This site is intended for health professionals only

At the heart of general practice since 1960

pulse june2020 80x101px
Read the latest issue online

The waiting game

Una Coales

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

    Una Coales's comment 20 Jun 2014 8:20pm

    No amount of GP surgery training can prepare a prospective BME candidate for a CSA examiner or actor unaware he has strong unconscious racial bias for whites and strong unconscious racial bias against blacks, chinese or asian doctors. Without CCTV recording or testing of actors and examiners for unconscious bias or strong racial preference, BME candidates may never be fully reassured of a fair exam even after working 3.5 years as a NHS GP trainee.

  • RCGP and BAPIO collaborate to address pass rate discrepancies

    Una Coales's comment 20 Jun 2014 8:15pm

    There was no evidence to prove racial bias as no CCTV cameras were placed in each of the 39 CSA exam rooms and therefore without videorecording, candidates may not request evidence for appeal challenges.

    Motorists seem to have more legal rights as they may request access to CCTV footage to appeal convictions.

    Approx £8k is all that is needed to install CCTV cameras in fhe 39 rooms to record digitally and store indefinitely or at least until the next diet.

  • RCGP pushes for overseas GPs to remain on UK performers list to combat recruitment crisis

    Una Coales's comment 20 Jun 2014 10:58am

    Who would want to retrain full time for 6 months and get paid £50 per 4 hour session, pay and sit an MCQ test similar to the AKT, pay and sit a simulated surgery exam similar to the CSA, to be able to return to work as a NHS GP returner and end up working as a salaried employee of APMS when you can have the respect of your colleagues and patients in Australia or Canada and be paid 4 times as much and see both medicaid/medicare state patients and private, alongside each other.

    Retraining is 6 months at the moment but the hardest hurdle is the simulated surgery and you cannot practice seeing patients until you have passed simulated surgery, catch 22.

  • GP numbers fall 3% since 2009

    Una Coales's comment 20 Jun 2014 10:50am

    The numbers will continue to fall. I have been told by the BMA Chair of Council, singled out in a closed meeting with him last month, that a motion to ballot GPs on mass resignation, strike or a 2 week OOHs boycott is NOT an emergency motion and that I have missed the April deadline for June ARM motions. I tried to explain, this is an emergency as the NHS contract is financially unfeasible (GPs are committing suicide, are suicidal, are quitting in droves, burning out, emigrating, taking VER, and 98 GP surgeries face bankruptcy and imminent closure).

    I reminded him I still had the option of finding 9 other BMA council reps (GPs, med student, academic dr, consultants) to propose a motion to the BMA Council for a ballot on strike, OOHs boycott or mass resignation. I asked Vautrey on Council and GPC but he has no appetite for a GP ballot. I raised strike, boycott, etc leverage at the LMC conference but only got boo'ed by the LMC reps.

    The BMA Chair of Council Mark Porter told me he only listens to GPC and that I should speak with Chaand. Chaand suggests I speak with him at the ARM next week and round we go.

    So thank you for voting for me to be on BMA Council but it seems the bureaucracy is similar to NHS England in my opinion, and any motion to BMA Council must be proposed by 10 council members and then the council of 27 voting members then vote. Try getting GPs and consultants on the BMA council to agree on a motion to benefit GPs alone? Impossible, especially with a Coventry consultant anaesthetist chair who told me he only listens to GPC. Well I am not on GPC even with the most national sessional BMA GP votes. Does that mean my role as a BMA council rep will be in name only?

  • RCGP to charge for new revalidation toolkit

    Una Coales's comment 18 Jun 2014 10:29am

    The next step I foresee is government asking GPs to pay to be appraised and revalidated, ie you pay £500 to be appraised each year and you pay £700 to be revalidated every 5 years.

    As for training practices, remember the government plan is that practices will part pay then pay the entire salary of any GP trainee.

    In a national recession with a £1.4 trillion national debt, all public sector funding will be stripped, jobs axed and the public made to fork out more tax and pay for what once was a free public service.

  • GP recruitment crisis forces removal of thousands of patients from practice list

    Una Coales's comment 12 Jun 2014 4:10pm

    @10:49 thanks. I hadn't taken into account compounding interest. I hear that Inland Revenue will chase repayments even if a GP emigrates but I guess if he or she never sets foot in the UK again how can they reclaim?

    @2:32 pm the figures were cited at the annual LMC conference by a member of the BMA sessional GP subcommittee from NHS England stats. No, the hurdles for returning are so high, we are talking about 100s and not 1000s of GPs trying to return. It is almost a catch 22 for GP returners as they have to pay, sit and pass an MCQ test, then pay, sit and pass a simulated surgery exam and try to find a training practice who will take them on to retrain. But they cannot get a place on a returner training scheme until they have sat the SS exam. Yet they cannot revise as they are not allowed to see patients as they are not on a training scheme.

    The NHS England graph for NHS GPs leaving the NHS shows 2 peaks, one at 34 and one at 56, for women and men respectively.

  • GP recruitment crisis forces removal of thousands of patients from practice list

    Una Coales's comment 12 Jun 2014 8:57am

    Combine this with the average age of a female GP leaving the NHS at age 34 and men 56, we see that the initial £83,500 personal investment, needs to take into account, job/income longevity too.

  • GP recruitment crisis forces removal of thousands of patients from practice list

    Una Coales's comment 12 Jun 2014 8:55am

    The harsh reality is that university tuition loans of £9k/year + maintenance loans of £7,700/year x 5 years for medicine, mean future doctors need a specialty that will help them repay a £83,500 debt before they have even started work as a hospital trainee doctor. That reduces the number of medical students who opt for NHS general practice.

  • GP recruitment crisis forces removal of thousands of patients from practice list

    Una Coales's comment 11 Jun 2014 6:32pm

    It's not about the money. Most GPs are now women and we want to be able to juggle a family and work. Most do not want to be burdened with a 12-hour working day.

    For men, they want to have autonomy to practice and flourish, not be bogged down by rules and diktats.

    A golden handshake is not worth the cost to wellbeing.

    The NHS model is outdated. Time to encourage and help our young UK GPs achieve autonomy as semi private GPs with the freedom to set their own hours and pace.

  • GPs' independent status may change under Labour, says Burnham

    Una Coales's comment 06 Jun 2014 4:17pm

    A GP just shared that 'I used to work at an APMS practice as a lead , till then surgery was doing appallingly and when i turned it over , the manager was given best manager for achieving 100% QOF points ....???????? wth....... and she started acting as if she owned us --- immediately filed my papers and walked out.'

    Now contrast this with a private endodontist charging £1300 to do 2 root canals in one hour!

    Or a private cosmetic dentist charging £5000 for veneers. He said NHS GPs need to educate their patients that they are worth paying for. He left the NHS when patients DNA'd, took him for granted, etc. Now he sets his own hours! Total freedom!

    Until patients pay copayments and GPs are allowed to offer private services alongside NHS in a NHS GP surgery, working as a salaried employee of an APMS may be a nightmare! Did you really go to medical school to work at £44/hour vs £1300/hour as a dentist doing root canals?

  • GPs' independent status may change under Labour, says Burnham

    Una Coales's comment 06 Jun 2014 7:10am

    Take a glimpse of your future as a salaried GP (profit before patients), if Labour gets into power.

  • GPs' independent status may change under Labour, says Burnham

    Una Coales's comment 06 Jun 2014 7:05am

    Don't vote Labour. Salaried GP model means you are meant to do all the extras on your own time, during lunch, take paperwork home, check results in between patients, etc. and when patient mishaps occur, you will be blamed and summarily dismissed. You will end up staying late or arriving early, working extra hours unpaid to catch up as you will only be paid a 37.5 hour work week.

  • GPs should be paid per 1,000 consultations, says Gerada

    Una Coales's comment 29 May 2014 1:01pm

    This is the fundamental flaw with US and Australia's medicaid/medicare government schemes. The GPs can just keep calling pts on medicare/medicaid back for appointments, reviews, etc as the government reimburses based on bulk, the more patient consultations, the more GPs get paid.

    Akin to NHS trusts encouraging GPs to refer patients so they can charge the government tariff per patient seen and treated.

    The US government is tackling this with rac attacks, ie random audits of the medicaid/medicare charges made by US hospitals and imposing fines for overcharging.

    This is also the flaw behind dispensing surgeries in Hong Kong where GPs have a financial incentive to prescribe more expensive meds that get filled in the on site pharmacy.

  • University practices consider closing lists to students in order to survive

    Una Coales's comment 29 May 2014 12:53pm

    Place blame where blame is due. US subprime mortgages led to the collapse of some very major investment banks and led to some countries being on the verge of bankruptcy. We have seen what happens when people invest unwisely and have to be bailed out. Alas it means the UK's £1.4 trillion debt is very very real and this means ALL PUBLIC SECTOR funding is being slashed and if possible privatised to relieve the government financial burden to keep this country from financially imploding.

    I wouldn't want the Treasurer's job of trying to balance the books in a socialist country supporting the EU and a nanny state! And I wouldn't want to continue to be a worker paying 40% income tax on income over £32k to support a welfare state or contributing extra into a NHS pension to refill the empty pot.

    Just my opinion.

  • Large majority of GPs vote against charging patients for appointments

    Una Coales's comment 23 May 2014 7:38pm

    @6:28 when we stand by, do nothing and watch, we will witness more patients needlessly die under dangerous conditions: NHS hospital closures, long ambulance queues outside A&E and with each surgery closing, local A&Es will be hit hard with incredible overdemand and HCWs will see patients die who might have otherwise been saved had they had enough beds, theatre lists, staff, ICU beds, funding, etc.

    We are all doctors first, and what we are about to witness will play heavy on our souls and consciences.

  • Large majority of GPs vote against charging patients for appointments

    Una Coales's comment 23 May 2014 7:32pm

    OOHs is already collapsing. OOH GPs cannot afford the £12,000/yr indemnity for 36 hours a week or £17,000/yr for a 56 hour OOHs work week, esp when pay has dropped to £55-£61/hour!

    Pregnant GP mothers cannot find maternity locums. And with the average age of leaving the NHS being cited as 35 and for a man 57, we can see there is no way now to save the NHS with no powerful negotiating tools.

  • Large majority of GPs vote against charging patients for appointments

    Una Coales's comment 23 May 2014 7:08pm

    Correction 90p/patient/day

  • Large majority of GPs vote against charging patients for appointments

    Una Coales's comment 23 May 2014 7:02pm

    I attended the LMC conference and observed the end of the NHS. It was very sad to behold. I took to the podium and got a sense from the conference as to how they felt. I expressed that the 87 page agenda was full of words like ask, negotiate, demand yet there was nothing to negotiate with, no levy. The GP contract was imposed by the government and GPs were independent contractors who could just take it or leave it, resign one by one. They were not protected by employment law. There was no mention of negotiation tools like work to rule, 2 week OOHs boycott, strike in the agenda. I even reminded them of Bob Crow. Sadly the audience of LMC reps boo'ed at the mere mention of taking industrial actoon. It told me they had no appetite for a strike or mass resignation, that many were older GP partners, close to collecting their pension and did not want to create any waves even if it meant trying to save a profession for the younger generation of GPs.

    Sadly refusal to consider charging patients, also meant the certain financial demise of general practice. How can we provide a free at point of access service for 90p/patient/year from 8-6 Mon -Fri? Which sane-minded newly qualified GP would work for this capitation?

    As I listened to horrendous figures cited of only 40% of East Midlands GP training places filled, 80 empty GP training places in West Midlands, the closure of Ealing hospital, 23% GP partnership vacancies in Herts, Ayrshire GP partnerships unable to fill, etc. I was very sad.

    I meet the Tories next week and they will be leaping with joy that there will be no resistance from GPs, that they will meekly close up shop, one by one.

    Only UKIP's health advisor seems amenable to some form of semiprivate practice model to save the best of general practice, that precious 10 minute consultation in which a skilled GP appeases the soul of a worried patient and checks for red flags, diagnosing serious ailments or tending to psychological concerns. He wants to allow young GPs to adopt the dentist model.

    For now, young GPs will work as portfolio GPs, a mix of private, property, cosmetology, etc while the NHS crumbles. Even HSMP has changed its visa rules recently making it nigh impossible for any new Indian doctor to enter the UK to save the NHS workforce crisis. And we know the GP exam has blocked many IMG recruits for general practice after completing GP training.

    I am sad as the Tories think private companies want to take over the NHS, why? Did they not learn from Kenneth Clark when he was SoS 1988-90 that salaried GPs is too expensive as they are protected by employment rights and 37.5 hour work weeks. Also private companies only want to cherry pick soft services. Even ATOS handed back the multimillion pound NHS contract. And so the public will suffer, especially those who cannot afford private health insurance. Already young GPs are taking out PMI, like AXA and Pru for their own families.

    The poorest in our society will now suffer as no state funded government insurance like medicaid/medicare is in place once the NHS collapses.

  • RCGP will ensure examiners are 'representative of race and ethnicity'

    Una Coales's comment 22 May 2014 6:00am

    The only way to get the RCGP to agree to 2 examiners per CSA station (as they had for the oral module of the old MRCGP exam and offered 2 venues, London and Edinburgh) and to agree to videorecording each of the 39 CSA rooms for appeals (or offer the video module as an alternative as they used to offer simulated surgery as an alternative to the video module pre 2007), is if 10,000 BMEs/IMGs resigned membership of the RCGP. The loss of £5 million income a year would make them sit up and address the ICE of BMEs/IMGs with this exam immediately.

    If 1,000 BMEs/IMGs resigned the College, a loss of £500,000 of annual income would also cause them to respect BME/IMG members more and start to actively listen instead of impose.

    Newly qualified BMEs/IMGs are not aware that you do not need to pay the College to be a member to work as a GP once you have your CCT/CEGPR. You are put on the GMC GP register and NHS performer's list whether you are or are not a continuing member of the RCGP. You may use the Clarity toolkit to do your appraisals/revalidation.

    You only need to rejoin and pay for membership to obtain a certificate of good standing when you wish to emigrate to Australia or Canada and then convert to FRACGP.

    This is the same most powerful bargaining tool that NHS GP partners have at their disposal, if only they could open their eyes and see this as did the late Bob Crow who negotiated a £40k+ pay for train drivers with 6 months training to drive a tube train!

  • Major study casts doubt on benefits of extended access drive

    Una Coales's comment 22 May 2014 5:49am

    Glad we have Beth on GPC! I concur wholeheartedly with her sentiments and arguments.