We rant and rave but we do not act. What else will it take for the profession to see that the only way Government will listen is to sign those post-dated resignation letters. The longer we leave it, th more time we give them to bypass us. Until then, the only people suffering are GPs and their patients... There is only one language The Gov. understand- the language of political threat. If their political arses are on the line, they listen... Patients are only interesting as voters, not as patients...
Agree. At last some leadership with guts. Doesn't everyone realise they are strangling us? The only way Virgin et all could possibly hope to tender for such a contract is if they had doctors willing to sign up- any health care professionals actually. Where are they going to come from? How many GPs are there in the UK they would have to replace in 6 months? Come off it everyone- they couldn't do it- not unless it's you who is going to jump ship? No- the only thing lacking everywhere else in the UK (other than NI it seems) is RESOLVE. We have allowed ourselves to become scared and brow-beaten by a bullying Governemnt. Good for you Dr Black.
Never give up. The war isnt over until it's over. We are being run by giant corporations and massive government interests (much driven by the USA). TTIP should tell us that. But if we dont use what voice and influence we have then we allow them to walk all over us- and in the case of health care, all over our patients. There is some wisdom in exercising caution but leadership is there to help create strategy in the face of the enemy and provide vision for what we are fighting for. At the moment, I just see retreat...
Fascinating. I would describe myself as an expansionist. I believe in General Prctice at the heart of the health service and I want it to stay there and I am part of a practice that is doing everything we can to embrace positive solutions for the dire and precipitous situation we find ourselves in an a London inner city practice. BUT I spoke passionately for the threat of mass resignation because the Government and the population has to understand the situation as it really is. We can go on 'expanding' and innovating up to a point but however innovative you are there is always a limit, always a compromise to be made until no more can be made. The 2 'sides' have the same goal- the survival and improvement of General Practice at the heart of the NHS. And we all draw a line in the sand somewhere- at the SURVIVAL point. The judgement as to how much energy one has to put into survival and what kind of survival one forsees and can bear to put up with- this is the thing that differs. Being around too much negativity IS draining but we do have to be real. I find myself bridging both camps- I see the hardship, the grind the bereavment, the grief at the things we have lost and the temptation is to despair. But I refuse to despair because despair stifles creativity and adaptability. I believe it IS possible to hang on to our values whilst at the same time adapt our systems. It will look a bit different but there are signs of hope that it can be done (ask me about Microsystems). I am not giving this Government an ounce of credit for anything but the willful destruction of much that is good in our NHS but I am also determined NOT to let them destroy it. GP as we know it may be dying but that doesn't mean something even better can't spring ino new life, given the right conditions. Reductionists fight for those conditions. So whilst I join with reductioninsts to fight for good conditions, I join with expansionits to craft a new beginning. As Nigel says- we need to go forward together.
I think the fact that there are some out there who have opportunity and motivation to innovate demonstrates the potential resilience, brilliance and commitment to good care of GPs and General Practice as a whole. (Actually we already know that..) HOWEVER, to present this wihtout caviat, without any acknowledgement of the apalling situation the PM himself has put us in is unfortunate and naive. Hence the string of negative comments above. But this project may turn out to be really good and may, in the end, help patients which is what we are trying to achieve. I would like to credit Beacon Medical Group for at least taking advantage of whatever situation they have found themselves in- even if it does turn out they were far better supported than many of the rest of us. We don't know that however. What we object to is ANYONE seeming to give the PM and this Government an excuse to pat themselves on the back and give themselves credit. I hope the Beacon Medical Group did not suck up. I hope they told the PMs office that whatever they have achieved it was DESPITE the Government and nothing to do with their (disastrous) handling of the health service. I hope they told them that it was everything to do with GPs, their resilience, brilliance and commitment to care.
I'm with you Susie. I'm going to fight for it. Not given up yet!
And to the consultant above trying to drag you out of it- we provide phone and on line same day service to our patients WITHIN THE NHS, It can be done. It does need good management and some resources and determination but it keeps continuity and cradle to grave for those that need it. (we are not high earners and we are still fighting for survival but our satisfaction is high and team morale incredible ) ..
Terrified of public opinion. Want to be seen to be doing everything they can. Dont want to be accused of letting the public down. It's all defensive. They are not used to taking a lead and acting on principle because, after all, they are a union and they have to act in the best interests of members (however they interpret that). So don't wait round for the BMA to do something. Do something yourself- each and every one of us. I work in a deprived area so it's probably easier for me to get patients on board more quickly because they understand what it would mean for them not to have an NHS. But really- we have the whole population come to us at least 5 times a year every year. It wouldnt be that hard to explain to the public the truth of what is going on. The Gov have brought the political fight to us. So put up the posters, scatter the leaflts, find your 'on board' patients to come to your practice and explain to people in the waiting room what is going on. Get them to sign petitions. Speak to your MP (especialy if they are Tory) It is TOTALLY in patient's self interest to continue to have a service. In my experience the vast majority of patients are willing to be informed so tell them it as it is! Most people really do get it when it's explained. No more money. No more doctors. More hours. It's not difficult. If you have time and energy to post here, you have time to stick up a poster and help your PPG to understand that it's number 1 priority. You are NOT alone. You are just so beleagured that you think you are....
Clive Peedell and Erl Annesley are correct. The evidence for charging is not there and creates wasteful layers of bureaucracy. The fundamental problem is that it is impossible to run a modern health service for the population on the funds the NHS is being given. The only fair way is to increase taxation. We have an older population and one in which people have more complex needs. The NHS needs funds and better ways of delivering services which should be decided by those on the ground- health care workers and patients- not governments. There are many reasons why people are contacting us but they are fueled by the constant mixed messages that are being given out from Goverments who want to win votes and so tell patients that they can have everything, whenever and wherever they want it, whilst at the same time putting the blame for failure to deliver the impossible on the people who are crushingly giving the service- namely GPs, junior doctors and every other health care worker.
We do need to say things as they are and bring the debate to the public. We can't have something for nothing. Every system has its pros and cons. Teh NHS was founded on the principle of 'Free at the point of use' and it can still work (definitely in primary care) but it depends on collective will and collective responsibility, clear and unconflicting messages and everyone- governemnts, healthcare workers and patients- uniting to make it work.
Absolutely right Dr Chand in every detail. Our task as GPs, especially those in Tory areas, is to talk to our patients and inform them as to what is really going on. Get your PPG to raise petitions to present to your MPs. Get your patients to express their worries and concerns about local services in letters and MP surgeries. We need to rattle the Tory heart land. No apathy. No defeatism. Everyone can see what is happening and everyone is a political force either for good or for ill. Burke's aphorism rings true for us GPs too; 'all that is needed for evil to triumph is for good men to do nothing'. It's not co-payments or insurance or going private or any other money raising efforts (other than general taxation) that is going to save the NHS for our children and grandchildren and our friends and our neighbours. It's a general increase in tax funded health services coupled with the ability to drive change and improvements from the bottom up by the people at the front line and the people who use the service. We need trust and to be trusted. We have it from patients (they are your friends not your enemies no matter that they sometimes make unreasonable demands)and that is our strength. Use it.
But well done to you for telling it as it is. We all need to keep saying it and what is even more important we need to say it to our patients so that thy, in turn, say it to the local MPs who then put pressure back on him. Polititians hate being undermined by their own party and they are very sensitive to the views and moods of other MPs. We are all important cogs in a very large political wheel. We need to keep driving forward and gather momentum until the understanding of what is being done to the NHS and the will to pull it round is an unstopable force. Democracy is being unrdermined but dont underestimate the power of democratic fight back by voters.. Votes are the biggest currency of politicians..
The relentless negativity of some of the above comments is not helpful. At least people are trying to do something positive. If you can see the problem then do your bit to change it. If you've got energy to whinge, you've got energy to fight. I can see behind this to your disapointment and anger at what has failed to happen til now. Yes we have a ruthlessly biased and twisted press (some) and a hoplessly ideologically driven government (some) but your patients are the voters, the ones whom the politicians need to get them relected and they come into our surgeries every day. Tell them what's going on! Let people know. It's how revolutions start.. You see them as the enemy but patients are your supporters. In a propreely resourced service we wouldn't be blaming the patients for our pressures. They are doing what patients do- ask and even demand to be cared for! They need and want a primary care service and most of them do care about their services and their practices- even if tinged (or driven) by enlightened self interest. We now have a bit of time to build momentum and take some action. If GPs united and threatened resignation and were angry enough, who exactly are the government going to get to do the work? They cannot afford the political fall out... Lets not give way to bitterness and fear. Lets act. It's not lost yet.
The mood of conference waas overwhelmingly that the same-old-same-old was getting us nowhere and we are now in such crisis that we must take action. The Government isnt listening. Whatever new package they announce will just be sticking plaster, leaving us limping on. They do this every time and it just gets worse. We need to do something that shows we mean business. They are killing us anyway. Slow death or use the only weapon we have with any real teeth- the threat of resignation? We need to save General Practice for the young GPs coming after us and stop giving way to fear and the 'what ifs'. So Yes- if not now, when?!!
Loud honk from me! Brilliant piece.
I agree that weekends should remain for emergencies. 2 years ago, we introduced a Mon-Fri telephone triage based system with same day appointments in our inner city practice but we kept personal lists. Whilst we still don't have enough doctors to manage demand and we still work ridiculous hours, we are starting to see a reduction- yes REDUCTION- in our number of contacts per 1000 patients. Of course, this could be influenced by demographic changes and by the fact that we have a local area that has consistently invested in primary care/community services over the years but it's worth looking at as a way of containing demand. DH just published saying increased financial investment in general practice wouldn't make a difference but that is just rubbish as we know. Its about getting the right model for the area you are in and thinking about how everything fits together and impacts each part of the complex system that is health and social care.
People need health care.
Health care costs go up in EVERY country the more developed they are. Inevitable.
The cheapest and most efficient way to deliver health care is state funded health care. (No one can afford private health care unless in the very top earning bracket. The rest of us will be selling off our houses to fund it.)
Unless you want a situation where people with money can afford health care and people without money cannot, then you have to have state funded health care.
Every other system, including a co-payment system, perpetuates inequalities.
1. Raise more taxes for health care. (Somewhere, we all have to pay and we live in a SOCIETY where those who have more need to help cover those who have less.)
2. Make sure primary care access to health care is free at the point of use and of an excellent standard to help limit need for secondary care especially with aging population. If you want other ways to limit access to secondary care, make sure it is evidence based.
3. Make sure social care is robust
4. Make sure there is a strong public health lead.
I say it again, EVERY other way of providing health care either produces inequalities or is too costly.
I am for offering to resign. I don't want to be in a service that seeks primarily to serve those who already have. Everyone who is part of our society is worthy to receive care. And if we need to raise money, why the bureaucracy of co-payments? Why not raise taxes?
I too totally disagree with Dr Summerton. I am sorry, but there are situations when the side with whom one is supposed to be talking is SO unreasonable, SO lacking in understanding of the real situation, SO manipulative and disrespectful, that they leave one with no option. What this government has done and is doing is destroying the NHS, destroying good patient care and destroying the people within it. I for one do not want to stand by and let the excuse of my professionalism stop me challenging such destructive forces. I support these young doctors who have the courage of their convictions. No one can doubt their compassion and their work ethic. They demonstrate that hour after hour, day after day. I salute them.
Dr Boyle is right. Deprived areas are historically under funded but the situation is complex, nuanced (even within close geographical areas) and I have to say it, pretty unfair. Whilst General Practice was supported, these large discrepancies were overlooked and could be swallowed because the rewards of the job were over and above. Last year I earned about 55k for managing a list of 1600 in a deprived inner city area. If we hadn't fought for more money for deprived areas, I would be earning 35k this year. Many earn a lot less for doing even more. There are also significant changes that can be made in the way General Practice is run in some areas that can improve things for patients- but we need stability. This must not become a war in which we battle against each other to prove who is more worthy. The whole of General Practice is under funded, over stretched and demoralised and our real task is now a political one. We must persuade the public- our patients- that we really are on the brink and that without swift action, a house of cards looms for primary care. We MUST unite on this point and raise the alarm. It means more than moaning to each other. We must run the risk of alarming our patients and telling the truth or we will never overcome the media giants who greatly influence the minds of our nation. The LMC crisis conference will be a critical point...
Vinci Ho- you are right to mention the potential disaster of TTIP here- this will be American corporations all over us... God bless America? God help us...
But we can't blame locums for following market forces. Who would be a partner at the moment with so much insecurity when money is easier in another role and your mental health is almost certainly better?
Exactly 11.02. There is nothing wrong with the system but no system can survive the relentless reduction in resources when it is already acknowledged as providing the best value for money for any population based health system the world has to offer..
Agree. Entitlement is a mostly subjective word with objective parameters- it is meant to cover broad principles, not small details. It is perfectly valid to explain to patients that entitlement to everything under the NHS is a myth. They can be unreasonable about it (I find that most people are reasonable) but in the end, we draw the boundaries for them within the boundaries set for us. Sometimes unpleasant, but necessary...