View from Australia- Here any entitlements are stored on a person's medicare card. The entitlements and the administration/eligibilty etc are administered by someone else. As rightly pointed out, immigration status is only one of the criteria. People can and will game the system. But, when you put it in with a clinical consultation/setting, you are setting it up to fail. And yes- if the proverbial hits the fan, its the GP who has to face the music. I don't know figures were obtained from. Jeremy Hunt qotes these same figures back in Oct 2013 too. see my blog for this and other wastage we just accept in the NHS/UK http://joebloggsgp.blogspot.com/2014/08/australia-clarity-of-vision.html
I smell a rat! We were as a profession against Health checks in Coventry for the reasons mentioned. The council told us it was getting a nice bonus to get the scheme rolling and if we didn't play ball they would go with other providers. This was always about funding and not clinically driven. Exactly the sort of thing that drive me bonkers. Drs taking on funding decisions based on local knowledge to help improve local outcomes sounds so good on paper. Duped me for sure. But, in commissioning it's all about money and the decisions always come from Westminster.
Anonymous at 6:51. Great to make personal attacks hiding behind anonymity. What does the BNP say about immigrants? What about Tony Blair invading Iraq? I bet a lot of gunships were used there? If you are going to judge a country by its tabloids, I guess you are a big fan of The Daily Mail?
Hmmm... Interesting figures and comments. I moved to Australia and pay a lot less in indemnity even though general practice here includes a lot more hands in stuff like skin exclusions, fracture reductions etc. Found myself asking a simple question. Why is cost of indemnity going up in UK? The major players there are not for profit organisations whereas in Oz they are big insurance companies. My own feeling now is that the GP as gatekeeper model is totally outmoded and incompatible with modern medicine. On the one hand you have consumers demanding 24/7 instant fixes and in this scenario you expect just 1 sector of the industry to act as a moral and financial vanguard to 'protect the taxpayer'. Most complaints relate to missed and delayed diagnosis which is directly related to 'rationing', whether that be appointments, investigations, referral pathways whatever. In Oz I feel no such pressure. Neither I guess do others and consequently the rate of complaints is lower here which leads to lower indemnity premiums. Lower by a factor of 10!
UK should then stop importing nurses and Drs from overseas. The taxpayers of those countries also loose out then. Or doesn't the Hon MP care about 3rd world countries?
There is a far bigger drama being played out here which I feel people are not realising. Partners are retiring,emigrating or as it says here- voluntarily handing in their contracts. This begs the question- where will the next generation of CCG commissioners come from? A CCG made up of salaried Drs by definition is a Corporate! This won't take too long either.
Poster at 1:22pm: you are making the same mistake the politicians are. You are confusing anecdote with evidence. Sure for some people practices offering extended hours will be more suitable. Are you seriously suggesting that every practice in Yorkahire or indeed that every patient needs this? If so, are you as taxpayer willing to pay for this service? Do you know how much more the Darzi centres get in terms of pounds/patient compared to the 'NHS model' service as you call it? Most cities need just 1-2 such practices, if any at all.
Putting the horse before the cart! When the pilots were rolled out, the decision to extend this model across the whole of UK was made even before the pilots had begun- so they were pilots in name only. The PMCF was meant to encourage innovation but we were told point blank that extended opening had to be a key component if we had any chance of succeeding. Only now is evidence trickling in and surprise surprise it's not rosy everywhere. If GPs practiced medicine in this fashion with blatant disregard to due process and evidence they'd be facing a fitness to practice hearing. Heads should roll for this.
Thanks poster at 4:05. No point preaching to the converted!
Great points raised:
1 family - no arguments there
2 very reasonable income as shown here in Oz without having to locum. Flexibility and freedom to open your own surgery
3 if you emigrate and leave no family behind, flight doesn't matter
4 weekends in Paris? Really?? Perth to all of South East Asia 1-2 hrs flight. Long weekends in Bali/Phuket eye etc.
5 cost of living cheaper? Says who. 1/10 to indemnify your practice.
6 Schools and Universities are great here too. And, I for one believe children make their own fortunes. Do all children in whole of UK attend top Schools/ Unis?
7 a bullish currency only matters if you're trading currency. Are you?
8 lastly, do any of the above make up for lack of clinical sovereignty? Family excepted of course
If you are staying back in UK because of family or friends there is little point in discussing incomes etc. would you leave family if the pay in Australia was higher? If so join Primary in Australia. They will give a half million dollar golden hello. This has to be on professional grounds to be a worthwhile argument. Changes are inevitable as is uncertainty in both Countries. To say that that the future of Australian General practice looks uncertain as a selling point for staying back in UK begs the question- is it any less uncertain in UK? If the medical home concept does take off in Australia then GP principals will benefit at the very least. And you know what? Here in Australia, anyone can open their own surgery and become a principal. Do you have that freedom or option in UK? There, I suspect it's Any Willing Provider. I know of at least 4 GPs from UK who have set up their own practices with 1-2 years of arriving here. One has 3 practices and another has 2. Oz= land of opportunity. Fact!
Note to all of you above comparing costs as no of patients- firstly all patient encounters are remunerated in Oz. So count the number of patients you see in UK and then add all the telephone calls and scripts and visits. Secondly, once you're in a country the conversion rate matters only if you have to repatriate money. Since I came the dollar has depreciated by 8-10%. So in UK terms my income has dropped, but nothing has changed here. Secondly, that cuts both ways. I'm actually bringing money over from UK to Oz so will actually gain, not loose. Indemnity is £500/year and petrol is 60p/litre!
In other words comparisons are very difficult. Don't migrate to make more money. Migrate to make similar money but have a better lifestyle and more importantly a care free work environment.
For a more detailed comparison read this :http://joebloggsgp.blogspot.com/2014/08/cost-of-living-in-australia-big-question.html
Give them more money and they'll come. Yes, they are coming to Australia!
Anonymous at 12:32- that's called blaming the victim. i sincerely hope you are not a NHS manager.
If the argument you promulgate were true we should sack the managers first and all failing trust, 111 and ambulances that are not keeping up with the winter pressure (happens every year so they should have been prepared) should be sacked and replaced by...you guessed it. A GP lead OOH service that will be miles ahead of anything Westminster can cook up.
I think the most telling comment is the one likening GP land to Helmand Province!
A UK GP partnership is the most lean and efficient NHS management structure. The partners work as Drs themselves, often full time AND manage the staff, buildings, regulatory hassles etc and the staff to management ratio must be the best of any NHS organisation. Plus, most partners have never had a day off in their life let alone a year. Maternity leave for partners is also a cost borne by other partners solely. Economies of scale is a complete misnomer- with large scale organisation you get large scale management structures and all attendant problems- sickness and absenteeism, large staff turnover, fallow posts etc etc...
If this were not true ask yourself a simple question- why is the cost of seeing a GP much lower than going to a hospital Outpatient and seeing a Dr (often a Dr in training earning a lot less than a GP)?
In my region in Australia called the Illawarra there are so many UK GPs we even have our own Journal Club and the numbers keep rising day by day.
Lost in translation? A salaried model is proposed for GPs. Presumably the EWTD will then apply. Hospital posts have shot up as quote 'Drs have been sucked into hospital jobs to comply with EWTD rotas" Hospital posts are unfilled despite these huge increases in training posts as clearly said trainees then don't want to become consultants (Emergency medicine, care of elderly etc) What a merry go round!
Russell Thorpe I am not for one moment recommending you emigrate. I am merely saying that the model you propose DOES work as I now have first person experience of it. But in order to change contracts/ payment models that change has surely got to come from the govt and not working GPs.
Russell Thorpe- this is effectively what happens in Australia. We work as independent Drs under one roof- the roof maybe big or large but we are still independent and more or less have our own list of patients. It really is best of both worlds as other Drs' performance, time keeping etc have no impact on you or your income. But this I feel is only possible in a fee for service system. Best wishes.