Are we not a country of free speech anymore?
We need to drastically reduce the work load of GPs.
GPs are happiest with continuity of care looking after no more than 600 patients, as it is impossible to deliver the higher modern standards of care with any more. Payment should be per consultation, utilizing their full hospital experience. GPs have to be able to access nearly all investigations without referral. They should choose who they wish to work with and most importantly there HAS to be co-payment for numerous reasons, but obviously not for all patients. e.g. Canada
Research shows that the happiest professionals are those that have a skill that is in high demand and can charge a relatively high amount per hour worked. They also need to have control over their working hours and prefer self-employment. Interestingly they tend to be happiest when working by themselves, not with others. Guess who these people are?
Plumbers and in particular those working on boilers and heating.
“June 1, 2018
It seems plumbers are guaranteed not to get that sinking feeling every time they go to work…
A survey has revealed that Britain’s plumbers are the happiest professionals in the country. In fact, 55% of plumbers said they were ‘very happy’ in life.
It seems tradespeople are way ahead in the happiness index because builders were next on 38%.
The survey was commissioned by Boundless, an experiences company with a 94-year heritage.“
“Those in the public sector are less happy than counterparts in the private sector”
Need to move to Canadian / Oz model with 600 or so patients per GP with Co-payment...loads of time to cover everything..and higher income
As policenthieves said, it is what always happens with new technology. It will become far more disruptive if and when this service spreads across the UK. No difference to how automobiles replaced horses. Do not forget that it is not just GP services, but also hospital services that are increasingly being delivered virtually. If not already doing it, GP and hospital care will eventually be forced to deliver their services in the same way.
The really scary bit is when AI becomes more advanced. The virtual delivery of services does not threaten jobs, just how those jobs are delivered. However AI will certainly threaten jobs and is definitely coming!
Here is what would encourage more salaried GPs:
Imagine If GPs were able to negotiate a highly paid part-time salaried job, similar to consultants’ and were allowed to build a private practice as a GP or GWPSI treating their federation’s patients, as part time consultants do in their local catchment areas. Imagine if there was routine private health insurance that provided this cover. Imagine if this insurance was a routine package as part of corporate employee benefits. Imagine if the long term medication that these GPs prescribed privately was then continued by the federation...
I see nothing that will persuade new GPs to become salaried or partners. In fact I can see more existing partners becoming locums. So the new corporate GP federations will be forced to develop a huge number of departments working across the 50-100,000 patients e.g. the following:
Complaints, QoF, HR, Pay, Appointments, Diabetes, FP, Mental health, all CV disease, Paeds, ‘women’s services’, gender dysmorphia.... and if we have à Labour Govt social services, housing and benefits..perhaps even education, refuse collection, public parks, exercise facilities, food banks (already started)...
General Practice will be controlled by an Oligarchy of the State and PLCs with many of the elite of our profession owning shares and sitting as Directors on the Boards.
Sadly a long way from the autonomy of the old small GP practice!
Even if IR35 rules apply locums normally manage to negotiate a higher hourly / sessional rate than salaried doctors. And as you say locums can get around IR35 by moving from job to job. As far as I am aware NHS employers have been told by NHSE to only offer jobs inside IR35. The concern was that many clinicians would take advantage of this loophole and give up their NHS contracts. My partner has some personal experience of this. NHSE was probably told by ‘Govt’ to do this to maintain income tax revenue.
Sadly, as you said, this makes continuity of care worse.
Many hospital consultants now prefer to be on a long-term locum basis for similar reasons to GPs. They are better able to control their work load and get higher financial remuneration for their time. Becoming a locum can also reduce tax burdens through company formation, either by becoming incorporated or forming an LLP.
Granted, GP Partners often do most of the work. However becoming a salaried GP is not the answer. It is the salaried GPs that are being exploited more than locums. That is why most GPs are increasingly becoming locums. They have the ability to control their work load and develop other areas of interests, more than salaried GPs do. It requires very good negotiating skills for a GP to get a favourable salaried contract. Hospital Consultants have the power of the BMA Consultants committee behind them.
Turn out the lights, I agree with you. I have worked as a GP in Canada and the job enjoyment factor was far far higher compared to the UK, where it is getting worse and worse. I was given enormous respect from patients with a vastly decreased workload compared to General Practice in the UK. And there was continuity of care, which patients loved.
Sorry, I forgot to mention...also a higher income.
Clare, the standards of care, particularly for chronic disease management, are higher than in the past. That is good. So what should have taken place was to increase the base pay per registered patient so that GPs had more time to deliver the new higher standards of health care with a reduced personal list maintaining their income and continuity of care. This is what has taken place in Canada and elsewhere where General Practice remains popular. That is also why newly qualified GPs are emigrating.
Instead of this the NHS decided to invest in hospital care to a greater extent compared to General Practice. Add to that even more procedures, better investigations, an aging population and a tendency to medicalise almost everything resulting in a vastly increased work load... That is why, as you say, it is impossible to deliver health care in the same way.
All that needs to happen is to copy General Practice as done in Canada and Australia.
Clare, years ago General Practice was not subspecialised, using your examples: GPSWIs, Mental health leads, practice lead for QoF, appraiser. Those were happier times for GPs. They could build their own teams. I am not saying that the clock needs to be completely turned back, but the present job is bad enough and is getting worse as GPs are being forced into larger structures, becoming more specialised with less continuity of care. Patients want continuity of care and when patients are happy they respect the clinicians delivering their care. That in turn creates more job enjoyment for GPs and will drive recruitment.
Most newly trained GPs elect to work as locums, not just because more of them are female with families, but because one can simply walk away from the stress of the job and leave all the complaints, bureaucracy etc. to GP partners
General Practice will not become popular until there is:
More autonomy to practice and refer as one feels. GPs are not machines
More continuity of care
Allowing GPs to choose the colleagues that they feel happy working with. We all want to choose our ‘tribes’
More respect from the regulators, paymasters, hospital doctors, media, politicians and the general public
Basically General Practice needs to move more back to how things were many years ago
The problem is that while the trend to medicalise everything persists and when there is no brake on consultations, reducing the demand from patients with MSK problems will not decrease GP consultations. Instead the ‘freed up time’ will simply be filled with demand for more consultations regarding mental health, minor illness...
Research has shown that the happiest workers have autonomy, skills that few others have, and a high demand for their services. So they can pick where and when they will work, with who (only if they want this as many prefer to work without others), and receive a high hourly rate of pay e.g. a self-employed plumber.
In the distant past GPs commonly worked by themselves, just with the help of their spouses and their job enjoyment was extremely high, sadly very very different to today.
Has anyone seen Milton Friedman’s proposed completely unregulated health care in a private system allowing free capitalism to be the only control. This could invite snake oil Medicine. He was extreme, but I think his idea could work if partially applied. One would need to add some simple form of measurement of outcomes.
GP training in secondary care should only be for short periods, six to eight weeks, in the majority of clinical OP clinics where the trainee consults patients with a Registrar or above monitoring the trainee in the same room. So up to eight clinical areas can be covered in a year and twelve to eighteen over two years, more than enough. Then another year in General Practice. GP training has been done like this in Canada. Note NO ward work.
Most of the new money is going to federations not to individual practices. The question is will the new funds / manpower be equitably distributed, rather than go to those practices that are ‘in’ with the local power base?