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Gold, incentives and meh

The real conspiracy of NHS England

Dr Nishma Manek

That got your attention, didn’t it? Perhaps a story has crystallised in your mind already.

We all knew it. The government and NHS England have been plotting to systematically destroy general practice. With sympathetic nods and public-facing pledges to try harder, they’ve been taking back our contracts – only to throw them in the fire when our backs are turned, gleefully stroking beards as they watch plumes of smoke erupt from their ivory towers.

It’s a seductive story isn’t it?

But it’s fake news. As a trainee and avid follower of the headlines, I shared these concerns. But I’ve spent the last year as a clinical fellow in NHS England, and I’ve been searching for some hint of conspiracy to destroy general practice.

I expect to get a kicking for this, but I want to lay out some truths. As is often the case, the truth makes for far less juicy reading, so do feel free to switch to Trump’s Twitter feed.

You see, I’ve dispelled some myths of my own this year. I’ve found no hidden agenda to destroy the partnership model. There’s no secret plan to sell us off as salaried slaves to super-partnerships, or knock us down so hungry hospitals can devour us whole. They’re not lying through disingenuous teeth when they say, ‘if general practice fails, the NHS fails’.

They don’t always get it right. They know that a glossy plan won’t matter if it’s not felt in our consulting rooms. But far from being soulless zombies working at the whim of politicians, I can now see they’ve got some of the toughest gigs in the profession.

They don’t have the ability to take to the airwaves, point fingers, and rally the troops with cries for more resources. Or the everyday ‘thank you’s from patients that help us to persevere when tasked with the impossible. And any positive progress or deflected problems often slip under the radar.

But having internalised the same passion we have for shoring up general practice, they toil on. They walk tight ropes in a way that I couldn’t have imagined. And knowing that we’ll never feel like it’s happening fast enough, or going far enough, to keep ahead of rising demand.

Pulling back the curtain, I can now appreciate the delicacy and complexity of the constraints they work within. We’re living through unprecedented political instability, with no ‘magic money’ tree to shake, huge pressures on primary care, and plummeting professional morale. So those sweet spots of where change needs to happen, that seem so glaringly obvious from the outside, are smaller than we might think.

But if you look at the headlines, you’d struggle to believe there’s anything positive happening at all.

Across the world, fake news is having a moment. It feels like we’re increasingly prioritising the deceptively simple over the honestly complex, the visceral over the rational, and making judgements based on summaries of summaries.

Our declining deference to experts, rising scorn for the political establishment, and tendency to lock ourselves in social media echo chambers where opinions are confirmed with breath-taking confidence, rather than challenged, are increasingly blurring the lines between fact and fiction. And the less attention we pay to facts, the more ‘non-facts’ are being deployed.

I’m beginning to worry that general practice is heading down the same path. Doctors are often discerning when it comes to assessing evidence. We remember those lovely funnel plots from medical school, and we’re quick to spot publication bias. But do we apply the same diligent consideration to the headlines in general practice?

Chronic, unfocussed criticism, generalised and amplified in echo chambers, is harmful. And I think we’re at risk of tipping the balance. There’s a sense that it’s now being embedded in the psyche of the profession, spilling over to our trainees, and subtly altering perceptions of our career, at a time when we need them more than ever before.

Criticism is like our body’s inflammatory response to injury. When it’s acute and targeted, it’s helpful. It signals where the insult is so a response can be deployed. But when that inflammation becomes chronic and self-perpetuating, it can cause lasting damage- and damage that continues long after the original insult has been dealt with.

I think this matters. Because there’s a fine line between passionately defending our profession, and inadvertently being part of the problem. And there are consequences of crossing that line. At best, nothing changes, and we’ll continue to wallow in our collective sea of cynicism. But at worse, we drown in a spiral of negativity and, worst of all, deny others the privilege of joining our field in the process.

And those repercussions will continue long after today’s headlines wrap tomorrow’s fish and chips.

Dr Nishma Manek is a GP trainee in London and is the national medical director’s clinical fellow at NHS England

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Readers' comments (57)

  • Oh I thought it was something to do with 10+ years of sub inflation rises in funding for primary care increased dumping of work onto an underfunded and understaffed primary care workforce, the ageing demographics of a workforce/country, increased unrealistic demands.and increasing costs.Wait till the tsunami of indemnity fees starts to hit in the Autumn (another effective pay cut].If they are not plotting it must be just plain ignorance or incompetence.

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  • I'm sorry Nishma. It doesn't wash. Neglect can be just as much abuse as overt violence is.
    'If GP fails the NHS fails'
    Thats what they want isn't it?

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  • I thought this was a well argued and important article. Just wanted to say so, in case I'm the only one posting a positive comment!

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  • You are wrong. Conspiracy theories aren't in fact that glamorous. There is no guy sitting in a bunker in a jump suit stroking a cat, rather it's the banal business of people protecting their own interests. Remember, Jeremy Hunt wrote a book on how to privatize the NHS. I've heard it from reliable sources that government don't want to contract with units smaller than 50,000 patients which is why we are being herded together. We have a college that has only recently stool up for GPs, having spent the last decade toadying up to government and creating the worst exam in medicines history. There are also a few people in the CCGs and PCCCs who have a really low opinion of GPS and want to see the back of us because we hold them to account. A large number of politicians have financial interests in provider companies who are working out where there is money to be taken from the NHS - it's in the public domain and not fake news. Combine that with our death by 1000 cuts funding, a growing army of well remunerated regulators and greedy legal firms that have successfully pushed our indemnity to £10 000 and you can see that this is reality, a boring conspiracy but just as awful.

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  • NHSE and the government are lying, if only to themselves.

    The true lie is that communism and central control can work as a mechanism to allocate resources, when this was disproved with famine and totalitarianism in the 20th century.

    There is always a cost and opportunity cost to all actions. Keeping patients tied to NHS GP, by ensuring that is the only route to NHS services they are eligible for through tax, crowds out private primary care.

    If those in power valued the 'truth' they would acknowledge that there needs to be payment by users of healthcare at the point of use, and that the NHS scores poorly compared to many European systems on outcomes such as dying from severe disease (OEDCD reports) and only does well on outcomes that measure how much a health system is like the NHS! (i.e. Commonwealth report).

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  • Haha.

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  • 1. You are marginal to the real conversations in the cabinet office and DOH.
    2. Unfortunately so is Arvind.
    3. Perhaps not conspiracy, but a clear ambivalence as to whether we continue to do an impossible job on meagre resources (which is fine to them) or collapse and be replaced by a command control system like hospitals (which would also be fine to them).
    4. They say fine words publicly and privately to NHSE to keep everyone quiet whilst this plays out either way. You can tell people's true intentions by where they invest the money. They must find Robert Varnam running round with his 10 high impact actions, and the RCGP staking their reputation on the illusory £2.4 billion quite hilarious.
    5. GPs who work for NHSE and anticipate a parallel career have taken Jeremy Hunt's shilling and have a need to toe the party line (for personal advancement) and buy into it (so they can sleep at night). Your article should have really started with a clear statement of your role and ambitions. Then we would have understood from the first line what your context was: 'ambitious trainee with little real world experience who has plum NHSE job says NHSE doing a great job'. I wouldn't have read any further.
    6. The real test of CO/DOH/NHSEs attitude to general practice is the state of the profession. The only way you can really tell that isn't by working in the NHS directorate, its by seeing patients in general practice, and trying to deliver general practice to a population you are committed to.

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  • There are probably well meaning people in NHSE, you may well be one of them. You haven't specified any of the positive actions that have been taken, and in terms of assessing the evidence, when I started as a partner I left work at 18.30, indemnity was way less than it is now, there was healthy competition for Partnerships, training places over subscribed, sveeral less layers of regulation and the profession seemed stable and well respected. Compare to now, 12 hours days, usuall in at weekend to catch up, not a hope in hell of recruiting, training places unfilled, CQC et al making an almost impossible job that much worse, sppiralling indemnity and anyone who can get out planning to do so. I don't know the motivations, but the results speak columes. It's either deliberate (NHSE or DOH, lines increasingly blurred), or incompetance. End result is the same though.

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  • I have some legitimate and robust questions...if you please....

    What "qualifications" do you need to have to work for NHS England that we do not have?? Please list them...I am asking for specific lists

    What "expertise" do you have or need that the rest of us lack?? A PhD in NHS England studies? We need further clarification?

    To gain authority, you need to explain precisely why you know more than the rest of us that gives you the relevant expertise and qualifies you for this assumed mentorship role to your colleagues?

    We all fully accept that this is your version of reality but it is in my opinion disrespectful and offensive to your colleagues to assume we are all simpletons unable to process any information ourselves without relying on your pre-digested views.

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  • Another non GP telling people who have been doing this job since before they were born how it is! Great. Thank you for the insight.

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  • Nhsfatcat

    If there is no conspiracy then NHSE are like a chef who can burn boiled eggs.

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  • If this post was designed to help us "see the light" then it has had the reverse effect on me.
    Personally, I am bloody sick to death of being "told what to think and do" by those with grandiose and inflated egos. As far as I am concerned intelligent professionals should be "allowed" to come to their own conclusions rather than fed others views-so thanks but no thanks.

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  • The facts on the ground do not reflect the views shared in this article.
    Always the blame lying with the old mantra of increase in population. It's bollocks. That is a small part of it but the constant pace of change; money Diverted away from core / basic services into Revalidation; new teams and non evidenced half ideas and no one seemingly just stopping to learn lessons from failed debarcles ( various IT programmes). No one listening or believing the experts. That's the real problem.

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  • I have a friend who has worked several levels higher than yourself in NHSE for many years, they categorically define that there has been a conspiracy by the treasury to defund and impoverish general practice since 2005, this is completely intentional with no thought to the consequences for the NHS, despite warnings from NHSE - and not something that NHSE has been able to alter, the same individual states categorically "We know general practice and the partnership model is dying, its not that we are letting it happen, we're just not saving it".
    I trust this individual to be honest with me as I've known them for years and they have nothing to gain from this disclosure.
    So if NHSE are standing by and watching general practice die, they are guilty of neglect, and if they publicly have accepted the treasury stance on gp income and resource, they are guilty of colluding in the demise of a profession, and possibly ultimately the NHS.

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  • The background:-

    https://www.fmlm.ac.uk/programme-services/individual-support/national-medical-directors-clinical-fellow-scheme

    https://www.fmlm.ac.uk/nishma-manek

    I wonder if you are media and politically savvy, using what you describe to attract our attention in one of the means of communication to Primary Care which in my career experience consistently provides a fuel to negativity.

    Typically, exploring the background to the headline reveals a different story, just like here.

    The other comments here also reveal the effect of NHS behaviours on how those at the front line of Primary Care now feel. Surely cause for grave concern?

    I am passionate about Primary Care and have been through my career (nearly at an end - thank goodness you say!) and have recently found the TED talk "Start with Why" followed by the unabridged audiobook an enormous help with the feelings of negativity which you describe. It may help others.

    I respect your right to have an opinion, but wonder if you are exploring the realities in Primary Care which are producing the loss of morale, inability to recruit, some of the negative behaviours becoming more prevalent (or exposed by the pressures) - and before those who wish to comment say "we do not have a problem" - look ahead to a possible situation of clinicians not there due to retirement, illness, etc.

    Happy to explore this further.

    IntraHealth Parkgate Surgery

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  • Azeem Majeed

    Thank you for your article Nishma. I notice that many of the people who have criticised you are unwilling to give their real names.

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  • Tom Caldwell

    No problem giving my real name. You are of course right that there is no conspiracy. It is simply open Tory policy and opportunism.

    There is no way that chopping pensions, reducing budgets and staffing, clustering into nice convenient sized chunks and aligning IT systems to mine information usable by private providers could in anyway be preparing general practice for larger providers to swoop in with APMS contracts.

    There is no way that the NHS is becoming simply a brand under which large private providers are picking off what they see as the juicy profitable bits.

    There is no way for example that these larger groupings could ever be changed to a cheaper to provide GP lead not delivered service... oh no. Nothing in the direction of travel suggests this at all.

    As to how much access I have to insider info, probably a little bit less than you. As to how much you have, only you can answer that.

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  • Sorry Nishma, I'm with DT.
    Some would politely say that 'there are none so blind as those that cannot see', others might suggest 'what else would you expect from someone who has clearly invested in partisanship'.

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  • Hi Nish. Don't normally head below the line myself, but couldn't let the Prof's straw man about all dissenters being anonymous stand so as someone whose stock-in-trade is whinging about the powers that be, here's my chronic unfocussed two cents.

    Let's be honest, this article never had a hope of hitting the fabled 5 stars, but it already has you drowning in plaudits from what Pev might call the wider Morlock community, so swings and roundabouts eh.

    I do think you make some valid points. Of course the people you work with in NHS England are not evil, just as my appraiser is not evil, my CQC inspector was not (provably) evil, and the U-boat Kapitänleutnant in Das Boot isn't evil. They're all normal people trying to do the best they can in tough jobs. But that doesn't mean that their actions and the system they support have a benign effect on us ordinary working GPs; quite the opposite. (Except the U-boat guy, on whom the jury is still out).

    There's a reason we're in a spiral of negativity. In the ten years since I was a GP trainee like you virtually every aspect of the job has got worse. That ain't fake news, it's just a statement of fact, easily backed up by looking at the stats on GP workload, GP pay, indemnity costs, numbers of applicants for jobs and so on. I'm sorry-not-sorry if my response to this is criticism of the forces I perceive to be worsening the situation, whether through malice or ineptitude. But the idea that my criticism is now a bigger problem than the *actual problem* is just daft, frankly.

    "Why are you retiring/quitting/moving to Australia?"
    "Well, my job is fine. In fact, I couldn't be happier. But I keep reading in the papers that GP is bad so I thought I'd better get out". SAID NO ONE EVER.

    I don't know if NHS England can make the job better. I don't believe they go into work each day to actively try and make it worse. But that's what keeps happening anyway. So here's some targeted inflammation for you; tell your BFFs at NHS England that if they really want to Make General Practice Great Again they should take all the five year forward view money and put it directly into the global sum. Nothing puts bums on seats like cold hard cash.

    In the meantime I will continue to call it as I see it. There is a great British tradition of therapeutic grumbling in times of adversity; it's not chronic inflammation, it's catharsis. And without catharsis you know what you end up being full of.

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  • I'm not sure if I'm intellectually challenged, but I just don't understand this article?

    Who is the "they" you keep referring to? Is it GPs working within NHSE? Is it managers? Is it the government?

    As a frontline GP working in deprivation, I am utterly perplexed by your viewpoint.

    Am I wrong to assume that NHSE represents the government? Are you seriously defending this government's track record?

    The 2012 HSCA was an unmitigated disaster and has accelerated the road to privatisation. The ICS is the thorn in the side of this privatisation agenda - which is why it has been slowly and painfully eroded over the last 5 years.

    GPs don't really change - we've always valued autonomy, continuity and the ability to innovate. These are the cornerstones of partnership. But terms and conditions have been made so unpalatable that we are all turning our back on it.

    Who do you think is responsible for these terrible T&Cs? It's certainly not Trump.

    Please could you explain why NHSE moved practices down to the lowest common denominator within the PMS reviews and why they are doing nothing to protect leaseholders within health centre buildings and why they are not intervening in rising indemnity costs?

    And please explain who the "they" are.

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  • Oh my god I cannot believe I've just written 400 words for Pulse and not been paid for it.

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  • Having been in a position to "negotiate" with NHS England over GP contracts I am fully aware of the pressures they are under and sympathise with the difficulties they face which are part of the Tory Policy to destabilise and privatise the NHS (sorry 'tis sad but true). I will not accept however that the negativity and demoralisation of the GP's at the coal face is contributing to the problem. I for one have reached my limit in being expected to do more, be responsible for more and do it with ever diminishing finances and to do it with a smile on my face in order to attract unsuspecting trainees into the mess. I am sorry Nishma, but your comments are well meaning but unfortunately both insulating to those experienced practicing GP's and incredibly naive. It would be interesting to hear your views in 5 years.....

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  • NHSE are just obeying orders and do there jobs. I've heard that before somewhere.Ah yes.This is the explanation given for some of the most nasty things done by the human race,to the planet and other Humans.I was just doing my job, it doesn't make it right though.

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  • I was naive when I was young too and believed DOH was doing its best. However I am older now and I think you will find that these conspiracy theories you mention about a secret agenda to destroy general practice to pave the way for private companies are absolutely 100% true !!

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  • I'm not sure I understand your argument. You tell us that we shouldn't discuss the negative aspects of our profession (of which there are many) but then dont provide us with any alternative argument to suggest why we shouldn't!? We have reached a tipping point and it's high time we all started sharing the success stories provided by the desperately needed GPFV...oh wait...

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  • Tom Caldwell

    Hold on hold on, I get it... Its satire isn't it?

    This is tongue in cheek

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  • so basically you're saying it's cock-up not conspiracy

    could be either but the effect will be the same

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  • Riddle me this....

    Why is it that NHSE refuse to let struggling practices close their lists to give them a chance of survival but as soon as they collapse and the remaining partners have to hand back their contract NHSE take them over and immediately close the practice list.

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  • Just some numbers, not opinions. In NI
    [2004] Average profit per patient per year =£ 80. Consultation rate = 2.5/ year.
    [ 2015 ] Average profit = £ 60. Consultation rate = 6 / year.
    or 80/2.5 = £ 32 vs 60/6 = £ 10.

    No hidden agendas. It is open warfare and we are the sitting ducks. Hunt called it Penance, I think.

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  • Vinci Ho

    Always enjoy the poignancy of many of your previous articles, Nishma.
    Returning to reality , though , is a different matter.
    At the end of the day , people working in NHSE are merely doing 'a job' earning a living and I agree that they might want to do their best to improve this undeniably extraordinary and unique circumstance in the history of British general practice. But have they really had any autonomy or must they follow orders from above instead? Like us , perhaps they have very little choices .Oppression is descending from the top of hierarchy at successive level. Lack of determination and leadership to fix domestic issues in this government is evident .
    But if one wants to give some benefit of doubt to the politicians, the verdict is still :''Never attribute to malevolence what is merely due to incompetence'' (Arthur C. Clarke).
    From Capita to Sustainability and Transformation Plan (STP) , resilience funding to premises support etc , the word hypocrisy only kept repeating itself . The caveat of genuinely hurting our patients has become more and more plausible.The careless whisptof 'Public sector workers are overpaid' revealed the true mentality of a government willing to sacrifice people's well being for better economy and GDP rise.
    Winston Smith worked for Ministry of Truth in 1984 but never really wanted to lose his soul and true identity . He was not allowed to show any negativity towards the establishment and his fate was clearly sealed with a drop of melancholia.

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  • Hi
    Brave article but u have confused the decency of those u have met with a malignant system (whether so by design, incompetence or entropy history will tell eventually)
    The chronic inflammation you identify is the direct result of repeated failure to address many acute flares over many years. The damage is not beimg caused by chromic maladaptive GP criticism but by the cumulative fx of the failures themselves. It is hard to avoid the conclusion that this disruption is intended at some level but more scary is that it is pretty clear that like brexit no one has a proven replacement that is sure to work and so the damage to equitable healthcare in this country could be profound & irrecoverable. And that those social darwinists who profit from it won't be that bothered by what happens at the bottom of the pile

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  • I for one will NEVER forgive the Tories or their minions for what they have done to the NHS.It will take generations to repair the damage that has been done at all levels it hasn't gone too far to be repaired already.Do not be an apologist for what is in effect a branch of government.There is blood on their hands and no amount of excuses will wash the stench of this away.I will Never vote Tory again as long as there is breath in my body.

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  • You mean it's cock-up, not conspiracy?

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  • Dr Dean Eggitt

    Just a thought....

    Groupthink, a term coined by social psychologist Irving Janis (1972), occurs when a group makes faulty decisions because group pressures lead to a deterioration of “mental efficiency, reality testing, and moral judgment”. Groups affected by groupthink ignore alternatives and tend to take irrational actions that dehumanize other groups. A group is especially vulnerable to groupthink when its members are similar in background, when the group is insulated from outside opinions, and when there are no clear rules for decision making.


    Janis has documented eight symptoms of groupthink:

    Illusion of invulnerability –Creates excessive optimism that encourages taking extreme risks.

    Collective rationalization – Members discount warnings and do not reconsider their assumptions.

    Belief in inherent morality – Members believe in the rightness of their cause and therefore ignore the ethical or moral consequences of their decisions.
    Stereotyped views of out-groups – Negative views of “enemy” make effective responses to conflict seem unnecessary.

    Direct pressure on dissenters – Members are under pressure not to express arguments against any of the group’s views.

    Self-censorship – Doubts and deviations from the perceived group consensus are not expressed.
    Illusion of unanimity – The majority view and judgments are assumed to be unanimous.

    Self-appointed ‘mindguards’ – Members protect the group and the leader from information that is problematic or contradictory to the group’s cohesiveness, view, and/or decisions.

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  • 2 articles in pulse now from a similar theme from leadership fellows. Very questionable ideas being purported. Clearly upset us all and an indicator actually of poor leadership. What is going on? I think that there is a major problem with leadership training. How are we as a collective feeding this back? Where are the GP educational supervisors? I would really appreciate their opinion on pulse. Could they be interviewed. Nishma have you discussed your views with your supervisor? I think you should reflect. Thank you for sharing and please do not be hurt by the hostility that you are experiencing. You are a trainee and we should be more respectful.

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  • Increase hoops for GPs and CCGs and government bodies all not listening and ignoring patients who like a good quality local and friendly healing centre with the modern age of medicine. That is the messy culture of our environment .

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  • Nishma have you ever spoken to Simon Stevens? Have you seen his speech to delegates at a conference when he was just leaving his job as CEO of Commissioning at United Health (where is currently being taken to court for part of their fraud) stating that he had a plan to open the NHS to US private health firms? Have you seen what is happening in Plymouth where NHSE closed 4 surgeries despite widespread patient and staff protest and now more surgeries are closing due to excess pressure and lack of GPs?

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  • On second thoughts I'm frankly more dismayed than angry - bemused - is this really REAL - comes across as propoganda - Let's get some fresh faced trainee GP to tell them it's all going to be OK and was just a bad dream! REALLY? That's the best you can come up with? We really are up SH1T creek without a paddle!!

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  • I too deal with NHSE extensively, from a completely different angle and none of the people I deal with know that I was a GP.

    I agree with the vast majority of comments and criticism of the article, the comparison with fake news is a little childish however.

    Although individuals within NHSE may not be evil or have bad intentions there is no excuse for incompetence. The civil service structure rewards project completers and often we have met several NHSE representatives whilst negotiating as the managers move posts so frequently.

    Which is one of the reasons NHSE cannot negotiate competently.

    Don't under estimate the aims of the political policy - there may not be a stated aim of destroying the NHS but for many it is a part of their ideological make up.
    The fact the consequences and cost may be huge is of no consequence to them.

    I suspect the comparison we should be making is to the grenfell tower disaster and the years of choices that led to that event. I was dealing with mini disasters everyday when I quit GP land. It's worse now.

    I hope the writer can reflect as to why they are simply wrong.

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  • "The revolution will not be televised" G.Scott-heron

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  • Nishma,I for one can see where you are coming from. Being one of those BMEs what has been battered by four NHSE and PCT louts for 7 years just because I had the impunity to take one of them to an Employment Tribunal and then getting an affirmative for 3 cases against the PCT single-handed while PCT was represented by a respected Law firm from London. I declined to sue them and offered to shake hands but the gesture was not appreciated.
    I considered myself to be going into a spiral of negativity from the point when I actually became a partner as at every step, the PCT Contractor would step on my toes.
    And then I ended up in a course of Clinical Leadership. I went through the modules - The Myers Briggs self assessment, Negotiation skills, the wonderful prospects of our 20th century state of art NHS and blah blah blah.
    For a few months, I was elated and as positive as one can be. The course finished and I was sponsored to do a BME Leadership course. One of the Speakers just happened to be our esteemed CQC Chief and I even felt positive about his work.
    Then I came back to the reality and my Mentor in Manchester wrote to the local NHSECCG Team recommending me to participate in the local development programmes. The balloon burst. I was not welcome.
    You've just been to a course and I guess you are still sailing on that cloud which actually will fizzle away because it is a cloud - it clouds your thinking, your judgement and your perception of reality.
    A course is a course, unfortunately, and brainwashing techniques are far advanced but they do not do any good as they prevent you from even considering the eventuality that there are flaws within the system.
    I repeat myself in forums raising the same stale topics but until somebody explains to me why my payslip/ my Open Exeter statement/ shows 'Total Payment Units' as 4660 but I am being paid for only 3450 - I will not rest.
    In a private company if your payslip said your payment is for 4660 and you were paid for only 3450 - the matter would be in Court.
    In NHS, there is no institution in this country which can explain the discrepancy and no solicitor wants to touch the matter till I get an explanation from somebody.
    Corruption, thy name is NHSE.
    We can't shut our eyes to criminal behaviours just because somebody funded a Leadership course and promised to make us world class leaders.
    Cynicism is at times the first step towards sanity. ( That is my quote and I sincerely believe in it)

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  • winston had been advised to revise the boot production statistics down in back numbers of the times . he knew at heart the second statistic was no more or less a lie than the first as the evidence of his own eyes showed the majority of the population walked around barefoot and in all probability no boots at all had been produced

    (with apologies to George orwell)

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  • There are some fundamental flaws in this article, made worse by the wide readership and the lack of declaration of interest.
    The very fact that NHSE will only support bods of 30k plus patients (fact) will serve to destroy the conventional structure and worse prevent those practices doing anything different or novel. I wish NHSE had a plan but having dealt with them for the Practice Pharmacy pilot it is terrifyingly clear that they have no plan, no vision and unfortunately no insight. The move to STPs will further confuse matters.
    A misguided plan I can understand complete incompetence I can't.

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  • The fundamental problem is the inability of GPs to seriously look for ways of working and earning outside OF the NHS. We choose to be dependent and then whinge about the consequences.

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  • you forget to use the wordlist! please rewrite your articles as requested, sorry, suggested by your mentor:
    brilliant job
    hard working
    real difference
    value for money
    NHS leadership
    forward view
    24/7
    GP worthless scum
    more research is needed
    can i have a tenured research job please?
    (hint - one of these is NOT to be published)

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  • So the leaked memo of allowing vulnerable and failing practices to wither on the vine was not in fact true?

    So all these collapses are not part of a 'National BluePrint'?

    You take us all for fools.

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  • I have been trying to work out why I feel such disquiet at this article when the comments seem at variance with it, and with which I broadly agree.

    In my previous comment I posted background for Dr Nishma Manek.

    "National Medical Director's Clinical Fellow Scheme

    The National Medical Director’s Clinical Fellow Scheme for doctors in training in England is sponsored by Professor Sir Bruce Keogh and managed by FMLM.

    The scheme has been established to fast track and support those doctors in training who present with the clearest potential to develop as medical leaders of the future."

    Perhaps my concern is that the outcome of the time spent in that environment has resulted in an article that to me is confusing and is certainly not inspirational, uplifting or what I would have hoped from "a medical leader of the future"

    No anonymity here, our Teams are constantly discussing ways of maintaining and modernising the services provided by our Practices to our Patients, and am very happy to discuss with anyone from FMLM.

    To do this I am even considering subscribing!

    Andrew Challis

    IntraHealth Parkgate Surgery

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  • Its not important whether its NHSE trying to hold the fort,cock up or conspiracy as behind them there is little political true will from any party to adequately financially support GP in its present form in common with many public sector good things unless there is a massive problem [Like having adequately resourced
    and monitored decent building and fire safety regulations]

    GP trainees are appropriately savvy consumers and are opting out of traditional career arrangements until things are clearer and fairer.

    The next iteration of general practice will not be what people are used to or what they want, but as its needed it will need to happen and be made attractive enough to encourage enough people to do it.

    These are difficult uncertain times, and we are part of that unfolding uncertain change.

    Luckily, we have great people, with a great NHS, so I think it will be alright in the end.

    But its going to a really difficult next few years.

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