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GPs go forth

Clinging to the cliff edge

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In no particular order, here are some things that have happened in the past few weeks.

• We’ve banged our heads against a PC screen trying to figure out why, despite jumping through all the Avoiding Unplanned Admissions DES hoops, our 10 grand pat on the head is showing as a somewhat less bankable zero. Meanwhile, the ‘automatic’ CQRS flu data extraction failed – another £10,000 down the back of someone’s sofa. It is, of course, our job to sort all this out.

• At 1pm on my last day duty, someone from our local care home requested a visit for a patient with a cough. At 2pm someone else from the home requested a visit for a different patient with a cough. Repeat hourly until 6pm.

• We heard the outcome of our federation’s bid for pharmacists from the pilot the Government trumpeted would save us all. Our pitch was supported by local GPs, the CCG’s prescribing committee and the Local Pharmaceutical Committee, created a trailblazing job description and aimed to ease workload in an under-doctored area. So naturally, it failed.

• A letter arrived from the police firearms department requesting a report on a patient. It contained the phrase: ‘While we understand most GPs are unlikely to charge a fee for the provision of information…’ Yeah, why would I charge for a non-NHS service to cover my time, my reputation and my secretary’s efforts? Lawyers wouldn’t charge, would they? And it’s only about a man with a gun. What’s the worst that could happen?

• I had an email from a community nurse stating: ‘While we were visiting Mr X, he passed a type 1 stool. Please review.’ Yes, really.

Etcetera etcetera. You’ve had much the same, and probably worse. Because this is what general practice life is like nowadays – a soul-destroying pisstake.

The response of the more militant is, ‘strike’. After all, the juniors did, almost. But it’s not that simple. We don’t have a single issue to pin a strike on. Our malaise is all-encompassing. We are undervalued, unpaid, abused and generally fannied around with to the point that, frankly, the job is now a crock of shit.  A type 1 shit, at that.

The rational response isn’t to strike, it’s to walk away. And that’s what’s happening. Oh, didn’t I mention? The other significant event was the resignation of the senior partner in a practice just across the corridor. He’s had enough, and the ripple effect may turn into a tsunami. So you know those things you talk about but hope won’t happen? Grey pubic hairs, cancer, the disintegration of general practice as we know it? They’re happening – at least the GP bit is, because our hastily contacted LMC told us. 

We really are clinging to the cliff edge – the most literal of tipping points, as the Government must realise. Either it will accept that the post-2004 contract ‘penance’ should stop short of actually annihilating general practice, or the conspiracy theorists had it right when they said it’s what the politicians wanted all along.

So watch the hand when it’s offered. It may haul you back from the brink. But more likely, it’ll shove you right over.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield

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Readers' comments (18)

  • Problem with community nurses is the managers, they prefer the cheaper inexperience community nurse to the trained DN. We now have such things as transformational leads whose job seems to be to stop us doing anything. They don't pay GP's so don't care if everything is passed into them. We on the frontline should all strike, not for more money just for less managers and made up jobs.

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  • Jump, for God's sake: I did 12m ago as a senior partner in a practice left to drown by our CCG/Acute Hospital/LMC/Area Team (yes, all 4). Not easy to tell the difference between handwashing and handwringing when these groups get involved: either is a chocolate teapot response anyway! Happy to put it out to tender for £200 per patient but not to put a small fraction of that into a dedicated, existing team.
    It is great fun being a clinician (it is more than enough to concentrate on). Somewhere a Civil Servant is laughing at you for doing all this work for £65 per patient per year.
    Have some self respect.. and don't give me the "what about the patients" cr*p: they are good enough at getting what they want and the NHS/CCG/DOH automatically resume responsibility. Which is where it lies anyway.

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  • 449 pm
    the precise problem= some GPs get 200 others 100 pounds a year. Some do a lot of penance, others none at all.
    If the GPC does not look after at its own members, there will be no GPs left.
    And that is how it should be. GP land is so so horrible, I wish I had never, ever taken up a partnership with a share in the building and the nightmare of redundancy pay.
    I am stuck like Peverley. Whatever happened to him after his AF ?
    The only thing I can say from my mountain ledge position of only working harder and harder for less and less is = Please, please go if you can and do not become a Principal. Please, the nightmare is beyond sleepless nights and anxiety and worry.
    It is toxic, painful and full of horror. It maddens me when THE leaders of the GPC just complain and do absolutely nothing. if they cannot see the damage they are causing, they should be told.
    They should resign. Look at GP land under their stewardship.

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  • I jumped from the Titanic of partnership in April thank goodness. But, from the lifeboat of salaried status (and still bobbing about in the rough sea), the cries of anguish from those left behind still haunt me.

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  • NHS General Practice is dead
    All of this is true

    Killed by
    -unrestrained and unresisted patient demand
    -dwindling resources and income because CCGs are in deficit.
    -funded from 6.2% of the NHS budget, to conduct 90% of all NHS medical consultations.
    -because the game is rigged under PBR to suck all NHS funds in to Hospital Trusts, also in deficit, and swallowing up all the so-called NEW money promised to the NHS
    -leading to a demoralised workforce
    -leading to General Practice being shunned by young doctors
    -over-regulated at every turn by every body that you can name
    -pension terms so diminished that retirement no longer holds the security that it once did
    -endless antipathy from many sources of the media

    BUT WHEN ARE THE PUBLIC GOING TO BE TOLD THE TRUE CLIFFHANGER STATE OF GENERAL PRACTICE?

    WHEN IS GPC GOING TO GET ITS MESSAGE ACCROSS?
    THERE WOULD BE UPROAR IF THIS WAS FRANKLY, HONESTLY AND CREDIBLY PUT TO THE MEDIA IN A FORM THAT THE PUBLIC CAN UNDERSTAND

    HOPEFULLY BEFORE TOO MANY MORE PRACTICES PULL THEIR SHUTTERS DOWN FOR THE LAST TIME

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  • Sad but true.
    I jumped eighteen months ago, from the shit to my feet.
    I hope Basildon misses your senior partner.

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  • Una Coales

    Well done @Peter and @Paul for posting with your names, the first step to becoming human again, not anonymised slaves living and working in fear. Your humanised comments/testimonials hold more credibility because you are putting your names to it, like witnesses giving evidence to the intolerable workloads imposed by the government with this unilateral slave work contract. If the GPC has deaf ears, Pulse does not and has been an incredible public forum for GPs to conbat the media bashing of this profession. At least GPs can say, we fought back as hard as we could, we shouted from the rooftops to the BMA GPC, we tried our best to save general practice and ultimately, the only thing we could do in the end was walk away from an abusive life-shortening situation.

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  • Drachula

    They've been out to get the independent contractor status since 1948. I suspect that will be the new deal - now that most practices don't own their buildings, they can remove GMS. (Mostly owned by the senior partners)
    Of course, there will be a vote, but we're all so wrung out, it'll be voted through as "anything's better than this". Like last time with OOH bribe. Look where that got us.
    Happy 2016 everyone.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder