Graduate of Otago University Medical School 1974. MB ChB Dip Obst. FRNZCGP FRACGP. Moved NZ to Aus. 1989.
Interested in different medical systems, epsecially primary care systems, funding models, medical politics etc
Have a son and his famiily living in London. Visited the UK in 2011 - loved it. Especially enjoyed a week on canal boat doing Warwickshire Ring.
Observing where you are at, from the other side of the world, (Oz) it appears we are all caught up in the same situation, basically in between a rock and a hard place. If you are restricted in funding, and therefore unable to protect yourselves against the inevitable creeping medical inflation, which always runs at a higher rate than official inflation rates, and limited (as we are in Oz as well), in the ability to compensate by passing some cost onto the consumer, (totally in the UK case), then as you can't generate income out of thin air, something has got to give, and it ends up being the GP income that 'gives', from having to prop up an increasingly uneconomic model.
A similar situation is developing in NZ as well, where the capitation has not been indexed for inflation for yonks, and the economic climate puts a brake on the level of private fees the public will bear, so you are not alone in this phenomenon.
As I near the end of a 40 odd year GP career, 50% in NZ and now Australia, nothing has happened to change my view, that if GP is to survive anywhere as a financially worthwhile choice, it must be by dint of achieving a decent salaried position as the public servants we in effect are. So, yes, in my view the role of GP as an independent contractor is way past its best by date everywhere, not just the UK.
This blog hits the nail on the head precisely of what is one of the most negative things about GP, compared to most jobs, actually, (and I mean anywhere - I'm in Oz), and that is the opportunity to interact, (chat, laugh, debrief), with one's staff and colleagues, and without the flapping ears of ever-present patients to stifle discussion.
It's the main thing I miss when we gave up having drug rep hosted lunches. The opportunity to sort of bustle them out, and have a general chinwag before we each departed for our rooms to let battle recommence.
(We got sick of the repetition about only the latest money-spinning drugs).
Man, that gave me the best laugh I have had in a ling time. You maybe heard me from the other side of the world. I keep an eye on you folk, (I'm in Oz), and it amazes me how similar the situation general practice faces is, right round the world, even taking into account the differences in the actual systems.
We also have the folk in ivory towers continually coming out with...how did Tony put it..? "jargon-riddled, patronising, sloganeering, mindless and meaningless bullshit"...I love it, can I plagiarise that mercilessly over here Tony...please..?
Anyway the most frustrating thing of all is these folk keep coming up with these...well, ok, let's grace them with the term, 'ideas', because they cannot/will not, offer the one thing that would actually help. MONEY..! There, I said it. If you pay Drs well enough, and relieve them of the burden of the worry about just keeping the doors open, they will beaver away, driven by their own altruism, (which we all have in spades, and the pollies know how to exploit it suits), and do a fantastic job looking after our patients, because IT'S WHAT WE DO..!
Dear people, we hear your pain. here in Oz, we are also under a similar 'pump', with another 4 years of complete inflation indexing freeze imposed, on top of 2 we have just been through, and like you at a time of increasing demands from chronic disease management.
Now, they also want to foist some form of re-validation on us. Having heard how well that has worked for you, you can imagine the feelings here. And, like you also, we find our medical representative bodies apparently toothless when it comes to influencing Govt to listen to us.
Aw...c'mon guys...where's yasensayuma..?
Far too many on her post anonymously too in my view.
As a GP on the other side of the world, (but who has family in London), I can completely understand Brexit. When we visited London in 2011, my strongest feeling everywhere I went was... "where are all the English folk gone?" I found them out in the small towns and country.
As to Iceland putting England out of Euro 2016 - sometimes even a minow can roar. Don't forget which is the only country, (with just 4 million people), to have won the Rugby World Cup three times, both home and away, and back to back..!
As to being a salaried GP. From my point of view, (sadly too late now for me, as I am about to retire), I have always felt that a salaried position was the most appropriate way to remunerate GP. I nearly went broke serving a lower socioeconomic area in NZ, years ago, (too many unpaid accounts that was), and things are not that much better here now in Australia as our patient subsidies have been CPI frozen a further two years until 2020. In all cases the culprit have been under-funding, while costs continue to rise, right..? The only protection from this is for the GP's salary to be quarantined, and costs met separately. No wonder hardly anyone wants to be a partner over there now, as you are all in the same underfunded boat.
Here in Australia, we were accorded the status of 'specialist' some time back. It made not a particle of difference. No income increase - in fact the medical subsidies the Govt pays for services have been frozen for the last 3 years, and now to remain frozen for the next four until 2020. Sound familiar..?
As to status - no change - still looked on as just GPs, with frustrating restrictions on some investigations and medications, so...lose no sleep over it - just be glad you are out..!
Just don't think coming over here will improve things much for you. It won't. But as in the lead article - consider getting salaried if at all possible, so you get increases when others do, and are not responsible for ever-rising costs.
As a GP from the far side of the world, my impression is that we all face the same achilles heel, when it comes to GP remuneration, and therefore, let's face it, job satisfaction. By this I refer to the central issue of the GP's income being effectively intertwined or bundled with the whole business cost structure. Meaning that if funding is curtailed - which all Govts achieve by just not inflation indexing properly, then as inflation of everything else does occur, the GP's income effectively 'deflates'.
This appears to be the case even where our systems differ a lot, with you on practice population capitation, and us on patient subsidies, with the theoretical at least option to charge a co-payment. Ie, so-called private. That might sound attractive, but there is a catch. When the Australian Govt set up the current Medicare, they included one really restrictive & diabolically cunning, not to mention anticompetitive, clause, whereby if the patient subsidy is not accepted as full payment, (referred to here as bulk-billing), then the patient must pay the whole fee up front, then be reimbursed later with their subsidy.
As you can imagine therefore, if you have a whole lot of practices around you being effectively, (to the patient), free, it is fairly hard to get clients when they are going to be slugged (their term) a fee that sounds a lot more than it really is. So, no scheme is perfect.
However, over 40 odd years in the game, and in two countries, (NZ, where I started out in GP now have a hybrid, part capitation, part private gap charge system, but are also killing it by not indexing the capitation funding at all over the last 15 years), so I have come to the conclusion the best way for GPs to be remunerated from their perspective, is for it to be in such a way their income is quarantined, as it were, from practice costs, and costs met in other ways. Ideally that would include bulk funding based on population, plus a user pays contribution, because any free service is over-used and abused. It appears that this could only be achieved by GPs being paid as the public servants they in effect are, and that would mean a salary. I could certainly live with that, as I am on the brink of retirement and woefully prepared for it, as under our system we don't even have a pension fund as you do.
So, when you consider the above, perhaps you are not so badly off as many appear to feel, and at least you are closer to the possibility of moving in the direction I just indicated than we are, for sure. Some of you are already salaried I understand. My advice is go for that, and go hard. Then you have not only the right, but the collective might, to negotiate a reasonable outcome. Just sayin'...
I have seldom ever heard such eminently sensible, practical, fair, and consultative words from any medical administrator. If only we had someone like that as our Minister for Health here in Oz
Sounds very much like the UK needs to look seriously at a no-fault type of compensation scheme like the one called the ACC = Accident Compensation Commission, which came into being the year after I graduated in 1975, in New Zealand. It means that things like medical misadventure, or serious accident related disability of any cause, is settled in a non-adversarial way, with compensation being able to be more modest as a cost, because it is paid expeditiously, and with minimal legal costs involved. The docs involved can even appear in support of the patient's claim because there is no requirement for anyone to have been proven negligent for compensation to be awarded.
One benefit for us Medicos was that it has kept medical indemnity costs very low compared to say Australia, where I now practice, and which is only now starting to look at a similar, but less good, National Disability Insurance Scheme, and much lower than in the US or UK.
I still think of it as the most enlightened piece of social legislation passed in my lifetime.
I feel for balance, constrained to introduce an element of reality here. As a GP currently working in Australia, having done so of the last 26 years, following 12 years in NZ, both countries with similar primary care systems, I find myself wondering what country the author of the following comment lives in...
"It may seem appealing to you to be paid for not having to see patients , however with a bit of elbow grease (talking about Australia) and effort you can push your earnings into the stratosphere and give yourself the opportunity to retire far earlier than you would be able to in the UK."
Ok, if you work in what amounts to a GP sweat shop, i.e. long hours seeing many patients a day, including after hours and weekends, (or charging like a wounded bull in a very affluent area), you might get a gross income around $500K, but most are far below that. Also, one must remember that in our system there is no income source other than when you one on one, in face to face consultation. The minute the patient leaves the room, your income stops. Also that is all there is. From that one pays all expenses, and tax, and then you get what's left, from which you also have to try and provide for holidays, retirement savings, and so on. There is no paid leave, or study leave, or pension scheme, let alone any long service leave such as hospital medical officers receive, and I believe you also get in the UK in GP, depending on status. So no - not all in the garden is rosy. Especially as it appears to be a worldwide phenomenon for Govts to try and save money by screwing GP funding down as far as possible. We face another 3 years of no inflation indexing, for example, having just come out of a couple of years of near zero indexing. Personally, I would accept a public service type salary any day. I'm 68, and still can't afford to retire, so I'm afraid that last post is somewhat hyperbolic...
Here in Australia, we have had a national screening program where an Immunochemical Human FOBT kit is mailed out to people of certain age, and augmented by us giving others in the in between ages a kit they pay for, for about ten years now. The pick up rate is significant.
Those with significant red flag symptoms or close adverse FHx go straight to colonoscopy, but at least doing FOBTs on those with lower statistical risk makes the numbers scoped manageable. I find it hard to believe you don't have this, and back your moves to press for it.
And we think we GPs are under the pump here in Australia. This proposed contract sounds atrocious, and my heart goes out to all docs over there becoming thoroughly disillusioned re their career choice, which was, and still should be, something to be proud of and really rewarding emotionally and financially, but is being ruined all round the world by bureaucrats trying to penny pinch.
I have only had time so far to read the top 10 comments to the lead article, but already have formed the strong impression that most of you are suffering from a type of medical isolationism/persecution mindset.
As a GP who qualified and practiced first in NZ, and now Australia, (and very familiar with the US situation), I can tell you all, if you substituted the words NZ or Australia for UK, and Medicare for NHS, the lead article could be virtually an exact description of what is also happening in the antipodes. Yet we have the mixed public and private system many of you seem to think would be your salvation. And it you want to see what happens in a fully private insurance based primary care system, just look no further than the US, which has the costliest, yet one of the worst performing primary care services in the world. And record dissatisfaction from its primary care Drs.
People there have been many times, when I just wished someone would just pay me a salary to be a GP, and be done with it. No system is perfect, but health is viewed as something any enlightened nation should make available to its people with minimal financial barrier. That is a given, right..? The issue therefore comes back to how to achieve this, and mandates substantial government funding. I personally feel there should also be a modest user pays contribution to damp down overuse. The bugbear, however, no matter where you are, is under-funding, pure and simple. So the thrust of the lead article is right, in my view.
NZ introduced a part capitation fee and part private fee system 15 years ago that worked well - until lately, having ruined the system that preceded it by failing to inflation index the govt subsidies. Why i sit struggling again..? Because they did the same thing, and failed to CPI the capitation funding for most of that period. Sound familiar..?
Australia is doing the same to medicare funding. Lift the funding - the system works. So, that's where the pressure has to be applied. Trying to convert to a private insurance funded health system now would beg the warning... "of beware of what you wish for, as you might just get it..!"
I'm just glad I'll be gone by then. Good luck with all that.