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GPs face long wait until retirement as review omits them from age-related 'risk' list

GPs face working late into their sixties before qualifying for an NHS pension after a major review excluded the profession from a list of ‘at risk’ jobs that were difficult to do later on in life.

Preliminary findings from the Working Longer Review group - which includes representation from the BMA - said that it had identified dentists, surgeons and midwives as groups who would struggle to carry on in their jobs if retirement ages were raised over 60 years. But not GPs.

The GPC criticised the omission of GPs from the list of ‘at risk’ professions, saying there is a lack of understanding of how strenuous working as a GP is.

The Working Longer Review group has been considering ‘how NHS staff will continue to provide excellent and compassionate care when
they are working longer’ and was a last-ditch attempt to block chancellor George Osborne’s plans to increase the retirement age to 65 years by 2015, and subsequently 68 years by 2046.

Last year, the BMA said it hoped the Working Longer Review - a group of trade unions, NHS Employers and the Department of Health - would decide that those with physically or mentally demanding jobs could have their retirement age capped earlier.

But a review of evidence from University of Bath researchers - published last year - that found NHS workers were capable of working longer when reporting to the Government last year.

This new evidence is a further blow, omitted GPs from the list of ‘at risk’ professions. The list included nurses, midwives, porters, paramedics, catering and estates staff, surgeons, mental health practitioners, radiographers, community health workers, physiotherapists and dentists.

According to the review group’s evidence call from NHS staff, there was ‘a very high level of concern about their physical and psychological capability to undertake their NHS duties for a longer period of time’.

The report stated: ‘The fear of burnout and the cumulative impact of very physically demanding jobs are cited by most as the reason why they think working longer will pose a problem to safe and effective service delivery and excellent patient care in the future… The following areas of risk were identified…’

Despite a ‘day of action’ in June 2012, the BMA has all but conceded that GPs will have to continue paying up to 14.5% pensions contributions after the Pensions Act is enshrined in law.

GPC deputy chair Dr Richard Vautrey said he was disappointed in the findings. He said: ‘Yes we had hoped to be treated in line with other doctors, particularly those who are in stressful situations. Large numbers of GPs are looking to retire and we struggle to retain doctors. Pensions are one of the issues that are driving GPs away and that needs to be recognised by Government or they will face a crisis of recruitment and retention. They need to actually deal with that urgently.’

‘GPs do all of those jobs, essentially, so I think that the fact that GPs aren’t on that list is quite odd. There is a lack of understanding of what is involved in general practice and the pressures on GPs, but it is all too obvious when you look at the numbers who are looking at retiring as soon as possible.’

‘You are almost running a marathon in general practice every day just to keep on top of the workload, do ten-minute consultations, repeatedly dealing with emergency situations. You need to be mentally and physically fit to cope with that.’

 

Readers' comments (51)

  • "The list included nurses, midwives, porters, paramedics, catering and estates staff, surgeons, mental health practitioners, radiographers, community health workers, physiotherapists and dentists."

    So we are to believe we have less "physical and psychological" stress as GPs then catering staff, porters and estate staff?

    If GPC/BMA has any interest in representing the GPs, they should mount a legal challenege to this non erected "Working Longer Review group" to ask for proof this is the case. But I know they won't as BMA really has no interest in protcting the primary care.

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  • Teeth are very heavy, they must be heavier than a ring pessary. Teeth are very difficult to extract, more difficult than a ring pessary in an 80 years old atrophic vagina.

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  • As a GP I would say that 25% is exclusively mental health related and the rest often has a big mental health component.

    Every ten minutes we see another patient with a different problem and have to shift gear to find solutions to diverse problems. Often one treatment worsens another condition. We have to consider so many different things. General Practice is incredibly stressful. You often take on the patient's burden.

    I have a pension forecast for me to retire at 55. I may even go earlier if the stress gets any worse.

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  • This report will not stop the exodus or the recruitment crisis.

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  • Divide and rule,quite simple. Silence for the response, there won't be one, because for the majority of new GP's part time work will not be considered high risk.

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  • Vinci Ho

    See , this is devious.
    By not including us into the risk , it has a metaphorical meaning that GPs were lazy bas***d and hence they could work longer than 60 years old to repay what they had 'owed' the service.
    If you do not know think this is insulting , you are a 'saint' .......

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  • Sorry to be the diagreeing voice here, but almost all the doctors I know, whether hospital or practice based, work part time anyway.

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  • We should be allowed to retire at 60 because by then we have worked as many hours as someone working to 85 with normal "office " hours .

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  • Bob Hodges

    Stop contributing to the NHS pension then!!

    It's called 'form SD502'

    It's now just a VERY expensive life insurance policy - 2 years death in service equivalent life cover costs buttins compared with a couple of grand per month contribution to the NHS Ponzi scheme.

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  • Took Early Retirement

    Even better Bob, go early like Mrs G and I are.

    Actually this shows how tish-scared (anag) the Vermin (aka HMG) are: they want all the existing GPs to go on to 70 as they KNOW they are in a massive workforce crisis which can only be solved by importing lots of GPs from Romania.
    John (Formerly CW on DNUK, years ago)

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  • At this rate I don't think I'll make it to 60. Best to leave now with an intact brain .

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  • HMG can TAFF AT ARD ; A lovely American expression translated as Take A flying F''' at A Rolling Doughnut. Rather graphic .

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  • Good to know the BMA will always fight our corner with a spineless softyl worded when required, I may be working until I keel over during morning surgery but at least I will not be wasting any more on subscriptions to a toothless trade union.

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  • Excuse omissions above.
    Softly worded criticism when required.
    Subscription not subscriptions.

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  • Agree with bob nhs pension scheme no longer fit for purpose,I have left the scheme and my partner in his 40s about to leave at end of month as worked out £1800 of pension now costs £47000 in contributions and tax a year!!! You all need to get out of this scheme now

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  • Una Coales

    Pensions are exempt from contractual law. Remember this. Terms may change at government's whim.

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  • Tom Caldwell

    So in short work until you drop then they don't have to give us any pension

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  • Isn't this all getting a bit silly now? 68 is unrealistic, I'm just trying to imagine it now but I can't quite envisage practicing safely. Surely it's time to leave the NHS for greener pastures before these proposals get even more absurd?

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  • Lazy lazy nhs gp's, always bleeding. Just leave the nhs or take the abuse. Simple. - private GP with a private pension!

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  • Time for us all to leave the nhs and work as truly independent providers on a fee for service basis. I am beyond caring whether this is worse for patients. You reap what you sow - daily mail etc. Time to look after ourselves as noone else will

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  • From BBC news re a&e abuse:

    Healthwatch England chairwoman Anna Bradley said: "A&E has become NHS Express. The problem is it was never designed to be a catch-all service and nor should it be allowed to become one.

    "But blaming people for going to the 'wrong place' when we need care and support is the wrong way of looking at the problem.

    "I'm not absolving us of our responsibility not to clog A&E whenever we get the sniffles, but until the health and care sector offers a more consumer-friendly experience, things are unlikely to improve."

    Katherine Murphy, of the Patients Association, agreed.

    She said: "The NHS drastically needs to improve the out-of-hours care to ensure patients in acute emergencies are able to receive the high quality of care that A&E departments provide.

    "Until then people will turn up at A&E in desperation with everyday medical problems. "

    .... These people have no clue! They are getting a free service... If they want consumer friendly maybe they'd like to fund that!!!!! I can't take any more of this crap. I'm looking at a career change. I'm burning out

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  • I was duty doctor yesterday and there were 91 'Emergency' calls from patients yesterday that I alone fielded, on top of some routine appointments, with 30 more shared amongst my colleagues.

    I spent until after 8pm, when surgery closes at 6.30pm dealing with all the calls to ensure no-one was left uncared for. This was non stop 12hrs of care, no time for lunch, driving between visits was my only break from patient contact.

    I am in my 30's but can not imagine I could continue with this workload in my 50's, let alone 60's.

    Due to holiday cover, I have the joy of being on call again today.

    I planned for added years to my pension so I could retire at 55, now with 'Enforced Changes' (Thanks BMA) I reckon I like many others may never live to see a pension - 'Win Win' for the DOH, and extra taxes for my entire career go to paying off the national debt.

    Why continue??????

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  • Yep, it's tough.
    I've been full time all my GP career and approaching 50 soon.
    I've had 2 meetings with my financial adviser and will get out of the pension scheme at 52 yrs 9 months which is when I switch to the new scheme. After this I would get the arse taxed off me but until that point and with 8 added years (4 years as a locum and abroad mixed in) I have managed to preserve a decent pension deferred to 60.
    Then I will get a massive monthly saving to try and get another lump sum in another scheme if I ever get to 60.
    But how and in what form will we be working until then?
    God only knows.

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  • 'I am in my 30's'
    Get out, do something else.
    I am really pissed with my self that I didn't get out in 2004 but the new contract gave us some hope that the GPs would be treated as professionals and our income recovered to a level where it was appropriate for the 50 hours + most of us were doing BUT the threats of QoF and the contract are now bearing fruit and the 'gains,' which were, actually levelling out, recognising the poor position of the profession are now all pruned back through the lack of investment. I have warned of too many patients, too few Drs too many hours leading to quality GPs burning out - it's real and >65yrs doing the same LMFAO- coffins or GMC and no pension claimed, taxman happy!

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  • To the editor -

    Will you be asking the BMA what they will do about this? I'd be very interested on their explanation

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  • Took Early Retirement

    The BMA is busy keeping its powder dry

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  • but seriously - is anyone surprised?

    can we now start debating about alternative models e.g. like our dentist colleagues before the profession is totally destroyed?

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  • My GP father collapsed and died of an MI on his visit round many years ago. Due to inability to replace retiring partner two years ago, I have had about three weeks off per year for the last two years. I routinely work 12 hour days and do all my own terminal care. I am not yet 50. I cannot envisage still being capable of doing the job well into my sixties. How come when GPs work far more hours than the EWTD do we class as having less stressful jobs than those within hospital who do abide by the EWTD rules?

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  • Whilst the Working Longer Review may have drawn these conclusions, I suspect for the majority of cases human physiology will simply kick in and large numbers of GPs will end up on some form of incapacity benefit, off with long term sickness or suspended due to medico-legal claims. It is not possible for most people to work full time as a GP until 68 and stay alive.

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  • agree with Anonymous | 04 March 2014 6:48am

    but i don't understand why we can't debate the private GP model?


    here is my 2 cents ...

    it should be possible to have a model of care where there can be a single private GP or a larger private practice with several GPs i.e. scalable.

    Payment can be direct or indirect via insurance schemes and could be for time or activity.

    Ok - we will have to opt for private pensions but if we set ourselves up as limited companies and took advantage of pension tax breaks we may get a better deal?

    The NHS could still exist but with the primary care element (the bit that does 90% of the consultations) private BUT in the hands of doctors i.e. front-line staff who provide the service not big companies?

    any other ideas???

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  • Took Early Retirement

    5.36 pm- you are right: it works in Aus. However there are too many people in the BMA who have a vested interest in the status quo for anything to change till younger doctors get involved and get militant. Or, emigrate!

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  • 6:48am
    Totally agree with you!….. as also do many others grass roots GPs.

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  • Is this not the Liverpool Care Pathway for GPs?

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  • I'm a newly qualified GP. I think it's inevitable that I'll have to work to 68 (or longer if the pension age is increased in the meantime) so I plan to go part time when I'm 50. That's my plan to survive.

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  • Una Coales

    John Glasspool, I am an activist and running for BMA Council and I have no vested interest, do not chair a CCG, own a chain of surgeries or sit on the GPC. I say GPs should work to rule not bend over backwards. At some point, the BMA has to say NO to the government. Is this not another form of constructive dismissal to get GPs to retire and hand over their surgeries?

    The latest news I am hearing is of senior GPs retiring and letting the lease expire, leaving the remaining GPs facing no premise to practice from.

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  • If things are this bad why are we not voting to become salaried employees with contracted hours, contracted duties and contracted rights just like the nurses, surgeons, midwives etc !

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  • Una Coales

    @11:14 pm Familiarise yourself with a new legal term called 'unilateral variation'. This means that an employing GP practice, HMO or APMS may decide to change the terms of the salaried GP contract by ending the current mutually agreed one and asking you to sign a new contract with new less favourable terms. This is legal!

    Also doctors did not go to medical school to end up as salaried GPs on £44/h for an APMS while private GPs may charge £70-£130/consultation, private hospital consultants may charge £240/consultation, lawyers may charge £200/h, and barristers may charge £1000/h.

    And furthermore, there is much higher risk and stress when one salaried GP is also responsible for prescription signing of all the nurse practitioners whilst trying to see pts at 10 minute intervals, 5 minute phone consultations and email consultations on the horizon.

    Most would opt to be a portfolio locum GP, retire early, transition to private GP land or emigrate.

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  • I hope you succeed Una - we need someone who has the guts to draw a line in the sand, now.

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  • I agree... Una you are the first potential BMA council member who has spoken spoken with any sense of the reality of our working lives. We need to openly debate the option of leaving the NHS, taking on salaried roles or continuing with the constant change cycles that we have now.

    I sincerely hope you are elected as the BMA is desperately in need of a backbone!

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  • Una Coales | 05 March 2014 6:57am

    I wish you the best of luck as you are the only pro-doctor potential leader we seem to have but a lot of disgruntled grassroot docs like myself have torn up our BMA membership and have no say and I fear that colleagues who are BMA members are going to vote for the same old faces.

    I agree with you re: salaried posts and would add why would anyone run up a student debt of upto £250,000 and do an inherently expensive (defence fees + pension) and risky job (high risk of failing training and being struck off) for what would be the equivalent of a civil service job (net pay after defence fees and pension of 40k a year) with non-secure terms and conditions whilst their employing company (virgin etc) gets the profits. i.e. we take all the risks and get all the downsides but are not entitled to the benefits.

    It is such a shame that a once proud profession has been allowed to sink in the gutter because of a failure of credible leadership by the RCGP and BMA.

    I think the only option is for a move to private practices (single handed to large scale) run by GPs with direct or indirect (insurance) payments. we would still take the risks and work hard for our patients but without the interference of third parties (DOH, NHS England) and can better manage our workload (control private list size and charges)

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  • Took Early Retirement

    Sadly Una, I too resigned from the BMA ages ago, so cannot vote for you. I have now c 83 days to go before taking my own premature retirement.

    I used to like your postings on DNUK, where I was CW. Are you/were you, working in Luton? Maybe that is a false memory on my part.

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  • Una Coales

    Thanks @8:09, @9:44, @1:21 and John Glasspool aka CW. There are only 2 options left for GPs in the UK, accept secondment into salaried GP federations or venture into the private sector as our NHS consultants based in big cities already do. It will be a painful process as the public are not used to paying to see a GP. They have accepted paying £9k/y for university fees, paying NHS dentists 3 charge bands ranging from £18-£214 and soon will accept paying to see a semiprivate GP or face long waits in the NHS.

    Meanwhile to prevent burnout, I would advocate a work to rule. You cannot take on more than you are humanly capable of. Your job is not worth an early grave. Consider talking to an accountant about weighing up transferring your NHS pension funds into a private SIPP pension so you may cash out at 55 and make sure you are asking for an annual pension statement to see exactly how healthy or not your NHS pension is and that they have credited all your pension payments.

    NHS GP partners have fought a valiant battle to save the best in general practice. I am not sure how much more you can withstand in this prolonged government battle to dissolve GP partnerships and turn into a salaried service.

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  • At the rate GP's are being flogged to death by these crazy new ideas, i have to wonder how many of them will physically fit to work at 60, if indeed they survive that long.

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  • This is a very interesting discussion and perhaps I could put in my two-pennyworth. I am a retired dentist (aged 74 now).
    The problem goes right back to the start of the health service when Aneurin Bevan asserted that: -
    "The collective principle asserts that... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means"
    In Place of Fear, p100
    and notoriously solved the long stand-off with the BMA by "stuffing the doctors mouths with gold"
    He did the same with the dentists with the result that most GPs and dentists accepted the DoH terms because they would be much better off working in the NHS than struggling to make a living from private practice - something that my father did - he was one of about 500 dentists who opted to remain in private practice. The rest joined the NHS and made a much better living than him for at least 15-20 years.
    I worked in practice for 40 years - by the time that I started the NHS had been cut (by a combination of dentists working harder and earning more so that the DoH had to cut the fees to keep the Treasury happy) such that I personally could not earn a living on the terms available then and was lucky enough to take over from my father and maintain a mainly private practice. But as my specialty was paediatric dentistry I did have a pretty large NHS practice of children. Time spent was about 30% NHS 70% private. Income about 15% NHS 85% private. So my private practice was subsidising my NHS practice.
    Over the years dentists (and I suspect doctors) have found ways of working faster and faster and more efficiently with the result that the DoH (pushed by the Treasury) has consistently cut fees to keep pace.
    In my view the standard of care cannot keep up with this feedback mechanism.
    In my honest opinion the standard of care at my local GP surgery does not bear comparison with the care given by all the staff at my old dental practice which is mainly private - children still seen under the NHS (subsidised by the rest of the practice - I suppose that you could call that a "loss leader")
    (to be continued)

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  • I would love to have a local private GP who could afford spend some time with me if and when I needed it. I suspect that quite a large proportion of the population that has gradually been weaned off the "free at the point of care" by dental charges, prescription charges, spectacles, physiotherapy etc etc.
    The trouble is that the population of GB, the politicians and I suspect many of us still agree with Aneurin Bevan that "The collective principle asserts that... no society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means"
    However none of us can agree on what is the definition of a sick person - but if the state is going to fund care for sick people there needs to be a much tighter definition of what a sick person is.
    David Owen made a stab at it many years ago when Minster of Health and knew that the state could not pay for all health care. We have not made great progress since then.
    I loved my time in practice but would have felt like most of you and most of my colleagues who were and are working on DoH terms if I had been working under them.
    Ater all that you have put into your training and careers you need to be masters of your own destiny. Try private practice - you will probably be poorer ( I understand that most private dental practitioners earn less than their NHS colleagues) but you will enjoy your hard working day and want to use your immense skills for many more years - I retired at 72 regretfully - I was still enjoying looking after people.

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  • to 9.12pm Jim

    I am currently working overseas in Australia, as a SHO in GP. I have been here for 2 years now.
    That is exactly what happens in Aus. The system in my opinion is so much better for the patient.
    There are GPs that bill privately, there the patient often has to pay a small fee or 20-30dollars, and medicare (the aus government funded health system) pays the rest of the fee.
    The other GPs get the whole payment from medicare, and no out of pocket for the patient.
    Gps typicall earn 60-70% of the billings from either medicare or privately. Obviously private billings are slightly higher.

    This is better for the public in my opinion, as if the patient comes in and requires >15 min consultation, then you are able to bill higher to medicare, so the government recognise people have complex needs, which seems totally ignored in the NHS. You can bill up to an hour if required, to make management plans etc.
    This allows better patient satisfaction.
    It also allows better doctor satisfaction, in my opinion, it feels less rushed, and like you can spend quality time doing your job properly, instead of having 8 mins to do your job, and paperwork. Paperwork/referal time is included in the billing time.

    It does mean that some times, GPs may be quiet and earn less some days than others, so maybe there is a bigger element of risk, but certainly the take home pay of an average GP would be higher than UK.

    Quite frankly, why did I leave the NHS? overworked and underpaid. I could bearly afford to live and pay off my student loans, so I left. Now I get paid double, do a 40 hour week (that was in ED also!), protected hours are exactly that here, max 40 hours, if you go over, double pay. Double pay at weekends also.

    The NHS needs to realise that until it changes working conditions, people like myself will continue to leave, and there will be nobody left. I know at least 30-40 uk doctors here in Brisbane. Around half the australian work force in my hospital is UK graduates, including consultants.

    I myself now have been offered a place in GP training back in the UK, and I face a dilemma. Do I return because of family reasons, or stay here...The thought of returning is a miserable one with no prospects. It is a shame the NHS has driven so many of us away like that.
    A major change is needed.

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  • JIm Page | 05 March 2014 8:57pm

    Thanks for that insight Jim - I certainly think our Dental colleagues had the right idea - at least they can hold their heads high that they united and did something about their situation. Sadly we have become used to being disappointed. I've lost count at the number of times colleagues write 'this is a line in the sand' etc but our leadership don't do anything substantial.

    I agree with your analysis re: private provision - it will be hard work but we can get on with our job of caring for our patients properly (in resource and in time).

    I admire my Dental colleagues for taking a stand - but have you noticed there is almost never any bad press on dentists but anything that goes wrong in the NHS gets shifted to GPs. I still don't know how in the mid Staffordshire Scandel (hospital care) GPs still managed to get blamed!

    Nevermind in 25 years time I will be retired too if I live that long!

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  • Una Coales

    Thank you Jim and @0:03. I enjoyed reading both your posts. I am trying to show NHS GPs the path back into private practice as was once the case for all GPs before the NHS. While they build up a private list, there will be lean years followed by years of plenty as the public gradually accept that quality medical care costs, just like a quality education and just like in Australia, the government will continue to reimburse health care for the poor or elderly.

    We are in a transition period. I know many NHS GPs fear change and perhaps they should shadow a private GP to see how it can be done as it was done once upon a time.

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  • Una Coales | 07 March 2014 6:27pm

    You have my vote !

    Would love to hear more on how such a model will work but feel you definitely have the right idea!

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  • Una Coales

    @8:52 pm. Thanks. It is almost as though government is saying thank you GPs for giving up your private practice to work for the NHS 66 years ago but now this social experiment is unworkable and on the verge of bankruptcy so we would like you to go back to being private GPs again. The 60 year experiment failed as we daren't charge our voters co payments to keep the NHS solvent even though the costs of medicine, treatments have climbed and the number of elderly living longer with chronic diseases has grown by the millions.

    So here is how to go back to private practice. Sorry we bothered you. http://drunacoales.blogspot.co.uk/2013/07/nhs-gps-are-now-asking-me-how-to-be.html

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