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What do GPs owe the NHS?

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The one thing I told my team to look out for in the health secretary’s speech at Conservative party conference was any sign that he would be compelling trainee doctors to work in the NHS. My prediction proved correct.

I doubt many GPs feel particularly valued by the health service at the moment

Jeremy Hunt announced in Birmingham that medical graduates would be obliged to work in the health service for four years: ‘This mirrors the approach taken by the Armed Forces,’ he claimed, brandishing the £220,000 in public money that it costs to produce a graduate from medical school.

But let me unpick that statement a bit. There are some definite similarities between a soldier and a doctor: a highly developed sense of public duty, the mental toughness to save lives and a capacity to work in what could be classed as ‘war zones’.

A standard bursary for an undergraduate degree course is £6,000 from the British Army and comes with the expectation that the recipient serves at least three years after graduating. But medical students don’t receive direct financial help – in fact they pay around £40,000 in tuition fees and graduate with debts of up to double that sum.

I studied at a time when some students had grants rather than loans, but if anyone had suggested to me after I completed my BSc in physiology that I would be compelled to work in publicly funded research labs for three years to ‘pay back’ my tuition I would have laughed in their face. So what makes the medical profession different?

I am sure many GPs would agree that being a doctor does involve a sense of public service and deep loyalty to the NHS. But I doubt many GPs feel particularly valued by the health service at the moment. There has been a sustained defunding of practices over the past decade and a Pulse survey last year showed half of GPs to be at high risk of burnout. In this toxic environment, is it fair to expect GPs always to ‘put country first’?

And while trainees may soon not have the choice to leave the UK health service, already qualified GPs do. And this presents an ethical dilemma. In a major investigation launched today, we look in detail at the expansion of the private healthcare industry, and this includes private GP services.

The recent launch of an ‘Uber-style’ online GP service is symptomatic of a wider shift in the way healthcare is provided, away from the taxpayer-funded model that has dominated since 1948. But these models can only succeed if GPs are willing to work in them.

The Doctaly service relies on GPs using their own surgeries to carry out consultations (not with their own patients of course). And the new GP version of Deliveroo – GPDQ – deposits a fully trained doctor on your doorstep within 90 minutes for the price of £120.

Here it behoves me to mention the extra £2.4bn pledged in the GP Forward View in England and the £500m promised in Scotland by 2020. But this crisis of morale is happening right now. There is a real risk that ties between the profession and the public sphere are being irrevocably eroded and that the health service has taken its GP workforce for granted for too long.

It would be a disaster for the NHS, but could anyone blame GPs if they looked at the way they are treated now and decided to forget their ties to the publicly funded health service and seek better pay, conditions and respect in the private sector or abroad?

Nigel Praities is editor of Pulse

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Readers' comments (14)

  • I see so many amazing doctors and in particular GP's who have given blood health and marriages to the NHS.

    I found 15 years of service my limit.

    But there is very little left to give, those who do so because of a self driven sense of obligation.

    Fortunately the younger generation are realizing the old social contract is truly broken. You have to look out for your self in every way.

    Its truly a shame that we've come to this.

    Its broken.

    On a positive note doctors should get paid more fairly (in private based systems) - I never looked back once I left !

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  • Sadly the old NHS many us grew up & loved as an institution has gone - the mutual support & respect,even little things like the Doctors mess, bar parties & hospital reviews & balls are all thing of the past - like the military they were essential for maintaing morale & a sense of belonging & value.

    Now none of us are valued - by managers or patients alike.

    Health & marriage & thereby family are my biggest loss & now it is too late to get anything back from it.

    Mortgaged to death & uninsurable what a legacy - thanks NHS!!

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  • Great article Nigel!
    I have just seen a patient with a verruca who is fed up paying his chiropodist £35 per time (8 minutes approx.) to sort out his wart and wanted me to "cure" him for free. I just had my cat immunised and de-wormed at the vet in 10 minutes for £130 and overheard someone else paying £1500 for their pet to be treated. Gone are the days where people valued the NHS and doctors because no money changes hand. It is perceived as free and as such valued as worthless. So much is made of the founding principles of care irrespective of the ability to pay. It is used to ethically challenge doctors to provide for free because we have forgotten the tax payer was meant to pay the doctors to provide. We don't value the care system and then blame it when it lets people down. It is always blamed on evil private providers cherry picking and putting profits before patients, that argument has worn so thin. The profession I joined 26 years ago has been so denigrated that it is no longer attractive to the high calibre students who used to compete for places at undergraduate or post graduate. We have slept walked into the next evolution of care. A two tier system of those that can pay and those who have to take their chances. Sadly it will take a generation to get the best back.

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  • Fantastic piece Nigel.
    One of the challenges we have is those such as Jeremy Hunt (it's not just him) truly believe what they say is correct and are utterly unable to challenge their own beliefs.
    Either that or at their pay grade they are authorised to drive something (policy) through on the back of utter lies, erroneous and manipulated evidence and falsehoods.

    Where the divide is so deep and wide it is almost impossible to meet in the middle..... so what we see happening is inevitable.
    The profession is sidestepping the current state of affairs and finding a way... hence private services, uber and the like....

    Even the public has failed to stop this happening despite all the campaigns to keep the NHS public...

    This is a sad indictment on the political system in this country where yet again it fails to deliver on one of its key principles
    Being an agent of the people; listening to the people.

    If the political system is not ours.... who is running the show because it is not us!!!

    Take care all of you;)

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  • 1058 This is not a sleep walk. In NI funding to GPs has been cu from 11 to 5.5% in 12 years. It is deliberate policy.
    From the DOH perspective, if you can pay GPs 6 pounds per consult [ 3 take home ] and you can still get plenty of them, why bother paying more?
    Talking about pay, dentists and accountants as well know how to charge. My accountant is 200 pound an hour and THE DM is angry that GPs ge 100 pounds per hour on Christmas night.
    I, for one, believe this nation does not value its doctors at all.
    Ultimately though a separate spectre of increasing litigation may put paid to even the most altruistic of doctors. For me, it is about time. Let them so with the noctors.

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  • answer....NOTHING.
    look nobody OWES anybody anything outside the human rights act and outside of job contracts.
    Either the NHS accept market forces like every other sector in society or they are totally stuffed in the future.

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  • The market is not an option. Try to control prices and waiting times rise. Try to contain costs and vacancies rise. Set a price ceiling on locums and rotas are unfilled.
    Ultimately the only way to ignore market forces is to bring in forced labour, like Venezuala. PS any politicians reading this please note this is advice not a policy a suggestion!

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  • One disadvantage of the military "busary" used to be that reward for a five year commission that took the place of the government's pension contribution which was about the same as the the bursary amount then. One had to buy these years back for continuity- I wonder if this applies now?

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  • I used to work as a youthworker on one of the most deprived estates in the UK. We ran a Friday night drop-in and charged 50p on the door so it was valued, with all the cash going to buy kit for the service. We had one or two who we knew really couldn't afford it, who we let in anyway, but most had additional money to buy sweets when they were there. The kids loved it so much they were happy to tell us who it was that broke in and stole a load of kit.

    The moral - if people really want it, they find the money to pay for it, however poor they are. And if you give it away for free, you'll be hated. GPs - learn it fast.

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  • I do not think that working for a spell for the people who trained you is unduly wrong. Hunt unfortunately is the wrong person to be in charge of the NHS because he simply does not understand the NHS thinking it does not work at weekends and that private companies would do a less expensive job when they would obviously do less work because of having to pay their shareholder dividends and their fat cat bosses' inflated salaries. He and a colleague wrote a book advocating the UK adopts the USA method of heath care which costs three times as much as the NHS and treats only one third of its patients. It is just that the Tories are not happy unless they can make a profit out of the pubic service. My Tory MP complained that the Post Office was incapable of making a profit but that was because it was a public service paid for by the taxpayer. Now they have privatised the Post Office, large numbers of them have been closed down. If you want a public service it is no use asking the private sector to provide it. Severe underfunding by the Government of the NHS is a root of its problems.

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