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Revealed: Sixty GP practices across the country facing imminent closure

Exclusive Around 60 practices across the UK are facing imminent closure due to issues over funding and recruiting staff, Pulse has learnt.

In a measure of the recruitment crisis and funding squeeze facing the profession, local GP leaders have warned that they are witnessing an increase in the number of practices considering giving up their contracts altogether.

Pulse surveyed 25 local GP leaders from across the UK, and found that 60 practices were either notifying their patients about their closure or were in talks about relinquishing their contract.

The leaders of local medical committees (LMCs) or GPC representatives told Pulse that they fighting to keep practices open, but were facing a ‘slow train crash’.

They also cited the ‘domino effect’ that would occur if practices were allowed to close and large numbers of patients had to be reallocated to other neighbouring practices.

The BMA warned in May that practices were ‘imploding’ with the pressure on them, and that was leading to many being at risk of closure.

The survey found:

  • In Gloucestershire, three practices are under imminent threat of closure with GPs at one taking home no pay at all.
  • Six practices in Hampshire have been in discussions with LMC representatives about relinquishing their contracts.
  • One practice in Oxfordshire has closed this week because it could not afford the running costs, another is due to close due to a lack of investment in premises.
  • In Wales, four practices are closing imminently, and a further 10 are considering doing so due to recruitment problems.

Gloucestershire  LMC chair Dr Philip Fielding said: ‘We’re working with the area team and CCG to find a way of keeping them viable, and also to keep planning succession.

‘In one practice, the partners are taking no drawings. They are retired in terms of the NHS pensions, but they’re staying on for nothing to look for a successor. In another practice, the salaried doctors are earning more than the partner. It’s inherently unstable - it’s like trying to stop a slow train crash.’

Dr Charlotte Jones, chair of Wales GPC, said: ‘We have a number of surgeries in Wales that are in the process of terminating their contracts. There are examples in both urban areas and rural areas - one in Neath Port Talbot, one is Powys. One example is Dr Julie Lethbridge and Partners in Neath. It comes down to their inability to recruit partners - and remaining partners can’t cope. Even the good ones have difficulty recruiting, and it causes a domino effect.’

In Essex, there are similar problems with recruitment. Dr Brian Balmer, chair of Essex LMC, said that there were two that were under threat. He said: ‘It’s because they can’t recruit. The key reasons so far are the changes in finance and that people are leaving for various reasons - retirement etc. - and they can’t recruit.’

In Oxfordshire, NHS England has said it is closing the Wootton Surgery on 31 August because its premises was not fit for purpose. It said:  ‘The surgery, which only opened for five hours per week, would have needed considerable investment to bring it up to the standards required by the Care Quality Commission (CQC).’

Dr Robert Morley, executive secretary of Birmingham LMC, said there were two practices that had closed in his region. He added: ‘We’re going to see more and more of this. The only way to safeguard the profession and safeguard these practices is for partners to merge.’

Last year, an FOI request by Pulse revealed that 99 practices had closed between 2010 and 2013.

Readers' comments (61)

  • Vinci Ho

    Editor
    Make sure your facts are validated because DoH and NHSE will accuse you guys 'scaremongering' again !
    Please support the march on 5/7 , this Saturday in East London , organised by Tower Hamlets Keep Our NHS Public......

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  • Surely this should be headline news??

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  • Hunt could not give a s***.
    He believes in "market forces".
    Well, maybe he should warn the public about the effect of such "market forces"

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  • the practice in bristol that is closing made the BBC this morning, same reasons, lack of funds and not being able to recruit.

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  • Colleagues, it's the 4 R's

    Resources, retirement, resignation, relocation

    The first won't be taken seriously until all of us start to follow through on the others. Don't delay, make plans today

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  • @above
    add in a 5th "retention"

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  • There is no divine right for a partner to earn more than a salaried GP. If you are a partner that's the risk you take, its what you sign up for. If it was any other type of business there would be no sympathy for the owners/partners to be earning less than its salaried workforce. Why should healthcare think itself any different? There are other options than partnership. Certainly if a salaried job pays more why would I want the hassle of partnership anyway!

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  • 6th R: Rsoles to it all

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  • Anonymous @ 12.35pm
    When there are no GP partners left and no NHS General Practice who will be employing you.
    Backdoor privatisation is coming and that is the hidden agenda.The Whitehall bean counters have done the sums, figured the NHS is becoming unaffordable and privatisation is the way out of the blackhole. No politicians will have the balls to explain that one to the public.

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  • anon 12.35 - of course it is not a "right" - but any sensible business "partner" will wonder why to go on if this is the situation...and are better off being salaried as well.

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  • No partners, no buildings for a lot of primary care services. HMG wont afford a buy out and imposing a salaried service but instead are strangling the life out of GP land so that partners give up close the door and are forced to sell up. Who can afford to buy it all up?- You guessed it -private health companies who have many Lords, Ladies and MPs whjo rank amoungst theri shareholder and boadr members. The conservatives get a substantial amount of donations from the private healthcare industry.

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  • I'm sorry angry about HMG and them screwing us my typing above was very naff!

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  • Any other union would have us all out with placards, shouting "scab!" at the district nurses. Come on BMA, sort it out!!!!!

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  • if primary care implodes I don't think the private sector will be interested - they do not have a positive track record being involved. I would however put money on local hospitals running practices.

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  • anonymous 2.39
    where are the finanacially struggling hospital trusts going to get the money to buy the buildings and employ the staff to run a GP service?

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  • I say let it collapse.

    people don;'t appreciate what they have until its gone.

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  • anonymous at 12.35
    "There is no divine right for a partner to earn more than a salaried GP."
    If you read the article it says the partners are taking NO drawings, unlike the salaried doctors, presumably to keep the salaried doctors in work and the patients with access to medical advice. I think that's pretty altruistic and should be praised if not recommended.
    Whilst I agree with you about business risk, GP businesses are working in a rigged market with a sole customer but unlimited (indeed whipped-up) demand, ie they take the risk for the NHS but with their hands tied. Working for a health provider gives protection but I think many more partners will decide the risk, work and abuse isn't worth t and will resign in the next year or so and maore practices will collapse. C***-up or conspiracy?

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  • MY VIEW----->
    BLAME THE DAILY MAIL
    BLAME THE DAILY MAIL
    BLAME THE DAILY MAIL
    BLAME THE DAILY MAIL
    BLAME THE DAILY MAIL
    RUN BY GREEDY MULTI-MILLIONAIRES WHO "PREY" ON PUBLIC ANXIETIES.
    A "DESPICABLE AND DEPRAVED" RAG OF A NEWSPAPER

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  • Anon 12:35

    Contrary to what you pretend to be, you clearly have not worked outside of nhs.

    I don't know of any business owners who expects to earn less then their enjoyed staff long term. They may take less drawing for short term for long term gain but only because they predict situation well improve in the near future. Otherwise why be a business owner? Commercial business do not continue if there is no adequate profit, regardless of if their client may need their service to survive. Charities may be different but I wouldn't call them business and in fact charitable trusts are governed by different law.

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  • The hidden agenda is privatisation . It would straight forward to repair primary care and the fact that it is not being done gives the game away . If the Tories are re-elected kiss the NHS goodbye.

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  • ‘The only way to safeguard the profession and safeguard these practices is for partners to merge.’
    I wish.
    While considering the possibility of merging our own practice, but deciding to quit instead, I put the following poser to my 19 year old son:
    ‘If you mix one steaming pile of s**t, with another steaming pile of s**t, what do you get? The answer, ‘An even larger steaming pile of s**t’, was plainly obvious to him, as it should be to us all.

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  • Ad

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  • Sadly I had to go with market forces 2 months ago and retired at age 59 partly due to health factors. My pension is now well above what my recent drawings were. I am sure these same "market forces" will influence many GPs in their 50's adding to the oncoming implosion of general practice.

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  • Sir Richard n his pals are salivating at the whitehall streets which are paved in gold

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  • Una Coales

    The reality is, for countries to get out of a national debt of £1.4 trillion, it means privatising public services, ie privatise the railway, privatise post offices, privatise universities and now privatise the health care service. Government cannot keep publicly funding a £110 billion a year free health service in which public demand outstrips resources and manpower in the context of trying to keep Great Britain from bankruptcy.

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  • The problem is the private providers need to make a profit after paying their overheads and I cannot see how they can do this with the present funding arrangements. No doubt some will be happy to run at a loss for a while in the hope that insurance models are introduced. It may be possible to make 'efficiencies' by putting huge numbers of non clinical staff on the minimum wage and zero hours contracts, managing appointments from call centres and increasing the use of 'practitioners' but I'm not sure it will wash with the public who will still demand to be seen by a GP. The implications for secondary care costs in such a model are staggering.

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  • well done coalition..criminal damage you are doing to the nhs will lead to your demise

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  • @ 03 July 2014 11:10pm

    The public can demand what they like - once privatised, the old, sick and poor will be priced out of the market just like in the US and worldwide.

    They will be desperate and see even the local Witch Doctor when unwell - as they could never afford a Private GP.

    Once the dam collapses, it needs complete rebuilding at huge cost.

    Vote conservative and the NHS will be gone, vote labour and they were the ones who set the privatisation rolling - with Blair and his Private mates.

    All politicians ( Possible few exceptions - but none who are close to influence and control) are money grabbing t@ss@rs, and are in the back pocket of lobbyists and Private companies, if not on the boards already, will be on promises when voted out of office.

    Unless the public wake up soon to this - it will all be gone and too late to turn back the clock.

    BMA please stop negotiating, and start demanding change.

    Doctors - stop whining and support the BMA as they are powerless if they try and Strike - and the sheep among us decide to go to work as usual - so the 'Jubilee long w/end' had more impact on services than our so called strike.

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  • Una Coales

    CSA broke IMG GP trainee recruits. BAPIO stood up to the RCGP. The financially unfeasible NHS GP contract is breaking UK GP partners. When will BMA its trade union demand industrial action and stand up to government for a fair contract, fair working conditions and fair pay? Is it so much to ask? Why was a small agenda committee allowed to refuse my emergency motion calling for the BMA to consider a ballot for industrial action, for GPs to be allowed to increase practice income through private means by more than 10% as dentists do, for the BMA private practitioners committee to help NHS GPs source income? Why did this agenda committee think a debate on a BMA bear toy should take precedence?

    In the eyes of many grassroots GPs, it would appear the BMA couldn't care less. Government is protecting the lucrative NHS pensions of older GPs for the next 10 years. Is this not the same as accepting gag money? Don't strike on behalf of younger GPs who are working their socks off, burning out, committing suicide, quitting, emigrating, falling off their stools from exhaustion working 12 hour days, as the production line has been doubled and the speed increased. Why watch stools become vacant, one by one, as workers disappear? Who would want to join this assembly line?

    Why not increase the price of the product? Make consumers pay more for a product that has been priced too cheaply for 2014? Workers with 11 years med school and working experience cannot be expected to work this hard for pay less than a plumber.

    In 2009 I warned the RCGP not to be seen unwittingly colluding with government and bringing about the demise of general practice. Unfortunately the CSA exam has ensured that British BMEs and IMGs avoid general practice training like the plague.

    I also advised in 2012 that the BMA, RCGP, MWF, etc. should unite to protect general practice. They can only do this if they valued all GPs, IMGs and BMEs. And if they also valued white UK GP partners, they would demand industrial action and the means to survive like dentists and semiprivate GPs in Australia. Instead we will see the US health maintenance org model which was deemed as unsatisfactory by many Americans who then opted out.

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  • Una Coales

    http://www.itv.com/news/west/story/2014-07-03/6-000-bristol-patients-to-lose-their-gp/ The domino effect starts in September...

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  • yet the GPC's silence is booming across the land.

    It's time to abandon this long obsolete cult religion of the free NHS. Una is right, the money simply doesn't exist so keeping begging govt for it is blind stupidity. Patients need to pay for use of the system like they do in every other civilised country. Stop this Soviet Union adherence to a "free" model that does not work.

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  • Una, whilst I normally enjoy your fiery version of what the GPC should be doing, some of what you says is complete and utter garbage.

    Firstly you eschew the idea that the govt has no more money, so that privitisation should come in to the fore. Then you go and spread the idea that GPs should be lobbying the govt for more money.

    I'm sorry but you are wrong. If the govt can increase MP pay by 11%, manager pay by 6.1%, bail out RBS, build a £60 billion railway track, then it sure as hell can pay for understaffed and wavering doctors and nurses on the frontline.

    Then you perpetually fabricate a conspiracy theory about IMGs despite the high court ruling, AND continue to do huge damage to the reputation of the profession. You are doing damage by saying that it is okay for sub standard trainees to challenge the college because of their skin colour. You are in effect saying, screw the CSA, just let anyone through as a GP. Considering there is no decent alternative, I'm sorry to say, but that is a dangerous idea, and will damage the profession even more in the long run when substandard GPs give more credence to Daily Fail propaganda.

    The IMG issue is not even on debate here, which further shows your lack of clarity on the issue at hand and shows your desire to spin your issues to the fore - something that Cameron, Blair and the rest of them do particularly well.

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  • The governments answers to please for help, saying there are not enough GPs and practices are struggling? - we are sorting out extending GP hours and longer working/24 hour access/7 day appointment.
    The NHS constituion - gives patients the right to demand and get a referral to any specialty.
    The simple answer is to stop worrying about the funding of the whole NHS and the lack resources( if the government and people don't care- why should we) and refer anyone who wants or might need to see a specialist, admit every 50:50 clinical dilemma rather than waiting and watching, prescribe branded medication rather than generic, and stop being so good at what you do. More 2ww wait referral to keep Mr. Hunt and the pathologists happy. Generally swamp the system until it is clogged up from all sides, and when they come back for our help to sort the problem out- do some proper demanding rather than negotiating. But sadly the BMA and the many GP's will never have the guts to stand up and do any of this.

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  • The amount of GP bashing that is going on, I am surprised all GP's haven't resigned!
    My GP works 60 + hours per week but still NHSE think it is important that ticking little boxes is more important than seeing patients.

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  • Follow 'Save Our Surgeries' campaign on FB and twitter. Before, patients have had to fight for hospitals . Tomorrow is historic as for the first time ever we march for General Practice- the jewel in the crown of the NHS. Join us, Maureen Baker, MPs, Allyson Pollock and the people of a Tower Hamlets and Hackney. Bring your family, stand up and be proud to be a GP . It's up to us to fight back. Patients need to realise we are under threat! Don't be weighed down by cynicism - the enemy of action! Altab Ali Park Aldgate East 2pm or London Fields lido 3.45. Come and make history!!! Naomi Beer and SOS team

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  • Ps Press in abundance BBC ITV MIrror all filming. It will be better than Wimbledon!!

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  • Una Coales

    @12:19 easy to mudsling from anonymity? Who are you may I ask?

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  • Una Coales

    Well done Dr Naomi Beer for taking action. I wish the BMA had organised this march for its GP members or balloted its GP members as to what they wanted its trade union to do to save general practice as asking for more money has not worked.

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  • Una, why dont you answer the points on debate than worry about my identity?

    There is no mudslinging. Just holes in your argument.

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  • Una Coales

    @11:39 everything you have stated is false and has to be corrected which makes me wonder if you are a BMA or RCGP rep?

    The RCGP and BMA are lobbying for more money in spite of a £20 billion Nicolson challenge NHS efficiency savings. I am saying it is pointless to ask for more money when the nation is £1.4 trillion in debt. I am against HMOs and pro semiprivate GPs who may charge patients and also treat state medicare/medicaid patients reimbursed by the government. Semiprivate GPs will set fair market prices for healthcare but HMOs will seek profits over patients and have huge overheads.

    There is a reason 451 GP training places are vacant. There is a reason only approx 124 Indian doctors have been registered by the GMC this year. There is a reason why an Indian Cambridge grad faces difficulty passing a subjective CSA exam using actors and not real patients. I do not have to join up the dots for you.

    There is a reason why the BMA is not balloting its members for a strike or action against this untenable NHS GP contract. Government has protected senior GPs pensions for the next decade. IMO the two are linked.

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  • Una Coales

    The question to ask is why has this government chosen the US HMO model over the Australian semiprivate healthcare model? Were there any generous US health insurance party donors? Were there any deals made between number 10 and US healthcare giants or other conglomerates? We can understand why they want to hand over £110 billion a year public debt to privatisation but why the HMO model of salaried GPs and NPs?

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  • Una Coales

    I must be getting close to the truth.

    Why did the Coventry consultant anaesthetist BMA chair Mark Porter interrogate only me for 45 minutes in May at BMA House on my wish to put in an emergency motion or council motion on a ballot on strike action by GPs against a financially unfeasible NHS contract that was bankrupting GP surgeries even before my role as council member was to be ratified at the AGM in June?

    Why was I left feeling intimidated and bullied by the BMA for seeking to present GPs concerns about this NHS contract/NHSEng demands driving GPs out?p
    Why did they reject my emergency motion at the ARM in favour of a debate on a BMA bear toy?

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  • This comment has been moderated.

  • Una: there is no doubt you have more insight and backroom discussions/threats/gossips. Its the job of all the GPs who are a BMA/RCGP to discuss and be honest on the hidden agenda the government has on GP future.
    the discussions of USA model and other big private providers have been around for sometime and for them to work we need to all be salaried GPs

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  • No Una, forget the conspiracy, I'm no BMA/RCGP rep. I'm just a rank and file first 5 GP getting on with the coalface. I have no issues with your lobbying for more funding for primary care but find your desire to bring the CSA issue tiresome.

    This is especially true because several of my IMG colleagues in my year failed CSA and decided to blame the college rather than themselves, because we, the rest of the group who practiced with these trainees could all see that they were not going to pass. Who did they use as proof of the conspiracy? You.

    You have now become a rallying point for substandard trainees who face supposed discrimination. The true discrimination, in my eyes, is not that they were black or Asian or white, its that they were substandard.

    The sad truth is that these trainees face 13 different examiners of all faiths and nationalities, 13 different actors and yet they fail over 4 sittings. There is little chance of conspiracy. There is only borderline candidates who were probably not good enough in the first place.

    And yet, for example, women are far more likely to pass the CSA. Are you suggesting the CSA is sexist too?

    I don't really rate your anecdote about a cambridge graduate failing. Your problem is that you think everyone should pass. I think differently in that the exam is one of competence. Those who fail do not pass the competencies for the RCGP curriculum, simple as that.

    In terms of 124 graduates. I really would like to see equal number of our graduates go to India, practice for 3 years and come out with a CSA equivalent. I bet you less than 124 would do so.

    The true irony is that other countries have no such qualms about IMG pass rates. Our overly politically correct culture and abhorrent at even the mention of the racist word makes us bend over, and are the only reasons that the pass rate is even under debate.

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  • well done mr hunt
    you are a failure

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  • Una Coales

    http://youtu.be/3v4Sq7oDCgo all NHS GP partners facing bankruptcy should watch this clip of a singlehanded GP in North Carolina who underwent similar nightmare tick box bureaucracy, CMS inspection (like CQC and NHS Eng) and finally had to close her practice in rural NC due to stress and bankruptcy. Government overregulation is to blame!

    Allow semiprivate practitioners autonomy to treat patients in peace. Alas in countries with a huge national deficit, govt public funding is tightly ringfenced and that includes any public state funded healthcare like NHS or medicare/medicaid. To work in such a public funded system in the context of a national govt deficit will always be stressful.

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  • Una Coales

    @9:33 I am sorry you did not help your IMG GP trainees even when you 'knew' they would fail. I did help IMG GP trainees by teaching them how to control unconscious bias when forced to sit an exam behind closed doors with only one examiner and not 2 to reduce observer bias, an exam with no CCTV recording to challenge at appeal, an exam which fails 4x more British BMEs than white UK grads.

    I have had the pleasure of seeing IMGs achieve a resit CSA score of 95 and 101 after a one day CSA course. This score is even higher than some UK grad scores. I have seen an IMG go from 55 to a score of 85 after one day of learning how to control unconscious bias against IMGs, a belief that IMGs or foreign training is substandard.

    I see IMGs as geniuses and boost their self confidence which has been damaged by beliefs from colleagues that they are substandard. I am an IMG and proud to be one. I am also a British born BME and proud to be one.

    I have fought for exam fairness for IMGs because I know that before the CSA changed its format in Sept 2010, more IMGs passed and fewer white UK grads passed. I know that CSA can be improved once the RCGP acknowledges unconscious bias, tests for it and applies controls as is done in America since 2007.

    The past president of the BMA is an IMG Indian. The past chair of the RCGP Mayur Lakhani is an IMG. IMGs are NOT substandard because they are forced to sit an exam behind closed doors with just one examiner per station. Make the exam fairer and you will ensure the public that you have not passed substandard white UK doctors who passed due to positive unconscious bias or strong unconscious racial preference for whites or failed bright IMGs due to strong unconscious racial preference against foreigners.

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  • Anonymous | Sessional/Locum GP | 05 July 2014 9:33pm

    women are far more likely to pass the CSA. Are you suggesting the CSA is sexist too

    Remember when it was the opposite way round it was considered sexist and exams across the Uk were changed from GCSE upwards to 'correct' for this. Interestingly this analysis has ceased now the exam does favour women.

    Of course internationally validated exams (unlike the csa) seem not to have these issues.

    The CSA is the outcome of a politically correct culture.Its laughable to think of a College exam based upon actors and linguistic theory rather then medical knowledge. The CSA has no evidence behind it to say it improves or is an accurate measure of clinical skills.

    I suspect you'll remain a locum for your career with your complete lack of insight

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  • Una, I have never said that IMGs are all substandard. I have worked with, helped train and pass CSAs for several IMGs. Many IMGs are excellent clinicians. However, what I do not like are those IMGs who are substandard to hide behind racism as some kind of excuse. It isn't.

    And I'm afraid you have been responsible for pushing the political corrrectness completely the other way. I'm sure I'll get heckled by IMG registrars for being racist just for expressing my opinion, hence the anonymity.

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  • Anonymous | GP registrar | 06 July 2014 6:34pm

    "I suspect you'll remain a locum for your career with your complete lack of insight"

    Is that some kind of insult? What are you, like 5 years old? Because its pretty weak.

    In terms of the rest of your rant....

    If you want to talk about lack of insight, you should evaluate your idea that the CSA should be knowledge based.

    I'm not sure if you've sat the CSA or passed it or not, but you've obviously missed the nuts and bolts of general practice: 75% comms/psychosocial, and 25% knowledge.

    Incidentally, knowledge is already tested at the AKT.

    If you want to send a reply insult, please try a little harder.

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