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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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  • Peter Swinyard

    Remember the pensions "fight"? No use leading your troops if they don't follow.
    What will it take to unite a formerly proud profession?
    8 annual pay cuts? No
    Cuts to pension rights? No
    Lifetime earnings cap? No
    Loss of "in perpetuity" MPIG? No
    Outrageous increases in indemnity costs? No

    Just tell me!!!

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  • This is about leadership, if the leaders could not mobilise grassroot GPs, then it is obvious you do not have the right leadership capabilities or the appropriate level of engagement with grassroot doctors !! GPs are tired, stretched and ready to strike !! we need the right coordinated approach that reaches every city and every locality !!! get your act together BMA

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  • Hunt will win

    1. He will train up a load of cheap alternatives to GPs so patients can still see someone free at point of need
    2. Or GPs will cave in and do what he wants.
    3. Or GPs quit en masse and take the blame.

    The only way his strategy can fail is if the profession dont allow him the time to implement 1. This means all GPs agreeing on a strategy that means patients turn up at practices and there is noone there to see them. There would then be calls for his head on a platter

    JH is sensibly betting that GPs cant organise their way out of a paper bag.

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  • GPs as a group are just wet and have the business sense of a potatoe...a wet one at that. The NHS survival group has a grand total of £1400 of donations. If each GP just gave a pound that should be £46,000. Stop blaming the BMA and RCGP and get off your own collective arses and do something positive.

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  • Great suggestions Shaba. If only we could implement them. GPs are sadly incapable of uniting and that's what @unt and his mandate are using against us.
    Sigh :(

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  • Well said Shaba. The fight needs to be taken to the politicians and also some of the public. Just being defensive may not get us far. Fight hard. Fight long. Fight dirty. If not prepared to deliver the knockout punch, theer is no point in geting in the ring and go a few rounds

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  • Well said and well written . We GPS are so fragmented within ourselves that it is no wonder that the government is playing around with us and until such time we will continue to suffer . it is a disgrace that we have put up with such contempt from the government . The NHS is on the brink of collapse and we can all do ourselves a favour by resigning on masse so that the power that be can realize how valuable we are

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  • Count me in. Anyone else?

    I didn't join the toothless, let's-not-actually-inconvenience-anyone "strike" over pensions and haven't been a BMA member for many years, but I'll do whatever I can to make sure that today's junior doctors don't have to experience the brutal hours and low pay that those of us who trained in the 1980s and 1990s suffered.

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  • Hope Maureen reads this and finally gets her act together and step up, otherwise, resign, resign, resign.

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  • Hunt will win.patients are the first priority.
    Therr is no pint striking.this is bound to happen.this is becoming evident now.

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  • Unfortunately this will never work as the near retirement GPs who have already milked the cow and have protected pensions will never support it. They will be the bleeding hearts that will sabotage any effort to unite.

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  • I don't agree with some of Shaba's suggestions, which are just too controversial. Refuse to do house calls for all but palliative care? You can see the Daily Mail headline now when a patient dies as a result. No, there is only one strategy which will work here. A mass application by GPs, dult publicised, to the GMC for a certificate to practice abroad and mass undated resignation letters from the NHS to the BMA. That, together with a unified campaign involving other disciplines, led by the BMA and RCGP (for once) is our only chance to gain support from the public who will rightly ask what will happen if their surgery closes, or becomes private. The government have imposed one contract too far here. It can not and must not be allowed to succeed, or the NHS is doomed. Industrial action in its conventional form is highly risky, unlikely to succeed and is unlikely to gather public support when the body count rises. Sadly, a much more likely outcome is that doctors will abandon the system altogether. Let's not forget - doctors don't strike. They leave.

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  • NICE need to do an evaluation of what a GP can safely offer in a day; hours and numbers of patients taking inconsideration complexity and number of issues; then they announce guidence and we stick to it.
    Hundreds of patients a week would not be seen by each dr. 10m per problem would be the norm (figure plucked from the air, much like most of HMGs)
    Although i doubt even NICE can full appreciate and evaluate what we actually do- WHICH IS THE UNDERLYING ISSUE!

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  • Una Coales was and had the spiritual analogy of General Custer and Jean Denjou but unlike the Battle of Little Big Horn USA and the Battle of Cameron Mexico ..the soldiers did not fight on and those of us who wanted to never got the chance ..conscription advice hidden and too many fair weathered colleagues

    Author of this ..C'est tres jolie pensee et gentil main la maison est fini. Vie n'est pas

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  • I think we need to be more selective. Not all my housebound patients are palliative but they sometimes need visits. Refusal risks harming the old, frail but long suffering who will suffer without having an impact on govt. but with damage to doctor-patient relationship. Similarly, a crem form boycott would merely make a bad situation worse for grieving relatives and rebound on us rather than govt. I don't know how boycotting CQC "en masse" would work given only those about to be assessed would actually be in the front line. Our strength lies in supportive patients being warned about what they risk losing and joining the defence. p.s. In the 80s, it was 1/3 normal rate, not 1/2 - you were lucky!

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  • Refuse to do house calls for all but palliative care is an excellent idea but already seeing some shooting it down. We cannot continue this ridiculous demand of visits when people feel like it. every other country can cope without home visiting .

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  • How many have gone to visit and patient not in! How many get taxi to shops/hairdresser/ OPD spots etc Attend GP!!! I'm 80 or whatever age they quote so I'm entitled to a visit as my right and paid my taxes etc etc I have arrived at times and fully mobile dressed person answered door and I asked where patient and told - that's me doctor 👿👿👿

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  • @ 10.54

    NICE's research on safe nursing levels was blocked by the government. Cover up, delay, deny and attack whistleblowers. Another mid staffs is a certainty as the politicians that run the NHS are not interested in patient safety. Draconian healthcare worker regulation that is punitive does not raise standards. Properly regulating the hospitals, the managers and whistleblowing legislation and a corporate manslaughter aka the US just might.

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  • @2.27
    I suspect if I mess up today- 26 this am, 2 visits, 25 booked this pm, I'm duty so will have to take on more if needed, the GMC HMG won't give a toss and I'll be fried!
    BW
    10.54.

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  • Fully agree that home visits need to be drastically limited . The free uncontrolled home visit system in the UK is archaic and unsustainable in modern practice . No other country does it like this AFAIK.This is one of the main reasons I now only Locum , because I do not want to be tearing my hair out in the middle of a busy afternoon surgery and then have entitled people demanding home visits when they could attend by taxi/ relative .

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  • Tell all patients requesting a visit, apart from palliative care ones, to go to the nearest casualty and if needs be they call for an ambulance.
    After taking a careful history that is and documenting it. This could go for anyone after your workable limit, say 30-40 contacts a day, could be told to go to casualty or the nearest walk in centre.
    I suspect this happens in some areas already.
    There's only so much we can safely cope with in a 10 hour day.
    That should soon snarl the system up.

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  • I think we need to stand united as an entire profession - ALL doctors of all grades together. The only task we all do, that we can stop doing, without harm to any patient, is stop signing death certificates.
    "We simply don't have time."
    I would expect it only to be a matter of days before we get some real, sensible negotiation from all parties as the morgues overflow.

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  • Fine words brothers and sisters, but unless and until Maureen and the Cardie Club are willing to come down from their Ivory a Tower, grab a Donkey Jacket and man a brazier, it's all just pith and wind. The time for strikes has passed. The time for mass resignation and emigration is here. Act now. And make some noise on your way out.

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  • The only thing we all ( as doctors) need to do is stop paying GMC fees enmasse. No patients harmed or inconvenienced but a MASSIVE message to government whilst also sorting out the GMC. It's a win win. I have suggested this to the BMA but was told that they don't have a problem with the GMC.

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  • Ildiko Spelt

    Well written, Shaba! I agree with all you say there...

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  • 10 30 --birds of a feather flock together my dear anonymous amigo

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  • Nice article; about 5 years too late but nevertheless good advice;

    There's a feeling of rebellion in the air...

    Its now or never.....

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  • The lack of evidence based, vicious and punitive over regulation of medicine desperately needs 'sorting out'.

    Meanwhile, the GMC advertises £70k plus a year jobs for the non medically qualified with private healthcare, a generous car allowance, working from home and 'a comfortable and relaxed working environment'.

    These are cushy jobs. Meanwhile, the professions is dying on its feet and the likes of this quango fail to have come up with what is a safe patient work load or safe staffing level.

    The non medically qualified ex-journalist chair earns in excess of £500k a year.

    The GMC has nothing to do with patient safety. It cannot provide a shred of evidence that what it does is useful or that it is fit for purpose. Yet it wants to do more and more....

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  • This comment has been moderated

  • Strewth not another ten point plan.when do any of them make any difference...but if you do want to make one up put something positive in .not just ..stop this; stop that.....

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  • A blanket refusal to do OOH would be effective and would only be needed for a short time . However no one will agree - so we're fucked .

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  • OHP@6.17: I'm guessing you are unfamiliar with the concept of industrial action

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  • GPs are never United they don't stand up for themselves or each other, lots of GP trainees have been thrown out of training without any further chance to get back, they are left in all kind of struggles..... Anyone stood up for them? Nobody and nobody ever will..,Hunt is right let him play games because we deserve it!!

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  • No point I crying when you are already fucked!!!!

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  • JDC just announced strike ballot. Why stop at juniors? I'm a 25yr veteran GP and I'm itching to down tools and march.

    If we're going down, it may as well be fighting.

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  • It is time for industrial action
    Just do medicine
    And no nonsense ie
    Re validation
    Qof
    Ccg work
    Qof
    Etc
    The public would support us as the quality of medical care would IMPROVE without the mountains of pathetic ludicrous bullying bureaucracy

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  • The greatest betrayal of the profession, is taking 'pieces of silver' to be an appraiser (GMC collaborator). Shaba have you got a reasonable justification? (have heard lots of lame excuses and only one person who admitted 'that it is good easy money').

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  • Sorry, I don't get the idea of stopping unnecessary home visits as a form of protest - why on earth is anyone still visiting the non-bedbound? It is in YOUR power to stop this NOW, for your practice.

    Seriously, cardie nonsense like this (which no other country has) is why we're in this hole.

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  • Best is for practices with more than 3000 per wte to stop accepting new patients. First the millions of young me who have not registered will rush to do so boosting incomes.

    The action would be taken on the interest of patient safety. The govt would cave in within days as millions of tax payers roamed the streets looking for somewhere to register.

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  • Lorna, I'm in and hopefully the rest will join once there is a plan. It's just about getting that date and time for action and once that goes viral things should happen. Question remains about coordinating the whole thing. Any ideas? Anybody?

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