French equivalent of our GP's

[KathyC]

[quote user="sweet 17"]

Well, you know what, Kathy, all those admin people are needed to balance the books, look at ways to save the surgery money so that more of the dosh can go to the "partners", to crunch numbers (so that it looks good when the surgery makes a hit of 90% of flu vaccination or whatever), to do their best to be "on target" with the latest directive from the Dept of Health.

It is this waste of funds that saddens me the most.  Despite all the millions poured into the NHS in recent years, I fear a lot of it has been misspent.  I don't say all of it of course and it was obvious to me before I left the UK that going to the surgery had become a better experience altogether.

I still maintain, however, that the amount of money spent has not been reflected in the improvement in services.

[/quote]

 

I couldn't agree more! And they say that the French system is too bureaucratic!

[moonraker]

I live in a village of 2200 people and we have 4 doctors; 3 in a group (no receptionnist, a telephone number to call for an appointment) and one on her own. I've just got back from seeing mine (one of the group) and I asked him how much of the 22€ fee went into his pocket! He thought it was about 5€ after tax but even before income tax he pays 1000€ for the surgery rent, 600€ to URSAFF and 600€ for professional insurance every month. He does about 4 hours a day, 4 days a week, plus home vists, plus an "emergency" weekend every couple of months. His wife is a teacher and it's her salary that pays for the house. He knows of three young GPs that have had to give up in the last 6 months and admits that without his wife's salary, things would be very difficult. The state pays him nothing.

[Patf]

An article in yesterday's Sunday Times reports that the average salary for a UK GP is £111,566. Hospital Consultants £118,200.

[mint]

And it's been in the 90 thousands for quite a few years now.

[Daft Doctor]

Hi, no axe to grind whatsoever, but as a UK GP myself, I just wanted to make sure everyone is properly informed.  I think the average GP pay in the UK will certainly be around £90+K, (not £111K as quoted in the Times article) but has in fact fallen over the past couple of years.  As the press have correctly reported, GPs in the UK got a massive pay rise in 2004/05 and to a lesser extent in 2005/06.  The government botched the contract negotiations in 2004, were far too generous, and thought that GPs would not attain more than 70% of the quality targets set for them.  The figure achieved was more like 95% (no surprise to GPs), hence the big rises.

Since then there has been an income freeze for GPs to try to offset the over-generosity, and in addition, there have been more strings attached to getting some of the income, e.g. extended opening hours, 48 hour access, etc.  GPs have same costs as many other businesses, such as staff, IT, insurance, gas, electricity, premises maintenance, etc, etc, which of course have continued to rise with (or in the case of energy well above) inflation. The net effect of that is that GPs earnings net of all expenses have in fact fallen since 2006, and things are gradually coming back into line to where the government expected GP earnings would be in 2009/10.  Personally I wish they hadn't given so much to us back in 2004, as it is always harder to give up income once you've had it compared with never having had it in the first place!  Nontheless I think we remain very well paid for what we do, despite the fact that the job is actually a lot more difficult (and wearing) than many people realise.  

We are obviously however much better paid than our colleagues in France, where there are twice the number of GPs per head of population, and by what has been said on this forum, the french GPs work very hard for their money.  They seem to operate from premises and with equipment and IT (if any) akin to what was common in the UK in the 1970's, so the fact that they do such a good job and remain motivated despite all that and low pay is a credit to them indeed.  I wonder however if there is any trade-off in the overall quality of care provided (treatment, prevention, record keeping, audit, etc) in such a low investment fee per visit/service system.  The UK spends a much smaller percentage of its national income on health care than France, despite what its GPs get paid, and one reason it can do this is the gate-keeping role that GPs have to hospital and outpatient care in the UK.  I believe that in France patients can and often do self-refer to specialists, bypassing GPs and logging up high costs for the state as a result.  Maybe that is one excuse the french health service uses to pay its GPs so little?  I think the truth is likely to be that there are good things and bad things in both systems, none being ideal.

[Jo]

There was a report in the media recently that for the first time in UK there is a nurse who earns £ 100,000 .....wish I'd kept it up!

[moonraker]

Goes back to 2007 but interesting!

http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/sick-pay-massive-rise-in-gps-salaries-worsens-nhs-cash-crisis-431801.html

 

Just one more thing; the French can no longer "bypass" the GP to see a specialist or they lose a lot of money. They can see three or four specialists (ophthamo, gyneco, dentist and  psychiatrist) without being sent by their GP but that's about it.

[KathyC]

[quote user="Daft Doctor"]

 

  I wonder however if there is any trade-off in the overall quality of care provided (treatment, prevention, record keeping, audit, etc) in such a low investment fee per visit/service system. 

[/quote]

 

In my experience, rather the opposite seems to be the case. I've had a general check up each time I've been to see the GP which has now led to my finding out that my cholesterol level is too high. In the UK, no GP ever seems to lay hands on a patient unless it's absolutely necessary! I'm sure that the record keeping is absolutely tip top in the UK but I don't personally believe this to be the ne plus ultra of medical care!

[odile]

Shame you seem to have had bad personal experiences with GPs in the UK. My personal experience is of extremely caring, hands on, tests on - doctors in the UK. You can't generalise because of your own GP.

I wonder how GPs are trained in France. In the UK it is 5 years at Med School (minimum) followed by 1 year pre registration, 1 year post reg- then 3 years compulsory GP training = 10 years. Is there such a thing as GP training in France?

[Clair]

[quote user="KathyC"][...]In the UK, no GP ever seems to lay hands on a patient unless it's absolutely necessary![/quote]

I'd have to agree with that. I cannot remember my UK GP ever checking my blood pressure unless I specifically requested it.

[mint]

Daft Doctor

Please don't get me wrong.  I've said in an earlier post and I'll repeat it here.  Whatever doctors get, I'm happy for them to have it.

As I also said earlier, the training alone would have killed me nevermind the job itself.  I'm not saying Brit doctors get mega bucks and are useless; French doctors earn a pittance and are wonderful.

I myself have worked in the NHS in one capacity or another, girl and woman for 20 odd years (though it's not been by any means my happiest nor most well paid job) and I do understand about the pressures that doctors and indeed other NHS staff work under.

Incidentally, I've not been entirely happy about my medical care in France.  I have mentioned elsewhere on the forum that in the UK, my asthma was largely managed by a wonderful specialist nurse in the Asthma Clinic with occasional visits to my equally wonderful GP when I'd needed it.

Here, in France, I've been seen by my sweet and overworked GP who has really only repeated the drugs I was on in the UK.  I have had my lungs "listened to" by my French doctor but no one has tested my lung capacity nor reviewed the drugs I'm on.

I have a French friend on this very forum  who has advised me that I need to request a referral to a Pulmonogue (well, Lung Specialist anyway) and I will, of course, do that.

For my money, however, I would prefer my Asthma Nurse because I did many things myself to help my asthma which I discussed with her and the measures worked very well indeed.

I don't particularly feel that I need to involve a specialist (with all the expense that that would involve for the state) and I would be perfectly healthy with the least amount of medical intervention.

LOL, these French are real hypochondriacs! With apologies to Clair, Frenchie and 5-element and all present company excepted.

So, Daft Doctor, no need to apologise for what you earn.  And the systems, as far as I can see from my own experience of it, are more different than they are alike.  Quite why the French system is seen as superior and why the WHO consistently place it above the UK's, I am not informed enough to comment upon.   

[KathyC]

[quote user="odile"]Shame you seem to have had bad personal experiences with GPs in the UK. My personal experience is of extremely caring, hands on, tests on - doctors in the UK. You can't generalise because of your own GP.

I wonder how GPs are trained in France. In the UK it is 5 years at Med School (minimum) followed by 1 year pre registration, 1 year post reg- then 3 years compulsory GP training = 10 years. Is there such a thing as GP training in France?
[/quote]

Actually I've had excellent GPs in the UK and I've been very happy with them. They just don't seem to want to examine you unless they can avoid it and certainly don't test blood pressure etc unless it's relevant to your reason for being there.

[KathyC]

[quote user="sweet 17"]

 

  I have mentioned elsewhere on the forum that in the UK, my asthma was largely managed by a wonderful specialist nurse in the Asthma Clinic with occasional visits to my equally wonderful GP when I'd needed it.

[/quote]

 

You must have been luckier with your respiratory nurse than my husband was. He was invited into the surgery to check his inhaler technique in the middle of January, with very severe COPD! There's really no alternative to a bit of common sense!

Having said that, the one thing we've been unhappy with in France is the pulmos. Whilst I've been grateful that he's been able to see one at all (very difficult in the UK) the two we've seen so far have been particularly useless, so we're still hunting for a good one.

[moonraker]

My best (and only friend left in the UK) was treated for 6 months at an Asthma Clinic before someone realised she had inoperable lung cancer. She died a few months later.

When I had respiratory problems here in France, just like any hypochondriac, I saw my GP (9 years training) , had an X-ray and was diagnosed with Emphysema. At least I knew straight away and wasn't messed about for six months.

 

[mint]

Kathy and Moonraker, I was only talking about myself.  Apologies.

As for me, I was a qualified nurse, midwife and health visitor plus one or two other things (stuff) so I knew the score. 

I stand corrected; of course, not everyone else does.

Hope all goes well for you and yours!

[Clarkkent]

[quote user="sweet 17"]

 Quite why the French system is seen as superior and why the WHO consistently place it above the UK's, I am not informed enough to comment upon.   

[/quote]

http://www.cato.org/pubs/bp/bp101.pdf

I put "WHO rankings" into Google and got a lot about a certain time traveller. But I also got the above URL which links to a somewhat critical paper about the WHO ranking system. If nothing else it shows how they arrive at the weighting system used to determine the ranks.

[KathyC]

[quote user="moonraker"]

 

When I had respiratory problems here in France, just like any hypochondriac, I saw my GP (9 years training) , had an X-ray and was diagnosed with Emphysema. At least I knew straight away and wasn't messed about for six months.

 

[/quote]

 

My husband was diagnosed with asthma originally and they then changed the diagnosis to emphysema after he nearly died. I believe it's very common as everyone in his pulmonary rehab group said the same. Have you seen a pulmo and, if so, are you happy with him/her?

[KathyC]

[quote user="sweet 17"]

Kathy and Moonraker, I was only talking about myself.  Apologies.

As for me, I was a qualified nurse, midwife and health visitor plus one or two other things (stuff) so I knew the score. 

I stand corrected; of course, not everyone else does.

Hope all goes well for you and yours!

[/quote]

 

No need to apologise, I'm sure we've all had different experiences, in both systems.

[KathyC]

[quote user="Clarkkent"][quote user="sweet 17"]

 Quite why the French system is seen as superior and why the WHO consistently place it above the UK's, I am not informed enough to comment upon.   

[/quote]

http://www.cato.org/pubs/bp/bp101.pdf

The above URL links to a somewhat critical paper about the WHO ranking system. If nothing else it shows how the weighting system used to determine the ranks is arrived at.

[/quote]

 

They certainly seem to be a pretty right wong mob, although it's always interesting to read different points of view!

[Daft Doctor]

In an earlier thread on the forum I mentioned that I am planning to move to France eventually and may end up doing some GP work where I settle (if any is available and if they will have my help).  I guess only then will I really know how each system stacks up relative to each other.  Its interesting as always what a diversity of views there are on the subject of health and GPs, wherever one happens to be!

[moonraker]

I haven't seen a pneumologue because I had just stopped smoking and I'm not getting any worse; a puff of Seretide occasionally and that's enough! Another X-ray due in March and if my lungs haven't got any worse, I'll leave it at that. If I need to see a specialist I'll go to the CHU in Bordeaux.

Would still like a cigarette though, even after 2 years without!!!! (30 a day for 47 years).

[mint]

Clarkkent

Thanks  for your link.  Fascinating stuff and would merit a deeper reading than I have been able to do this evening.

Kathy, thank you for your kind comments.

[JohnRoss]

Just like to comment that we are very happy with our generalist, the only thing is that he will not come out at night but advised us to ring for an ambulance in an emergency. A surgeon I saw some years ago told me that he thought that he got between a half and a third of what an equivalent surgeon would get in the UK. In fact that year, 2004, a lot of French surgeons went to Wembly for a meeting and a demonstration to the French Govt how strongly they felt they were underpaid. There was some political reason why they had their meeting abroad. Having had three surgical procedures in France I know where I want to be operated on and that ain't the UK!..........JR 

 

See http://www.buzzle.com/editorials/7-21-2004-56910.asp

[KathyC]

[quote user="moonraker"]

I haven't seen a pneumologue because I had just stopped smoking and I'm not getting any worse; a puff of Seretide occasionally and that's enough! Another X-ray due in March and if my lungs haven't got any worse, I'll leave it at that. If I need to see a specialist I'll go to the CHU in Bordeaux.

Would still like a cigarette though, even after 2 years without!!!! (30 a day for 47 years).

[/quote]

 

Keep exercising; next to giving up smoking it's the most important thing that you can do for respiratory conditions. Pulmonary rehab has kept my husband alive for longer than we could've hoped for.

[KathyC]

[quote user="JohnRoss"]

Just like to comment that we are very happy with our generalist, the only thing is that he will not come out at night but advised us to ring for an ambulance in an emergency. A surgeon I saw some years ago told me that he thought that he got between a half and a third of what an equivalent surgeon would get in the UK. In fact that year, 2004, a lot of French surgeons went to Wembly for a meeting and a demonstration to the French Govt how strongly they felt they were underpaid. There was some political reason why they had their meeting abroad. Having had three surgical procedures in France I know where I want to be operated on and that ain't the UK!..........JR 

 

See http://www.buzzle.com/editorials/7-21-2004-56910.asp

[/quote]

 

GPs don't  come out at night in the UK anymore, unless they're doing extra work for the out of hours service. When we called SAMU out one Sunday evening for my husband it was one of our medicin traitant's partners, although that was just a coincidence.