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At the heart of general practice since 1960

2016: too much conversation and not enough action

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It is a tradition of mine to look through the year’s issues of Pulse as we prepare our December edition. It is always a reflective experience, but even more so this year because so much has happened in 2016.

Funding is harder to find than a politician who understands Brexit

We began the year with the heat and fire of the first Special LMCs Conference since 2003.

Pulse had just released figures showing the number of practice closures was running at a record high. The anger of delegates was palpable as they voted to consider submitting undated resignation letters if a credible rescue plan was not forthcoming. ‘If not now, then when?’ was the salient message from the meeting.

The counter offer came in April. NHS England attempted to douse the flames of radicalism, with its GP Forward View promising an additional investment of £2.4bn into general practice by 2020. The magnitude of this pledge caught many by surprise, I certainly read it with a sharp intake of breath, but it was a bit like a promise to make amends in future from a cheating spouse.

‘I’ve changed!’ cried NHS England, with its arms flung wide. ‘I’ll believe that when I see it,’ responded most GPs (except – famously – the RCGP).

The sense of betrayal deepened in August, with the GPC’s decision not to explore any options for industrial action, after a letter from NHS England containing yet more promises. It felt to many GPs a bit like their supposed best friend had just shacked up with the aforementioned cheating spouse and they were now left out in the cold (apologies for the strained metaphor).

Eight months on from the forward view, GPs have seen little improvement. If anything, things have got worse. The promise of a ‘turnaround’ for the profession has yet to materialise. An NHS England director asked me recently whether Pulse would stop being so negative about the measures managers are taking. I shook my head and said: ‘Not until GPs feel a change on the ground.’ Our survey results released today show things are going backwards.

To give NHS England credit, cash has been released for a much-needed GP counselling service and a scheme to help protect GPs from spiralling indemnity costs.The above-inflation pay rise in April was welcome, and timely.

But as Pulse has reported, so-called ‘resilience’ funding is harder to find than a politician who understands Brexit. The resignations of partners and the closures of practices continue. We may have a few hundred more trainees this year, but practices are still struggling desperately to recruit. The years of underfunding, coupled with more recent cuts to PMS or MPIG and soaring workload, are making life impossible.

It feels a bit like NHS England has ticked a box and then moved on to more pressing matters – like the crisis in acute trust finances, or its ‘sustainability’ revolution, which mainly involves shutting hospitals and shifting yet more work onto the shoulders of GPs.

And the strength of feeling grows – just look at the plans being prepared by LMCs in some areas, which include the radical step of taking GPs outside the health service.

But let’s be clear – most of the GPs I meet greatly value the health service, but they have fallen out of love with the system they have to work in. These moves are born of desperation, rather than a desire to trash the NHS. 

Yes, 2016 has been a remarkable year for the profession. But if nothing concrete changes in the months ahead, then 2017 may mark a watershed.

Nigel Praities is editor of Pulse

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Readers' comments (9)

  • Why is Nigel having to tell NHSE the truth the BMA and RCGP should be? Bravo.

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  • Good to see that Nigel stood by his values. I wonder if NHSE / DoH offered 'anything' to Cogora / Pulse to change their reporting 'style'?

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  • Vinci Ho

    This is for you ,Nigel. Thank you for defending the morality of medical journalism. Montesquieu established the ideology of separation of power in a democratic system; the three powers of legislature , executive and judiciary 18th century.Then we have the fourth power/estate - the Press. Unfortunately, power comes with corruption and absolute power comes with absolute corruption.
    Even after the Leveson Inquiry , there is no deterrence to certain media(those incidentally like battling us all the time)abusing its power and it is a sign of times that even the independence of our judiciary was insulted ( although we do not ,arguably ,have entirely independent and separate legislative and executive power in UK government historically ). But I agree with Thomas Jefferson to prefer a government with newspapers to one without newspapers.
    Say and write only what you believe, Jon Snow......

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  • Spot on Nigel! Loving the analogy of General Practice feeling like being with a cheating partner, to be reassured frequently but all the time your cheating spouse is shacked up with your BF!

    Certainly this all feels like a massive betrayal to us.

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  • How is it that someone who isn't even a GP understands and empathises with our plight more than some of our Leaders?

    Thank you Nigel, as always.

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  • Great to see realistic critical thinking in the press. I have long suspected medical leaders, especially in the BMA suffer significant bouts of Stockholm Syndrome. True, popularism can be dangerous if unchecked, as is militancy, but unions and colleges have a moral and legal duty to represent their members' interests, and not pull the plug unexpectedly when the members are screaming for action... In memoria of the pensions actions of 2012, the trainee doctors contract of 2016.

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  • I have , reluctantly, resigned from my partnership this morning. I feel guilty as I like and respect my partners , and feel like I am deserting a sinking ship.
    It is making me ill, and I only have one body. I am going to be a risk to my patients, and cannot allow this.
    I look round at my partners , and see the stress of our work on them. I worry about their health too.
    I have carefully considered the options, but see no way out. The GP contract is impossible. It is woefully underfunded. Even if I could persuade my partners to accept a tiny income, we would never be able to replace the senior partners when they retire.
    I think the lack of action of the BMA and the RCGP is unforgivable.

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  • The BMA does not represent its members, the doctors. It spends too much effort on stuff that isn't in its remit.
    The Royal Colleges have lost all their power since they and the Deaneries gave over responsibility for education to GMC. No one speaks out for the staff at the coal face. It may be happening behind closed doors but cant see any beneficial results. Doctors are recognising, one by one, that they have to take back control of their own lives and careers because there ain't no cavalry coming. God help the poor and sick.

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  • Fantastic progress and outstanding reflection on a great Health Service that is striving for the benefit of the patients. Keep it up!

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