When interim managers command salaries of £1000/day and management consultants charge like wounded Rhino's there is little left to fund GP's who actually do the work.
Adequate funding of social services by addressing the age old problem of means tested social care and "free" health care is one giant step to solving the problems. That has been fudged for generations as health is a vote winner! Having one budget means the debts can't be pushed around the system, and the public made aware of the total cost of health and care. Pushing the problem into primary care will cause it to finally collapse and then there will be just massive increases in A+E and costs.
Since the 2004 contract there appears to have been a vendetta against GP's which pervades most of the NHS and media. I had a district nurse refuse to do a flu jab on a housebound patient because her boss told her that we GP's earn too much and we should do it ourselves! The independent contractor status enables GP's to resist political interference and do what is best by their patients. There needs to be an activity based contract which rewards good practice but that would be unaffordable in the current climate. The shock of how much is done in primary care for free will hit the treasury if it becomes a PBR contract. The push towards super practices and MCP's is going to lead ultimately to a salaried service which will then negate the need for LMC's then the GPC and ultimately destabilise the BMA. Maggie T did it to the Miners will May do it to the BMA?
It is the business model of the NHS that causes the burnout. GP's are on a block contract with no safety valve to curb demand, payment by activity would prevent burnout as there would be a financial incentive to absorb the work and pay someone else to do it. Until that changes having a helpline or visiting a counsellor without backfill just means more burnout as the work does not go away.
Hunt wants to denationalise the NHS and rely on private homeopaths. It is galling that he is thanking the staff of the NHS when he is systematically making it impossible to care properly. Imposing contracts and threatening to fine new Doctors if they leave before their pound of flesh is removed. Clever people are being put off becoming doctors as the tuition fees and loans coupled with the working conditions are crippling. Who in their right mind would sign up? All he needs to do now is asked retired doctors to give back their "gold plated" pensions and he will have a full house!
It is because GP practices are self employed small businesses that they are allowed to fail. The push is towards a fully salaried service as part of MCP's. The promised money is like every political announcement hot air and no substance. Where has the £1Billion for practice infrastructure gone? The hoops practices have to go through in order to access the funds are mind boggling in their complexity which then relies on a hastily organised committee to sign off in time which in my experience rarely happens.
I asked the Chair of our local STP about moving 25% of workload into the community when there was no workforce free to accept it. His answer was that the hospital workforce will be retrained to work in primary care which will take time as they are very risk averse in hospitals. Not sure the staff have been briefed as the plans had been drawn up already and not even published. Most are based on a fall in demand yet there has always been a steady rise in demand which will only increase with age. All the plans are based on assumptions and extrapolations of previous pilots which have never been fully implemented once the pump priming money ran out. It appears we will all fall into the massive trap of signing up to plans that have no chance of success. GP practices are closing because of 10 years of disinvestment and denigration of the profession. They are not financially viable enough and small enough to fail despite the 'new deal' money. Has anyone managed to access that money??
It has always been divide and rule. The profession is not united as there are so many conflicts of interest and personal prejudices at play. GP's are divided into partners who can't strike because they have to run their businesses and salaried who could but would only harm said businesses. Hospitals consultants have their private practice outside their NHS time so rely on the Junior Doctors to cover the work in the NHS. Those voted to represent doctors at the BMA are also split between primary and secondary care but not equally represented at board level. The lure of the gong keeps quiet many who would otherwise be more vocal. Until the profession learns to respect itself and its diversity of provision the political class will continually undermine and denigrate the profession. They will not value it because we do not.
Watch now how a new Consultants contract will be imposed. Softened up by having to declare their private earnings then swinging changes to force the seven day cover. Sad day for the BMA.
It's not the middle aged men I worry about it is the teenagers and young men who use huge amounts of testosterone in order to bulk up in the gym. The desire for the body beautiful is putting them at risk from dodgy dealers.
The male menopause needs much more evidence based analysis to determine who will benefit though my experience is replacement in men with low levels does improve their wellbeing.
And how much will GP's have to pay the ARTP for accreditation? If provided by NHSE to raise standards I'm all in favour but if it is another cost to practices then I can see a rise in referrals.
Not surprised! Every practice is vulnerable with increasing costs and reducing income. Quality of care suffers and is a symptom of a failing system. The business model of the NHS is unsustainable and no-one is brave enough to tell the public what they want is unaffordable. The political masters are deliberately denigrating the profession with the latest stab Consultants having to declare their private income. The goal is denationalisation of the NHS and forcing all into salaried jobs.
My view is that the drive is towards a fully salaried system. Even though the five year forward view is to move care into the community most of the work will be done by nurses paramedics and physician assistants with much more involvement of community pharmacists. The Family Doctor role will disappear into one of care co-ordinating and fire fighting demand.
Still significantly below the Prime Minister, which all salaries are compared. CEO's of trusts £240,000, Sir Martin Sorrell £68.5M last year its all relative. Why there is this obsession with GP pay when we are self employed small businesses I don't know other than to deliberately undermine and denigrate the profession.
Just to add to the confusing messages and illogical workings of NHSE this is a response to an enquiry as to why our payments are going down despite our list growing...
"Both the PMS contract and GMS contract are paid based on your weighted list size and this has reduced. The fact that your actual list has increased does not have any bearing on your payments – it is the weighted list that counts for this. The reduction in weighted list size and increase in actual is to do with the ages and mix of patients on your list. We cannot access the calculations behind how the actual list becomes ‘normalised’/weighted. This calculation is done nationally across all GP practices. You may be able to compare the change in the make up of your list yourself."
So NHSE can't access how the payments are calculated what hope is there that any of it is right?
GP's must share the burden of the austerity pain like the rest of the NHS or so I was told by NHSE. The problem for partners is it directly hits profits and therefor take home pay. In the salaried world there is no cut in salaries (except if you are a junior doctor and they impose a new contract on you!)Locums are just using market forces which the Government has tried using in the NHS since the late 80's. This is all to soften up the whole NHS to hand over to accountable care organisations who will offer a way out of partnerships and a salaried role, which will be very attractive to doctors who just want to practice medicine, and not worry about running the business.
Yet again focussing on the wrong problem. Just need to commission appropriately where patients access healthcare either the GP if perceived non-urgent or A+E if perceived urgent. Stop using patients as the problem in the system it is the system that has to change to manage the publics expectations and the politicians to fund those expectations!.
I asked my registrar to google the symptoms he felt at that moment which was abdominal bloating. The top ten causes that must not be missed were ovarian cancer endometrial cancer etc and was mainly in over 50 females. Nowhere did it say it does not affect men so he would have run straight to have his ovarian cancer excluded!! Apps are only as good as the user. Unless demand is curbed by co-payments the NHS is doomed. There is not enough central funding to attract the best people into working at any level in the NHS from cleaners to consultants. We allow Bankers to keep their wildly inappropriate bonuses so they don't leave the country why are we as a country allowing this destruction of the professions.
Who is applying pressure on the regulators to come out with these threats? The regulators should be looking to see if the training is compromised by the new contract and checking that patients will be kept safe. It could all be avoided if the Secretary of State withdraws the imposition and there is an honest debate about how much the country can afford to pay for its seven day NHS.
It is divide and rule again. Set the consultants against the juniors by denouncing the strikes which undermines their position. Contract imposed on Juniors and then watch how a new contract for consultants comes out which will be imposed, then the nurses AHP's etc Once that all happens the workforce will be so demoralised anything else will seem good and along come United or Virgin offering jobs following new contracts given via the STP route!