I'm just grateful that I experienced the profession (albeit fleetingly) in the days when it was a delight to practise and we couldn't get 70 yr old GPs to retire.
The "solution" that these clever folks (!) are seeking lies in doing a comparison of GP in the late 80's / early 90's with today. No CQC for a start. No complaints culture. No "You haven't cured MY obesity yet!"
How much money do we spend on over-regulation? Who ever did a cost benefit analysis of regulation? What's the NNH (early retirements) for a CQC visit?
Just what we knew all along - the woes of the NHS are all down to lazy GPs bunking off for a half day and having an easy life. Hence the burgeoning recruitment into GP, all-time high morale and GPs flooding back to the UK from their failed sojourns abroad to re-join the lotus eaters and get a share of the loot.
Thank goodness that I'll be leaving soon. And this is a major factor. Fear and intimidation.
I have to quell my despite for the individuals who do this sort of work. Frequently, they are sanctimonious parasites.
As a former GP appraiser, I have no doubt from my first hand experience that the A&R processes and the CQC’s style of inspections have been and continue to be major contributors to the workforce crisis and the transition from partner model to salaried GP.
Only last week, I heard from a local practice manager about an inappropriately hostile CQC inspection of a local practice, in which I have appraised several GPS and which provides really excellent primary care. One of the partners, in their late 50’s is now seriously considering retirement, which sadly will not be followed by any Locum work.
We have allowed the progressive destruction of our discipline, general practice, which has been done under the banner of regulation and inspection. The situation is now unrecoverable and as a patient I fear for the continuity of my care and for the care delivered to my relatives.
Collectively, we are complicit in a national tragedy.
Clare’s contributions (apart from the CGC/CCG typos) are impressive. I’ve not seen such a measured, thoughtful and incisive analysis of our woes for a long time. I’m thinking of Brian Goss.
But sadly it won’t change the inevitability of this dystopian future she projects.
GMC director of registration and revalidation Una Lane said existing processes make conducting patient feedback ‘harder than it should be.’
So too the consultation process!
The registration process for the consultation survey asks personal questions that I just don’t trust the GMC to hold impartially and in confidence. I’m actually quite surprised at the depth to which my distrust of my regulator has sunken.
The GMC consultation survey is not anonymised. Who on earth would trust this organisation to not store critical feedback and use it against them subsequently?
Cost benefit analysis? NNT? NNH? Who regulates this regulator?
All questions that the CQC is immune from.
No accountability there. Just political popularism.
NICE guidance is that we should aim for 3% Positive Predictive Value for cancer referrals. So you’ll have to forgive me if 97% of my referrals turn out not to have cancer.
A tragic unintended (?) consequence of the barrage of regulation and overload. And the effect on the cost of healthcare provision is yet to be fully felt. When the GP / patient relationship breaks down at a population level, one of the most important roles of general practice is lost - to properly and efficiently guide the patient through the NHS.
In the long run, it’s cheaper and more humane to fund the system sufficiently that GPs have enough time with their patients and know their patients well enough to guide them back into health.
No problem. Primary Care Networks, AI and new recruitment initiatives - to the rescue!
You’re just not listening!
The solution lies in Working at Scale, (useless) initiatives and technology.
Repeat after me...
A&R = concrete lifebelt for a profession drowning in regulation
Answer = Working at Scale, technology and recruitment initiatives.
What IS the problem?
We're so far off-beam, I'm not sure even 5,000 GPs in place this very morning would solve the problems.
(*Cash Equivalent Transfer Value, as distinct from the Lump Sum at 55)
Merlin is right that the NHS Pension scheme is unfunded - meaning its effectively a Ponzi scheme, which is why they've stopped people taking a cash-equivalent lump sum out and transferring that to (for instance) a SIPP.
But here's the rub: guess who's got a properly funded pension scheme. The MPs!
*Not sure if he's the originator but I've heard Sir Muir Gray use your quotation. And he is a past leader of the NSC.
Sadly, very familiar. And the chances of "the powers that be" being able to identify let alone address effectively all of the multiple factors leading to this perfect storm are minimal, I'm afraid.
The individual personal tragedies are heart-breaking. But the bigger picture - in terms of how we cope without effective primary care - is even more scary. And no, the answer does NOT lie in Working at Scale, or Working Smarter, or AI, or telemedicine.
No-one cares. No-one wants to listen. Plenty want to gloss over it. Plenty are invested in the very processes that are weighing us down. And new initiatives are generally as helpful as throwing a concrete lifebelt to a drowning GP.