about money, as the shortage spreads to other specialities, a large number of med students are only keen to work in glamour specialities like cardiology and oncology. I believe the Obs/Gynae situation is so bad that government are now offering some kind of financial incentive to med students prepared to choose that speciality.
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Eastwood
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Post by Eastwood on Apr 15, 2021 23:03:11 GMT
Most are self employed, or employed by the practice, which is a standalone business that bids for NHS work from its local Commissioning Care Group, and so sets its own pay levels, but the basics are: “There are two contractual options for GPs. They can be: 1) independent contractors who are in charge of running their own practices as business either alone or in partnerships. They have autonomy in how services are delivered according to their contract with the Clinical Commissioning Group. In England, these GPs have increasing responsibility for the commissioning of hospital services for the community 2) salaried GPs who are employees of independent contractor practices or directly employed by primary care organisations. From 1 April 2020, the pay range for salaried GPs is £60,455 to £91,228.”
But if there's shortage those pay rates should be more than hospital specialists in competative fields, bet they aren't, hence a market that isn't a market and doctors going where they are less needed. Don't e tell me many doctors choice won't be influenced by the amount they can earn.
I've genuinely met very few medics who make their postgraduate specialty choices based on earning potential. What differentials there are tend to be on the amount of private work available which is much higher in some specialties. GPs who want a bit of extra cash tend to do some out of hours work to boost earnings. Nearly all specialisation is based on what specialty you have an affinity for. Apart from anything else the exams are bloody difficult in many specialties so doing one you aren't interested in or good at is foolish. Dr Eastwood sat multiple exams every year from when she was 15 until she was 32 with the single exception of the year she turned 25 when she was finishing her JHO jobs. She now has 4 degrees, 2 fellowships, 5 college / faculty memberships and 2 diplomas and when she writes out her full name (for the most formal occasions only) she has 8 post nominals totalling 40 odd digits so it looks frankly ridiculous. Despite all that her specialty is not a lucrative one and has no private work so she's not exactly raking in the cash in comparison to what she could have chosen had she been motivated purely by what private work availability there was.
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Post by Daft H'a'porth A'peth A'pith on Apr 16, 2021 5:50:21 GMT
I never said everyone is motivated by £.
But a true market would give GPs substantially more than other specialities to fill the shortfall in numbers.
Reality is the NHS isn't funded as a true market, just as a half-assed version of one.
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Eastwood
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Post by Eastwood on Apr 16, 2021 6:52:57 GMT
I never said everyone is motivated by £. But a true market would give GPs substantially more than other specialities to fill the shortfall in numbers. Reality is the NHS isn't funded as a true market, just as a half-assed version of one. Well in a true market some GPs would charge more in wealthier areas and the staff shortages would be in poorer areas which would have fewer doctors per head. Pre NHS this was obviously the situation and GP earnings varied hugely across the country depending on area. Your theory doesn’t work though because medical employment is in some ways a true market in that a lot of doctors can earn more by leaving the UK so those who are more financially motivated can respond to market forces that way.
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Post by Daft H'a'porth A'peth A'pith on Apr 16, 2021 7:10:42 GMT
I never said everyone is motivated by £. But a true market would give GPs substantially more than other specialities to fill the shortfall in numbers. Reality is the NHS isn't funded as a true market, just as a half-assed version of one. Well in a true market some GPs would charge more in wealthier areas and the staff shortages would be in poorer areas which would have fewer doctors per head. Pre NHS this was obviously the situation and GP earnings varied hugely across the country depending on area. Your theory doesn’t work though because medical employment is in some ways a true market in that a lot of doctors can earn more by leaving the UK so those who are more financially motivated can respond to market forces that way.
OK, so its not a true market, just a badly rigged one that doesn't reflect patient , sorry, stupid ill customers, needs, let alone their priorities in a non customer led customer led NHS.
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Eastwood
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Post by Eastwood on Apr 16, 2021 7:24:51 GMT
Well in a true market some GPs would charge more in wealthier areas and the staff shortages would be in poorer areas which would have fewer doctors per head. Pre NHS this was obviously the situation and GP earnings varied hugely across the country depending on area. Your theory doesn’t work though because medical employment is in some ways a true market in that a lot of doctors can earn more by leaving the UK so those who are more financially motivated can respond to market forces that way.
OK, so its not a true market, just a badly rigged one that doesn't reflect patient , sorry, stupid ill customers, needs, let alone their priorities in a non customer led customer led NHS.
Not meaning to be rude but do you actually have a point? I know you love a moan but what actual changes are you proposing and how would they improve things?
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Post by East Anglian Lefty on Apr 16, 2021 8:32:31 GMT
Legally I can't see how you'd impose a requirement to work for the NHS. You can't stop people from moving abroad, or from deciding they want to change career, or from having a medical issue that means they can't work any more. There's a similar issue but more severe issue with retention of newly qualified teachers, which I'm always surprised doesn't get more attention given the cost of training. But ultimately the way you solve that issue is to make sure people do not want to leave the profession - reaching for coercive measures just suggests you don't have any ideas about how to persuade them. Paying people properly always helps It doesn't hurt, but teacher pay has gone up quite significantly over the past two decades and the retention crisis has got worse. Other factors are clearly at play and are probably more effective (and certainly cheaper) fixes.
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mboy
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Post by mboy on Apr 16, 2021 8:45:45 GMT
There is a shortage of GPs because more than half of them are women. That doesn't make any sense.
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Post by Daft H'a'porth A'peth A'pith on Apr 16, 2021 9:05:38 GMT
OK, so its not a true market, just a badly rigged one that doesn't reflect patient , sorry, stupid ill customers, needs, let alone their priorities in a non customer led customer led NHS.
Not meaning to be rude but do you actually have a point? I know you love a moan but what actual changes are you proposing and how would they improve things?
Well as a layman,
I would suggest that if we are contracting people to do jobs, for a start GPs saleries could be higher than hospital doctors and on a par with abroad, so we retain GPs.
If we're taking about service from GPs. Don't lock patients out, as is happening now. Treat people's needs, not as Covid vehicles. People's mental health is currently going down the shitter because GPs have been making people take covid tests rather than listen to them and treat them a people, try and diagnose their real problems. GPs are exasibating health problems rather than treating them by continuing to woship the almighty covid.
If we're talking about hospital services treat people's needs, treat them for 'possible' cancer, try and save lives not just those of people who have the Covid we should worship.
If we're talking about approach then the NHS should be a prevention of illness service not just a treatment service. Yes I'm moaning, because I think the NHS service has fallen a lot in the last year and I don't believe that the self-interested service will want to quickly return to a higher quality service because Covid is a good excuse for all failures. Now, the medical profession and government has an out for failure, why would they want to actually design a service that works best.
In the end Covid is an great excuse for bad service / practice within and without the NHS, bad service / practice is becoming 'new normal' in our society encouraged by our enlightened bad practice government and bad practice medical experts.
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Post by Daft H'a'porth A'peth A'pith on Apr 16, 2021 9:05:59 GMT
There is a shortage of GPs because more than half of them are women. That doesn't make any sense.
Maternity Leave and more likely to work part time mean more bodies needed, whether male or female.
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Crimson King
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Post by Crimson King on Apr 16, 2021 9:10:43 GMT
There is a shortage of GPs because more than half of them are women. That doesn't make any sense. I think it may be suggesting that a significant part of the workforce wants to work flexibly, part time and so on so the head count is much less than the FTE. In fact the problem is probably larger than thas and most male GPs also want to do the same. It is one of the great atractions of the job. It is probably a refinement of the Labour pool argument J.G.Harston was making, if you skill is so short you can make a living selling it for half the week why would you work all the hours god sends?
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Post by Daft H'a'porth A'peth A'pith on Apr 16, 2021 9:11:44 GMT
I also note that my asking questions about the NHS is defined as moaning, even when it isn't.
I guess were still not allowed to ask questions our almighty health service, ever.
That may seem cynical, but it is the impression that is coming across from it at the moment.
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Post by Daft H'a'porth A'peth A'pith on Apr 16, 2021 9:13:09 GMT
Maybe some of theseposts need shifting to the NHS thead BossMan
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Eastwood
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Post by Eastwood on Apr 16, 2021 9:14:40 GMT
There is a shortage of GPs because more than half of them are women. That doesn't make any sense. I can see where @boogieeck is coming from but there’s more to it than his simplification. Specialties with more female doctors (Paediatrics and GP to name two) have more Maternity leave and part time working then specialties like Surgery that remain more male. But male GPs even those without children are choosing to work part time as well. Workforce planning needs to account for the fact that Doctors in their 30s will have children and go part time for a while. So you need more graduates, more trainees and more GPs to account for that.
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mboy
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Post by mboy on Apr 16, 2021 9:15:08 GMT
I doubt maternity leave is a major feature for GPs given their average age. The part-time issue is only significant if you insist on counting the number of employees rather then the number of FTEs. People who go part-time would often quit if they couldn't go part-time, which is even worse.
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Crimson King
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Post by Crimson King on Apr 16, 2021 9:57:16 GMT
another snippet of info. Most GP services are provided by practices which are (as pointed out) small businesses with a number of partners and usually some salaried doctors. There is no profit as such, just an income for providing services according to the contract, which after paying expenses (including crucially the salries of the salaried docs) is shared between the partners so it isnt enough to simply increase the salary of a GP, you have to increase the contract value as well or the partners end up taking home less than the people they employ (as happened to me at one point)
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Post by Daft H'a'porth A'peth A'pith on Apr 16, 2021 10:01:23 GMT
another snippet of info. Most GP services are provided by practices which are (as pointed out) small businesses with a number of partners and usually some salaried doctors. There is no profit as such, just an income for providing services according to the contract, which after paying expenses (including crucially the salries of the salaried docs) is shared between the partners so it isnt enough to simply increase the salary of a GP, you have to increase the contract value as well or the partners end up taking home less than the people they employ (as happened to me at one point)
Fair enough.
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Crimson King
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Post by Crimson King on Apr 16, 2021 10:07:41 GMT
another snippet of info. Most GP services are provided by practices which are (as pointed out) small businesses with a number of partners and usually some salaried doctors. There is no profit as such, just an income for providing services according to the contract, which after paying expenses (including crucially the salries of the salaried docs) is shared between the partners so it isnt enough to simply increase the salary of a GP, you have to increase the contract value as well or the partners end up taking home less than the people they employ (as happened to me at one point) Fair enough.
I wasn’t getting at you, it comes to the same thing in the end - give GPs enough money that people want to do the job. It’s just that the partnership model (which I believe is an almost unalloyed good thing) makes it a but more complicated. In this context as most GPs are not motivated by money (or at least any more money than they need to live comfortably) giving them more money can end up with each individual working a bit less and more being needed.
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Crimson King
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Post by Crimson King on Apr 16, 2021 10:10:21 GMT
you have a point, part of the answer lies in some of the issues Mr Dr Eastwood raises - its not just the money we have to ask why Doctors would rather earn less and work less if possible
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