This site is intended for health professionals only

At the heart of general practice since 1960

pul jul aug2020 cover 80x101px
Read the latest issue online

Independents' Day

Una Coales

  • Seven GPs elected to BMA Council

    Una Coales's comment 22 Apr 2014 9:14pm

    This story went from 'popular' to 'controversial' since I last read this article. Not to worry, I am grateful that Pulse is giving mention to my primary objective, and that is to give GP members what they want, a ballot on strike or mass resignation. Enough is enough.

    The term of office starts June 26 and then I can write up the council motion for the September 24 BMA Council meeting. Really tight schedule as with each passing month, more NHS GP surgeries are struggling with MPIG cuts and now an A&E doctor is writing me at his wits end working 12-14 hour shifts with a 20 minute break if he is lucky and struggling to provide for his family. He is burning out.

    I just don't see medical students saddled with a £70k debt (£9k/y x 5 yrs + £5k/y living x 5 yrs) entering GP training when the job prospects look so dim.

    I have my work cut out for me to show socialist ideologists that ideology will not pay the bills for GPs or A&E doctors or help them cope with intolerable workloads and work stress.

  • We have a year to save general practice

    Una Coales's comment 21 Apr 2014 7:26pm

    GPs on the BMA Council need to thrash it out with consultants on the BMA Council to receive permission to ballot GP members for mass resignation from the NHS GP contract. If a majority of GPs vote yes to mass resignation, then GPC has stronger negotiating power to then sit down with NHS England and the DoH and get a decent contract with fair pay and fair working conditions.

    If consultants on the BMA Council refuse to vote for balloting for a strike or mass resignation, then GPs walk. They quit, they retire, they emigrate, they close shop, they change careers and leave the chaos for consultants in A&E and hospital specialties to sort out.

    I can't imagine any sensible consultant refusing GPs their right to be balloted to demand fair working conditions and pay vs the collapse and end of general practice.

  • We have a year to save general practice

    Una Coales's comment 21 Apr 2014 7:12pm

    http://bma.org.uk/about-the-bma/how-we-work/uk-and-national-councils/bma-uk-council/members-of-bma-council Here are your 33 voting members of the BMA Council 2013-14. Half may change when the results of this year's election come out later this week.

    Our job GPs is to convince the non GP members of the BMA Council, that their NHS hospital jobs are also at stake as once GPs fall, so will hospitals. Yes some have a private income as consultants, but not all. And the bottom line is patients will suffer if the NHS is replaced by complete privatisation and not even a semi private healthcare system to protect the poor and elderly.

    GPC is to negotiate the terms of the GP contract. They are given their directives from next month's annual LMC conference. I hope someone on an LMC has asked for fee per consultation, fees for DNAs, ability to earn private income to subsidize state, etc.

  • Practices' income cut by thousands as NHS England devalues QOF

    Una Coales's comment 21 Apr 2014 6:26pm

    Thank you Thomas Quinn. I have read and absorbed. I agree we have to make a stand with clout. John Hendy QC is the barrister for trade unions. If NHS England tries to stop strike action with a host of contract breach notices, the BMA could engage Hendy, who won silk barrister of the year in 2013 in employment. After all each practice pays a levy of approx 50p/pt/year to the LMC/BMA GPDF.

    We cannot watch GP partners work for £2.80/pt or £500 for 200 hours. Trade unions have a responsibility to engage and ensure workers have fair pay, fair working conditions and also look after the well being of its workers.

    Next month I shall be attending the annual LMC conference in York and as I am only slotted to talk on behalf of sGPs, I may need to take to the soapbox.

    I have a meeting with number 10 next month and am in contact with UKIP's health advisor. Sorry I don't have contacts with Labour as I am of the opinion that if they win, they will borrow even more irresponsible sums that will ensure our country is next to follow Greece and beg for a bailout. Note how our politicians stress the need to stay within the EU at all costs, it is a financial safety net.

    The bottom line is we must put this £106 billion NHS healthcare service in the context of a growing elderly population, in a health service that can prolong life, offer infinite and expensive medicines and treatments and a pension that may have been emptied by the government to cover costs. It doesn't help that we have a £1.4 trillion debt, that university fees will continue to climb past £9k/year, that this government seems to want to shut down all NHS services rather than convert to semi private like Australia, that this country only has funds to pay the interest to countries like India and China from whom we are borrowing to stay afloat.

    No easy answer. A move towards private general practice is plan B. Plan A would be to adopt the Australian and Canadian model of healthcare. Infinite demand on the NHS unfortunately means the socialist model is not viable. Spending tax payers money by taxing at 40% for over £32k income is hurting workers already.

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 21 Apr 2014 4:34pm

    You're right @1:58. You'd think our BMA trade union would issue an official statement on this study. After all it seeks to further undermine IMGs.

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 21 Apr 2014 7:55am

    One may not draw conclusions from a flawed study.
    http://www.bmj.com/content/348/bmj.g2621?tab=responses

    A consultant cardiothoracic surgeon lists all the flaws with this study in BMJ responses. Well worth reading!

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 20 Apr 2014 6:21pm

    @3:02 pm. Very impressed by your comment! Wow and from a GP registrar too! You are well beyond your years in clarity and wisdom!

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 20 Apr 2014 9:17am

    23% of NHS GPs are foreign graduates. We are in a national GP shortage crisis compounded by an exit actor CSA exam that fails 64% of IMGs and 4-6 times more British BMEs than white Brits. This recent study authored by 2 researchers who have been commissioned by the RCGP in the past also, so not entirely independent, may undermine the confidence of NHS IMG GPs working flat out to keep their surgeries open at little to no partner drawings.

    I once wrote and advised that the RCGP must not be seen to be unwittingly aiding government and contributing to the demise of general practice.

    Without GPs and with constant government cuts to GP funding, GP surgeries will close and patients will not get semiprivate healthcare but solely private; Government has not come up with any provision as of yet as to how the poor or elderly will access healthcare once the NHS closes.

    At a time when our profession needs unity, feeding media to bash IMGs, is in my opinion, contributing to the demise of NHS general practice.

    Remember private GPs and consultants belong to another organisation, the Independent Doctors Federation, who, in my opinion, are doing a great job lobbying against private health insurance cuts to reimbursements and high MDO indemnity charges.

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 20 Apr 2014 8:47am

    Another government recruitment drive from India to help A&E doctor shortages. http://www.telegraph.co.uk/health/healthnews/10142181/NHS-looks-to-India-to-solve-AandE-staff-crisis.html Why should India help the NHS after all the recent bashing?

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 20 Apr 2014 8:42am

    Thomas I found this. http://www.bbc.co.uk/news/10202803 It seems that the NHS does active recruitment drives in India to plug junior hospital jobs when the NHS is in a shortage crisis. Seems illogical then for this study to bash IMGs when the NHS is desperately short of GPs?

    NHS IMG GPs are very demoralised over this study and many are looking towards emigrating to Australia along with their UK counterparts.

  • We have a year to save general practice

    Una Coales's comment 19 Apr 2014 9:57pm

    http://m.youtube.com/watch?v=AiJSZ4MpHZ4

    John Hendy QC is the barrister for trade union rights to ballot members and strike or ballot for mass resignations without NHS England handing out breach of contract notices. He was silk of employment 2013. He represents for Unite against difficult employers and we sure have that with NHS England?

  • We have a year to save general practice

    Una Coales's comment 19 Apr 2014 8:46pm

    Right guys. I AM on the BMA council ballot and I AM for a ballot for mass resignation! Look out BMA! Council results to be posted after Tuesday and if I get the most number 1 votes, you had better give BMA GPs what they want! MASS RESIGNATION BALLOT! We cannot watch this ship sink. General practice is simply not going to go to the dogs. Patients have no idea what will hit them when the domino effect commences. I may not have manly b*lls but I certainly can play chess and there is no other option.

    If BMA does not take action, you might as well knock your king down.

  • Practices' income cut by thousands as NHS England devalues QOF

    Una Coales's comment 19 Apr 2014 5:32pm

    Thanks Ahmed. Then resignation en masse from the contract is what is needed. Time to ballot all GPs. 60,000 GPs must agree something needs to be done? Proud of the 23,000 GPs back in 1966 who stood their ground and dared to call for a national strike.

    Plan B is that GPs vote with their feet.

    No action sees the end of NHS general practice. Action sees the transition into semiprivate general practice. History will note which path the GPs of 2014 chose.

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 19 Apr 2014 3:28pm

    Good question Thomas. Interestingly doctors from North India tend to head for the US and are now thriving as attendings, professors, etc. vs doctors from Southern India tend to come to the UK and struggle for equality and end up as SAS grades, salaried GPs, and now face the ignominy of sitting an exam with predominantly white British actors conducted behind closed doors with no CCTV or video for appeals.

    At least the USMLE is sat by both US and foreign medical graduates and the clinical is recorded, taped and assessed by examiners outside of the room. Appeals may be challenged with tapes.

    I do wonder why this country cannot treat IMGs with the same respect as other countries like America, Canada, New Zealand, Australia etc.

    I count myself as an exception to the rule, coming back to the UK instead of staying in the land of equality, diversity and opportunity in the States,

  • Practices' income cut by thousands as NHS England devalues QOF

    Una Coales's comment 19 Apr 2014 7:04am

    http://www.standard.co.uk/news/health/seventeen-gp-surgeries-at-risk-of-closure-from-nightmare-cuts-9266965.html

    John now more than ever we need the BMA Council to ballot its members on strike action. With the removal of MPIG many practices now may not balance their books as the old Carr-Hill formula is flawed. GPs are now caught between a rock and a hard place either working for free or for £500 for 200 hours as Dr Patel is in the article link above to keep their severely underfunded practices open or face £1000s in staff redundancy payouts. GP surgeries will go bankrupt.

    The contract has to be changed to fee per consultation or fee per service with either private services allowed to be offered alongside or to ask pts for copayments. We must address the fact that no external income is coming into the practices to balance the books now.

    With 100,000 patients suddenly without a GP if these 17 practices fold, the repercussions and burden on surrounding practices will create a domino effect. We are looking at collapse of general practice within a year, ie by the next election and 60 million patients without access to a NHS GP. There aren't enough private GPs set up to provide care for 60 million.

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 19 Apr 2014 6:25am

    All this fuss over PLAB that tests and allows approx 2,700 IMGs join the depleted NHS workforce each year.

    the number of candidates who took PLAB Part 1 and passed each year
    ,with the pass percentage

    PLAB Part 1 1998 -2012
    Candidates Pass Pass%
    1998 3272 908 28
    1999 3605 1211 34
    2000 3438 1631 47
    2001 4680 2826 60
    2002 8305 5095 61
    2003 12500 7825 63
    2004 12584 8004 64
    2005 9117 5630 62
    2006 3979 1842 46
    2007 2506 1002 40
    2008 2493 944 38
    2009 3404 1477 43
    2010 4545 2391 53
    2011 4068 1425 35
    2012 2930 1344 46

    b. the number of candidates who took PLAB Part 2 and passed each year
    ,with the pass percentage.

    Part 2 1998 -2012
    Candidates Pass Pass%
    1998 649 516 80
    1999 1198 1067 89
    2000 1362 1132 83
    2001 2508 2091 83
    2002 3741 2948 79
    2003 6579 5207 79
    2004 8208 6392 78
    2005 8569 6585 77
    2006 2936 2166 74
    2007 1379 1080 78
    2008 1370 938 68
    2009 1847 1284 70
    2010 1636 1168 71
    2011 2637 1835 70
    2012 1735 1182 68

    c. the number of IMGs who registered for the first time as new doctors
    with the GMC for every year since the PLAB was introduced.

    First Registration Year # of Doctors
    1998 4,947
    1999 4,365
    2000 4,644
    2001 4,252
    2002 5,147
    2003 11,996
    2004 6,328
    2005 5,821
    2006 3,159
    2007 2,609
    2008 2,841
    2009 2,589
    2010 2,971
    2011 2,461
    2012 2,727

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 18 Apr 2014 8:26pm

    Why bash IMGs? They sat and passed PLAB, a UK exam that only 2/50 UK grads could pass in 1999. Can we instead focus on the EU doctors from the following countries who use the EU trade loophole to get out of sitting any UK exam, PLAB or MRCGP.

    Member states of the EU
    (year of entry)
    Austria (1995)
    Belgium (1952)
    Bulgaria (2007)
    Croatia (2013)
    Cyprus (2004)
    Czech Republic (2004)
    Denmark (1973)
    Estonia (2004)
    Finland (1995)
    France (1952)
    Germany (1952)
    Greece (1981)
    Hungary (2004)
    Ireland (1973)
    Italy (1952)
    Latvia (2004)
    Lithuania (2004)
    Luxembourg (1952)
    Malta (2004)
    Netherlands (1952)
    Poland (2004)
    Portugal (1986)
    Romania (2007)
    Slovakia (2004)
    Slovenia (2004)
    Spain (1986)
    Sweden (1995)
    United Kingdom (1973)
    On the road to EU membership
    Candidate countries
    Iceland
    Montenegro
    Serbia
    The former Yugoslav Republic of Macedonia
    Turkey
    Potential candidates
    Albania
    Bosnia and Herzegovina
    Kosovo*
    * This designation is without prejudice to positions on status, and is in line with UNSCR 1244/99 and the ICJ Opinion on the Kosovo declaration of independence
    EU around the globe

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 18 Apr 2014 6:08pm

    'One explanation for the GMC's review of the PLAB examination, reported here last week, is offered in Doctor(p11, 10/6/99). The newspaper claims that when the GMC's Professional and Linguistic Assessment Board exam for doctors was tested on a sample of 50 UK graduates last year only two passed. This is an embarrassing result whatever way you look at it, though it is claimed that the sample was not representative. According to the story, the results were then withheld from the council's deliberations last month for fear it would lead to claims that the test was unfair to overseas doctors.' http://www.bmj.com/content/318/7199/S3a-7199 Enough said.

  • Practices' income cut by thousands as NHS England devalues QOF

    Una Coales's comment 18 Apr 2014 6:43am

    Thomas, I predicted all this in 2009. What has to happen next is for the BMA Council to agree to ballot all its GP members on national strike action. If the majority vote for a strike, then NHS GPs can renegotiate a contract that allows them to charge tariff per consultation, allows them to charge £20 for DNAs like dentists, allows them to charge NHS patients private fees for appointments after 5 pm, allows them to offer private services alongside NHS to subsizide the state income and not have a rule that says you cannot offer patients private treatment if they can get it on the NHS (NHS trusts like Chelsea & Westminster can offer private care, private wing, etc.to subsidize their NHS side and NHS dentists offer 50:50 state and private, for example, NHS dentists tell their patients that an x ray is a private charge, etc.)

    If the majority of NHS GPs vote no strike, then you have to make a plan B, as the government will step up the attack on GP partnerships as the next election is May 2015. Their aim is to replace all GP surgeries with 8-8 7/7 walk in centres and do not care who mans it, nurses, techncians, physician assistants, salaried GPs, etc. Your plan B then means learning how to go private, not ideal as you wanted to offer care to those who could not else afford. Young GPs are now working locums for new private practices set up by ex NHS GP partners and enjoying the 30 minute appointments in these self pay private GP surgeries. Others are working for BUPA or Nuffield Health with their 15 min appointments or 60-75 minute health checks. And of course you have the option of VER or emigrating.

    The threat to the BMA and RCGP is that their annual fees are optional. The RCGP derives an income of £13.7 million in annual membership subs alone. For those who go private, the IDF membership has been growing at a tremendous rate, because for £250y or £25/y if retired, they offer enormous support, appraisals and have their own GP RO who, has as far as I am aware, not failed a doctor yet and only deferred a handful. They have a strong lobbying committee and have ensured their private GPs and consultants are supported and protected and have even challenged PMIs.

    Time for both the BMA and RCGP to step up their game and earn their £448 and £509 annual fees, LMCs your practice levy payments, and show you they have your backs. The only way to survive as a generalist is if the government allows you to be semiprivate GPs as in Australia, Ireland, USA, New Zealand and Canada. There is a reason why our GPs are fleeing to Australia. Maybe it is time for our nation to take some lessons.

  • Patients consulted on charges for walking sticks and knee braces by CCG

    Una Coales's comment 17 Apr 2014 8:42am

    Co-payments should have been introduced much sooner and the ability of GP partnerships to offer private services alongside NHS, to subsidise and keep their surgeries solvent amidst the MPIG and QOF state cuts. Instead we will see a domino effect of surgeries closing, the public put at high risk as they will not be able to get a GP appointment in a timely manner, and the NHS will collapse faster. For all those who objected to even a fiver or a tenner, you will see instead no NHS and all private at much higher self pay or insurance cost to the public.

    What happened to adopting Ireland, Canada or Australia's system of semiprivate healthcare so we could offer state alongside private as GPs? NHS dentists offer 50:50 state and private services, the latter subsidizing the former as a way for their businesses to stay open.

    The only solution is national strike action as this contract will only lead to the end of general practice and redraw another one that allows GPs to charge patients for private services in their building and also to buy their buildings so they may become semiprivate solvent practices, ie bring Australia to the UK instead of send all our GPs and consultants to Australia.

    For young GPs who must remain, I would suggest you sign up to private practice as a means to have a job and learn new skills instead of suddenly receive your salaried GP redundancy notice from the NHS or receive lots of stress as a GP partner trying to run a business on half the budget.