@10:25 if the BMA submitted unsigned resignation letters or OOHs boycott, general practice would come to a stand still for a week at most, before the PM and government caved in and gave us GPs fair pay and fair working conditions. That is why we have a trade union, to ensure doctors are not exploited, overworked, underpaid, robbed of their pension, bankrupted.
If we do nothing, 99 surgeries will close in East London and the domino effect begins as 100,000 patients look for a GP practice elsewhere. How safe is it when a patient has to wait 2-3 weeks to see a NHS GP? What if the public knew they could pay £70 to see a private GP on the same day or next? What if we could provide a compromise, co payments as in Australia and Ireland?
Hospital consultants need to be on our side as without GPs, secondary care is next to collapse. However this means they would then just fall back on their private practice. The problem is that not all parts of the UK can afford to provide private care as the population are mostly deprived. They will lose out.
We must change to survive!
@2:13 good catch. Yes missed out highway pension robbery, seniority swindle and empty legacy. You are right. If we do nothing, we watch government starve out all NHS GP partnerships.
Frontline troops cannot survive without funding, supplies, rest periods and to demand they fight 8-8, 7/7 against a continual and rising wave tide of consumerism, entitlement, growing population with EU floodgates wide open and global health tourism too...well how can 7,000 and dropping NHS GP partnerships survive coping with millions in WWIII on their own?
Yes there is no legacy left when all NHS GP partnerships finally close their doors due to forced insolvency. Even now my youngest is resisting general practice despite her school matching her with general practice as a career.
It means bright medical students who may have wanted to be GPs, are now being swayed against. Without new GPs, there is no future for the profession.
No recruits and no legacy mean we watch the ashes of general practice disappear into the wind...as for institutions like the BMA and RCGP, membership may be severely affected if GP as a profession becomes extinct? Time to join forces and demand strike action or en masse resignation, nothing more, nothing less to save general practice!
If you allow the government carte blanche, not only will they privatise healthcare but insist everyone pays 100% copayments. Please listen to your NHS GP who wants to ensure the poor and elderly are not overlooked. Semi private Irish/Canadian/Australian healthcare systems are the best modern way of treating both those who cannnot afford to pay and those who can and it keeps doctors from self flagellating themselves as @9:47 so aptly described. I lost an overworked dear GP partner colleague to suicide this year. I will do everything in my power to ensure GPs are safe too!
@Anthony I am so glad to hear you made your exit in time. Yesterday I learned that a GP partner dear to me committed suicide in his early 50s. His family and mother are heartbroken. IMO the NHS contract killed him.
Please GP partners out there, it is time for en masse resignation from this untenable and unworkable NHS contract that will either force you out through bankruptcy, burnout, ill health or God forbid suicide.
We have our very own never event among us. It is time to demand a ballot to walk out of this nightmarish NHS contract and demand better working conditions, better pay and literally, demand a life-line!
Typo..hear not here.
Having read an umpteen page report by a GMC appointed assessor sitting in on a poor GP's consultations, be ready to here criticisms like did not wash hands in between every patient (whether you examined them with gloves or no exam), did not hold the otoscope in the correct manner, did not remove all clothing to auscultate the chest front and back, and so on and so forth.
This is only yet another ruse to put pressure on NHS GP partnerships to sell out and hand back their surgeries.
When will we unite and call for en masse resignation with undated signed letters of resignation from a contract that is clearly designed and changed unilaterally to ensure GPs are set to fail and the landscape of general practice changed to cheap salaried GP workers under the thumbs of managers ensuring profits over patients?
http://youtu.be/5cvHgGM-cRI Dr Pamela Wible US family physician explains on Tedx how 400 US doctors are now committing suicide every year due to the stresses of bureaucratic govt medicaid/medicare mandates and box ticking to receive reimbursements rather than face to face human patient encounters.
This is happening with the NHS. Her solution was to call a town hall meeting and ask the public what their ideal GP surgery would look like and within a month created it! Before the overhead was 74% paying for the large building, the practice staff, admin, etc. and now her overhead is 10% as a sole practitioner and she offers 30-60 minute appointments via online booking! No queues of patients inside and outside the building! She even says she does not turn away anyone who cannot afford to pay! So like lawyers she mixes pro bono with PMI and self pay income. She can even work part time!
I surmised that if she charged $70/30 min appt and offered 8 appts x 30 mins or 4 hours a day, she could earn £100/h or £400/day or £100k per year for what amounts to part time work!
All NHS GPs have access to approx 2000 patients each on their list and they could write to them and say they are now going private and easily make double the living seeing 200 patients. The dr/pt ratio would be a lot safer and GPs would be happier.
Her ideal clinics have spread like wildfire across 50 states of America and is saving doctors' lives from burnout.
It would certainly increase GP recruitment if budding GPs saw a future for general practice in the UK and the public would be safer.
Apologies for the typos. Can't find my reading specs and typing on an ipad. That's 'whole' series, 'box' ticking, 'sector' and 'self'.
Fascinating rebuttals by another physician in Once more unto the breach http://theincidentaleconomist.com/wordpress/once-more-unto-the-breach/
This physician compares the burden put on public sector physicians to that put on public sector teachers in the US.
The bottom line is either we need a stronger trade union led by the likes of a Bob Crow pushing for en masse resignation or strike or we vote with our feet.
Here is an article in the Wall St Journal mirroring what is happening to NHS GPs. In the US, govt health insurance called Medicaid/Medicare is mandating a while series of electronic health record tbox ticking that is driving physicians mental and cutting reimbursements. The context is the same as in the UK. Both nations have HUGE national deficits and are looking at ways to control government public expenditure on health. Here the govt health insurance is called the NHS and over the pond it is called medicaid for the poor and medicare for the elderly/disabled.
Poignantly this physician writes of retiring early and suggests physicians not accept any medicare/medicaid patients. This is similar to us asking for an en masse walk out from the NHS GP contract.
At the end of the day self paying patients means you are in control of your own business and keep your ICS. The longer you remain working for the public healthcare sectorr, the more you are likely to feel stress as the government continues cutting expenditure.
Plan for more pressure and mandates to be dumped on remaining GP partnerships, to force them to amalgamate and move into new builds as feds to then be able to decommission them and commission APMS or US/UK healthcare giants to take over the government burden.
A ballot for en masse resignation is to ask government to give GPs a lifeline, semi private, state+private sellf pay, else the public will only have 100% private care and who will look after the elderly and the poor?
CCGs may be empowered to decommission existing GP partnerships and commission federated GP surgeries who have moved into modern premises. Thus neatly packaged, feds will be handed to large APMS at which point only the remaining doormats will be asked to stay on at £57k to work as salaried fodder and cover local community hospitals, local nursing homes, their own hospital admissions (round, write up orders, treat, discharge), GP surgery clinics and go home exhausted after a 12 hour day, totally emasculated. There is a reason for the national shortage of family physicians in America and it is headed our way.
Plan your exit strategy. Less reliance on a NHS ball and chain pension. Think property investments, portfolio career, dermatology GPSI, work for private schools, investment funds, cosmetology, private GP locum work, etc.
@9:09 pm history will look upon the NHS GPs of 2014 and judge us for taking action to sustain general practice by pushing for a transition into semi private practice like our hospital consultants, dentists and NHS trusts or for meekly accepting and watching NHS GP surgeries close one by one.
The longer GPs operate on a shoestring budget with more secondary care patients dumped onto GPs' laps, the more risk and shortcuts they are forced to take on. It will only be a matter of time before GPs get caught out and end up before the GMC and a civil court for damages. Why put yourself in a very precarious position? Why try to triage 140 phone calls or whizz through clinics at 10 minute speed consultations, hoping you haven't missed anything serious. Demand has been given free rein! There aren't enough GPs. Funding has been slashed. It is a death trap.
How bad does it have to get before you resign en masse from a contract that will either send you to an early grave, rob you of your life savings as you will be responsible for your practice staff redundancies and tax liabilities, or end you up in jail for 5 years for wilful neglect?
For surgeries on the brink of bankruptcy and closure, GP partners be aware of TUPE, as employers you may be liable for the redundancy of your long-serving staff even when left with no option but to close and liable for the ongoing tax liabilities for the next year or 2. So instead of gratitude after decades of service to ensure access for all, you will have to pay out of pocket in the end for the privilege of having served the NHS.
I spoke to a GP who is still alive and was present during the infamous 1966 GP strike. He said their bargaining tool then was to refuse to sign any sick notes.
Scroll forward and in New Zealand doctors went on strike and refused to sign cremation forms. You can imagine that the strike only lasted 48 hours as the mortuaries filled up.
If the government has bound the BMA in legalities preventing a strike, then we need trade union barristers like John Hendy QC to take on government as every trade union should have the right to strike or take action to ensure fair pay and fair working conditions,
If you think it is greener on the other side, I just chatted with a young female who has completed a summer bank internship and said bankers are in the office from 4:30 am when the markets open and are there until 9 pm and then go drinking with clients until 1 am so many live on 3 hours sleep! And the money is not as good as it was 10 years ago (when our economy was in the black).
I guess the bottom line is that the only way out is being your own boss and go private so you are not stressing over intolerable work demands, bureaucracy, reducing pay, etc. When there is a housing shortage, house prices go up. When there is a GP shortage, govt cuts GPs pay! Until then, we can demand a ballot for en masse resignation as we are no longer doormats!
@1:56 you have a point. The Australian health minister is announcing today that they cannot afford free health care on the current scale (Medicaid/Medicare).
@2 pm yes I would also support charging for DNAs but that would again mean a change to the NHS contract to allow charging patients.
The bottom line is the way things are going, there will be no GPs for the NHS and the only ones who stick around will be private GPs charging full price for consultations.
With a semi private system, the poor and elderly get reimbursed by the state, so this cuts down on trivial visits, and thus reduces demand as it is UNSUSTAINABLE currently.
Yes I can see some try to abuse the free medicaid/medicare system but without some provision for the poor and elderly, we would not be a modern society?
@9:01 the answer is to address demand. Start charging £10 a GP appointment to reduce demand. And start charging £100 for an A&E visit as Ireland does to stop overflow to A&E. And if left wing socialists chant that the public deserve free medical care at point of access, you chant right back that GPs deserve fair working conditions and fair pay, we are not gonna take it anymore!
@10:02 pm yes I am hearing that hospitals are charging CCGs for extra lists and paying consultants up to £200/h to see a list of up to 8 (fewer with DNAs) patients for follow ups. We GPs have also had to take the savings we have made and hand it back to hospitals who seem to always be in the red.
Clearly we must negotiate for a contract that pays per service/consultation like the tariff hospitals and dentists charge.
Being a NHS GP partner is like a double edged sword. You are self employed so exempt from the EWTD of 40 hours but at the same time employed by govt and subject to unilateral variation of the contract with a trade union whose hands are tied up in legal knots and rules. The only way out is individual or en masse resignation from a contract that will either drive you to an early grave or bankrupt you.
Why should patients learn how to self manage minor ailments when they can pop into their GP surgery and see a GP for a free checkup, free prescription and free refills?
Ever wonder why patients are discharged from hospital or sent out from outpatients with a hospital prescription but do not fill their prescription in the hospital pharmacy (as they would have to self pay) but instead take it to see their GP to exchange for an FP10 to get meds for free?
The cost of meeting CQC tickbox demands to pass premise inspection (think £10,000s), cost and time to pass revalidation (think scrutiny of NHS England RO), cost and time to run a GP surgery on a shoestring budget and cost of TUPE (protecting existing practice staff) may well be designed to ensure the timescale is met in time for the next general election.
One by one practices will resign.
@12:16 pm On the contrary, you do NOT require MRCGP to work as a private GP. Hugo is a friend of mine and only has MBBS. You can gain experience on the job as in the days of apprenticeship. The GMC says any doctor with MBBS may work as a private practitioner on Harley Street or elsewhere. MRCGP is a requirement for NHS CCT/performer's list. http://www.thelondonclinic.co.uk/consultants/dr-hugo-rowbothom