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At the heart of general practice since 1960

We must fight - and the time is now

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I don’t remember much about being a junior doctor in the 1990s, other than long hours on call for half my hourly rate. Who else remembers the gross sense of injustice and exploitation? This is exactly what the Department of Health is trying to bring back with its threat to impose a new junior doctors’ contract, which will result in a pay cut for working the same hours. 

The reason is obvious: the ministers want to introduce routine seven-day working without a significant increase in expenditure.

Core hours are to be expanded from 8am to 7pm Monday to Friday, to 7am to 10pm Monday to Saturday, resulting in a lower banding for the same hours. The theory is this money will be recycled to pay more for Sundays and nights, but we all know how recycled money works: we’re all pulled down to the lowest common denominator, as has happened with the PMS reviews.

For GP trainees, the situation could be even worse.

The banding that equalises pay between hospital and GP training posts will go, which could result in a GP trainee pay cut of £15,000 per year. These massive losses may be offset in other ways, but with all this uncertainty, why would anyone want to join the profession?

We are no longer in this alone. Juniors, consultants, GPs – we need to fight for our profession, which is becoming a laughing stock in the developed world. The only body that can unite us is the BMA and I am sure many, like me, would reinstate their membership if decisive action were proposed. We need to stop feeling emotionally blackmailed and devise creative ways to take industrial action without significant damage to patient care.

This will differ for all specialties, but here is my 10-point proposal for general practice:

• Stop all home visits except for palliative care patients. We are one of the few countries where patients can get to hospital appointments and the hairdressers, but not to their GP.

• Stop prescribing all OTC medications. This will inconvenience, but not harm, patients.

• Prescribe the most expensive option in each family of drugs. Let’s start dishing out rosuvastatin and esomeprazole.

• Stop engaging with the CQC. If we do so en masse, what can they do – close us all down?

• Stop engaging with revalidation and appraisal. As above – we can all be referred to the GMC. 
I don’t care that I will be out of a job as an appraiser.

• Stop signing sick notes. Let’s face it, we hate policing the system anyway.

• Stop writing reports for the Department for Work and Pensions. We aren’t paid for most of them anyway.

• Stop attending CCG meetings. It’s a good excuse to be rid of the poisoned chalice.

• Stop providing any out-of-hours service. When A&E is on its knees, ministers might realise we already provide a 24/7 service.

• Stop signing cremation forms. Granted, this will be the least popular but it’s not risking any lives.

How much more will it take before we stand together, shoulder to shoulder, and fight our corner? For how much longer will we accept these contract impositions? We cannot allow this to continue. We must act… and the time is NOW.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (49)

  • Vinci Ho

    Say this again,I would say the non-cooperative movement should start from those 'representing' us in CCGs. All GP commissioners walk out and resign .......

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  • Vinci Ho

    Respect your people but also respect your enemy. But as history always tells us(or if you are a fan of GOT) , the ferocity of any political conflict so often involved the 'rest of the family',especially the next generation ,the younger ones
    OK.These politicians want to revenge on us because of the GP contract in 2004 but this does not provide the excuse to hurt our following generations. Nothing had moved me more last year when all these young people went on the streets in Hong Kong to protest against a government which has no interest in their future. Yes, you can get a low pay job but you never really have the chance to move up the scale(and the politicians take credit of how low the unemployment rate is).
    Of course, the bottom line is a purge;to wipe us out all together. The insult on us is beyond any limits. 'you can kill a scholar but you must not humiliate him/her'
    There is no place to spread the evil amongst our innocents.
    This is war and we must solidify..........

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  • Peter Swinyard

    One idea is one which I believe is still in the regulations. Demand to see a patient's Medical Card before any appointment or treatment is offered. Failure to show this will allow us to charge the patient and give a receipt which, in times of yore, would have been reimbursed by the Family Practitioners Authority (remember??) and deducted from our emoluments.
    Imagine what fun the bureaucrats would have in sorting that out!!!

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  • The only way to do this is to forget about trying to protect patients and for all doctors to come together and strike at a set date when all services will be withdrawn. This must even include A & E. There is no point in trying to keep goodwill with our patients. That day has long gone.

    The government will give in within 2 or 3 days. In fact it's quite likely the strike will not even need to take place. Just the threat of it will be enough.

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  • Here is my 1-point proposal for general practice:
    Do not go into work from a given Monday. All telephone calls routed to 111.
    And wait.
    (And No I do not need a ballot as I have a contract. And Yes I may be held in breach but I’m retired anyway)

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  • 12 months ago our CCG locality group was told there was no longer any money to pay GPs to attend management meetings. Two of us pulled out but seven chose to continue to attend meetings despite them lasting several hours. Until the cardigans grow up such lists are pointless

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  • No point being nice guys anymore time to fight back against the bullys.If we dont, we will carry on getting beasted by the posh boys,who went to the right school and were"born to rule".If we dont fight back there will be dark times.

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  • "Anonymous | 22 September 2015 3:45pm

    12 months ago our CCG locality group was told there was no longer any money to pay GPs to attend management meetings. Two of us pulled out but seven chose to continue to attend meetings despite them lasting several hours. Until the cardigans grow up such lists are pointless"

    And there's the reason why GPs are trampled on like dirt - you behave like dirt. It is always so easy to find a group of GPs who can't wait to betray their colleagues and their profession

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  • If GPs had this much courage, we would not have been in the position we are in.
    RCGP has to come off the mantra of GPs being patient advocate.

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  • Set a date for a month's time. Action to be taken and inform and miblize over the net.
    We'll have our day of protest.

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