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Dr Peter Swinyard: 'A perfect storm threatens general practice'

Any action which can help practices provide excellence in care must be a good thing, the chair of the Family Doctor Association writes

The FDA fully supports any action which can support practices in providing excellence in care to their patients, with good continuity of care being the hallmark of modern traditional family practice, proven to increase patient satisfaction and reduce health care costs.

The perfect storm of reduced resources, expensive locum cover (my practice had recently to pay £1,000 for a day’s cover) and impossibility of recruitment even to desirable practices is threatening the whole future of general practice in the UK.

The domino effect is becoming a reality. If a neighbouring practice closes due to impossibility of recruitment, how will neighbouring practices recruit to service the patients allocated to them?

Market forces only work where the provider (ie a GP) is a truly independent contractor. We have so many confounding factors here that market forces cannot work. We cannot choose who we take on as ‘customers’. We have a monopoly ‘employer’. We have books of regulations governing how we run our businesses. We are inspected to death. We cannot set our own prices, nor decide what work we do. We cannot even recruit a partner without ‘permission’ from the CQC. We are dependent on the ‘employer’ for premises and for our pensions (which look much more like those of an employee than an independent contractor – also the discretionary sick and maternity pay). We cannot set our prices at a level which allows us to develop premises independently. We cannot choose our hours of opening.

So – market forces? I think not.

If the government believes so much in market forces, it must allow us to have the independence to compete in a true market, with pricing of services set by practices not by central government.

I don’t see that happening. What could happen is that an entire area loses its NHS GPs and the remaining doctors set up as private GPs. As long as the government allows patients to receive NHS prescriptions (as is their right) from non-NHS doctors, the economics would work out fine even in deprived areas as no government would leave a population without health care and some subsidy arrangement would be quick to emerge. A medical fund? Panel doctors?

There is a dearth of good young doctors wanting to be GPs and we must wise up to this and work smarter with an increased use of a clinical team. But where are the training schemes for practice nurses and health care assistant to support this? Where is the demand management, which must come from Government, to allow the remaining GPs to cope?

I wonder who will be there to look after me as I head off towards senility.

Dr Peter Swinyard is the chair of the Family Doctor Association and a GP in Swindon.

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Readers' comments (13)

  • Thank you Dr Swinyard for a concise, cogent summary and appraisal of the current state of NHS primary care.
    Needless to say, I for one couldn't agree more.
    There is one glimmer of light at the end of the tunnel -- which is that after a decade of the political/media axis abusing GPs with a wholly one-sided argument, the first signs of sensible debate are emerging.
    Unfortunately, to use a physiological metaphor, sometimes homeostasis does not act quickly enough to correct imbalances -- the delay can result in the potential demise of the organism.
    It remains to be seen whether action will be timely enough to rectify the potentially terminal state of affairs in current UK general practice and, if not, how effective and equitable the replacement turns out to be in providing health care (never mind the political repercussions).
    I somehow suspect that the current political incumbents will not have to worry too much about accessing a GP, whatever happens.

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  • By definition, a Contract is mutually agreed. We have unilateral changes, impositions, inspections, rules and pay cuts. We do not have a Contract,we have a Diktat. We GPs need to change this. If we so decided, no one can stop us. But we need to do this, otherwise GP land will be decimated in this obviously unfair Contract.
    I do not think the GPC sees that by doing nothing, the future of General Practice itself is in jeopardy. If we do not attract doctors, it is patients who suffer ultimately. No unfair system can survive very long.

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  • Business or Service...which do you want?
    It's a bit like PFI: "how much money have you got, Mr. NHS?...well this is what you can have, coz this is what it costs, you moron!" You cannot plead poverty and pass the losses to your suppliers. GPs are not growers for Tesco. The competition watchdogs are sleeping through this one.

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  • Will it not be easier for the powers that be to stand by and watch the NHS GP system fail before playing the privatisation card? They will say that the system we have now was not fit for purpose and GP's could not cope. It will be an easy way to make it sellable to the public just before an election.

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  • Azeem Majeed

    A good analysis from Dr Swinyard. General practices in many parts of the UK are under severe pressure through increases in the volume and complexity of their workload, reductions in practice funding and increased practice expenses.

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  • Second post from top - you have hit the nail on the head. "CONTRACT" - why has the BMA not challenged these contractual changes in court??????

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  • Could there be grounds for challenging the BMA itself for accepting this contract in the first place?

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  • fundamently everyone agrees there is a big problem with the NHS.

    the only disagreement is on how to manage the problems

    increased funding vs. increased efficiency (aka as more for less)

    the stress in the system is that there are little or no more efficiency changes to make - pensions, pay, and goodwill have been raided. given that there is a huge deficit (projected) on nhs funding of £30 billion and all political parties have said there is NO MORE MONEY then we have (or are reaching) an endpoint.

    so what plan do our healthcare leaders have ?

    so far this week we have had -

    suggestions to tackle fat healthcare staff and concerns on antibiotic prescribing.

    with leadership like this why worry !

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  • I got out of UK general practice and moved to Australia. The fee-for-service model here is excellent. Longer consult=higher payment; procedure done in the clinic = extra payment. It encourages GPs to deal with things thoroughly and in-house if possible. We suture, excise, plaster undisplaced fractures, incise and drain, venesect, mirena, etc etc - none of it is rocket-science but the patients appreciate you more when you do more. Of course there is some government control of rebates, but it's nothing like working as an NHS wage-slave.

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  • Some political perspective on the future of the NHS:

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