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Independents' Day

Una Coales

Una Coales

  • Is it time for the GPC to get militant?

    Una Coales's comment 02 Jan 2016 4:43pm

    My daughter asked me why does the BMA not let GPs strike like junior doctors? Good question. Now has anyone got an answer?

    Perhaps because the government has protected older GPs pensions for 10 years, allowed them to draw final salary scheme pensions, have a generous cap of £1.8 million, tax free lump sum withdrawal of up to £450,000 on top of an annual payout of up to £78,000? For the rest of us 'plebs', the government has decided the £34 BILLION pension debt is too big for them to handle in the context of owing the public £1.5 TRILLION pounds, and they will claw back as much as they can. On the cards, consideration of one tax of 30% on all pension withdrawals, consideration of removal of the 25% tax free lump sum (big ouch), capping annual pension allowance to £10,000 from £40,000 for big earners, cap of £1m pension (hm at 30% taxation that means withdrawing £700k which just about covers a mortgage?) and removal of final salary scheme has already taken place.

    Might be worth considering putting your money into a fixed rate bond savings account yielding a steady income and with no wait until you are 70 to cash out the bond but rather 1-2 years?

    Or better yet emigrate to a country with low taxation and a public deficit that does not equate in the trillions...ahem Canada and Australia?

  • Is it time for the GPC to get militant?

    Una Coales's comment 31 Dec 2015 5:34pm

    I fear establishments like the RCGP and BMA may have outdated themselves as grassroots Generation Y GPs may survive without paying optional membership fees, and it is smart young Asian GPs who are revolutionising general practice in this country by transitioning like dentists, despite RCGP CSA exam results suggesting Asian UK GPs are not as bright, as they seem to be failing an actor CSA exam up to 4 times more than whites. In life, GPs are not judged on their acting abilities, but their clinical acumen and with an open market, they will have plenty of customers because they do know medicine!

  • Is it time for the GPC to get militant?

    Una Coales's comment 31 Dec 2015 5:28pm

    Even though some NHS GPs are hoping the BMA will come to their rescue and offer a ballot on industrial action or mass resignation, based on my experience trying to get this through last summer, in my opinion, chances are close to NIL!

    For GPs who must stay in the UK and work for family or carer reasons, there is another way and that is by becoming a private GP with a consulting room or an online GP with a virtual consultation. Today as I sat in traffic behind a red bus, a HUGE ad stood in front of my was an ad for I was intrigued as would the public to read of a consultation with rx for only £10. I went home and looked up the website. 2 GPs, one a female Imperial College grad and past GP partner in Kent had not only developed the concept, conducted market research, but also arranged for ads on red buses, underground and digital! Amazing!

    It means that if you decide not to hold your breath for the BMA to save your life, you might wish to inform 200 of your patients you are setting up on your own and if you want more clients, think red bus advert!

    I am optimistic that we can save general practice in this country but it has to transform into an accessible modern affordable and competitive self pay concept if PMI is too expensive for the public.

  • Is it time for the GPC to get militant?

    Una Coales's comment 31 Dec 2015 3:37pm

    @Janine, brilliant synopsis! Now do take care of yourself. The NHS is not worth dying for. Remember work life balance. Let's hope the BMA pull up their socks else they may see their optional £400/year membership nosedive.

  • Is it time for the GPC to get militant?

    Una Coales's comment 30 Dec 2015 9:28am

    Great read @Vinci. I feel like a dinosaur having watched the first Star Wars film oh so many eons ago.

    We have hope as long as Generation Y doctors know how to organise, share information (refuse to be gagged) and ask help from the public via strike action.

    As predicted, the ACAS meeting seems like a stall, no major progress and it seems strike action may finally proceed next month. We GPs and now NHS consultants watch with baited breath to see if public pressure on their MPs will finally bring about a fair and safe contract for all or we watch the final nail on the NHS coffin. Now it is shared responsibility for the preservation and integrity of health service in this country.

    We are not alone. We were never alone. We have 65 million patients in this country. It is time they stood up to save general practice, as you say the last dying breed of jedis.

  • Clinging to the cliff edge

    Una Coales's comment 29 Dec 2015 6:18am

    Well done @Peter and @Paul for posting with your names, the first step to becoming human again, not anonymised slaves living and working in fear. Your humanised comments/testimonials hold more credibility because you are putting your names to it, like witnesses giving evidence to the intolerable workloads imposed by the government with this unilateral slave work contract. If the GPC has deaf ears, Pulse does not and has been an incredible public forum for GPs to conbat the media bashing of this profession. At least GPs can say, we fought back as hard as we could, we shouted from the rooftops to the BMA GPC, we tried our best to save general practice and ultimately, the only thing we could do in the end was walk away from an abusive life-shortening situation.

  • Is it time for the GPC to get militant?

    Una Coales's comment 29 Dec 2015 5:17am

    Edit: beloved Phil Peverley

  • Is it time for the GPC to get militant?

    Una Coales's comment 29 Dec 2015 5:15am

    Next month will be 2 years since the tragic suicide of an overworked Liverpool GP partner. He was very proud of his young adult children, a daughter who attended Oxford university and a son Cambridge. This will have been the second Christmas spent without their father. The agenda committee of the BMA annual representative meeting of June 2014 refused my emergency ballot to take into consideration Pulse's ballot on mass resignation and ballot its GPs. In the audience were Liverpool GPs and an ED consultant who had tried in vain to resuscitate him. They were eager to hear my emergency motion. But no, the agenda committee refused and so no debate was held and his death was not heard.

    His death and that of other GP partners will not be in vain. Based on my experience with the BMA, I too believe that they will remain inactive, all talk but no actions. Save yourself. If you find you cannot keep going as we have seen our belove Phil Peverley struggle with the insurmountable work load, then take a break, retire early or emigrate. Forget the managers who crack the whip or the Chair of the RCGP who says it is the best time to be a GP. We all know it is not. Make 2016 the year you put yourself and the future of your children first. The NHS is not worth dying for. GP is just a job. Happy New Year.

  • Is it time for the GPC to get militant?

    Una Coales's comment 24 Dec 2015 8:17am

    @11:03 pm well done for emigrating abroad in time and enjoying professional autonomy and financial freedom.

    For other GPs to say being a GP is not about the money, I beg to differ. Every job is about the money to some extent. The older generation as @11:03 pm quite rightly pointed out had a free university education. Generation Y now face debts up to £100k with interest accruing at 4% from the moment they take out the loan. This is extremely harsh as in the States, university and medical school loans start accruing interest when one becomes a resident, ie has a paying job as a junior doctor.

    This means they have to take into consideration whether the medical specialty they have chosen is enough to repay student debts, and apply for a mortgage to provide a roof over their family's head, while paying more UK tax than the older GPs had done decades prior.

    I would suggest members of the GPC and conference committee declare their NHS pension figures as a pension pot of £1.8 million may influence their decision as to whether or not to accept Shropshire or Derbyshire's pro active motions. The older generation need Generation Y to top up the NHS pension pot in order that older GPs may continue to cash out large sums. Sadly Generation Y GPs must put in more to take out less at a much older age in life.

    From the stats of my blog enlightening Generation Y GPs of all the pros and cons of working life as a salaried GP or GP partner in the UK and life in Australia/Canada, I am allowing them to make a fully informed career decision, something many are not exposed to in their training.

    I think all medical schools should include a course on financial management so they know the truth before embarking on a career in state funded general practice.

    And when money is an issue, as we see with many GP surgeries, we see burned out GPs and potential for patient harm. Money is the core to providing a robust health service.

    And I agree, to use the words 'Militant' and 'Controversial' when raising motions to ensure the safety of GPs and patients by bringing up the only tools left to GPs fulfilling a unilateral work contract, is not helpful as it suggests rebellion instead of hardworking grassroots GPs who have found their self respect finally!

  • 'Several LMCs' to call for mass resignation and industrial action

    Una Coales's comment 21 Dec 2015 1:45pm

    Can we ask Hamish Meldrum to come back?

    "Many GPs would resign over NHS reforms
    A majority of GPs is ready to resign from the NHS unless new contracts are in place by next year, a British Medical Association ballot showed today.
    The threat of the mass resignation of thousands of family doctors from the health service comes just days before the General Election, and shows the medical profession's level of frustration at the slow pace of NHS reform.
    The BMA ballot asked all 36,000 GPs in the UK if they would be prepared to submit an undated resignation letter in April next year if the Government had failed to agree on "significant and acceptable" reforms to the 50-year-old GP contract.
    Doctors are frustrated that despite a pledge in the NHS Plan that contracts would be reformed, ministers have so far failed to start negotiations.
    Two-thirds of doctors responded to the ballot.
    Nationwide, nearly nine out of every 10 of those who responded - 86% - said they would be willing to quit.
    In Scotland 69% responded, of whom 84% said they would consider quitting.
    In England the response rate was 65%, with 86% voting yes. In Wales the response rate was 63%, with 87% saying they would be prepared to resign from the health service.
    In Northern Ireland, 67% of family doctors responded - with a massive 90% indicating that they would resign if new contracts had not been agreed by April 2002.
    Dr Hamish Meldrum, deputy chairman of the BMA's General Practitioners Committee, said: "The message this ballot sends could not be clearer or louder.
    "The result demonstrates the depth of disenchantment, despair and disillusion felt by GPs throughout the UK.
    "Regrettably, they dramatically confirm what we have been telling Government's for years, that general practice is at the end of its tether."
    Doctors want the new contracts to reduce the amount of bureaucracy and administration they face, and to define their roles and responsibilities more clearly.
    They have also been increasingly critical in recent years over the growth in workload caused by Government initiatives and reforms, which they say have left them with less time for patients.
    The average GP now conducts more than 10,000 consultations a year and spends just eight minutes with each patient.
    The ballot is not a vote on industrial action but does demonstrate the level of frustration at the Government among GPs.
    The NHS Plan promised an extra 2,000 family doctors by 2004, but the BMA estimates that England alone needs 10,000 more family doctors to ease workloads on the profession.
    According to BMA figures, there were only 113 new GPs last year - and many of them would not be working full time.
    Dr Meldrum said: "Morale among GPs has never been lower, workloads and expectations never higher.
    "There has been a persistent failure to provide the level of resources at practice level to enable family doctors to treat their patients properly or quickly.
    "GPs want more time with their patients to provide a first class service. Now it is the incoming government's turn to provide time for general practice."
    The ballot comes a day after hospital consultants warned that increasing workloads were preventing them from delivering quality care in the NHS.
    While the BMA said it wanted to negotiate with the Government over new contracts and avoid any resignations, the threat of thousands of GPs leaving the NHS next spring could cause chaos.
    Dr Meldrum said: "I think we can make a lot of progress and find solutions and prevent what would be a disaster for the health service."
    Doctors who resigned from their NHS contracts could work for the health service in other ways, he said, although he declined to explain what these could be.
    And Dr Meldrum admitted: "It may in the short term be a more limited service, depending on what clinical care we are able to give.
    "It is possible that private work may be an option.
    "It could be that some GPs choose to do that."
    Dr Meldrum said: "The present arrangements under which most GPs contract to provide medical services are failing both GPs and more importantly our patients.
    "We believe that we need to reduce bureaucracy and ensure a contract that is based on quality of service rather than a number of patients on a GP's list."
    He said doctors were "profoundly disappointed" at Government delays in negotiating new contracts and responding to other concerns about NHS reforms.
    Dr Meldrum said: "The intention was not and is not to encourage GPs to throw in the towel.
    "It is to highlight the fact that primary care is on the edge of an abyss of collapse due to a failure of recruitment and retention which has not been addressed by successive governments.
    "The GPs of the UK have today sent a wake-up call to the politicians."
    Family doctors said they could spend between two and three hours a day on bureaucracy and administration.
    Of Labour's handling of the health service in the last four years, Dr Meldrum said: "In many ways they have started to put more money into the NHS but they have failed to address the problems of bureaucracy and have failed to understand just how deep the problem is in general practice."
    Dr Kenneth Harden, head of GPs in Scotland, said that problems there stemmed from the shortage of doctors in isolated, rural constituencies which meant GPs were often constantly on call.
    "We are very keen to enter into discussions with the Government.
    "They will find us willing partners who want to find a way forward."
    Dr Tony Calland, head of family doctors in Wales, said difficulties there were especially highlighted in the valleys, where there had been an influx of Asian doctors in the 1960s who were now coming up to retirement age.
    "There is going to be a very substantial loss of GPs in the Welsh Valleys," he said.
    "Unless there is an attractive contract there will be large parts of the Welsh Valleys which may have difficulty in providing a primary care service."
    Areas of mid-Wales which are largely rural are also experiencing chronic recruitment and retention problems, he added.
    In Northern Ireland, Dr Brian Patterson said the political situation had stalled the process of setting up primary care groupings and had led to increasing disillusionment among GPs.
    Doctors who said they would not be prepared to resign had done so partly because they feared they would bankrupt themselves if they did quit, he claimed.
    "It is frightening because the results of this ballot mean that the profession in which I work and value is now under severe threat."
    A spokeswoman for the Labour Party said home visits by GPs had fallen by half and night visits by one third since 1990, while the number of family doctors had risen by 9% and there had been a 40% increase in the number of practice nurses.
    She said: "We recognise that the jobs that GPs throughout the UK are doing and we are keen to negotiate new contracts.
    "We want a GP contract which reduces bureaucracy and improves patient care."

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  • 'Several LMCs' to call for mass resignation and industrial action

    Una Coales's comment 21 Dec 2015 1:43pm

    @Andrew thanks for the historical input.

    Undated mass resignation also worked for GPs in 2002.

  • 'Several LMCs' to call for mass resignation and industrial action

    Una Coales's comment 21 Dec 2015 11:06am

    @David undated mass resignation letters worked in 1966. It got the government's attention. The public would not dare sit by and watch all their country's GPs resign. No bluff needed to be called.

    Look at the media and public interest when 98% of junior doctors voted for strike action over an unfair and unsafe unilateral NHS contract. They would have succeeded in changing the contract had the BMA not backed out in the 11th hour IMO. The momentum and impact of a strike has been lost.

    A majority ballot for undated mass resignation would attract media attention and GPs would definitely have the sympathy of their patients. The government would have been forced to lessen the leash on the contract.

    Meanwhile Plan B is happening already. GPs are quitting one by one, handing back their contracts, emigrating, retiring early, but that would leave no GPs left to man NHS GP surgeries and Generation Y GPs have figured out that working as a salaried GP for a private company may not repay the student loans or cover a mortgage. This is the worst scenario for patients GPs, no general practice.

    Remember the dead cannot speak, but we surviving GPs can. Let's get our GPs a fair, safe contract with the only leverage the government will listen to... A sod this contract and bring a fair one to the table or we all withdraw from this bankrupting, unilateral 7/7 slave contract. It's now or never as GPs are on the brink.

  • 'Several LMCs' to call for mass resignation and industrial action

    Una Coales's comment 21 Dec 2015 10:41am

    Well done Dr Mary McCarthy, chair of Shropshire LMC for calling this special measures LMC conference and your LMC motion.

    Well done Derbyshire LMC (your website shows all members as NHS GP partners, not a single locum or salaried) for putting pressure on your treasurer and BMA GPC negotiator Peter Holden to put in a LMC motion on industrial action and undated mass resignation!

  • 'Several LMCs' to call for mass resignation and industrial action

    Una Coales's comment 21 Dec 2015 9:56am

    Better late than never... I emailed this BMA emergency motion to a Westminster CCG board member in hopes he would second back in April 2014. His father was on the BMA GPC. He declined to second. I fought so hard to get an emergency motion through the BMA to save the lives of battle-fatigued GP partners. My motion was instead edited and reduced and never accepted. It is a relief to see some LMCs finally put in a long awaited motion on behalf of themselves and their burned out colleagues. Many Generation Y GPs have watched how their seniors at BMA have behaved and have chosen Canada and Australia.

    Emergency Motion Ballot

    Conference asks that GPs be balloted for mass resignation from the NHS GP contract:

    I. In favour of a copayment system like Australia with government providing means tested medicaid and medicare insurance for the poor and elderly/disabled and for the rest to pay per consultation/services.

    ii. With undated resignation letters.

    iii. To save the existence of general practice, which as a profession is threatened with extinction, due to lack of manpower, lack of government funding and lack of workforce recruitment.

    iv. In favour of a contract that allows NHS GPs to offer patients private services for any treatment also available on the NHS so that private income may subsidize and sustain the NHS side to keep surgeries financially viable.

    v. In favour of a contract that pays per consultation and is no longer based on an outdated Carr Hill formula, as removal of MPIG now prevents practices from balancing their books.

  • Niall Dickson: ‘We want doctors to feel protected’

    Una Coales's comment 21 Dec 2015 8:43am

    Two Solutions.

    1. Time limit. There should be a deadline for initial investigations, ie 8 weeks max. and another deadline for being given a date for FTP. No open endedness and months of agonising wait.

    2 Access to legal representation. All doctors under GMC investigation must be provided with a legal team, either by their MDO or if they refuse, by the GMC. This will diminish stress significantly.

    The difference between the 2 GMC referrals was the presence of a legal team to support and defend the accused. Surely we could insist that MDOs may not refuse to represent any doctor member who has been referred to the GMC? Or the GMC should provide a lawyer if the doctor has no MDO representation? Even a criminal is provided with a lawyer if he has none.

    3. The GMC should arrange counselling for any doctor under investigation to help with the drawn out process. The amount of evidence a doctor has to provide from his CCG, employers, etc. to prove his innocence is enormous. Therein lies the problem with 'guilty until proven innocent'. The onus should be on the accuser to provide enough evidence to prove guilt before the GMC investigates. In other words, better initial screening.

  • Niall Dickson: ‘We want doctors to feel protected’

    Una Coales's comment 21 Dec 2015 8:23am

    @7:10 pm I am sorry to hear you are facing an FTP. I hope your MDO has agreed to represent you. MPS agreed to represent me when I was referred to the GMC by the RCGP in 2008 and as I had a brilliant lawyer/barrister team, the amount of stress I could have been under was significantly diminished. And I ran for President of the RCGP to change and improve the college who had used the GMC as a commercial weapon imo.

    However in 2012 when I was referred to the GMC by a UK BME GP who had misunderstood a passage about unconscious bias in my CSA book, this time MPS said they were using their discretion not to represent me. This is where stress levels rise as I, as well as every other GP, am not a lawyer. And yes there was no time scale specified by the GMC to their initial investigation. When an initial investigation runs into months, it wears an innocent GP down, especially when it runs over Christmas and one has a family to look after. I kept calling the investigating officer for a time, when will the 2 medical assessors decide? But no date was ever provided. I got the impression the GMC was short staffed and backlogged. To keep sane I booked sessions of CBT. I was mentally healthy before the process but the endless waiting with no news was depressing to say the least. And there was the fear of having to self represent at an FTP or pay £10,000s to hire a barrister all because one GP decided to take offence to a passage on unconscious bias!

    By the following year 2013, I got a letter from the GMC that I was cleared, case closed, decision was it was a misunderstanding. Almost 5 months for someone to reach the same conclusion any reasonable person would have had they read the passage in context of the chapter on subconscious bias!

    Yes I have faith in the legal and medical assessor but did it really have to take 9 months the first time and 4-5 months the second time around?

    And no, I was not suicidal before the GMC referral and not after, only during a lengthy protracted process without any medicolegal support from MPS, I had paid £1000s to over many years.

  • GPC calls for Professor Steve Field's resignation 'forthwith'

    Una Coales's comment 18 Dec 2015 7:36am

    Edit. @00:44 am who cares not who care. Sorry typo on my ipad.

  • GPC calls for Professor Steve Field's resignation 'forthwith'

    Una Coales's comment 18 Dec 2015 7:35am

    @00:44 am who care? We care. Until the BMA ballots GP partners on undated mass resignation from a killer unilateral bankrupting NHS contract, abused GP partners must make an escape plan. From newly qualified GPs getting a GMC referral for a delayed home visit to junior doctors being fired for whistleblowing (, things are only getting worse, much worse until the government succeeds in privatisation of the unsustainable free at point of access socialist NHS.

  • GPC calls for Professor Steve Field's resignation 'forthwith'

    Una Coales's comment 18 Dec 2015 7:17am

    Correction, on page 87/155 of the CQC annual report it does have a footnote that says Field started in Sept 2013 at a FTE of £175k so £85k was for half a year's pay. Not a 100% pay rise but still, not a pay cut?

  • GPC calls for Professor Steve Field's resignation 'forthwith'

    Una Coales's comment 18 Dec 2015 7:01am

    Please stop falling for government's traps...Prof Field is now martyred as a whistleblowing hero by the Daily Mail and public this morning! And please stop using the GMC as a weapon! This only fuels more malicious GMC referrals against innocent doctors by management using the GMC as a weapon instead of dealing with internal employment matters, and others using it for purely vexatious reasons.

    Instead ask why Field got a 100% pay rise between 2013/14 £85k and 2014/15 £175k + £30k pension contributions as CQC chief inspector while NHS GPs and GP surgeries themselves got a huge pay cut and are struggling to keep afloat.

    Ask why your monies and others are funding CQC staff pay in the order of £149 MILLION a year.

    Ask why CQC can give your practice feedback but not vice versa.

    And yes some of you have spotted that Field's practice has not been inspected.

    As for Maureen Baker representing the RCGP and Chaand Nagpaul the BMA, yes they too are experienced politicians and know what to say but judge the orgs by their actions! Just as we judge Hunt by his actions not his words regarding NHS contracts. Judge the RCGP for continuing to fail more BME/IMGs than white UK. Judge the BMA GPC for refusinf to ballot GPs on any form of industrial action from work to rule to undated mass resignation. Actions not words!