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The waiting game

Una Coales

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

    Una Coales's comment 22 May 2014 5:42am

    Training examiners and actors in E&D is NOT the same as testing them for unconscious bias. A BME examiner told me on April 17 that she had done the Harvard IAT online test for unconscious bias and came up ''moderate' preference for the white race!

    I spoke to Pauline Foreman, the new CSA chief examiner on April 17 at the BAPIO conference in Birmingham and she confirmed there will be NO videorecording of the CSA rooms for evidence for fair appeals, NO 2 examiners per station, and NO testing of the actors or examiners for unconscious bias.

    How may BME/IMGs be reassured they will face a fair exam if unconscious bias is NOT adequately controlled? How did it make a male Indian GP trainee who had managed to get into Cambridge to study medicine, pass all his Cambridge exams and final, complete 3 years as a GP trainee, feel to then have to sit a 4th CSA because the exam will not test for unconscious bias which has been acknowledged by the world to exist since at least 2007 and can now be tested for?

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

    Una Coales's comment 16 May 2014 8:57pm

    Like John and many others retiring early from the NHS in hopes that the government will improve the GP contract for those left behind before NHS general practice collapses, so too have I resigned my membership from the RCGP yesterday, in hopes that if enough IMGs resign, it will expedite changes to the CSA exam to reduce unconscious bias. At the end of the day we want fair exams, fair pay and fair working conditions for all!

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

    Una Coales's comment 16 May 2014 8:52pm

    Case in point. Many British BME and IMG GP trainees wanted the CSA exam to reduce unconscious bias, ie with 2 examiners per station, videorecording of each station, video evidence for fair appeals process, etc. The RCGP did not do this so BAPIO raised £175k to take the matter to court and won a moral victory. The RCGP have one year to reduce the racial disparity.

    Or what if 10,000 IMGs had stopped paying £509 for one year, ie £5 million in RCGP subs. How fast do you think the RCGP would have fitted 39 CSA rooms with CCTV recording and paid for 39 extra examiners to work alongside as a shadow?

    If we apply the same principle to NHS GP partnerships and the need for a change to the NHS contract so that it can be delivered, either by adding DNA charges, handing back MPIG, reducing overdemand with £10 copayments, etc how fast will it happen if one GP surgery closes at a time? Now reflect on how fast the contract will be improved if 1,000 or all 7,000 NHS GP surgeries gave 3 months notice of mass resignation?

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

    Una Coales's comment 16 May 2014 12:12pm

    @3:38 if we do nothing, the domino effect will start with 98 GP practices facing bankruptcy within the next 3 months. We have a window of opportunity to raise public awareness of the imminent danger to patient safety when local areas start losing GP surgeries to foreclosure.

    Mass resignation or an OOHs boycott will alert the public that our health service is in dire straits. If your surgery is going to close within the year, then why not support mass resignation with 3 months notice?

    John is right, the private firms are not ready to provide bulk capacity to 60 million, especially when NHS GPs provided a lot of unpaid goodwill. Even migrant workers are not prepared to work for free.

    I am hearing that some EU GPs are finding appraisal/revalidation onerous and some are returning to Europe. When we say there is a national GP shortage, this already includes the bums on seats the NHS has tried to recruit from overseas and Europe!

  • GP 48-hour appointment standard could be contractual requirement under Labour

    Una Coales's comment 14 May 2014 10:25am

    @8:25 I have many locum GP colleagues who only do OOHs. I cannot see them boycotting work on behalf of GP partners. The problem we have is lack of unity as we are no longer 23,000 unified GP partners but a mixed bag of locums, salaried, portfolio, private, NHS partners further subdivided into PMS and GMS, UK, IMGs and EU, BMA members and non BMA members.

    A call for mass resignation or the late Bob Crowe's tactic of a series of strike days shows the public that workers are incensed and angry! Even the public will be able to see and understand if we make enough noise to show the public the truth and not the DM or political version.

  • Labour pledges £100m to reintroduce 48-hour target to see GP

    Una Coales's comment 13 May 2014 8:03pm

    I just voted UKIP on my postal EU ballot. At least the health advisor for Scotland UKIP is a medic, one of us! Meeting the Tories in 2 weeks. I am giving them one more chance to get it right or else I defect all the way next general election.

    Labour lost my vote when they imposed PFI debts on NHS hospitals and drove managers mental trying to tick boxes linked to income to meet insane interest payments at the cost of patient lives!

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

    Una Coales's comment 13 May 2014 3:31pm

    @10:43 the mass resignation ballot is a bargaining tool. If we do nothing, we watch our NHS GP surgeries go bankrupt. I agree I see the BIG private giants taking over and subjecting our GPs to salaried workerbee status and it will be a case of profits over pts.

    The ballot will grind the system to a halt long enough for the public to listen to GPs and ask questions of government. Then can we offer semiprivate healthcare and keep our UK GPs who are leaving in droves! It is the only viable option against 100% privatisation.

  • Labour pledges £100m to reintroduce 48-hour target to see GP

    Una Coales's comment 13 May 2014 8:05am

    @6:08 What would you like? Guernsey option, Canadian option, Australian option or the Irish option? All sustainable semiprivate models of healthcare in which patients are safe and GPs are happy.

    Because government has been kicking the NHS football around at every general election, they argue it is political suicide to charge patients. So be it, let the NHS football deflate and everyone walk off the football pitch. Game over.

  • Labour pledges £100m to reintroduce 48-hour target to see GP

    Una Coales's comment 13 May 2014 7:59am

    @00:31 the time frame is deadline May 2015, the next general election.

    If the BMA is powerless to change the course of history, ie general practice destruction and along with it the NHS too, then there is nil else to do but go private. The red flags are all there, increased factory assembly line demand, docked pay by 50%, workers leaving for Australia, smaller factories bankrupt and closing, larger factories next, etc.

    If the BMA effect change with the most powerful bargaining tool at any trade union's disposal, ie a OOHs boycott or en masse resignation, then the government will be on its knees. Surely before they take away your livelihood and force you to close your GP surgeries due to bankruptcy (but still leave you with the staff redundancy bill to payh, you would want to see payback on the government, your demanding and unrelenting boss who only beats GPs with sticks and ne'er offers you a carrot?

  • Labour pledges £100m to reintroduce 48-hour target to see GP

    Una Coales's comment 13 May 2014 7:37am

    @00:31 I have started up a petition for a BMA ballot on mass resignation from the NHS GP contract. Either sign or email me at

    I was cringing as Ed Milliband was on the tv saying patients should be seen on the same day by their GPs. So it is the GP's fault that they are overworked, underfunded, risk chronic stress, an early grave and are just not working fast enough on the NHS factory assembly line? Nothing to do with the assembly line has just sped up with more parts to assemble in record time with no rest periods, 50% reduction in pay and half the manpower?

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

    Una Coales's comment 12 May 2014 9:15pm

    @8:11 pm how may you contribute to help the wellbeing of our fellow GPs? We are all in this 'system' together until we work out our own exit strategy. My own exit is fast approaching.

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

    Una Coales's comment 12 May 2014 9:12pm

    @5:21 I have found a reason to stay in the BMA! They now offer 24/7 BMA counselling service for GPs! Put this on your speed dial 0845 920 0169 and be put through to a counsellor immediately for a 30 minute phone session and you may book weekly sessions too or just call back daily for more counselling! This in itself may be well worth the £443 annual sub fee. There is no limit to you calling night or day whenever you feel stressed, overworked, depressed, low, etc.

    At a time when the NHS is no longer offering occupational health for GPs, the BMA has bought a 24/7 counselling service package for its members! Well done!

  • Labour pledges £100m to reintroduce 48-hour target to see GP

    Una Coales's comment 12 May 2014 9:02pm

    @7:22 Re UKIP, I have been instructed by a Scottish medic UKIP health advisor to say 'Anyone with any sympathies to the Labour party should be in no doubt these guys want to debase primary care and drive you to an early grave.'

    Sounds like we need more medics to infiltrate all the political parties to educate them that NHS GPs are NOT going to provide 60 million people unlimited 48 hour access appointments for £3/consultation even if they had the manpower which they don't.

    If you are a young GP, please bear in mind that the door to Australia may close in 1-2 years as Australia is filling up with former NHS GPs! You'll need letters of good standing from the RCGP and GMC.

    Else you may be stuck working as an underpaid overworked salaried GP for a private bulk provider.

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

    Una Coales's comment 12 May 2014 8:46pm

    Thank you Justin and Elizabeth. List started to bring with me to both the LMC conf and BMA ARM. Already been told to do nothing and wait to sit in an induction meeting in September. Not that I ever do as I am told as my mandate comes directly from the membership!

    @5:21 happy to also start a second list to bring to BMA House June 17 eve meeting on interactive engagement with its members, to identify the needs of its members. Email me your reasons for resigning BMA, name and reason.

    @BBC news announcement of Ed Milliband's call for 48h access to GPs. C5 news rang me and borrowed my lines for their reporter outside Parliament, too few GPs, overworked, etc. I couldn't get to Monument in 15 mins to say on tv Ed is guilty of blatant electioneering! He must be in lullaby land if he thinks there are enough GPs to offer 60 million people unlimited GP appointments in 48 hours for £3/appt.

    I shall quote MetroIndia headlines 'there is a strong drive to create instability in the NHS.'

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

    Una Coales's comment 12 May 2014 8:40am

    We all know. We know that it is unsafe to make pts wait 2-3 weeks for an appt especially if it is one for a DVT, cellulitis, pneumonia, perforated viscus, etc. Is it safe to rely on the lay pt historian on the phone who is battling with a receptionist to make an appt?

    In 1990 as a US med student I sat in on a Charing and Westminster NHS hospital outpatient clinic and heard a consultant explain the long waiting list for a triple bypass to a middle aged Indian man. His face was long and sad. He and the consultant knew he would die before his life saving op because of the rationing NHS wait list. And when the pt had left, the consultant turned to me sitting as an observer from the US and shared that the pt would probably die before he ever got his op.

    We all know that patients could have better care. We all know that underfunding and skeleton staff are putting patients at risk of harm. We all took the Hippocratic Oath. We all have a conscience and moral and ethical desire to protect our patients and our colleagues wellbeing.

    A healthcare system that is imposed on our patients that may risk their lives needs to be fundamentally changed. It is time to make that change, to transition into semiprivate healthcare so that no patient is denied safe and timely care.

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

    Una Coales's comment 12 May 2014 8:27am

    @8:13 you are absolutely correct. How can GPs work to a government contract that may be changed at whim with 3 months notice? How can GP partners keep stressing out as to how to deliver a safe service when they are constant strain to adapt to a further detriment to the contract, what contract?

    At a time when NHS general practice is on its knees on the verge of collapse, the BMA should be much more vocal and demand drastic action of its members.

    I need a seconder for an emergency motion on the day of the ARM. If you and anyone else who will be there would like to second, third, fourth etc, please email me your name to In fact I am happy to start up a petition of names of grassroots GPs who want the BMA to take some much needed action to fight for fair pay and fair working conditions.

    We cannot stand by and watch patients we send in to hospital bounce back from A&E without a diagnosis, be sent back to be referred by the GP to a different department of the same hospital, have their operations cancelled repeatedly, etc.

    We must demand a change to the healthcare system. Semi private care will allow some form of government state medicare/medicaid to pay for the poor/elderly and for copayments/PMIs/self pay to keep GP surgeries solvent. We must recognise that there is a massive GP/A&E doctor shortage in the UK. For safe medicine, patients need a safe ratio of patients to GP. I can't fathom a surgery in Essex in which 8,000 patients lives and wellbeing are all dependent on one single GP! Or the amount of strain he or she must be under personally.

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

    Una Coales's comment 10 May 2014 2:01am

    Sorry for the typo, that's 99 GP surgeries.

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

    Una Coales's comment 10 May 2014 2:00am

    Thank you Bob and @10:40. Wow the Guernsey option! We have been here before! Reggler went to Canada. Young GPs heading for Oz. Got another email today from a part time salaried female GP who is headed for Australia now that her psych consultant husband has secured a job there.

    Only this time, if the BMA do not act and ballot its members for OOHs boycott or mass resignation, then the entire NHS will collapse before everyone's eyes! Nurse shortage in the 1000s, A&E crisis, GP shortage, closures of GP turning back once the domino starts falling with the imminent closure of 99 GP surgery within the next few months.

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

    Una Coales's comment 09 May 2014 9:43pm

    @7:06 I know. However I have a mandate to represent my voters, to have doctors' backs and to make a lot of noise, so that when the last NHS GP partnership closes and the public look around and cannot find a GP surgery to register with and have to travel miles to the closest Virgin APMS, they will know we GPs of 2014 did try to warn the public, we did try to walk out of this doomed NHS GP contract, we did try to get the BMA to ballot its members on en masse resignation or OOHs boycott, we tried EVERYTHING to save both our profession and primary care for our patients.

    And when Virgin and other private providers are then handed permission to charge 100%, the public will clammer come back NHS GPs!!! We are more than happy to pay a £10 copayment to see our family GP or £100 to attend A&E, we can't afford these 100% private fees!

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

    Una Coales's comment 09 May 2014 4:20pm

    Thanks Robert and Bob. Sorry that should say undated signed letters of resignation. Yes we are all making a lot of noise and finally debating this. It does need to be taken to the public forum because the public need to know what happened when all NHS GP surgeries fold within a year and privatisation takes over.

    I still plan on queueing for the soapbox in a couple of weeks at the annual LMC conference in York. They'll have to drag me away, kicking and screaming. I get one whole minute to convince the conference that en masse resignation with 3 months notice to abide by NHS Eng rules or OOHs boycott (not in the contract) is needed to grind this machine to a halt and demand a better contract with fair pay and fair working conditions.

    Next is an emergency ARM BMA motion on the day in June in Harrogate. Don't hold your breath. I predict the agenda committee will attempt to block. Don't tell me why as you guys elected me to speak up for you!

    Keep bringing on the ideas. I am just doing what I am told by you. I took a long distance call from Brisbane earlier this week and listened as a former NHS GP regaled working life in Oz, at $200,000 a year and $400 a week rental for a 4 BR house, less tax, co payments and 20-30 minute GP appointments, it is very sweet.