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Gold, incentives and meh

I can’t be the fall guy any more

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I have in front of me a letter from the A&E department. This is what it says:

‘This 15-year-old lad was playing football on Saturday, and lost his ball up a tree. He climbed the tree to recover it, but fell out from about eight feet and landed on his back. He did this four times. On the final occasion he fractured his clavicle.’

These letters give me the material for these articles. Human stories. The utter absurdity of the behaviour of homo sapiens. The basic material for 500-odd magazine columns, since I first started writing them 20 years ago.

The fascinating thing is the ambiguity. The obvious conclusion is that we are dealing with an utter moron, the type of dude Darwin predicted would be weeded out of the gene pool. But there is another interpretation worthy of serious contemplation.

Perhaps we are witnessing one aspect of the indomitable human spirit. The triumph of hope over experience. He kept climbing and he kept falling. It’s almost heroic. By definition, we only see the failures. Who knows how many teenagers keep climbing and get their ball back at the fifth or sixth attempt? There are probably many.

As I read the letter, I’m laughing and crying in equal measure. Because I now know this experience is nearly over for me. Because I can’t go on.

This article may be unique in the annals of Pulse because a decent proportion of it was written in a hospital bed, with 15 electrodes attached to my body and an IV drip limiting the use of my right arm.

The oxygen mask was hampering my vision and the pulse oximeter had to be transferred to a pinky, because I don’t type with those. But hey, a deadline is a deadline.

The fact that I was back in rapid AF and heart failure within an hour of getting back to work after a short holiday is not, I think, coincidental. The escalating workload, the tumbling income, the futility of trying to keep up with demand, the frustration of being the last port of call for so many problems that really are nothing to do with us; the sheer lack of time to practise medicine as it should be practised. It is insupportable that we are dumped on, taken for granted and held responsible for the failings of others. Above all, the total absence of interest in the vacancies at my practice makes the future as a GP partner unbearable to me.

My love affair with my profession is over. I hate this bloody job. I can’t stand going into work any more. It makes me depressed, unhappy and, latterly, literally sick.

I believe there is some currency in the Government’s ‘5,000 GPs’ idea, but I think they’ve got it the wrong way round. I predict 5,000 fewer GPs over the next five years, as people like me reach the end of their tether. I know of literally no one around my own age who is not thoroughly disillusioned. None of us will still be practising at retirement age. And there is no way we can be replaced, let alone the overall numbers of GPs be increased.

I have climbed my tree and fallen out too many times now. If I was stupid, I would get back up and start climbing again. But I realise that next time, I’m going to fall out and break something. In fact, I may already have done so.

Dr Phil Peverley is a GP in Sunderland.

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Readers' comments (156)

  • Una Coales. Retired NHS GP.

    WHY our dearest Pev can't just quit... From his April blog 'Meanwhile, in the real world, my own practice is fragmenting at a rate I wouldn’t have thought possible only two years ago. Several departures have left me as the last partner standing in a practice that has two full-time equivalents, but needs five. Personally, I am drifting in and out of atrial fibrillation, and recently learned the true meaning of ‘panic attack’. It’s not nice.

    I’m supposed to buy my partners out of their share of a £1m building and then become personally liable for the redundancy packages of 15 employees, should it come to that. An advert in the BMJ produced precisely no applicants for the partnership post; after all, who would voluntarily take this shit on?'

    He is caught between a financial rock and hard place. Let's say there were 4 partners originally (list size 8,000) who own £250k each of a £1m bldg. They have left the surgery one by one and the partnership contract gets rewritten each time. Which means Pev has had to pay them £250k each out of his own pocket as they leave or £750k in hopes that he can recoup the money when he sells off the commercial building, that is if anyone wants to buy a nhs gp surgery.

    As he is the last partner standing, If he quits and hands back the NHS GP contract to NHS England, he has to pay 15 employee redundancy packages or say £150,000-£300,000 out of his personal savings. He is financially screwed.

    This is what it means to be a NHS GP partner delivering an unworkable NHS contract and not allowed to be a limited liability company like private companies can who are now delivering many NHS services. I blame the BMA trade union and LMC who charge each practice a levy to negotiate for them. No fair deal!

    This NHS GP contract is set to drive many a GP partner in their late 40s (not the older lot with a gold plated up to £1.8 million pension cap protected for 10 years from 2012 or the wealthy managing director GPs buying up 25-60 surgeries) to an early grave or financial destitution, especially if they are the last GP left in the surgery to pay off staff redundancies and debt liabilities.

    I wish I had an easy answer for Pev's predicament. He faces financial destitution and life if he quits or working to an early grave if he remains.

    And our BMA refused to allow my emergency ballot on action! Mass undated resignation from a financially crippling and unworkable GP contract that is literally killing our GP partners! Shame on the BMA leadership!

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  • You need to quit now not only for your own sake but also for your patients.

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  • Indeed, it's clearly time to put your own needs before those of you patients; like most GPs you' ve clearly done far more than your 'bit' for them over the years as the job has become increasingly difficult not helped by a full-on political assault upon the welfare state and our own once proud profession's role within it. So go easy Phil in the knowledge that you've made a real difference to the lives of thousands of your patients and very many of your peers. Take care.

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  • Una Coales. Retired NHS GP.

    Pulse editor and Pev, clearly what is holding Pev back is the enormous financial liability he faces when he hands the surgery back to NHS England.

    Can we not help him? Can Pulse or a close friend of Pev or even the Sunderland LMC set up a Just Giving donatiom page so that we may all donate what we can to help cover his staff redundancies and any remaining practice debts? The BMA and LMC must have a charity pot for members in dire financial situations?

    This is what Pev needs right now to then be able to walk. Remember we GPs practice holistic medicine. The root cause of his panic attacks, atrial fib and heart failure is stress over his practice financial debts and his personal liabilities if he takes out advice and hands back the surgery.

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  • you cannot go back full time.full stop.very soon you will make up your own mind what to do,and i know what that will be.

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  • I feel only GPs themselves understand our job and whilst everybody around us pays lip-service to the idea that we are tested to destruction they cannot embrace the idea of actually being in our situation. I salute you as a kindred spirit and fear for others who call themselves a GP.

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  • My heart goes out to you, and is really hope you find a sensible way out soon. Ultimately the situation may well not be as bad as Una says. I doubt that the redundancy payments would be as high as she says...... Effectively about a year's pay for each member of staff sound excessive to me, assuming that they have not all been employed full time for 30 years. You would also be unlikely to have to find all the money to buy out your ex partners' entire shares as there is likely to be a partnership mortgage in place which can be taken over until the property is sold ( either to a new provider or on the open market). There will be some capital which can be used.
    However, the situation is terrible and others should not belittle the incredible commitment and risk that partners make.
    A Facebook page is a nice idea, and I would contribute. However, we just don't know how many partners are in this position and might need our help. Do the GMC know? If not, why not? Are they actually asking practices and partners if they are in trouble? Do the BBC know? Would Phil be prepared to talk to the press and explain what is happening?
    Above all, why in God's name would anyone take on a partnership? Sadly this can only get worse and anyone currently holding the risk could get burnt. I don't see why Una thinks this does not include those in their 50s and 60s who want to retire.
    Good luck Phil.

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  • To anonymous at 29 May 7.35pm....
    "your patients need you more than your family"
    "the NHS pension will provide for your family"
    Yeah, that's right, soldier on, die early, doesn't matter does it???....as you pension will give your bereaved a pot of money!!!! You're a f**king disgrace.

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  • Thought this was another spoof to start with - then the horror struck....any post which puts income over Phil's health as Una initially did just misses the point. And it is unlikely that his problems would be served by charitable giving.

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  • Around us NHSE takes over the practice and TUPEs the staff, so redundancy costs may be avoidable.

    You cant pay people unrealistic valuations for a surgery which is worth far less than most partners think it is. I hope the practice contract was not rewritten each time with fairy dust valuations in it.

    I got out at the start of April. I think I avoided a similar situation by the skin of my teeth. I akready new it was get out our die soon. The stress was terrible, I had panic attacks, nightmares, waking in the middle of the night wrrying about the practice and now it is lifted.

    I still wake up with nightmares about being unable to admit patients due to bed shortages but at least that is not real and in my life now.

    The public, our "leaders", the politicians seem to have no idea (or they don't care) about how being a GP now damages, and destroys your relationships, your social life, your will to live and your soul.

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