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GPs go forth

Una Coales

  • Become a partner? Not if I can help it

    Una Coales's comment 18 Aug 2014 7:57pm

    @6:03pm I think the salaried GP may have grounds for a constructive dismissal claim and compensation for her 5 years of loyal service. Public humiliation by one's boss is not the way to manage disagreements with employees. The GP partner may be offloading inappropriately as a sign of burnout due to the added stresses of care plans for all the elderly patients in the surgery, but that said, there are boundaries for professional behaviour, respect and working with colleagues.

    Dav, one salaried GP in charge of an army of NPs is doomed to fail. I have taken calls from burned out lead salaried GPs who have worked in such models and the NPs even when they can sign prescriptions, asks the salaried GP to sign to lower their medicolegal risk. The salaried GP then may end up doing double, triple the work as he or she has to basically oversee any NP prescription and mx. An APMS may turn around and scapegoat the one salaried GP when patient mishaps occur. And when rushed, one salaried GP may make a mistake, like miscalculating a diamorphine syringe driver in haste while double tasking, taking calls, signing NP rxs, consulting and end up under police and GMC investigation all for let's say £78k a year before tax?

    Who in their right mind would take on a salaried GP job for APMS in charge of a clinic full of NPs and take on ALL their medicolegal risk too while APMS managing directors sit on profits?

  • Become a partner? Not if I can help it

    Una Coales's comment 18 Aug 2014 5:14pm

    @8:47 am if I were that salaried GP, I would hand in my notice on the spot with immediate effect. Only work where you are valued and respected. Five years of loyalty should be rewarded with gratitude and appreciation, especially at a time when GPs may choose to go private, work for BUPA, emigrate, locum, try media work, occu health, cosmetology, prison GP work, cruise ship tax free work, yet this salaried GP chose to stick it out in one NHS GP surgery...

    @11:58 if you applied all those clinical skills and hours to private practice, you could cash in on a private pension much sooner than a NHS ball and chain pension...just saying.

  • Become a partner? Not if I can help it

    Una Coales's comment 15 Aug 2014 10:23pm

    Happy big 5-0 birthday this weekend @4:05 pm. Good luck in Canada!

    Good luck in Perth Tanya! It will be a welcome relief to be in control of your working conditions. Let your patients know when you leave so they can come and say goodbye to you. I never got a chance to say thank you and goodbye to my family GP of 20 years before he emigrated as I had no idea until he was gone. :-(

  • 5,000 GPs prevented from returning to workforce by 'red tape', says the RCGP

    Una Coales's comment 14 Aug 2014 2:36pm

    5,000 GPs prevented from returning to the NHS workforce or 5,000 GPs glad to get away from the NHS and emigrate to Australia, New Zealand and Canada? Double speak?

  • Should we let GP practices fail?

    Una Coales's comment 14 Aug 2014 2:00pm

    What I want to know is why the BMA negotiated a GMS contract that prevents GPs from forming limited liability partnerships?! This then makes NHS GP partnerships a very high risk venture in the current financial climate and with a unilateral financially unfeasible government NHS GP contract. GP partners become personally liable when the business fails for practice debts and staff redundancies!

    Why do regulations then allow private companies with shares to form limited liability companies to provide NHS GMS GP services so that the government foots the bill if they were to go bankrupt delivering NHS GP services.

    BMA GPC can you answer? Who in their right minds would accept a unilateral government GMS contract and be denied the right to form a limited liability company?

  • Become a partner? Not if I can help it

    Una Coales's comment 13 Aug 2014 3:22pm

    With more medical schools places cropping up and more closures of NHS hospitals, there will be fewer hospitals to complete FY and specialty training. The prospect of our young medical students may well be a £84k-£100k government student loan debt and unemployment as they try to scramble for an FY hospital placement!

  • High speed rail route could 'deprive UK of thousands of new GPs'

    Una Coales's comment 12 Aug 2014 11:05pm

    Or is this simply a case of NIMBY?

  • High speed rail route could 'deprive UK of thousands of new GPs'

    Una Coales's comment 12 Aug 2014 10:43pm

    The CSA exam was held at Croydon while renovations were being made to RCGP Euston. The lease was approx £700k a year; not exactly threatening the financial viability of the college to lease the Croydon centre again during neighbouring HS2 building works.

  • Should we let GP practices fail?

    Una Coales's comment 08 Aug 2014 11:24pm

    @10:09 PS I first learned about private general practice from a Pulse hard copy feature article on Dr Samina Showghi, a GP in her 30s, who set up her own private practice in Harley Street. It is not searchable in the online Pulse archives. Perhaps because the article is over 10 years old. Might be worth asking Pulse to interview her again and even Dr Laurence Gerlis who runs a same day doc franchise to ask them to discuss the pros and cons of private GP practice and how they set up their own practice.

  • Should we let GP practices fail?

    Una Coales's comment 08 Aug 2014 11:09pm

    @10:09 If Pulse will permit me, here is my article on how to be a private GP. http://drunacoales.blogspot.co.uk/2013/07/nhs-gps-are-now-asking-me-how-to-be.html

    The BMA sGP conference will be inviting ex NHS GP partner Dr Fiona Payne, now both a private GP and IDF GP Chair, to give a talk about being a private London GP. Both she and Justine, left their NHS GP partnerships and now work together in private practice.

    For NHS GP partners still squeezing in and covering 40-50 telephone consultations for free as the duty doctor, in the private sector, GP phone consultations are charged at £20 per call. Food for thought.

  • BAPIO 'struggling' to pay legal costs following CSA exam row

    Una Coales's comment 08 Aug 2014 9:53am

    Perhaps the British Medical Association can contribute again, as the treasurer announced a £1.7 million profit at the BMA ARM this year so no BMA or RCGP member has to be out of pocket. They have an international doctors subcommittee and a GP trainee subcommittee, the latter had been collating testimonials.

    In my opinion, this should have been a battle the BMA doctors trade union should have fought and engaged with the Equality and Human Rights Commission on behalf of its BME and IMG GP trainee members who alleged licensing exam discrimination, instead of hand over a paltry donation of only £25k to a small Indian doctors group to take this major case to High Court in their stead. BAPIO with the support of the BMA spent up to 2 years in 'negotiations' with the RCGP to little avail.

    Having sat through the 3-day High Court case and taken notes, it was a big shock to hear the Judge announce at the end, that this was 'not my area of expertise' and that he would 'allow an appeal as a different Judge may rule differently.'

    Why are the RCGP refusing to install CCTV cameras in all 39 CSA licensing exam rooms for fair appeals? CSA is a potential GP career breaker. Surely, candidates have a right to ask for evidence to contest, especially if they faced an extreme hawk examiner who gave them 0/9, then failed overall by 1 mark and face an outcome 4, release from GP training.

    Motorists have to drive by numerous CCTV speed cameras and may request a DVD as evidence when charged with speeding.

    Why are BME and IMG GP trainees not treated with the same rights, especially if they feel there was impropriety among the actors or examiners behind closed doors that affected their scores. Only video evidence may prove who was in the right and who was in the wrong.

    In 2010 black and ethnic minorities made up 38% of GP trainees...without BME and IMG GP trainees, general practice recruitment will be hit hard.

  • Practice closures campaign presents 20,000 signatures to Downing Street

    Una Coales's comment 07 Aug 2014 10:01am

    Wrong strategy. 100,000 signatures needed for any debate in the House of Commons. Asking for more public money in the context of a national public deficit of £1.4 trillion is unreasonable. Allowing GPs to set their own prices, supplement income to sustain a viable business, and autonomy to deliver medical care without being tied to financial targets and reams of bureaucratic red tape, would be the answer and for that it requires some form of industrial action.

    It is now too late to save general practice. Which medical student with a £83k-£100k student loan, would voluntarily opt for a career in general practice which involves training for 3 years to then pay £1563 each time to sit a potentially career breaking CSA exit licencing exam?

  • Should we let GP practices fail?

    Una Coales's comment 07 Aug 2014 9:53am

    Yesterday received news of a NHS London A&E manager who took his life yesterday morning. He leaves behind a young family including a baby.

    Today I heard from an ex NHS GP partner couple who set up Pioneer Health Services in Brisbane and paid a new GP $21,500 for seeing patients in his first month in June. That's £141k a year. They are looking for more GPs to come work in their clinic.

    Plan your escape. Do not work yourself to an early grave to meet impossible targets, bureaucratic or financial. It cannot be done. Set up private practice or emigrate until the government comes up with a sensible mutually agreed contract for provision of care to state patients.

  • Should we let GP practices fail?

    Una Coales's comment 04 Aug 2014 6:57pm

    @6:02pm you are right. There are only 2 choices left for GPs who remain, either work as salaried employees for private or past NHS managing directors, or try their hand in independent private practice (will need to reeducate local communities to get used to paying for a GP consultation, as they do to see a plumber, electrician, hairdresser, etc.)

    Just heard from a mother describe how her daughter only received a government loan for 40% of her university halls rent, so the daughter has to work and study and has maxed out her bank overdraft. Imagine how a medical student can survive financially for 5-6 years at university? Would a salaried GP job be first choice? Now some F2s are going straight into private practice at the end of their foundation training!

    @2:48 yes the public will get used to copayments as they have already got used to paying dentists £200 for a root canal and taking out £9000/y tuition loan for university and £7,700/y maintenance loans too.

    @2:36 I appreciate a pragmatic Practice Manager who is both realistic and business savvy. Ideally the BMA should have balloted its members on some form of industrial action, to alert the public that we have to change the way we deliver healthcare in the context of a £1.4 trillion national debt and how a unilateral government contract is not a contract but forced labour.

    Ideally the BMA would then have had leverage and public support to sit down with government and thrash out a contract that allowed GPs the autonomy to set prices, charge copayments, and come to some arrangement for providing state care for the poor and elderly based on some form of medicare/medicaid state insurance.

    Why should government want to do this? Because, general practice faces extinction.

    But do they care? No.

    What happens to those who cannot afford to pay? They will queue up at the remaining state hospitals left for those less fortunate and perhaps private hospitals will come to some arrangement to get reimbursements from government to see some state patients.

    Will there be any GPs left?

  • Should we let GP practices fail?

    Una Coales's comment 02 Aug 2014 11:17am

    GMS is a form of govt GP contract so to change the regulations, needs urgent renegotiating of this unilateral NHS GP contract and not a begging petition to government for more public money. A government contract that is financially unfeasible means a bad business to enter. The contract needs to allow a business to be self sustainable, ie like dentists or Australia, Canada, NZ with semiprivate income, state insurance for the vulnerable, poor families and elderly, copayments, PMIs, self pay, etc to supplement any practice losses from state provision of care.

    Leverage! Not a Oliver Twist petition for 'I want more public money' in the context of a £1.4 trillion national deficit!

  • Should we let GP practices fail?

    Una Coales's comment 02 Aug 2014 10:51am

    http://m.bma.org.uk/mobile/practical-support-at-work/gp-practices/collaborative-gp-alliances-and-federations/legal-structures# 'As the regulations currently stand, GMS practices would be prevented from forming LLPs.' This regulation needs changing ASAP! In the current financial climate and with a unilateral NHS GP contract forcing financial instability, it is vital GMS practices are allowed to form limited liability partnerships!

  • Should we let GP practices fail?

    Una Coales's comment 02 Aug 2014 10:43am

    I am so sorry NHS GP partners that your trade union is not balloting you for a strike or some form of industrial action with support from your ED colleagues in protest to a unilateral financially unfeasible GP contract!

    With the government increasing performance management of NHS GP practices with avoidance admissions schemes, referral management schemes, CQC checks, removal of MPIG income, etc., NHS GP partners may find themselves between a rock and a hard place. One GP surgery tried to say no (they were a partner down and unable to recruit for over a year) and got a visit from NHS England and were put under 'special measures'. They were then visited annually and threatened with removal of the GP contract if they were seen not 'towing the party line'. Losing the GP contract for the GP partners meant bankruptcies from having to pay staff redundancies.

    This is where it is important to take financial advice. The safest way is to be a limited GP partnership. This means that when you do need to turn in a unilateral contract that is financially unfeasible, the tax man will collect his dues, then the secured creditors (ie bank) and then the unsecured creditors (ie staff redundancies). If a bank deems your premise is only worth £1 million and yet the mortgage due is £2 million, the bank will have to lose £1 million if there are no other practice assets or income left after the taxman has collected. This means the last to collect, ie the unsecured creditors, do not collect their redundancies.

    If you are not a limited company partnership, then the GP partners are each personally liable to pay out of pocket for all staff redundancies and the full amount of the bank mortgage!

    God help you GP partners who are in a partnership and not a limited company.

    Now is the time when you need a strong trade union to take ACTION with the support of your ED and hospital colleagues as when surgeries fail, EDs will be even more swamped and more patients will ultimately pay the price, in substandard care due to lack of resources and manpower. Let us pray it is not paying the price with their lives...

    Renegotiate this unilateral financially unfeasible GP contract NOW! Use the general election and industrial action as leverage. Stop appearing to put institutional and old boys' self interests first above the welfare of your subscribing doctor members and patients!

  • 'I feel guilty about leaving but it's becoming harder to do the job'

    Una Coales's comment 01 Aug 2014 8:32pm

    Good luck Leanne and Paul. Link in to the UK to Australia GP facebook group to make instant new GP friends in Aus. Remember GP is a job, it does not define who you are. You have a right to be happy, enjoy your family and work under fair conditions.

  • 5,000 doctors a year considering leaving the UK to emigrate abroad

    Una Coales's comment 01 Aug 2014 1:40pm

    Good for you David. Option 2 for those who cannot emigrate is trying to set up a private practice. The independent doctors fed can offer you appraisals/reval and free CPD education and support.

    @12:13 there are 11,200 private hospital beds in the UK (2012) and many NHS hospitals also have private wings and beds. http://www.privatehealthadvice.co.uk/figures-facts-about-uk-private-healthcare.html

  • Should we let GP practices fail?

    Una Coales's comment 01 Aug 2014 12:41pm

    David Wrigley as a BMA Council Member and member of Keep NHS Public (which you failed to declare), perhaps you can let us know why the BMA Council and BMA GPC have not balloted its GP members on some form of industrial action (boycott OOHs, mass resignation, strike action) and believes instead a petition to number 10 will have any effect? Why should the government give more public funding to GPs over firefighters, police force, armed forces, education? All public sectors are being hit hard with funding and job cuts.

    Why are younger GPs heading for Australia? Perhaps because they allow GPs to be semiprivate and treat the poor as well as those who can afford healthcare.

    Perhaps you would also like to share how much is in your NHS pension pot? As younger GPs have a cap on theirs and must contribute more to cash out less at a later date. And why the BMA refused to debate a Welsh motion on potential age discrimination with the new government policy from 2015 to protect pensions of NHS doctors who turned 50 in 2012 for 10 years?