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GPs go forth

Una Coales

  • Revealed: Sixty GP practices across the country facing imminent closure

    Una Coales's comment 05 Jul 2014 2:23pm

    I must be getting close to the truth.

    Why did the Coventry consultant anaesthetist BMA chair Mark Porter interrogate only me for 45 minutes in May at BMA House on my wish to put in an emergency motion or council motion on a ballot on strike action by GPs against a financially unfeasible NHS contract that was bankrupting GP surgeries even before my role as council member was to be ratified at the AGM in June?

    Why was I left feeling intimidated and bullied by the BMA for seeking to present GPs concerns about this NHS contract/NHSEng demands driving GPs out?p
    Why did they reject my emergency motion at the ARM in favour of a debate on a BMA bear toy?

  • Revealed: Sixty GP practices across the country facing imminent closure

    Una Coales's comment 05 Jul 2014 2:14pm

    The question to ask is why has this government chosen the US HMO model over the Australian semiprivate healthcare model? Were there any generous US health insurance party donors? Were there any deals made between number 10 and US healthcare giants or other conglomerates? We can understand why they want to hand over £110 billion a year public debt to privatisation but why the HMO model of salaried GPs and NPs?

  • Revealed: Sixty GP practices across the country facing imminent closure

    Una Coales's comment 05 Jul 2014 2:10pm

    @11:39 everything you have stated is false and has to be corrected which makes me wonder if you are a BMA or RCGP rep?

    The RCGP and BMA are lobbying for more money in spite of a £20 billion Nicolson challenge NHS efficiency savings. I am saying it is pointless to ask for more money when the nation is £1.4 trillion in debt. I am against HMOs and pro semiprivate GPs who may charge patients and also treat state medicare/medicaid patients reimbursed by the government. Semiprivate GPs will set fair market prices for healthcare but HMOs will seek profits over patients and have huge overheads.

    There is a reason 451 GP training places are vacant. There is a reason only approx 124 Indian doctors have been registered by the GMC this year. There is a reason why an Indian Cambridge grad faces difficulty passing a subjective CSA exam using actors and not real patients. I do not have to join up the dots for you.

    There is a reason why the BMA is not balloting its members for a strike or action against this untenable NHS GP contract. Government has protected senior GPs pensions for the next decade. IMO the two are linked.

  • GPs to be 'named and shamed' after missing cancer diagnoses

    Una Coales's comment 04 Jul 2014 10:50pm

    @5:31 I am so happy for you. You left before you were chained to a NHS ball and chain pension and before you acquired learned helplessness. Enjoy CANAAN.

  • Revealed: Sixty GP practices across the country facing imminent closure

    Una Coales's comment 04 Jul 2014 9:31pm

    Well done Dr Naomi Beer for taking action. I wish the BMA had organised this march for its GP members or balloted its GP members as to what they wanted its trade union to do to save general practice as asking for more money has not worked.

  • Revealed: Sixty GP practices across the country facing imminent closure

    Una Coales's comment 04 Jul 2014 9:29pm

    @12:19 easy to mudsling from anonymity? Who are you may I ask?

  • Revealed: Sixty GP practices across the country facing imminent closure

    Una Coales's comment 04 Jul 2014 7:16am

    http://www.itv.com/news/west/story/2014-07-03/6-000-bristol-patients-to-lose-their-gp/ The domino effect starts in September...

  • Revealed: Sixty GP practices across the country facing imminent closure

    Una Coales's comment 04 Jul 2014 7:16am

    CSA broke IMG GP trainee recruits. BAPIO stood up to the RCGP. The financially unfeasible NHS GP contract is breaking UK GP partners. When will BMA its trade union demand industrial action and stand up to government for a fair contract, fair working conditions and fair pay? Is it so much to ask? Why was a small agenda committee allowed to refuse my emergency motion calling for the BMA to consider a ballot for industrial action, for GPs to be allowed to increase practice income through private means by more than 10% as dentists do, for the BMA private practitioners committee to help NHS GPs source income? Why did this agenda committee think a debate on a BMA bear toy should take precedence?

    In the eyes of many grassroots GPs, it would appear the BMA couldn't care less. Government is protecting the lucrative NHS pensions of older GPs for the next 10 years. Is this not the same as accepting gag money? Don't strike on behalf of younger GPs who are working their socks off, burning out, committing suicide, quitting, emigrating, falling off their stools from exhaustion working 12 hour days, as the production line has been doubled and the speed increased. Why watch stools become vacant, one by one, as workers disappear? Who would want to join this assembly line?

    Why not increase the price of the product? Make consumers pay more for a product that has been priced too cheaply for 2014? Workers with 11 years med school and working experience cannot be expected to work this hard for pay less than a plumber.

    In 2009 I warned the RCGP not to be seen unwittingly colluding with government and bringing about the demise of general practice. Unfortunately the CSA exam has ensured that British BMEs and IMGs avoid general practice training like the plague.

    I also advised in 2012 that the BMA, RCGP, MWF, etc. should unite to protect general practice. They can only do this if they valued all GPs, IMGs and BMEs. And if they also valued white UK GP partners, they would demand industrial action and the means to survive like dentists and semiprivate GPs in Australia. Instead we will see the US health maintenance org model which was deemed as unsatisfactory by many Americans who then opted out.

  • Revealed: Sixty GP practices across the country facing imminent closure

    Una Coales's comment 03 Jul 2014 10:17pm

    The reality is, for countries to get out of a national debt of £1.4 trillion, it means privatising public services, ie privatise the railway, privatise post offices, privatise universities and now privatise the health care service. Government cannot keep publicly funding a £110 billion a year free health service in which public demand outstrips resources and manpower in the context of trying to keep Great Britain from bankruptcy.

  • Royal college backs Hunt’s ‘name and shame’ proposals

    Una Coales's comment 02 Jul 2014 7:48am

    Divide and conquer

  • GPs to be 'named and shamed' after missing cancer diagnoses

    Una Coales's comment 01 Jul 2014 9:26am

    The government wish to close the NHS ASAP due to a £1.4 trillion national deficit (compounded by Labour overspend on PFIs) and yes this is a daily attack on GPs and I warned you it would get worse, much worse as the general election approaches in May and they need to get the NHS handed over to privatisation so it is no longer a huge £106 billion/year state government funded debt.

    First they attacked the backbone of the NHS, IMGs, when SoS Lansley/HSMP cancelled all 10,000 Indian NHS doctor visas in one fell swoop in 2006/7 (a ploy which failed when BAPIO challenged the SoS/HSMP and won at High Court), then the government took the GP licencing exam away from the deaneries (summative assessment with its ~99% pass rate) and gave it to the RCGP in 2007 who then changed the exam to a subjective actor CSA exam with no videorecording of stations (US licensing and A level exams are recorded) to challenge at appeal for subconscious bias, with only one examiner at each station. I alerted BAPIO but alas the High Court judge, they got assigned, admitted in Court that this was NOT his area of expertise and allowed BAPIO 3 weeks to appeal as a 'different judge may rule differently' but BAPIO could not raise £200k again to ask for steps like CCTV recording and 2 examiners per station to reduce the racial disparity, especially with such short notice.

    We now see the number of GMC licenced Indian doctors has dropped from 3,640 to 130 this year and now we heard last week at the BMA ARM of the further repercussions when a GP exit exam fails 17x more IMGs and 4x more British BMEs, 451 national GP training places go empty.

    Secondly, the government has attacked the NHS pension. A 42 yo female GP partner decries how many times she has asked for a statement of how much she has in her pension and how much she will get when she cashes out. The sums keep coming back different, ie a difference of £700k! She says now the limit for the NHS pension is £40k a year.

    Dorrell told me to tell all GPs aged 50 and above to retire as he would in their shoes. Government are protecting pensions for 10 years for NHS doctors who turned 50 in 2012. One 71 yo GP told me the old NHS pension scheme means he has £1.8 million in it, cashed out a lump sum 3x the annual, and now lives on £78k a year. Sadly younger doctors know this is not the case for them and Australia and Canada are more realistic options.

    Thirdly we are seeing the daily media bashing of GPs to drive the remaining burned out, overworked GPs to quite, retire, change careers or emigrate as once GP surgeries fall and are all handed over to private APMS, can privatisation be completed. Already most of the private hospitals in London are owned by an American health insurance company.

    The BMA as a trade union can either offer opportunities for doctors to learn how to transition back into private practice, emigrate or can fight government with leverage (industrial action, strike, OOHs boycott which is non contractual for GPs). Without leverage, motions are meaningless. I tried to put in an emergency motion at the BMA ARM meeting in Harrogate on your behalf to urge the BMA to take action, and Chaand Nagpaul told me industrial action can include strike, boycott and mass resignation) but the small agenda committee axed it in favour of an emergency motion on a bma bear toy! Unbelievable!

    I have had the opportunity to sit and meet with number 10 advisors and it is better to know what is coming and prepare our GPs with contingency plans. I told number 10 to come clean about the economy and inability to fund the NHS anymore rather than let the public die needlessly and scapegoat GPs. They said it would be political suicide to bring up charging the voting public. Yet they charge university students £9k tuition and offer £7.7k maintenance loans a year which is not enough for university students living in London and we parents are paying the price yet again to maintain our children.

    The way things are going the government are favouring US insurance based HMOs over semiprivate practice (Oz and Canada). It means healthcare costs will skyrocket in order that they get profits over patients, instead of allowing clinicians to set the market price fairly as semi-private GPs like dentists were allowed to be and Oz and Canadian GPs are.

  • GPs must start saying ‘no’ to extra work

    Una Coales's comment 29 Jun 2014 6:27am

    Well written and advised Fiona! We caregiving GPs must learn to say NO and set boundaries or face burnout.

  • BMA demands occupational health services are funded in full

    Una Coales's comment 26 Jun 2014 4:01pm

    In the same breath, NHS England is slashing £40 million from its £100 million budget. Do not hold your breath, on occu health funding when they are trying not to renew practice building leases.

    1. Rely on the goodwill of your local GP surgery for hep vaccination, counselling etc.

    2. Use the free 24/7 BMA counselling phone service. 30 min appts by phone and can offer longer 50 min appts on a regular basis.

    3. Access PHP for anonymous doctor counselling.

    Look after yourself. You are NOT a GP; you WORK as a GP. Take care of yourself first. General practice does not define who you are!

  • Patients risk becoming 'bereft of a GP service' in some areas, GPC warns

    Una Coales's comment 25 Jun 2014 7:20pm

    @5:49 pm ditto October 2015 revalidation date and retirement date.

    My emergency motion as promised ŵas seconded by the walsall lmc chair, edited by Chaand Nagpaul and rejected by Fay Wilson on the BMA ARM agenda committee. Seems as though imminent domino effect of practice closures due to MPIG and a financially unfeasible NHS GP contract is NOT an emergency! And she said the agenda committee would not consider the press survey (of over 50% of GPs wanting industrial action quoted in Pulse which Chaand said could include strike, mass resignation or boycott)) either.

    I did everything I could to speak at the ARM, 6 speaker slips in vain to speak on GMC suicides, occu health, burnout, leverage, MPIG, etc.

    RIP Liverpool GP. I did my best to try to get the BMA to behave like a trade union and take action, use leverage, take action and not just words.

  • BMA calls on GMC to publish review into suicides of doctors facing investigation

    Una Coales's comment 25 Jun 2014 6:24am

    @9:10 pm the GMC answers to the Parliamentary Health Select Committee. Former GP Dr Sarah Wollaston has taken over from Stephen Dorrell as the new chair of this HoCs Health Select Committee and it calls upon the GMC to give regular oral evidence. http://www.bbc.co.uk/news/uk-politics-27911517

  • BMA calls on GMC to publish review into suicides of doctors facing investigation

    Una Coales's comment 24 Jun 2014 7:12pm

    Having personally received numerous calls and emails from doctors referred to the GMC between 2010 and 2014 and some suicidal, the reasons are:

    1. Medical defence orgs practice 'discretion' as to whether they will represent a doctor referred to the GMC. Often BME/IMGs are told their MDO has decided not to represent them even though they have paid their annual fees! This means an IMG has to write his own response back to the GMC complaint without legal support! A typical private lawyer may charge £200/h and £10k to represent at an FTP. I would suggest that the BMA should help by offering legal advice and editing the doctor's response?

    2. The stress then builds as after a doctor sends back a response with details of all employers and PCT/CCG, he or she waits months for the outcome of an initial investigation. He or she iloses confidence and often declines locum work while waiting. His response is seen by a lay person and a medical person. The lay person's decision carries more weight. The decision may be to dismiss or refer up to a fitness to practice panel.

    3. I have listened to an Indian orthopaedic junior doctor who blew the whistle describe how he had to self represent at a GMC FTP hearing as he was referred to the GMC by his trust on mental issues instead of dealing with the concern of risk to patient safety. Awful stress without any legal training. He described his frustrations at having to respond to a barrister's legal jargon.

    4. I have listened to GP trainees and GPs caught in a GMC loophole of assessments after deemed needing to work with conditions which basically makes them unemployable.

    5. I have seen a female GP partner contemplate suicide as she could not find locum work with all the GMC restrictions to her work and could not pay to keep a roof over her head. Even her MP could not get her out of the loop so she resigned her medical licence.

    6. I have seen a salaried GP referred to the GMC by his employer because he allegedly refused a paycut and was caught in a 5 year loop of mcq and sim surgery assessments before he was cleared.

    7. I have seen an Indian male MRCP GP trainee referred by his training practice over handling of a spurious K and the patient came to no harm. It took over a year and expensive lawyers to clear him.

    8. I have dealt with NHS consultant whistleblowers who were referred to the GMC after dismissal for gross misconduct.

    9. I have taken a call from an Indian male GP trainee in Scotland referred to the GMC and given a date for an FTP hearing in the new year, when he failed CSA until bapio intervened and stopped GMC referrals for CSA fails.

    10. Do we need more research as to why doctors commit suicide when referred to the GMC? Please all doctors know you can call www.acas.org.uk for free employment advice and call the free 24/7 BMA counselling phone service. I hope the BMA sorts this out. Perhaps anonymising names on complaints would be the first step to reduce unconscious bias against reading a foreign name on a complaint before the lay and medical GMC assessors as I have also seen how some white male doctors seem to only get 6-12 month suspension for downloading child porn, sexting patients, impregnating the vulnerable yet ethnic GP trainees get referred for minor clinical errors.

  • It is time for the BMA to ballot GPs on mass resignation

    Una Coales's comment 22 Jun 2014 10:11pm

    I have arrived in Harrogate. I need an ARM rep seconder to deliver on Pulse GP readers wishes. Please help me. One name of a seconder please to add to the emergency ballot as I promised voters. 'Proposed emergency motion by Dr Una Coales. Seconded by Dr ?

    That this Meeting could not have envisaged before the closing date of submission of motions, the critical effect of MPIG cuts leading to 98 GP surgeries in England facing severe financial cuts and possible bankruptcy within the next few months brought to light by a public protest in June: as a result, general practice now faces an imminent domino effect that may lead to the full collapse of NHS general practice and

    (i) calls on the BMA to let GPs as independent contractors invest in the NHS by opening the list to independent work like with dentists;

    (ii) calls on the BMA to engage with the private practitioners subcommittee to help NHS GP surgeries remain solvent by adding income streams as government has left these vulnerable practices hung out to dry with no help;

    (iii) requests the BMA to consider the results of a Pulse GP survey in May in which over half of GPs would consider a ballot on industrial action over funding cuts, as leverage to save GPs from bankruptcy and forced closure due to a financially unfeasible NHS GP contract to save NHS general practice.

    Emergency bma arm motion'

    I cannot let a wonderful Liverpool GP die in vain. Please anyone who is attending the ARM tomorrow, message me your name and constituency to add to the emergency motion for tha agenda committee to decide whether the ARM will debate.

  • Half of GPs support industrial action over future below-inflation funding awards

    Una Coales's comment 22 Jun 2014 10:07pm

    Crunch time. Help! I have arrived in Harrogate. I need an ARM rep seconder to deliver on Pulse readers wishes. Please help me. One name of a seconder please to add to the emergency ballot as I promised voters. 'Proposed emergency motion by Dr Una Coales. Seconded by Dr ?

    That this Meeting could not have envisaged before the closing date of submission of motions, the critical effect of MPIG cuts leading to 98 GP surgeries in England facing severe financial cuts and possible bankruptcy within the next few months brought to light by a public protest in June: as a result, general practice now faces an imminent domino effect that may lead to the full collapse of NHS general practice and

    (i) calls on the BMA to let GPs as independent contractors invest in the NHS by opening the list to independent work like with dentists;

    (ii) calls on the BMA to engage with the private practitioners subcommittee to help NHS GP surgeries remain solvent by adding income streams as government has left these vulnerable practices hung out to dry with no help;

    (iii) requests the BMA to consider the results of a Pulse GP survey in May in which over half of GPs would consider a ballot on industrial action over funding cuts, as leverage to save GPs from bankruptcy and forced closure due to a financially unfeasible NHS GP contract to save NHS general practice.

    Emergency bma arm motion'

    I cannot let a wonderful Liverpool GP die in vain. Please anyone who is attending the ARM tomorrow, message me your name and constituency to add to the emergency motion for tha agenda committee to decide whether the ARM will debate.'

  • Almost 40% of GP training places unfilled in some areas of UK

    Una Coales's comment 22 Jun 2014 10:04pm

    I have arrived in Harrogate. I need an ARM rep seconder to deliver on Pulse readers wishes. Please help me. One name of a seconder please to add to the emergency ballot as I promised voters. 'Proposed emergency motion by Dr Una Coales. Seconded by Dr ?

    That this Meeting could not have envisaged before the closing date of submission of motions, the critical effect of MPIG cuts leading to 98 GP surgeries in England facing severe financial cuts and possible bankruptcy within the next few months brought to light by a public protest in June: as a result, general practice now faces an imminent domino effect that may lead to the full collapse of NHS general practice and

    (i) calls on the BMA to let GPs as independent contractors invest in the NHS by opening the list to independent work like with dentists;

    (ii) calls on the BMA to engage with the private practitioners subcommittee to help NHS GP surgeries remain solvent by adding income streams as government has left these vulnerable practices hung out to dry with no help;

    (iii) requests the BMA to consider the results of a Pulse GP survey in May in which over half of GPs would consider a ballot on industrial action over funding cuts, as leverage to save GPs from bankruptcy and forced closure due to a financially unfeasible NHS GP contract to save NHS general practice.

    Emergency bma arm motion'

    I cannot let a wonderful Liverpool GP die in vain. Please anyone who is attending the ARM tomorrow, message me your name and constituency to add to the emergency motion for tha agenda committee to decide whether the ARM will debate.

  • RCGP and BAPIO collaborate to address pass rate discrepancies

    Una Coales's comment 21 Jun 2014 12:15pm

    Yes @8:44pm many candidates still write me asking whether to fork out another £800 to appeal a fail by one mark out of 117 marks. Without access to video station evidence there is no point in appealing as it will always be one person's word against another. Such a waste of subsidised tax payers' 3 year NHS training to then release a GP trainee at the end for failing by 1 subjective mark out of 117 so he can never continue to help out his training practice as a locum, salaried or GP partner af a time when 60 million UK patients need GPs who are dropping out like flies, retiring early, emigrating, going private, changing careers to banking, going into pharma, or just quitting as theirs is a secondary home income.