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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)

  • 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!

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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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