Survived to retirement but only just!
I think Shaba's question about what the NHS is doing with its funding is critical here. If we want to continue to invest in prolonging life at whatever cost, the NHS will always remain underfunded.
Equally, if the NHS continues to act as the go-to service for society's social problems and deficits in funding with bed-blocking and making GPs glorified social workers then it will remain under-funded.
As long as General Practice remains the service of last resort for every other services shortcomings then it will be under-resourced.
If Primary Care had sufficient DIRECT ACCESS support such as counsellors, minor mental illness nurses (as opposed to a team who only deal with major disorders such as psychosis and proven bi-polar cases), dementia care nurses, minor illness trained staff, Physios, Podiatrists, drug and alcohol workers, WITHOUT REQUIRING A PRIOR GP ASSESSMENT AND LONG REFERRAL DOCUMENTATION, then GPs time would be freed-up and the country would not need 6,000 GP social/minor mental illness recruits.
Equally, funding may be sourced (in part)from those services whose task has been to prolong the life of those poor souls with advanced dementia and frailty.
We need to move politician's agenda from the banner headlines to address society's real issues.
In the old days, before performers lists were even dreamt of, when a partner joined the practice, payments were made by their PCO 3 months in arrears. The small monthly interim advances were to help win covering staff costs etc. It was common practice for the existing partners to loan the new partner funds to be able to survive. Along with the cash flow problems were costs of contributing to the practice working capital, buying in, moving expenses etc. It has always been tough for GPs. New partners in many other professions including hospital colleagues seem to have more assistance when moving jobs.
I believe a payment for each patient contact will encourage an increase in quick trivial contacts in a similar way to historical payments for night visits, when GPs were happy to do home visits for a trivial illness such as a sprained eyelash. - This could in effect increase workload in the short-term. A correction downwards for each patient contact payment will inevitably ensue to reduce GP payments or a general correction to the global sum to constrain GP income to intended remuneration levels, possibly to include a claw-back, to which GP income was previously subjected.
GPs study medicine in order to become competent physicians able to diagnose, treat and support their patients from the effect of said conditions on their physical, emotional and social status.
Their role should NOT be to manage social crises, minor mood disturbance consequent to living conditions or their work environment or patients social inadequacies unless there is a significant underlying medical condition.
GPs should remain gatekeepers for the NHS as their role is invaluable to ensure resources are used appropriately.
Over the course of my 35 year career in Primary care, I have seen GPs assume the role of social workers to the detriment of having sufficient time to get stuck into diagnosing real pathology or taking time to help their less capable patients manage recurrent minor illness. Consequently, referral rates to secondary care have gone up and the GP role has been downgraded to following pathways through guidelines and supporting the less adequate. Many GPs now seem to assume this lesser role and even defend its importance.
Surely, we do not need highly trained medical professionals to fulfil this role. We should have a team to whom we can offload minor mood disturbance or housing or employment issues and resume the role for which we were trained. -I am sure their hourly pay rate would be considerably less than ours and they would not need to spend 5 years in medical school and several years in junior hospital grades to perform these time-consuming duties.
I bought added years and worked around the clock, maximising my income in order to build-up my pension pot for over 36 years. I did extra clinical assistant posts, out of hours work, did 9 sessions per week, Even the revenue from our surgery building was pensionable and so pension contributions were made and added to the pot. I protected my LTA in 2014.
However, as my compulsory pension contributions exceeded my allowance, the excess contributions were not added to my pot and I could not get tax relief on the excess payments either. So I was paying tax on a benefit I could not receive.
I am now drawing my pension, however, I am subject to a top-sliced deduction of £13,000 annually as a tax charge before I start paying for the pension I do receive.
I asked the BMA of which I was a member for 42 years for advice after I retired so enquire if there was any recourse for justice, but as I had resigned my membership on retirement a couple of months before they said they only represented current members and as I was no longer a member, they were not in the slightest bit interested.
The only advice I can give to the present slaves in the service is to find a way to divert some of your income to a limited company which is not subject to mandatory NHS pension scheme payments - Maybe sell your services to your partnership through your limited company. Just don't fall into the trap that I did in assuming that hard work pays and workers in the public sector will be looked after by government.
Shaba, Get some marriage guidance.
The analogy doesn't quite work as there are no other elligible partners on this island and it would be difficult for most to stay single.
There may be serious problems with the nature of the open-ended, poorly funded and unrealistic contracts imposed on GP partners. However, I think GPs would be naïve by thinking a salaried model would be better.
Who do you think will hold the GP contacts? – NHS England – probably not.; it would be delegated to a company such as Capita – Their reputation as an employer would make your present abusive partner look like a saint!!
A salaried GP workforce contract would probably be awarded to the lowest bidder who would need to make a profit for its shareholder’s, achieved by reducing costs (GP salaries). With contracts controlling GP employment across large swathes of the country, there would be few alternative employers so it would be a ‘take-it-or-leave-it’ scenario.
Before ditching your abusive partner, get some high quality professional advice and explore whether you can put a restraining order on him/her.
There may be serious problems with the nature of the open-ended, poorly funded and unrealistic contracts imposed on GP partners. However, I think GPs would be naïve to think that accepting a salaried model would be better.
Do you think you will have a model similar to hospital doctors? A word of caution: Many aspired to become consultants only to have their career in limbo as a ‘staff- grade’ (lower income, non-permanent contract ‘disposable’ doctor – not dissimilar to the GP hospital clinical assistant).
Equally, who do you think will hold the GP contacts – NHS England – probably not.; it would be delegated to a company such as Capita – Their reputation as an employer precedes them!! Just as colleagues who have worked part-time for them doing disability assessments. The contract to employ a salaried GP workforce will probably be awarded to the lowest bidder. The said company will endeavour to make a profit from the contract for its shareholder’s, which will have to be achieved by reducing costs (GP salaries). If the contracts are so large, there would be few alternative employers so it would be a ‘take-it-or-leave-it’ scenario.
Even if government gave assurances that the above situation would not arise, then we should be aware that mergers and acquisitions creating monopoly employers could arise further down the line. Equally, we are very used to GP contracts being re-written unilaterally and then imposed on us.
Before ditching the partnership model, carefully consider whether you are jumping from the pan into the fire!
Surely there is a difference between 'after' inapproriate prescribing and 'due to' inappropriate?
Sending overworked GPs to an early grave is not far from the truth. In the practice from which I retired, three of the successive partners died at 66 years and the fourth survived to 67 years - which is why I retired at 60. Our health is sacrificed for the welfare of our patients. The GMC motto should be; 'supporting patients, protecting doctors'
I presume they were using en'crypt'ed messages to reach them via seance mail
I just wondered why we have to pay so much for our GMC membership. Surely their private health subscriptions could not swallow-up all the cash they extract from us. Then the truth dawned on me: They are paying the very expensive high court hearing costs to challenge the MPTS decisions with our subs. So, I can expect our subs to go up and up as they battle with their own committee.
Could you contact me at: doron16854@gmail .com - it concerns the IGT training tool website which is insecure
Unfortunately my Mac will not open this site with Safari or with Goole Chrome as it considers it unsafe.
I have also tried to access the site with Internet Explorer at the Health Centre but the message is that the RC4 cipher is not cryptographically secure!!
Isn't it ironic that the IGT tool training site is unsafe. - maybe the subject of an interesting article on cyber-security and the NHS.
If legislation was updated to remove the present historic patchwork of highly prescriptive legislation, enabling GMC procedures to become more streamlined and efficient so they would no longer be forced to work in such a slow, bureaucratic way, what would they redo with the freed-up resources? - Reduce our annual subscription further or spend it on imposing more compliance on the workforce?
Every year, as medical patients overflow into the surgical facilities. this farcical situation recurs and deprives the NHS of much needed funds, The private sector then receives massive funding to contain the burgeoning surgical waiting lists.
Why can't the medical patients be sent to the private facilities and the 'idle surgical teams' get stuck into their workload?
Stratifying medical patients into their need for acute, non-acute, intermediate and convalescent beds should allow them to be nursed in appropriate beds. Transfer of care between consultant teams should facilitate the process.
Erecting Portacabin wards to counter winter pressures with skill-mixed temporary staff should be cost-effective.
Allowing GP's to accept an increased level of risk prior to hospital or following emergency Day-Hospital assessment with enhanced hospital-at-home teams to provide intermediate care, without fear of litigation may reduce hospital admissions via A&E. Or just simply break the chain of A&E to Medical Hospital admission and ink A&E assessment with care provided by the Hospital at Home using team.
Jeremy just needs to invest in Primary and Intermediate care and stop the conveyor belt transferring the NHS bullion into the private sector coffers.
Patients may claim need hospital admission but too ill to leave their home!!!!
It is much easier to assess a patient with good lighting, presence of support staff if required and some basic diagnostics at the surgery - They my need reassurance that can use the surgery wheelchair and will not be kept waiting and will be seen on arrival.
The GMC behaves like a machine with Aspergers - totally insensitive to the fallibility and vulnerability of GPs. It is so extremely patient-biased that it may eventually completely erode doctors' morale to an extent that it will itself pose a threat to the profession.