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Independents' Day

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)

  • 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.

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