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Gold, incentives and meh

GPs declare rescue package 'inadequate' and vote in favour of industrial action

GPs will be canvassed on their willingness to sign undated resignations and take industrial action following a passionate debate at the LMCs conference this morning.

GP leaders at the LMCs Conference today voted in favour of a motion that said that they ‘not accept the General Practice Forward View is an adequate response’ to the crisis in general practice, and ’considers it to be sufficient grounds for a trade dispute’.

The motion, proposed by Dr Jackie Applebee, from Tower Hamlets LMC, follows the call for mass resignations in January, which gave NHS England six months to provide a rescue package.

GPC chair Dr Chaand Nagpaul said the motion was about a ‘democratic process’ to see where GPs stand.

Delegates had said that there was not sufficient urgency in the General Practice Forward View, while speakers warned it had failed by not committing any money to core GP funding.

Dr Applebee asked: ’Are we going to accept the demise of general practice? If not now, when? Will there be a general practice to defend if we wait much longer?

’The Government can always find money if the will is there, but is the will there? We have to remember that this is a Government determined to drive through austerity. [Dr Nagpaul] very rightly said yesterday that we must hold NHS England to account, but how?

’They may have belatedly begun to listen but the GP Forward View does not throw the lifeline that practices need right here right now.’

This vote is the profession’s most robust response over whether the General Practice Forward View is adequate as a rescue package.

GPC chair Dr Chaand Nagpaul said yesterday that the number of people leaving general practice suggested that mass resignation is ‘an impending reality, and not a threat’.

Speaking on the motion today, he said: ’The GPC are servants of the democratic process and that democratic process means representing 35,000-40,000 GPs, most of whom are not here today. 

’So for me this motion is about that democratic process. It is about actually asking GPs where they stand. I think we know where they stand, we know exactly what they are experiencing, but it is about actually for the first time getting a real idea of what they want us to do, and what they are prepared to do.

He added that this ’isn’t about threat. He went on: ’I think what is important is that people are leaving, and my proudest moment was, like many others have said, becoming a GP… and then I am sitting here and I am actually worried whether my practice is coping today. And I think many of you here today are worried about whether your practice is coping today.

’I’m worried about looking at my emails. I worry about the two weeks of holiday I would like to take this summer. That is the reality and I think that it is right that we find out from the profession their intent and the reality that is unfolding before us.’

Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee, called on GPs to vote against the motion, saying junior doctors showed the level of support needed to make a stand - which GPs were unlikely to match. 

He said: ’What is the juniors’ greatest strength? It is unity. What would be our greatest mistake? To expose disunity. And that is exactly what a call for industrial action at this time would do. I’m sorry conference but we will not get anywhere near that magical 98% - and that will look like a defeat before we have even started.’

In January, the Special LMC Conference voted overwhelmingly to carry a motion proposing that ‘the GPC should canvass GPs on their willingness to submit undated resignations’ unless ’negotiations with government for a rescue package for general practice’ are ’concluded successfully within six months’.

Motions in full

AGENDA COMMITTEE to be proposed by Tower Hamlets: That conference does not accept the General Practice Forward View is an adequate response to the GPCs statement of need within the BMAs Urgent Prescription for General Practice, and considering this to be sufficient grounds for a trade dispute, unless the government agrees to accept the Urgent Prescription within 3 months of this conference, the GPC should ask the BMA to:

(i) ballot the profession on their willingness to sign undated resignations CARRIED

(ii) ballot the profession on their willingness to take industrial action CARRIED

(iii) ballot the profession as to what forms of industrial action they are prepared to take CARRIED 

(iv) produce a report to practices on the options for taking industrial action that doesn’t breach their contracts CARRIED

 

AGENDA COMMITTEE to be proposed by Cambridgeshire: That conference with regards to the General Practice Forward View;

(i) Welcomes the acknowledgment of significant past underfunding and commitment to increased spending CARRIED

(ii) believes that most of the investment promised is conditional upon practices delivering transformation and service change CARRIED

(iii) recognises that only some of the demands of the profession have been included, and instructs GPC to continue to press for further dedicated resources to support GPs CARRIED

(iv) does not believe that there is sufficient urgency in the measures described CARRIED

(v) is concerned that the present financial state of the NHS makes the prospects of these financial flows unlikely CARRIED

 

 

Readers' comments (87)

  • Where is the ballot paper? Bring it on

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  • What we are facing is intolerable cruelty from NHSE and we should quit before we have mass suicide in our ranks.

    Its very sad while GP Partners are facing bankruptcy, NHSE Officials are busy lining up their next jobs with siphoning of monies from the trusts, CCG`s and Hospitals.

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  • Took Early Retirement

    At least five years too late. Mind you, I can't complain. I'm out of it thanks to the last few years of inaction by the GPC and I never realized how good it could be to NOT be practicing Medicine in the UK.

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  • 10.45 totally agree. Joining you in getting out of this nightmare of general practice. There is no money coming until 2021 with conditions. Until and unless workload is addressed and made reasonable safe and appropriate General Practice is going down the pan.
    why wait 3months to vote. Stop faffing about and send out papers after this conference.

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  • Motion carried btw...watch the space now.

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  • Have the junior doctors inspired us into action?

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  • Good start but yet more faffing. Why wait 3 months? Ballot now and start the process. Also who wants more money? Most want less workload, please address that not the funding. No point paying partners more when they still can't recruit others to work for them.

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  • Ivan Benett

    Resignation will play straight into the Tory Privateers....which is may be what you want, but the public wont accept it.
    We have been here before, and we ended up shooting ourselves in the foot.
    Of course we need change, but that is happening (not quick enough I here you say). Anyway, good luck

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  • Finally

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  • Dr Bennet, what's more important? survival of GP or whether public wont accept end of free NHS culture? . It does not matter who pays for my service. All that matters is we provide good service and get paid appropriately for that service. If this country cannot afford to pay GP/hospital for service at market rates then public will have to part fund it whether they like it or not.Then only unreasonable demands will go down.
    NHS has lost goodwill of GPs/ hospital doctors. Don't expect us to go beyond call of duty to serve NHS and sacrifice our mental and physical health.

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  • Bring it on.

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  • The GPC and its Cardie members just don't have the balls!

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  • Empty words...

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  • Thle likes of Bennett are profiteering form various income sources due to connections. Once the 'dreaded privatization' occurs they'll be left in the level playfield which many cardigans from CCGs and LMCs will find hard to digest. That is the main problem people see with a GP ballot which will be carried through if it happens. And it will now dear cardigans so gear up for austerity - it's your turn!

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  • If this ballot does happen we will finally know the percentage of cardigans. You cant blast what you cant see.

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  • Bob Hodges

    I don't think it has anything to do with 'balls'. My problem is that is smacks of 'something must be don, so let's do this'.

    I'm all for effective industrial action, and I'll lead the charge like a Viking Beserker if so, I'm just not sure this is it.

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  • No you can't, but you can see those glib talkers at local meetings who support everything that will allow them personally to benefit from funding - King's or PMs or any other grubby penny they can lay their greedy hands on. These are the identifiable cardigans who are blocking any protests.

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  • What is the opposite of a cardigan? I don't know what to wear to express my support for ballot. Jeans on Fridays? Hoodies? Moustache?

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  • I'm not sure where this "privatisation" scare comes from. The fact of the matter is the demand will still be there and the population simply will be unlikely to accept a 111 style service or a nurse led service to replace the entirety of primary care.

    A private company doesn't make enough money out of general practice which is why the inroads made by Virgin et al are so low at present. It is simply too lean to make a profit from for most. If the govt decides to fatten the pot, then this problem would be solved without private involvement automatically.

    Unfettered free market privatisation is also never a bad thing for doctors, in view of the current supply and demand paradigm. Even in countries of oversupply, doctors make a respectable earning.

    So we need to stop worrying about what will happen if we mass resign and focus on changing the very poor conditions which is leading so many to retire, locum or emigrate, and so few to enter the profession.

    I find those who shout "beware privatisation" seems to have missed the point - that holding on as it is, is not longer an option.

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  • will locums and salaried gps be included ?

    if so where do i sign ?

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  • i think what Ivan is trying to say is that it will mean the end of the NHS as it can't exist without doctors?

    i beg to differ - even war zones have state healthcare - all that will happen is that there will be a smaller state health system (NHS lite) and a network of independent private GPs with funding streams from the consumer not the state. The laws of supply and demand will then take place i.e. market rates will apply. this will lead to greater funding for primary care and better services for patients.

    GPs who wish to work for the state can - but those who don't can work independently.

    this is a much better plan than poorly funded super-practices run by a few GPs managing support staff.

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  • 'all that will happen is that there will be a smaller state health system (NHS lite) and a network of independent private GPs with funding streams from the consumer not the state. The laws of supply and demand will then take place i.e. market rates will apply. this will lead to greater funding for primary care and better services for patients.'

    But surely what this will do is encourage doctors to work in the South East leafy suburbs where there are plenty who will pay for the service, and the poor run down areas in the North, where need is often the greatest, will be even more under doctored.
    I suppose I should be grateful that I am of an age where I could just walk away but I love my job and will always go the extra mile for my patients. Not a member of the BMA so of course my views are irrelevant anyway.

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  • Privatisation of Primary Care? Its already private.

    Its already run by thousands of independent partnerships, with almost all their income from government contracts.

    How can you fear privatisation of something that is already private?

    The problem for the government is time and again the GMS model of most practices is shown to be the most cost effective model. GMs and PMS are being brought into line and will leave the APMS contracts out on their own as the most expensive. Companies are handing back their contracts as unprofitable so if GP partnerships vote to resign you don't need a 90% vote. 10% would collapse the system!

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  • Every country needs healthcare. Healthcare costs money. A tax funded healthcare system like the NHS is a highly efficient way of providing this. If we move to a privately funded healthcare system it will cost the country as a whole a lot more cash and the service will be far less evenly distributed. Look at the USA. The rich will get what they want and everyone else - and that means most people - will be worse off and will have a lifetime of health related worry to deal with. As a country we need to be honest about how we want to fund our nations health care, we need politicians with the guts to explain why an efficient health care system is a good idea for the country as a whole and we need to be prepared to pay for it. The NHS is struggling because politicians lie about what the country can actually afford and massively underfund their hyperbole election promises. If we resign and go private that's bad news for the UK. It is perhaps what this conservative government wants but the privatisation of healthcare is good for no one but business. A privatised service will still need Drs and will pay for them. I'm a Dr so I might myopically conclude I'll be ok then, but one day I'll retire and be old, no-one else in my family is a Dr, my children won't be, my wife isn't, most of my friends aren't, we'll all be screwed by a privatised healthcare system. Maybe we need to threaten to resign to get the government to do something - but our aim should be to preserve our NHS - it's a great thing but it needs adequate and honest funding. Not the current Hunt bull.

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  • ?why wait : send the ballot paper now!
    we are a good 6500 patients practice and have not been able to recruit(no interest after 2 adverts) and one partner is leaving end sept,another partner going half time : I am mid 60 and I will throw in the towel as well

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  • With all the talk of the failings of GP forward view, I would like to know the position of the devolved health departments outside England, as far as I see it, at least you guys got something promised, it may not be great but it is a way lot more than is coming our way in Northern Ireland so far! Once again this is the National Health service that we are looking at, this includes more than just England, here we have been promised pharmacists to help out with our workload, no sign of more money or doctors though! 25 % of our GP workforce locally will be gone within 12 months in our county alone through retirement etc and still there is silence from local government

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  • @3:07- you have an important point there but tell this to the Eton boys and the political whores who are only interested in prospective top positions in private healthcare giants once they have liquidated the NHS. They give a sh*** to the fate of ordinary working people.

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  • Peter Mcevedy | GP Partner20 May 2016 1:55pm

    'the poor run down areas in the North, where need is often the greatest, will be even more under doctored'

    I work in the north as a locum and there is already very low staff numbers and we basically fire-fight each day. given that demand is set to increase with no new funding and no new staffing - things are set to get worse. there are, however, some affluent areas within the poorer areas - even in middlesbrough and Sunderland which could support small independent practices.

    My experience is that the poorest patients actually tend to be be the least demanding. It's the middles class and wealthy folks who feel because they pay in their £75 a year for primary care services then they want everything done now and perfectly.

    for example - i have a patient from a poor area who has knee pain with severe OA and has finally agreed to see Ortho to get it sorted and i have another patient at another site (middle class) who wants a referral even though there is nothing on the xray or no abnormality on examination or from physio assessment.

    moving to a part state and private system will mean that my poor (no disrespect) patient will get care and my worried well (middle class and wealthy) will have to pay for it.

    it's better than what we have now?

    so the worried well and heart sinks are catered for and the actually sick and needy will also be seen.

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  • Rather than the nuclear resign option could we gradually escalate to Def Con 1 ?
    1) no appraisal revalidation
    2) No CQC co-operation.
    3) No OOH work.
    Then if previous rungs in the ladder have had mass support-push the big red button.
    Yours sincerely Dr Strangelove.

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  • NHSE have produced a very nice glossy magazine - how much did that cost? the remedy is very simple for general practice. Relieve the bureaucratic and regulatory burden , simplify our pay structure and stop moving goal posts so we have time to provide proper care of patients which frankly is quite hard work and stressful in itself without all the other c..p!

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  • Dear Dr strangelove, ---YEE-HAH !

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  • Well done - get on and vote . I've left and it's the best thing I've ever done. Gp crisis is real and getting worse

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  • There is of course the third dimension - Private Health Insurance for ALL - Look how providing a Workplace Pension has become commonplace in recent times, why wouldn't paying £10 a month towards seeing a doctor, based on an individuals income level become commonplace with protections for Universal Credit recipients? It's a direction of travel that I see happening. It might not be a bad thing either, it would stop all this unnecessary visits to A+E and wasted medical practitioner time, it might even see a massive hike in GP incomes - the NHS is unsustainable in its present form - AND WE ALL KNOW IT - So don't be too quick to start being a member of the Sheep Flock - THINK - Good GPs could become scarce - premium incomes could well come out of the present NHS re-organisations - I certainly won't be playing any trade union games!!!

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  • What will the government do with our resignations?
    - hand our practices to local hospital trusts and management companies to run
    - import GPs from Europe and S Asia.
    They'll be gearing up for this now.
    In three months from now their plans will be well ahead.

    What other sanctions do we have, that will not incur loss of patients' sympathies, nor put patients in danger, nor put us at risk of misconduct claims?

    - resignations from CCGs - Probably ineffective as those on CCG committees have more to gain by compliance with government policy.

    - mass resignation from referral management schemes. Worth polling on this one.

    - mass refusal to pay GMC subscriptions? - difficult for BMA to implement - perhaps the money could be sent to BMA to transfer to GMC when it thinks appropriate.

    - mass refusal to pay CQC fees? - as above.

    - mass refusal to make referrals from one consultant to another. - BMA to ask for agreement to this policy.

    - mass refusal to prescribe medicines when effects/side effects are monitored by others - eg warfarin, methotrexate. BMA to ask for agreement for this policy.

    - Safety first policy - investigation and referral on minimal pretext. non-compliance with hospital efforts to offload follow-up to GP. BMA to ask for agreement for this policy.

    - Use of trademarked medicines on minimal pretext. Ineffective as government will instruct pharmacists to do generic substitutions.

    Let's keep thinking.

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  • The idea from the anonymous doctor of mass non-compliance with appraisal and revalidation in its current form was good too - but it won't have HMG quaking.

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  • -mass refusal to do death cert and crem forms. worked in Auz 10 y ago.
    - non payment of CQC is my favorite. they are useless and irrelevant, and can continue out of their own good will (doubt they have any)
    - mass refusal to do any work for one week only- will have massive repercussions making final effect monumental. will bring any government down whatever patients sympathies are.

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  • Common just ditch the country comrades. You are not respected in UK and never will be!

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  • bottom line is we need to think ahead and look at what our options are if we walk out and start developing alternative models of independent healthcare.

    agree a first step should be non-compliance with cqc, qof, unpaid work, re-validation etc

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  • Were not respected in the UK, patients and NHSE bully us to do their bidding through verbal abuse complains GMC and forcing unsafe rates of consultation.
    Not sure this will ever change.
    rather than all out strike stop the admin CQC stuff as above and just limit to 30 patient contacts per day citing safety concerns to see more - permenantly.

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  • Vinci Ho

    First of all one should remember :-Doing the 'right' thing is not the same as doing the righteous thing in the right time of history at the right place .
    And one should not predict or wish to predict the so called outcome(s).After all these years ,NHS with GP as a gatekeeper is a deterministic , dynamic system which is fully determined by initial conditions, with no random elements involved. But small changes in these initial conditions can lead to far-reaching but unpredictable outcomes . Remember what do we call these effects in Chaos Theory?
    Indeed , it is exactly the unpredictability one should be playing for in ,an once in a life time ,extraordinary space/time right where we are.
    A non-cooperation campaign should consist of a series of action. This ballot is only one of them. People already mentioned no OOH , absolute refusal to pay CQC fee, my naive advocation of walkout of all GP commissioners etc . It is not about being right or wrong . Rather it is all about creating wave after wave of unpredictabilities and uncertainties
    matching up with other colleagues' actions in NHS on this bunch of politicians.Yes, it is a gamble ,some people have clandestine agenda and unity is questionable . But the war is already lost when one has started to calculate concerns.
    GPC will have to explain and justify to the public and media why certain action is to be taken but more importantly , it should concentrate on how to create this tsunami of unpredictably/uncertainty on this government . The fact the PM had to concede to back an amendment to TTIP for protection of NHS , demonstrates certain 'outcome' will only happen in certain time under certain 'initial conditions'........

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  • I totally agree with Dr Glasspool. Thank God I got out when I did. (2011). I know , from my 32 in practice, through Mrs. Thacher, Tony Blair, and David Cameron, that GPs will never resign. Their's is a " fair accomplish". So, no point in making threats.
    Also, GPs should consider " do we want to be like Greece"? So, forego a little, to maintain the status quo.
    Retired GP.

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  • Bit frustrating really. We threatened mass resignations 6 months ago if we didn't get a rescue package. 6 months on we're still full of hot air and finding excuses to delay our threat. We needed action 6 months ago. This is another frustrating delay. The government know we will never do this. Which is why we have no hope and general practice is doomed. I'm tired of all talk not action

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  • Dr Andrew Green is right, the ballot will expose the fact that most GPS will not take action or resign. Partners dare not risk their homes and savings. Most new GPs are soft fluffy smiley women, not the fighting type.

    You have now called your own bluff, you will expose just how weak you are, and increase the rate you are trampled on. Well done! :(

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  • A bit of realism is required.
    Any increase in funding going to "primary care" will be siphoned off by the black holes aka acute trusts that are in deficit. There is NO MONIES coming to general practice.
    The only argument that will wash with the public is safety. ....but do they care.
    No it's a free service that is abused by everyone not just patients. More stuff is going to be dumped our way with no attached resources.
    I am getting out and changing career aged 43

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  • I see my children awake only 3 days out of 7, I drive a £8,000 car, I live in a terraced house next door to families who don't work and scream daily, I'm overwhelmed in debt accumulated in university education, I am abused daily by patients, get snotty comments from hospital doctors, midwives, health visitors, cpn's. I don't even get a lunch or coffee break.
    I'm sick of waiting for things to improve. I'm not the only one.
    Nobody respects us, I have a worse lifestyle than if I stayed home and developed a drug habit.
    Resignation, bankruptcy, redundancy payments, it can't be worse than the miserable existence I live now. I cry daily I ended up being a GP and am ashamed to say what I do for a living when asked.
    FFS stop messing around BMA get us a decent deal or get us out of this dreadful contract.

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  • 9:28am - don't count on the BMA to do anything. When your life is shit you have to help yourself. Ditch the country!

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  • Just get out of this disaster. The politicians abuse the nhs and everyone working in it.
    Time to leave and i have decided to do so at 41.

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  • http://support4doctors.org/detail.php/57/careers-advice-alternative-careers?category_id=13&subcategory_id=481

    worth reading

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  • I'm with Dr Strangelove on this one.

    The problem for many of us is that we own our premises and have mortgages to pay and we are simply not going to put in undated resignation letters - the govt know we wouldn't follow it through.

    However, not co-operating with CQC would be just fine, so long as everyone did it (but again, mortgages to pay).

    Refusal to do OOH work would bring the citadel crashing down PDQ, and overwhelm A+E departments who are already overwhelmed, but it seems like the govt only take notice of hospitals missing targets because that's what gets the press involved.

    Revalidation/appraisal refusal would also be just fine but only if everyone did it - and the problem with this and CQC non-co-operation would be that the first few risk losing their livelihoods over it.

    I do think there is a strong case to be made for not doing OOH work, and it would end up in private companies being asked to step in, who would have to pay a market rate and even then wouldn't be able to fill the shifts.

    Ultimately though, we can't do anything that would directly harm our patients, and sadly we can't afford to inconvenience them too much, or they will come banging on our doors and make all our staff so miserable they will leave and then the whole lot falls apart.

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  • at least everyone agrees that something should be done ?

    the next step is deciding what should be done i.e. what are the options ;

    1. do nothing - no longer not acceptable
    2. work to contract
    3. disengagement with CQC, revalidation and unpaid work
    4. mass walk out
    5. others - add to list

    with option 4 we need to know what will happen if we walk out - i.e. can we just transfer to be private GPs ?

    this is a bit like brexit or GPexit !

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