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The waiting game

Una Coales

  • We have a year to save general practice

    Una Coales's comment 26 Apr 2014 10:28pm

    @6:34 pm 'desperate voices of grassroots GPs'. I shall be following close behind you if I cannot save general practice by 2015! This motion is the only way to stop GPs emigrating, retiring and going mental under the immense workload.

    Mass resignation, the NHS Titanic is sinking, please allow GPs to evacuate, some have already left in lifeboats heading east for Australia or west to Canada, some are donning life jackets planning their exit strategy, some have taken VER and slipped away quietly in lifeboats heading for the shores, but the rest are stuck in the galleys, nervous, working all hours, trying to plug the gaping black hole in the bottom of the vessel, but the demand is relentless, the waters keep coming in and there aren't enough buckets or manpower to deal with each surge of water.

    The only solution is for transfer to a new modern vessel which will keep general practice afloat, a vessel based on Australian sturdy ships with enthusiastic workers and safeguards against flooding and sinking.

  • Seven GPs elected to BMA Council

    Una Coales's comment 26 Apr 2014 10:15pm

    John, thank you. I am doing this for you all, hardworking NHS GP partners who had no voice but had to open up the tabloids, read the bashing, go back to humbly working 12-14 hour days, never able to switch off, worrying about the next government swing of the axe (metaphorically speaking), figure out how to balance the books when it just wasn't going to balance but leave you with diminishing drawings, and all you ever wanted to do was be a doctor and look after patients. You'd think you had signed up to the SAS, the hours, the beatings, the mental stress, you have all taken and endured in silence.

    @5:58 pm wait until the BMA Council votes on the ballot for mass resignation first. They may vote against, giving GPs the right to be balloted on mass resignation, in which case, you need not rejoin the trade union as your wish may not be their command. I hope they take lessons from Unison, listen to your members! If they want a strike or mass resignation, give it to them!

  • We have a year to save general practice

    Una Coales's comment 26 Apr 2014 11:36am

    How about this for an emergency motion to the ARM:

    'That this Meeting, in light of the untenable and unworkable NHS GP contract now threatening the end of general practice within a year, calls upon BMA Council to conduct a ballot on GPs to consider mass resignation from the GP contract if the DoH and NHS England continue to withdraw practice funding and make practices unviable and bankrupt.'

  • We have a year to save general practice

    Una Coales's comment 26 Apr 2014 9:58am

    Why does the BMA not ask its members at conference whether they want to be balloted on a national strike or mass resignation like Unison did with overwhelming support from conference for a ballot for national strike action on June 15?

    Why do 34 members of the BMA council get to decide whether to ballot instead of 60,000 NHS GPs?

    Why so many layers of bureaucracy and tick boxes? When does a union stop being a trade union and become another bureaucratic machine?

    Better to go back to grassroots purpose and mission statement, to truly represent doctors and ensure fair working conditions and fair pay (without layers upon layers of bureaucracy, motions, rules, meetings, paperwork, permission for permission, etc.). Just a mere thought.

  • We have a year to save general practice

    Una Coales's comment 26 Apr 2014 9:53am

    Thanks John. Good on you too for letting your patients know the true state of affairs.

    @10:34 ;-)

  • Seven GPs elected to BMA Council

    Una Coales's comment 26 Apr 2014 9:27am

    What do GPs think of this Emergency Motion for ARM in June in Harrogate? I have incorporated all your ideas, concerns, and expectations. If we do nothing, NHS general practice collapses and disappears, no matter how much socialist ideologists believe healthcare should be free for all at point of access. We must face facts, public expenditure is being cut, taxes are being raised, public universities are now charging £9k/y+£5k living/y because our economy is one step away from Greece!

    Emergency Motion Ballot

    Conference asks that GPs be balloted for mass resignation from the NHS GP contract:

    I. In favour of a copayment system like Australia with government providing means tested medicaid and medicare insurance for the poor and elderly/disabled and for the rest to pay per consultation/services.

    ii. With undated resignation letters.

    iii. To save the existence of general practice, which as a profession is threatened with extinction, due to lack of manpower, lack of government funding and lack of workforce recruitment.

    iv. In favour of a contract that allows NHS GPs to offer patients private services for any treatment also available on the NHS so that private income may subsidize and sustain the NHS side to krep surgeries financially viable.

    v. In favour of a contract that pays per consultation and is no longer based on an outdated Carr Hill formula, as removal of MPIG now prevents practices from balancing their books.

  • Half of GPs still critical of RCGP's handling of the CSA exam row

    Una Coales's comment 25 Apr 2014 10:52pm

    My comment,'The High Court Judge made it clear to both the public authority regulator the GMC and the public authority delegated with administering the GP licensing exam, the RCGP, that now was the time to address the disparities in the CSA exam pass rates between British BME and white British graduates, between BME IMGs and white IMGs and between IMGs and white British graduates. Such actions could have, in my opinion, included more detailed exam feedback, installation of CCTV in 39 rooms (estimate £8k) for monitoring for unconscious bias and to provide evidence for fair appeals, revisiting the bar used prior to September 2010 when the pass mark for white British graduates was lower and for IMGs higher so as to reduce the disparity and offering GP trainees the option of the old video module in lieu of CSA for those who suffer from extreme performance anxiety.

    Understandably some GPs are unhappy with the 'actions' the GMC took by publicising a report on IMGs who sat PLAB and their subsequent performances at subjective Royal College exams like CSA which did not compare UK grads sitting PLAB so was not following a similar cohort throughout.

    I would hope that at a time when the NHS is haemorrhaging GPs, the RCGP will now adopt some, if not all, of the suggestions I had made known to them well before the legal action took place, so that BAPIO do not feel compelled to continue to pursue legal action through an appeal, an option offered to them by the Judge. Both the RCGP and GMC now have to show appropriate actions taken within a reasonable time, which in my opinion, would mean a year to get this right for all concerned to ensure we are not passing poor doctors or failing good doctors due to inadequate control of unconscious bias. Time to record all 39 CSA rooms, monitor for role player or examiner bias and allow tapes for fair appeals, as is the case with the USMLE licensing exam sat by both US and IMGs, with little disparities in pass rates.

  • We have a year to save general practice

    Una Coales's comment 25 Apr 2014 8:08am

    @3:59, Noddy Holder and John Glasspool, I sat next to Ian Brooman of http://news.bbc.co.uk/1/hi/health/1158223.stm yesterday and he explained how after 35 years of service for the NHS, he left at 62 to go into private practice and says he loves it and will keep on working forever. He is willing to help and advise any GP who has retired from the NHS. He is a local Kings College grad.

    I have now been in touch with the BMA secretariat so here are our options.

    1. An emergency ARM motion in Harrogate which needs me to find a seconder ARM rep and hand in the motion to the agenda committee on the first day of the conference to review at lunchtime.

    2. If the agenda committee do not feel that NHS general practice is not in crisis, that GPs are not working all out for less pay, that practices are not struggling to keep their doors open and pay their staff, that GPs are not disillusioned by the lack of activism within the BMA, then they will reject my motion on behalf of grassroots GPs demanding their own ICE, GP needs, a NHS contract that affords them the freedom that NHS consutlants, NHS dentists and NHS hospitals have, the ability to top up income with private services, the negotiating power to stop all these incessant practice cuts, breathing space, and all this can only be achieved by a ballot for mass resignation from a contract that is driving GPs mental, stressed, to burn out, to illness, to an early grave.

    Then we go to plan B. I need to find 9 other BMA council reps to help me propose the motion to BMA council for the July 16 council meeting. As my first council meeting is Sept, I would need a stand in currently on Council to present the motion in July.

    3. If BMA council consisting of GPs, med student, junior doctors, occu dr, consultants do not think GPs should have a right to be balloted on mass resignation which is what they are asking the BMA for, then GPs may seriously rethink the purpose of the BMA, their trade union.

    4. The annual LMC conference is May 22-23. I can gauge the audience as to how they feel about mass resignation in an informal manner using the soapbox. This will help strengthen my negotiations with number 10 the following week.

    5. If the BMA and government do not listen to NHS GPs to improve working conditions and ensure fair pay, then you know that your own profession and country do not value you or want you, so you are free to retire, try private practice, emigrate or change career paths.

    As we sat listening to Mr Debashish Ghosh, Royal Free breast surgeon who also operates privately and works from the LOC Harley Street clinic, I turned to now private GP Dr Ian Brooman who was now much older than 62 and said, when do you plan fo retire? He said, never, I love my job.

  • International graduates should face higher bar to work in the UK, finds GMC-commissioned research

    Una Coales's comment 25 Apr 2014 7:44am

    http://www.hindustantimes.com/world-news/major-drop-in-indian-doctors-coming-to-uk/article1-1211490.aspx#.U1ioIoaQ23s.facebook Indian doctors difch Britain in droves. Only 340 new Indian doctors registered with the GMC last year.

    This will have an adverse impact on the NHS with its growing elderly population, influx of EU and baby boom to get benefits,

  • Seven GPs elected to BMA Council

    Una Coales's comment 24 Apr 2014 6:23pm

    Okay who else is going to the ARM in Harrogate in June? We can put in an emergency motion on the day! Just needs a proposer and seconder. Happy to propose. Just need a seconder who will be there.

    Plan B is I meet all the BMA council reps at Harrogate and either find a seconder in the group for an emergency motion and also get 10 proposers to support a BMA council motion for July 16's BMA council meeting to ballot GPs for mass resignation from the GP contract.

    We must allow NHS GPs to be asked whether they want mass resignation from an unworkable and dangerous GP contract to ensure all GPs feel they are listened to, as much as the hours, days and years they have listened to their own patients. Let us give respect back to our hardworking GPs.

  • Seven GPs elected to BMA Council

    Una Coales's comment 24 Apr 2014 3:27pm

    I have been informed of the process for putting in a BMA Council motion to ballot GPs on mass resignation. It requires 10, yes TEN BMA council members to propose a motion for BMA council. There are 33 voting members and 20 nonvoting members. Sounds like I have to win over some consultants, junior doctors and medical students on BMA council just to put in a GP motion to save general practice!

    How many BMA council members to change a light bulb? ;-)

  • Seven GPs elected to BMA Council

    Una Coales's comment 24 Apr 2014 9:29am

    http://www.unison.org.uk/news/health-conference-backs-strike-action-over-pay How a trade union can win members!

  • Seven GPs elected to BMA Council

    Una Coales's comment 24 Apr 2014 9:28am

    Time to join forces with Unison who are balloting their 400,000 NHS healthworkers on a strike over pay. BMA should allow GPs a ballot on mass resignation. With an annual LMC conference in May and ARM in June, surely we can get a motion on mass resignation on the table somehow?

  • Seven GPs elected to BMA Council

    Una Coales's comment 24 Apr 2014 8:53am

    @8:12 RCGP council reps are NO LONGER trustees of the RCGP. They were all stripped of this duty at an AGM that members present voted to accept and hand over to a small group of 12 trustees. Only 2 GPs, myself and a female asian GP, raised our hands to object to this AGM motion. This, in my opinion, was a mistake to remove trustee function from council reps, as now many RCGP council reps feel their only role is to rubberstamp decisions made by the trustee board.

    As for running commercial MRCGP courses so does the RCGP who also administer the MRCGP licencing exam. Central RCGP runs commercial MRCGP courses as well as RCGP faculties, who make a profit from MRCGP courses and iMAP workshops.

    There are CSA examiners and other MRCGP CSA course providers on the RCGP council as council reps and even the RCGP Vice Chair Tim Ballard is a CSA examiner.

    My statements on the CSA exam are true. They are firsthand testimonials of candidates who have sat the CSA and the High Court Judge Mitting declared it a moral victory to challenge the disparity and has bought the RCGP and GMC time to address the disparities. He reduced the RCGP legal costs of £277,000 to £50,000 to be shared between the RCGP and GMC. He was making a statement that this disparity concern needed to be raised out of public interest and he ALLOWED an appeal ie for a panel of 3 high court judges to rule. A prior High Court Judge Justice Stuart-Smith had ruled in his opinion that the CSA was unlawful in a pre review hearing of the JR.

    The lack of support for IMGs is now leading to a mass exodus of IMGs alongside UK GPs. You get what you wished for...the end of NHS general practice by failing to embrace diversity and instead demoralisiing your fellow IMG GP workers.

    http://www.hindustantimes.com/world-news/major-drop-in-indian-doctors-coming-to-uk/article1-1211490.aspx
    Indian doctors ditch Britain in droves!

    Yes sadly I predict this generation of NHS GPs will be held responsible for the end of NHS general practice in years to come as they let racial differences get in the way of one unified cause, to allow for a transition into semiprivate general practice, the only sensible and practical way to retain independent contractor status and take care of the poor and elderly in the context of a national £1.4 TRILLION deficit and as I was told by Oliver Letwin MP, we are one step away from Greece.

    Ireland asked for a bailout from the EU when they were bankrupt and now they have semiprivate healthcare. Perhaps our economy has to get even worse, before we transition into a model that will be safe for patients and for doctors wellbeing and income too. At this rate, there will only be one model of healthcare, solely private and everyone will be forced to pay big sums.

    A socialist ideology of a free NHS for all at point of access in the context of a national deficit is a disaster. We must be practical about money and about how we manage unlimited free access. It can no longer be a free for all where the average wage of a worker is LESS than a family on benefits.

  • Seven GPs elected to BMA Council

    Una Coales's comment 23 Apr 2014 7:05pm

    No hiding now! The GPs on BMA Council who are currently serving and may put in a council motion on your behalf to ballot GPs on strike action or mass resignation are Chaand Nagpaul, Richard Vautrey, John Chisholm, Helena McKeown, Peter Holden, Louise Irvine, Robert Morley, George Rae, Mary Church, Sam Everington, Dean Marshall and Fay Wilson.

    May we ask one of them to please acknowledge NHS GPs' ICE and vote on a council motion to ballot members on a strike or mass resignation. My hands are tied until I start Council in September!

    With 10% of practices closed already and a 5% increase in population, are we not pushing the boundaries of the safe doctor-patient ratio?

  • We have a year to save general practice

    Una Coales's comment 23 Apr 2014 7:00pm

    Peter Holden, I note that you are already a voting and serving GP member of BMA Council! May I ask you to put in a council motion to ballot GPs for strike action or mass resignation please? GPs need urgent changes made to the untenable NHS GP contract? I do not start on Council until September. I am sure you can persuade the consultants on Council to see that without primary care, there can be no secondary care.

  • Seven GPs elected to BMA Council

    Una Coales's comment 23 Apr 2014 6:21pm

    Mustapha I know how devisive institutions can be. I am capable of thinking outside of the box to achieve an aim. And right now I have the welfare of GPs to protect.

    Where is the public and government gratitude for NHS GPs??? GPs worked their socks off for the national health service, hospital consultants only see a fraction of the patients GPs get through and keep their sanity, and how does the public and government reward them? By demanding 24/7 access? No good deed goes unpunished.

    Government's attacks on GPs reminds me of some hospital trusts attacks on principled hospital consultant doctor whistleblowers. Unfortunately who does government answer to?

  • Seven GPs elected to BMA Council

    Una Coales's comment 23 Apr 2014 6:16pm

    @12:34 I know things are bad in rural GP practices. I shall try to get a GP already on the BMA council to push through a ballot motion sooner as September seems a century away. I also have the ace up my sleeve, the meeting at number 10 next month after the annual LMC conference.

    @2:09 My last blog article was a plea letter addressed to Cameron and Hunt with comments from struggling NHS GPs and doctors at the bottom. Good idea to keep adding GP comments as a call to arms! His office got the original email version of the letter.

  • Seven GPs elected to BMA Council

    Una Coales's comment 23 Apr 2014 7:39am

    Thank you Khalid, John, Thomas and anons. When an employer makes the T&Cs so untenable that even patients lives are put at risk, we have to speak up and say NO! Not only to protect the wellbeing of doctors but also lives of patients. A ballot for mass resignation will bring about urgent roundtable discussions on how best to deliver healthcare and also protect doctors sanity, wellbeing and give them a livelihood.

    If the government wants to say, if you wish to be a state GP, the new terms are all salaried at £57k, then either GPs can say s*d it and go private or they can resign themselves to working for a charity but would need to find some other means of supplementing their income to raise a family, pay the mortgage, school fees, etc.

    Better if government gave GPs some respect by allowing them to continue as independent contractors delivering state alongside private as semiprivate practitioners as in everywhere in the Western world but the nanny welfare state UK. More emphasis should be placed on working than collecting benefits and free entitlements.

    All public sector workers have chosen careers working for the state as they have felt some moral societal responsibility, but this goodwill has now expired. One cannot feed a family on peanuts or risk an early grave.

  • Seven GPs elected to BMA Council

    Una Coales's comment 23 Apr 2014 6:29am

    @2:37 what's wrong with working 40 hours for BUPA or Nuffield for £80k-£100k with medical indemnity up to £5.5k paid for, no government target stress, £1k for CPD, no impossible 10 minute appointment for multiple complex problems, no 12 hour days for no extra pay, guaranteed 5 weeks AL, no inappropriate requests for sick notes, no bullying for whistleblowing, and protected study leave?

    Salaried GP / Primary Care Doctor
    To undertake regular clinical sessions delivering health assessments and primary care according to Bupa Wellness protocols and guidelines, ensuring a quality service to ensure high customer satisfaction. GP appointments (15-60mins per patient) & Health Assessments (up to 60 mins per patient, training providing).
    Full time (40 hrs p/w) or Part-time (min 2 days)
    Mon-Fri
    Permanent
    Location: London Bupa Centre, flexible on which centre (7 centres: West End, Kings Cross, Bank, St Pauls & Canary Wharf)
    Salary: £80,000 - £90,000
    Benefits:
    Contributory pension scheme: 3 percent, increasing to 5 percent after two years, and following that 7 percent.
    Annual leave – under 5 years 25 days over 5 years 27 days
    PMI & Health Assessment
    Paid Medical Indemnity - we will reimburse, pro rata up to full time, your medical insurance whilst employed, approx. £5500 per annum (this starts after successful completion of your probation period. Reimbursed after probation period passed)
    Life Assurance – 2 x Pensionable Salary
    Bupa Participation Scheme (opportunity to earn up to 1 weeks pay, based on meeting personal and company objectives)
    CPD monetary contribution: £1000 per annum (pro rated for part time)
    Protected professional development time: 5 days per annum is given to full time employed Drs (pro rated for part time)

    Lead Physician
    To ensure the efficient and effective delivery of clinical services within Bupa Health Assessment Centres in accordance with Bupa clinical policies and customer service standards and to ensure overall responsibility for clinical governance and clinical quality within the centre. Also to conduct GP appointments (15-60mins per patient) & Health Assessments (up to 60 mins per patient, training providing). This role is 70-80% clinical and 20-30% managerial.
    Full time (40 hrs p/w)
    Mon-Fri
    Permanent
    Location: Bupa Clinic near to Bank station
    Salary: £90,000 - £100,000
    Benefits:
    Contributory pension scheme: 3 percent, increasing to 5 percent after two years, and following that 7 percent.
    Annual leave – under 5 years 25 days over 5 years 27 days
    PMI & Health Assessment
    Paid Medical Indemnity - we will reimburse, pro rata up to full time, your medical insurance whilst employed, approx. £5500 per annum (this starts after successful completion of your probation period. Reimbursed after probation period passed)
    Life Assurance – 2 x Pensionable Salary
    Bupa Participation Scheme (opportunity to earn up to 1 weeks pay, based on meeting personal and company objectives)
    CPD monetary contribution: £1000 per annum (pro rated for part time)
    Protected professional development time: 5 days per annum is given to full time employed Drs (pro rated for part time)

    I am saying for the best of both worlds, government should allow NHS GPs to be semiprivate like in Ireland, Australia or Canada, instead of watch NHS GPs disappear due to exhaustion, lack of finances, lack of manpower. Else it will all be private and GPs can even set up as independent private GPs.

    One of my younger friends is doing locums at a private practice in South Ken set up by ex NHS partners and she enjoys the stress free luxury of 30 minute appointments with her patients.

    The BMA was originally a trade union for private doctors before the NHS and it was with much resistance that they caved in to working for the state, NHS.

    GPs have always been independent contractors.