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Gold, incentives and meh

GPs operating in an 'unforgiving climate of blame', says GPC leader in defiant speech

GPs are operating in an 'unforgiving climate of blame' through having to deal with pressure from litigation and the CQC while tackling 'unsafe' workloads, GPC chair Dr Chaand Nagpaul will say in a speech to the BMA's annual conference.

Addressing doctors from across specialties at the BMA's Annual Representatives Meeting in Belfast, Dr Chaand Nagpaul will say that 'pressures on general practice have sunk to new depths' since last year's meeting.

He will promise that GPs will fight every day to resurrect their 'proud profession' and highlight the fact that at the LMCs Conference in May, GP leaders gave the Government three months to accept the recommendations in the GPC's Urgent Prescription for General Practice or they would canvass the profession on its willingness to submit undated resignations.

Dr Nagpaul will lament the 'explicit wholesale transfer of care out of hospital' which 'continues unabated'.

He will raise troubling statistics, including:

He will say that all of this combined 'has led to a toxic mix from which existing GPs can’t wait to escape, and which many young doctors will not join'.

Dr Nagpaul will add: 'Far from the being thanked for working against all odds, there’s an unforgiving climate of blame. Litigation against GPs has rocketed, no doubt contributed to by us not being able to work safely. CQC adds further insult by crudely judging practices rather than recognising our impossible context.

'How callous to name and shame practices for not having the capacity to tick boxes when those struggling the most are rightly spending their time attending to patients rather than producing reams of policies to satisfy the clipboards of inspectors.'

And while general practice needs more funding, Dr Nagpaul does not want this to come out of the hospitals' budget.

He will say: 'The elephant in the room is of course money. As a supposed rich nation it’s shameful we spend less of GDP on health than most of the developed world, where we have a fraction of the hospital beds of France and Germany and lag behind most other OECD countries in our doctor and nurse numbers.

'General practice desperately needs more resources, but not by robbing Peter to pay Paul, but from a larger NHS pot that provides the level of care that befits a civilised state.

'This is everyone's fight, from doctors to patients and the public as taxpayers, to challenge politicians who are irresponsibly trying to squeeze a quart into a pint, while savagely slashing NHS funds under self-proclaimed austerity.'

Readers' comments (19)

  • I've just gone over to where the lifeboats are meant to be stowed and it seems the sensible GPs have already taken them all.

    So seeing as we're all going down with the good ship NHS who's coming to the bar to see what's left?

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  • Mr Mephisto

    The Northern Ireland Assembly seems to find plenty of money “down the back of the sofa” to bail out secondary care but give nothing to Primary Care (which is on the point of sinking). One sibling is plied with cash and resources whilst the other is starving and neglected. There are now 50% more hospital consultants than GPs in Northern Ireland (1000 GPs vs 1500 consultants) – that can’t make sense in anyone’s world. One sibling bloated, unfit and on the point of having a major cardiovascular event (stroke or heart attack) whilst the other sibling is rummaging through the garbage trying to find scraps to live off. One sibling is treated with kid gloves like a spoilt brat whilst the other is beaten regularly by politicians and the press. I think some form of re-balancing is needed here. Both siblings need to be treated equitably. In this case I’m all for stopping stuffing Peter and giving Paul something to live on.

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  • Dear All,
    Nice to see Chaand adopting my "toxic" descriptor. The NHS is now a toxic environment for GPs; overworked, over regulated, over criticised and financially penalised for performing better than anticipated against a contract signed off by Government.
    Everywhere in life the slightest criticism is rejected as bullying but not for GPs, the only protection we are offered is the GMC expecting us to become resilient.
    Well done Chaand, keep shouting that message.
    Paul C

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  • GPs should never have agreed to a block contract.

    It is easy to cut hospital services and expect primary care to pick this up with no extra resources. Not only that, but also to be judged by the public, media, politicians, CQC and Ombudsman as not performing despite zero resources to do the work.

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  • It is funny how commissioners trust us with the clinical dump/transfer of care, workload and liability yet seem pathologically unable to trust us with the money unless it is tied to bureaucratic KPIs and targets.

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  • given that there is no money or funding - what is the solution ?

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  • This comment has been removed by the moderator.

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  • Mr Mephisto

    The current policy of giving all the money to Secondary Care and giving all the work to Primary Care has obviously failed. Ploughing all your cash into Secondary Care obviously doesn’t work. We need a fundamental re-set of the entire system and we need it now. Hopefully the Northern Ireland Assembly politicians will have the sense to adopt Professor Bengoas recommendations when they are announced next week. If they don’t then our health care system in NI is bankrupt.

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  • Well said Chaand.
    Transferring secondary care to primary care is good. But it should come with funding.
    Patients are given the opportunity to complain directly to NHS complaints when we dont give medication that is costly. When we get these kind of complaints no one to support GPs . In addition to day to day workload we are spending all our lifetime contacting MDU and spending responds to these patients. When we are bombarded with workload without proportionate funding can we sue NHS/England?

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  • "ice berg on a cliff edge"? Presumably a climate change phenomenon....

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  • 'given that there is no money or funding - what is the solution ?'

    Drop the communist presumpton that all have to be 'equal'.
    Allow top up payments and co-payments like in the rest of Europe.

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  • Yet again the tired old Geldof solution to all woes: "Gives us your money!". How much do you want Chand?Have you costed it? Any idea how many billions we have already had? The NHS is awash with money, but most is soaked up on staff costs and the rest is squandered in a highly inefficient manner.I speak with battle-scarred experience as a GP Lead on Finance at a CCG.
    The problem is the concept of an amorphous, unresponsive and unaccountable nationalised organisation, not how it is funded.Throwing money at it has not helped in the past.
    If the end is providing a reasonable standard of public health funded by central taxation, we should go right back to the drawing board and review how we construct the means to achieving that end.Bankrolling the status quo is not the answer.

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  • Wake up, take a step back and let's be objective ……there will never be a glass big enough for the water pouring in and overflowing. This is the ‘me, me, me, now, now, now’ generation not the 'sorry to trouble you doc, would you mind' early days of the NHS. Either we cut demand dramatically and stop medicalisng non-medical conditions, or fund it adequately with massive (unaffordable) tax increases or a private insurance scheme partly based on peoples choices, and responsibility and accountability – of which there is zero currently. There needs to be a blunt and honest debate that is being hindered by the NHS holy cow.

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  • Toxic words but - no toxic or otherwise any action from this man.

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  • I am very sorry to read the posts of my fellow colleagues - your concerns are palpable.

    Anyone who has spent time in GP, knows how hard it has become now. As GPs, we've given from the very beginning and continued to give in very difficult circumstances.

    This situation cannot be sustained. The country, its people and the dedicated professionals within the NHS deserve better. That will only happen when we start to think and change.

    I have drawn up a list of things to do that may help. Please feel free to add to this:-

    1) Take the NHS out of the current method of administration. Consider a cross party organisation to safeguard it.

    2) Appoint a health secretary who, by definition of his/her role, must have significant healthcare experience.

    3) Ensure people, especially in the roles above, have no vested interests.

    4) Educate patients regarding the cost of healthcare and how it is funded.

    5) Consider ways of tackling the inappropriate use of NHS resources.

    6) Value General Practice. We, as GPs, are dedicated professionals, whose breadth of knowledge spans many areas.

    7) Take a fresh look at funding and the allocation of money.

    We need to have these discussions. I have always thought British General Practice is something "extra special". I would like to think that I am not alone on this.

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  • The situation is unsustainable as we as GPs just simply work harder.

    Consultants do not see more than their number in a clinic and do not do extra clinics unless paid.

    We should reduce our capacity in line with reduced funding ie offer less appointments, take time out of clinics to do admin, CQC appraisal etc

    And ask patients to go to AE instead. We have been keeping working harder to keep NHS costs down but hospitals and trust generate more work and income and hence keep getting more funding.

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  • So many Consultants are struggling too. [A+E and other consultants in N Ireland do those frightening 80 hour weekends with 3/4 hours sleep] Chopping their legs off is not the answer.Co- payments maybe.

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  • Anonymous | Salaried GP22 Jun 2016 7:43pm:
    "4) Educate patients regarding the cost of healthcare and how it is funded."

    One way to "educate" is to charge a proportionate co-pay.

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