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At the heart of general practice since 1960

Forced to fight over crumbs

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It was my day off today and a beautiful, sunny morning, but I still went into work. In spite of having already clocked up around 35 hours just halfway through the week, I still felt positive. I guess it was partly because the endorphins from my morning run were still bathing my brain and partly because I felt I was improving patient services. As prescribing lead, I have been busy implementing the new electronic prescribing service and I wanted to ensure protocols were written and the backlog of prescription requests was managed. 

Still positive, the first thing I did was log on to my email. What I remember most about opening that email was nausea rising from the pit of my stomach. I knew the news was imminent, but that didn’t stop the shock of what I saw. The figures for our PMS review had been released – and the situation was far worse than anyone had imagined.

My initial feelings were a mixture of anger, fear and despair. There was also the cruel irony of coming in on a day off to provide a better service for your patients, only to be informed you have to do more for less.

My practice is typical of many of those who receive the so called ‘PMS premium’ in the inner city: it is highly deprived; patients are poor, both financially and in self-care skills; and it is multicultural, with a range of languages spoken. Most of our consultations are carried out through an interpreter and it takes twice as long. We have higher-than-expected morbidity for a youngish population due to deprivation and ethnicity. The austerity drive over the past five years has also caused a massive increase in work. We’ve had an influx of patients wanting medical assistance for various appeals, from the bedroom tax to personal independence payments. Even if we adopt resilient policies to discourage these requests, they still impact on access.

Yet I know we are not alone in our plight. Every practice has its unique issues; those without our communication or deprivation issues will have a growing list of housebound, elderly patients. The simple fact is we are all struggling to remain sustainable within the current funding structure. It is clearly crucial to iron out historical funding inequalities that resulted from various political gimmicks.

But NHS England, in its wisdom, thinks we should all be drilled down to the lowest funded practice, not the highest.

The optimists around the table tell me not to worry because all this money will stay in primary care. Now, I like to consider myself a realist or a pragmatist, rather than a pessimist. But the reality is – there is no new money. This means that although a minority of practices in our area may benefit from the PMS pot of money, the majority will lose out. We are facing giving up a sixth of the cake in return for a tenth.

And at a time when we should be collaborating to survive, we’ll be fighting other practices to retain our share of this cake as it shrinks year on year for the next five years. When all is said and done, I wonder if patients realise all they will be left with are the crumbs.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (43)

  • ''My practice is in the inner city: it is highly deprived; patients are poor, both financially and in self-care skills; and it is multicultural, with a range of languages spoken. Most of our consultations are carried out through an interpreter and it takes twice as long. We have higher-than-expected morbidity for a youngish population due to deprivation and ethnicity. The austerity drive over the past five years has also caused a massive increase in work. We’ve had an influx of patients wanting medical assistance for various appeals, from the bedroom tax to personal independence payments. Even if we adopt resilient policies to discourage these requests, they still impact on access''........blah, blah, blah....

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  • don't feed the 10:19 daily mail troll. *yawn*

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  • Azeem Majeed

    My own practice in Clapham in London has a similar experience in 2012. In our case, the effects of the PMS review were then compounded by a list review.
    http://goo.gl/cp0XBf

    We have 'bounced back' since then and continue to get largely positive reviews on NHS Choices but many other local practices have very poor reviews (generally related to access problems).
    http://www.nhs.uk/Services/GP/ReviewsAndRatings/DefaultView.aspx?id=44441

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  • 10:42am

    You are yawning at 10.42 in the morning, you must be lazy

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  • 10.19 TROLLTASTIC!!!!!

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  • Baffling the number of voyeurs on these sites. GP is not a highly paid job for the risks, pressures and training involved in the UK. It is far better remunerated if it went private or in other countries that value highly skilled and hard working healthcare professionals. This will be apparent when its gone - even to the most ignorant trolling buffoon.

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  • ''In spite of having already clocked up around 35 hours just HALFWAY through the week..... but I still went into work in the morning''

    Wednesday is half way through the week. You went to work in the morning on Wednesday. AND YOU ALREADY WORKED for 35hrs on MONDAY and TUESDAY.

    Wow !!!!!!!. 17.5 hrs a day!!!!!!

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  • Thursday am is my mid week as I do Saturday morning surgeries. I had worked 36 hours by Thursday morning just like Shaba.
    Just finished my Saturday surgery and going home now and have worked 50 hours this week.
    These are my part time hours, other colleagues work longer.

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  • Stop moaning and quit the NHS or suck it up and keep eating the crumbs....the choice is there for all, the brave take it.....ex-GP Partner, mid 30's and much happier...

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  • Not moaning, just correcting an incorrect perception of how we work.
    I had a good morning in a valuable job and made a difference to several people this morning (at least that's what they told me ).
    I fully respect everyone's decisions to choose their own path in their careers, well done for finding the right path for yourself.
    Personally, I work long hours doing a hard job and see value in working for and fighting for our NHS. I know this may be with a loss of income comparable to that which I can earn elsewhere but I earn enough to provide for my family and that's all I need.
    BRAVE also are the doctors who continue to work hard in a system despite constant criticism.

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