Very difficult to know where to begin. I will throw a few random comments in as they enter my head:
1) Appraisal system is useless aka "not fit for purpose". The majority of decent doctors spend too long worrying about and preparing for it, while the few bad apples are slick at selling themselves on paper. One year I had to tick a box to confirm that I am honest! WTF?
2) A major problem is ever moving goalposts - targets to meet being changed every few months, guidelines changing far too quickly. The culture of "constant change".
3) As a partner in general practice, ie the old fashioned way, rather than a salaried assistant, employed by other gp's, I have always been paid adequately for my work, and in some years very well indeed. I don't think pay is an issue.
4) Not enough time per patient appointment to sort things out properly.
5) Increasing amounts of work that were hospital based (secondary care) being moved over to GP (primary care), but without the funding following the extra workload. By this I do mean funding, no pay. For example, a practice can do a lot more if it has the funding to take on an extra nurse/nurse practitioner/practice based physio etc.
6) The reluctance of so many in society to be realistic in their expectations of what can be achieved, particularly with the frail elderly.
7) The lack of continuity of care. When I was a young new GP it was not uncommon to give your home number to the family of a terminally ill patient in the community during the last few weeks of the illness. That just doesn't happen now due to workload and burnout sadly.
? Chronic underfunding of the NHS. I use to think this was not the case, until my wife (also a GP) learnt that for years the UK had spent a smaller proportion of GDP on the NHS than most other European countries.
9) The need, perceived need, to practice defensive medicine - overinvestigation of many patients to rule out any possible litigation.
Etcetera...